Indigenous mothers deserve better: Fixing Australia’s maternal health divide
Shanza Shafeek, fourth-year Law and Arts (Sociology) student at Monash University, discusses Aboriginal and Torres Strait Islander maternal health inequality, some promising initiatives to address it, and urgently needed reforms to boost Indigenous-led and culturally safe models of care.
Australia is often ranked among the safest countries in the world to give birth. But that safety doesn’t extend to everyone — especially not to Aboriginal and Torres Strait Islander women.
Despite decades of health reforms and Closing the Gap targets, Indigenous mothers and babies still face dramatically worse outcomes. These gaps aren’t accidental — they reflect a system shaped by racism, policy failure, and the exclusion of Indigenous voices from decision-making.
The deadly gap in maternal health
While maternal deaths are low for all women in Australia compared to other countries, Indigenous women are much more likely to die from pregnancy-related causes compared to non-Indigenous women. Over the decade from 2013-2022, the AIHW reports a maternal mortality rate of 14.4 per 100,000 Indigenous women giving birth, and 5.1 for non-Indigenous women. These deaths are often due to preventable issues like sepsis, blood clots, or cardiac complications. Their babies are more likely to be born underweight, premature, or stillborn, and less likely to receive proper follow-up care.
According to recent research, 12% of Indigenous babies are born with low birth weight — double the national average. And more than half of Indigenous women giving birth in public hospitals are discharged within 24 hours.
This isn’t just a health issue. It’s a justice issue — a visible consequence of ongoing colonisation, racism, and neglect.
Why is this still happening?
The reasons are complex, but they fall into three broad categories: geography, inequality, and exclusion.
1. Distance and disconnection
Many Indigenous women live in remote or very remote areas — over 18% compared to just 1.5% of non-Indigenous mothers. For them, access to maternity care often means travelling hundreds of kilometres, sometimes alone, to unfamiliar hospitals. Local clinics are often underfunded and lack trained obstetric staff or culturally safe midwives.
Even when care is available, it’s often rushed. Women are sent home early, without the support they need to recover or care for their newborns — let alone reconnect with family or Country.
2. Social and economic inequality
Indigenous women are more likely to experience poverty, housing stress, food insecurity, and limited access to health education. These social determinants shape everything from nutrition and smoking rates to antenatal attendance.
Only two-thirds of Indigenous mothers attend a first-trimester antenatal appointment — a key predictor of better outcomes. But when you factor in the cost, distance, and past experiences of discrimination in health settings, it’s no surprise some women hesitate to engage with the system at all.
3. Racism in care
Racism in care is both subtle and overt. Many Indigenous women report being spoken down to, having their pain dismissed, or being judged as parents. Others are denied cultural practices during birth, including the presence of Elders. More than half experience discrimination during perinatal care.
As Aboriginal midwife and researcher Valerie Ah Chee told Body + Soul, “Healthcare professionals need to recognise the diversity between Aboriginal women and our needs, start listening to us and stop thinking they know what is best for us in our pregnancy and birth journey.”
This distrust has real consequences. Many Aboriginal people leave hospital early — not because they want to, but because mainstream healthcare settings feel unsafe or traumatising.
What’s being done — and where it falls short
There are some bright spots. The Birthing on Country program, which supports culturally safe births on ancestral land, has improved antenatal attendance and birth outcomes in communities like Galiwin’ku. The Australian Family Partnership Program offers home visits for first-time Indigenous mothers, helping improve nutrition and reduce smoking.
And in 2021, the federal government released a new National Aboriginal and Torres Strait Islander Health Plan with a strong vision for culturally responsive, community-led healthcare.
But these initiatives often rely on short-term funding, voluntary implementation, and non-binding commitments. Cultural safety training is inconsistent. And Indigenous women remain underrepresented in decision-making — from hospital boards to health policy.
As Ah Chee put it, “We are always being ‘done to’. We need to actually start taking back some power so that we know what we need to do for ourselves.”
Good intentions won’t close the gap. Structural reform will.
Three reforms to make maternal care safer — and fairer
1. Make cultural safety non-negotiable
All health professionals should receive Indigenous-designed cultural safety training — not as a box-ticking exercise, but as part of continuous learning. Training should cover power, trauma, and racism, and be evaluated by Indigenous communities themselves.
2. Fund Indigenous-led models of care
Programs like Birthing on Country work because they are designed and delivered by Indigenous people. But only 1% of midwives in Australia identify as Aboriginal or Torres Strait Islander. We need scholarships, mentoring, and leadership pipelines — and we must properly resource community-controlled health services to lead maternal care.
As Bindjareb Nyoongar and Martu woman Kaleisha Pilkington shared: “My son was born into this room full of strong Aboriginal women, and I just feel like it sets him up for life.” That’s what culturally safe care looks like.
3. Invest in local, culturally grounded interventions
Many maternal deaths are preventable. We need care that is both clinically effective and culturally safe — from early sepsis screening tools to trauma-informed midwifery support. But interventions must be shaped by what communities need, not just what systems find convenient. That means long-term funding, local hiring, and accountability beyond just medical stats — including trust, safety, and wellbeing.
Listen to the voices that matter
Indigenous mothers, midwives, and communities have been calling for change for decades. The solutions are there. What’s missing is the political will to implement them.
Closing the gap in maternal health will take more than better services. It will take respect, partnership, and a system that doesn’t just include Indigenous voices — but lets them lead.
Shanza Shafeek is a fourth-year Law and Arts (Sociology) student at Monash University. She currently works as a paralegal in institutional abuse and wills and estates, and volunteers at the Asylum Seeker Resource Centre. Shanza is passionate about legal policy, family law, and advancing culturally responsive practices within the legal system. You can find her on LinkedIn.