Date Published: 1 March 2009

The gap starts in the womb

“If we are ever to close the gap in life expectancy between Indigenous and non-indigenous Australians, we must start at the womb.”

The quote starts an article in the current edition of the Medical Journal of Australia that calls for changes in the way the baby bonus is paid to improve incentives for antenatal care in Indigenous communities.

James Cook University’s Professor of Obstetrics and Gynaecology, Prof Caroline de Costa, and the Senior Medical Officer at the Apunipima Cape York Health Council, Dr Mark Wenitong, make the case for early, or increased payment of baby bonuses for women who present in their first trimester.

“Perinatal mortality rates for Indigenous woman are more than twice those of non-Indigenous babies, pre-term births are double, and low birth weight is two to three times more likely,” the report says.

“Many Indigenous babies start life pre-programmed for an early death.”

The report sites a French model that provides financial incentives for mothers to seek antenatal care early in their pregnancy, with 96% of expecting mothers registering inside 14 weeks.

“Antenatal care can never completely compensate for the impact of chronic disease or social disadvantage, but it can help treat some conditions, allow advise on the impact of cigarettes and alcohol, and generally provide the best possible start for the fetus,” the report says.

“Maternal anaemia, diabetes and hypertension can be detected and managed; urinary tract, sexually transmitted and other infections can be identified and treated; risk factors for pre-term birth can be identified and arrangements made for appropriate birth settings.

Simply showing a digital photo of the fetus can help mothers better identify with their fetus and decrease alcohol and cigarette consumption.

The idea of deducting some of the baby bonus from women who do not present early in pregnancy seems punitive – we need a carrot not a stick – but perhaps we consider either a modest increase in the payment for women who present in their first trimester, or some form of early payment.

Providing incentives for women to seek antenatal care early could help a generation of Indigenous children lead longer, happier, healthier lives.”

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