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Introduction

Australia is currently enjoying a high health status due to an elaborate health care system that is facilitated by the close partnership between the territory, state and federal governments. The perception of well-being among the citizens can generally be graded to be either good or excellent. Despite the good perceptions among the majority of Australians, some individuals especially the Indigenous populations do not share in this good. More importantly, Indigenous communities living outside the major cities heighten the discrepancies mainly because of varied cultural values as well as low socio-economic status when compared with other Australians. The subsequent literature will thus delve to exploring three cultural healthcare needs and how they differ from the Australian health care models, systems, guidelines, and policies.

Use of Contraception

Contraception is effectively a birth control method that prevents pregnancy through interfering with the normal process of ovulation, implantation, and fertilization. These methods can range from hormonal, barrier, spermicides, intrauterine, tubal sterilization, and vasectomy methods based on how they operate. However, majority of the birth control methods have a lot in commonality; if they are used faithfully they can become effective. The birth control methods can be applied orally, injected, implanted, vaginal, and surgical. Despite contraception helping in managing unwanted pregnancies, they pose quite serious risks to the users. For instance, the use of birth control pills can heighten the risk of getting heart attacks for women aged above 35 years (Gwynne et.al, 2016).

The use of inter-uterine devices increases the risk of serious pelvic infection through injuring the uterus by poking into the uterine wall. In order to fix this, a surgical procedure has to be undertaken. In some cases, contraception can be conducted through tubal sterilization. Tubal sterilization involves the tying of fallopian tubes by conducting a surgical procedure on the client. The surgical procedure can turn tragic if it causes bleeding hence infection (Hole et.al, 2015).

Australian federal government together with the state and regional administrations target to increase the comprehension of sexual and reproductive health care among the indigenous women. According to the World Health Organization, it is important for a state to promote human rights by improving access to reproductive and sexual education or care. This includes the progression of methods that can reliably be depended upon to manage children spacing. The Australian government believes that limiting the growth of population is just a step to improve health and development of the general public.

The overall rates of teenage pregnancy in Australia has been falling radically due to the intensified sexual and reproductive sensitization among the Aboriginal and Torres Strait Island. Besides sexual activity rates among non-Indigenous and Aboriginal and Torres Strait Islander being similar, the rates of teenage pregnancy in the latter remains high. Non-indigenous youth have more access to advanced contraception as well as the option of pregnancy termination. However, birth rates among Indigenous communities are high because the society believes that it is wrong to terminate a pregnancy. Additionally, majority of the Aboriginal and Torres Strait Islander women fear using contraception methods commonly available in the country (Hole et.al, 2015).

Access to contraception and other birth control methods among the rural Aboriginal and Torres Strait Islander population is limited because of staffing and cultural factors. More importantly, Indigenous women record a lower rate of consultations as well as attending primary care at 4.5% when compared to non-Indigenous women. Further, women living in remote and rural areas are often despised apart from there being a lack of properly trained personnel to dispense the services. More significantly, culture plays a hindering role for Indigenous women to take up modern contraception methods to help control birth (Gwynne et.al, 2016).

This statistics though worrying, indicate the need for registered nurses to do something to bridge the gap of contraception uptake among Aboriginal and Torres Strait Islander women. Access to contraception by young Indigenous women is just a small part of comprehensive sexual and reproductive care. Tackling the issue of higher birth rates among the indigenous communities, there is a greater need for the embedment of comprehensive sexual and reproductive care into the primary health care system. Further, the primary healthcare system needs to be structured around an appropriate cultural foundation. Registered nurses can also help resolve the issue by empowering them to stand up and claim their rights to the access to better healthcare services irrespective of where they are located.

Termination of Pregnancy

Pregnancy termination can be defined as the removal of a fetus or an embryo from the uterus in an attempt to end a pregnancy. The arresting of development a fetus at an early stage can take place in a broad range of procedures. Some of the commonly used pregnancy termination procedures include early medication and surgical abortion. At least 50 % of women in Australia who get unplanned pregnancies choose to abort. Additionally, a third of the Australian women will have an abortion in their lifetime (Hole et.al, 2015).

Whereas to many women an abortion seems the best option, the decision to terminate a pregnancy can be difficult to make. In making such a difficult decision, the women often consider their work, financial, housing, support available to them, and the kind of relationship they have. In 2014 alone, over 73,000 abortions were estimated to have taken place in Australia. The figure was arrived at by the extrapolation from the reported total abortions in South Australia given its share of population. Women in their 20s contribute the largest share of the abortions reported both in Western and South Australia. In South Australia, women aged 20 to 24 years were reported to account for near to 12% (Kildea et.al, 2017).

Despite the federal, state and regional administration’s insistence on the use of contraception to avoid unplanned pregnancies, many women still get pregnant unexpectedly. It will be unrealistic to anticipate that all sexually active women to not get an unplanned pregnancy in their life. The reason for high rates of abortions arise from the fact that no contraceptive is perfect. Contraceptive methods can thus fail even if applied correctly and consistently in every sexual encounter. WHO estimates that at least 6 million unplanned pregnancies could still occur even if contraception users used them correctly as prescribed?  Women seeking to terminate a pregnancy in Australia attest to using contraception before they became pregnant. According to a study conducted on Australian men, at least 24% of the men report to have experienced breakage of condoms during sexual intercourse (Gwynne et.al, 2016).

The women too may not be in a good position to negotiate for the use of contraceptive methods out of either coercion, being under the influence of drugs, lack of power to make decisions, and lack of information. Women also encounter numerous barriers to accessing contraception due to geographic location (rural) and lack of information. More significantly, privacy concerns, high cost of obtaining the service, and doctors or medical practitioners declining to prescribe the women better contraceptive options simply because of their personal cultural values (Shahid, Finn & Thompson, 2009).

Registered nurses can play an active role in reducing the prevalent cases of abortions in Australian women both urban and rural. For instance, lack of knowledge and access to contraception is claimed to be the largest cause of unplanned pregnancies in teenage women. There is therefore a huge need for increased sensitization of the society on sexual and reproductive health care. Besides spreading awareness of the various contraceptive methods to the young women, there is also the need for all levels of the government to provide appropriately trained and qualified personnel to work in the health facilities to offer these essential services. Bearing in mind that abortions can cause fatal consequences to the seeker of the services, it is of great importance for contraception to receive first priority (Cameron et.al, 2014).

Birthing In Country for Aboriginal and Torres Strait Islander

Majority of the Aboriginal women do not have access to culturally competent and high-quality maternity care as revealed by an Audit report produced by Western Australia. The audit report revealed that at least 70% of all the services provided did not meet the maternity care standards expected by Aboriginal culture. Increasing birthing choices seems to be the best option for the government to pursue in order to improving the quality of maternity care while attempting to reduce the child mortality rates. For instance, out of 1000 Aboriginal babies born, about 9.6 are reported to be dead at birth or die within their first 28 days of life. Non-Aboriginal babies’ death rate stands at 8.1 out of 1000 which is lower compared to Aboriginal children (Kildea et.al, 2017).

Birthing on country in simple terms is used to refer to giving birth to a child by an Aboriginal mother on the land of her ancestors’ land under the help of traditional midwives. The exercise used to be carried out by a traditional midwife. But these days, non-Aboriginal midwives can work in close collaboration with traditional midwives and elders to birth on country. Additionally, birthing on country is always conducted according to spiritual and traditional beliefs of respective communities. Birthing on country gives the mother and the child the sense of belonging from the connection they receive to their ancestral land. Many Aboriginal women are increasingly moving from rural areas to reside in urban centers where they have access to modern and high quality healthcare facilities. These women can therefore easily gain access to hospital for childbirth (Shahid, Finn & Thompson, 2009).

Despite the benefits that birthing in hospitals is most desirable, many women Indigenous women still prefer to birth on country for various reasons. Some of these women choose to go this route so that they can get physical connection to country. Majority of the women birthing on country also believe that it is nearly impossible to have a culturally and spiritually enriching birth in hospitals. The experience obtained in a hospital can also be a good reason for one to choose otherwise. A traumatic experience in the hospital can cause a women not to give birth in the hospital but rather go for country birthing. Aboriginal women are put off from hospitals because of racism discrimination issues which are ongoing in the hospitals (Kildea et.al, 2017).

Some women who have other children often worry about leaving them behind for a period of up to one and half month. Apart from children, the women may also have other adult dependents that need their attention. For this reason, majority of them will thus decide to stay home to give birth at the same time taking care of other family members. Nurses and healthcare practitioners need to establish trust with the Aboriginal clients while discussing birthing options. Aboriginal mothers are legally allowed to make decisions concerning their health care (Cameron et.al, 2014).

For women who would want to give birth unassisted, healthcare providers need to question issues regarded important to them in order to comprehend them well and be able to serve their needs better. Also, the clinicians need to offer evidence-based materials available so as to prompt a discussion around the benefits and risks while at the same time allowing them to make decisions willingly. Additionally, it is important for clinicians to explain the available alternatives to allow for the making of an informed decision. The reasons for choosing one alternative over the other have to be understood as well for ease of tracking the well-being of the mother and baby. All choices for bathing should be respected rather than rebuked because all of them carry equal significance. Registered nurses need also to recognize that they have a huge role to play in strengthening Aboriginal women’s health outcomes through carrying themselves with honesty, respect and professionalism.

Conclusion

Different people irrespective of their cultural background deserve to receive quality healthcare. More importantly, cultural differences ought to enrich the provision of health services that take into account and consideration people’s unique needs. To extend culturally fulfilling healthcare, practitioners have to meet certain conditions as described in the above literature. Working alongside members of the community at all levels of governance, registered nurses can effectively help improve health outcomes.

References

Cameron, B. L., Plazas, M. D. P. C., Salas, A. S., Bearskin, R. L. B., & Hungler, K. (2014).             Understanding inequalities in access to health care services for Aboriginal people: a call     for nursing action. Advances in Nursing Science37(3), E1-E16.

Gwynne, K., Irving, M. J., McCowen, D., Rambaldini, B., Skinner, J., Naoum, S., & Blinkhorn,   A. (2016). Developing a sustainable model of oral health care for disadvantaged         Aboriginal people living in rural and remote communities in NSW, using collective    impact methodology. Journal of health care for the poor and underserved27(1), 46-53.

Hole, R. D., Evans, M., Berg, L. D., Bottorff, J. L., Dingwall, C., Alexis, C., & Smith, M. L.        (2015). Visibility and voice: Aboriginal people experience culturally safe and unsafe          health care. Qualitative health research25(12), 1662-1674.

Kildea, S., Hickey, S., Roe, Y., Gao, Y., & Kruske, S. (2017, January). Birthing on Country (in    Our Community): A partnership approach to strengthen Aboriginal and Torres Strait     Islander maternity services in an urban setting. In 31st Triennial International     Confederation of Midwives Congress.

Shahid, S., Finn, L. D., & Thompson, S. C. (2009). Barriers to participation of Aboriginal people in cancer care: communication in the hospital setting. Med J Aust190(10), 574-579.

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