"Birthing on Country"
Birthing on Country is an international movement that emphasizes the importance of Indigenous mothers giving birth on their ancestral lands while utilizing traditional birthing practices. Originating in Australia in the early 2010s, this movement addresses significant health disparities faced by Indigenous mothers and their babies compared to their non-Indigenous counterparts. Central to this initiative is the RISE Framework, which outlines four guiding principles: redesigning health services to meet cultural needs, investing in workforce development, strengthening families, and embedding Indigenous governance in maternal care. The movement aims to create culturally sensitive care that integrates social justice elements into maternal and infant health. Research published in The Lancet highlights the effectiveness of birthing on country programs, noting improved health outcomes such as higher breastfeeding rates and decreased preterm births among participants. The movement was notably influenced by the late Indigenous midwife Molly Wardaguga, who contributed to the cultural insights necessary for its development. Overall, birthing on country represents a commitment to enhancing health outcomes for Indigenous populations through culturally informed practices.
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"Birthing on Country"
Birthing on country is an international movement that advocates for Indigenous mothers to give birth to babies on ancestral lands using traditional birthing techniques. Integrating culturally sensitive maternal and infant care with elements of social justice, the birthing on country movement originated in Australia in the early 2010s. It was developed to improve health outcomes for both Indigenous mothers and their babies. These outcomes have historically been marked by wide gaps relative to non-Indigenous mothers and children in Australia and other countries.
The birthing on country movement is built around a paradigm known as the RISE Framework, which specifies four principles used to guide traditional births on ancestral lands. A 2021 article published in the peer-reviewed medical journal The Lancet noted multiple significant improvements among Indigenous mothers who participated in birthing on country programs. The Lancet concluded that the data showed significant clinical effectiveness and advocated for the funding and widespread implementation of birthing on country services for Indigenous women.
Overview
In 2008, the Australian government made a public commitment to address wide gaps in health, life expectancy, educational attainment, and employment between Indigenous Australians and non-Indigenous Australians. A statistical analysis published in 2021 by The Lancet noted that 85 percent of child deaths in Australia occur during the child’s first year, with nearly half (49 percent) being attributed to medical conditions associated with the perinatal phase, including preterm births. The Lancet also noted that preterm births occurred among Indigenous Australian mothers at approximately double the rate of non-Indigenous Australian mothers.
A decade after the Australian government’s 2008 commitment, child mortality rates among Indigenous Australians had improved by a modest 7 percent. Official government statistics show that in 2018, Indigenous Australian child mortality rates were 141 per 100,000, or 210 percent higher than the non-Indigenous child mortality rate of 67 per 100,000. Government officials began to view the birthing on country movement, which began to emerge in the early 2010s, as a potential solution.
Australia’s Charles Darwin University credits the late Indigenous midwife and cultural leader Molly Wardaguga as a major founding figure of the birthing on country movement. During her life, Wardaguga provided culturally specific insights regarding maternal and infant care to clinical researchers, leading to the development of the RISE Framework. The four principles of the RISE framework include “Redesigning the health service” to meet the unique cultural needs of Indigenous mothers and their children; “Investing in the workforce” to make birthing on country a viable alternative to standard practices; “Strengthening families,” and “Embedding Indigenous community governance and control” into the birthing on country model.
In reporting the results of a multi-year study comparing birthing on country and standard birthing control groups, The Lancet found statistically significant associations between birthing on country and improved health outcomes. Specifically, birthing on country programs were associated with higher rates of extended participation in antenatal preparation workshops, an increased likelihood of mothers exclusively breastfeeding their infants, and decreased rates of preterm birth.
By the mid-2020s, the birthing on country movement in Australia had been credited with reducing preterm births, providing better health outcomes for mothers and their babies, and providing health services that were cost-effective in the long-term, although some challenges remained.
Bibliography
“About Us.” Molly Wardaguga Research Centre, Charles Darwin University, www.birthingoncountry.com/about. Accessed 12 Jan. 2025.
“Closing the Gap Report 2020.” Australian Government, ctgreport.niaa.gov.au/child-mortality. Accessed 12 Jan. 2025.
Hickey, Sophie, Sarah Ireland, and Yvette Roe. “Birthing on Country Services Centre First Nations Cultures and Empower Women in Pregnancy and Childbirth.” The Conversation, 22 Mar. 2022, theconversation.com/birthing-on-country-services-centre-first-nations-cultures-and-empower-women-in-pregnancy-and-childbirth-170641. Accessed 12 Jan. 2025.
Kildea, Sue, et al. “Effect of a Birthing on Country Service Redesign on Maternal and Neonatal Health Outcomes for First Nations Australians: A Prospective, Non-Randomized, Interventional Trial.” The Lancet Global Health, vol. 9, no. 5, Mar. 2021, pp. 651–659.
“RISE Framework.” Molly Wardaguga Research Center, Charles Darwin University, www.cdu.edu.au/mwrc/rise-framework. Accessed 12 Jan. 2025.
Woods, Cat. “Indigenous Mothers Are Being 'Failed' in Australia – So They Are Taking Measures into Their Own Hands.” BBC, 29 Apr. 2024, www.bbc.com/future/article/20240429-indigenous-mothers-are-being-failed-in-australia-so-they-are-taking-measures-into-their-own-hands. Accessed 12 Jan. 2025.