Evaluation of systems reform in public hospitals, Victoria, Australia, to improve access to antenatal care for women of refugee background: An interrupted time series design

Autoři: Jane Yelland aff001;  Fiona Mensah aff003;  Elisha Riggs aff001;  Ellie McDonald aff001;  Josef Szwarc aff005;  Wendy Dawson aff001;  Dannielle Vanpraag aff001;  Sue Casey aff005;  Christine East aff006;  Mary Anne Biro aff006;  Glyn Teale aff008;  Sue Willey aff006;  Stephanie J. Brown aff001
Působiště autorů: Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia aff001;  Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia aff002;  Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia aff003;  Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia aff004;  Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia aff005;  School Nursing and Midwifery, Monash University, Clayton, Victoria, Australia aff006;  School of Nursing and Midwifery, Mercy Health and La Trobe University, Bundoora, Victoria, Australia aff007;  Women’s and Children’s, Western Health, Sunshine, Victoria, Australia aff008
Vyšlo v časopise: Evaluation of systems reform in public hospitals, Victoria, Australia, to improve access to antenatal care for women of refugee background: An interrupted time series design. PLoS Med 17(7): e32767. doi:10.1371/journal.pmed.1003089
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003089



Inequalities in maternal and newborn health persist in many high-income countries, including for women of refugee background. The Bridging the Gap partnership programme in Victoria, Australia, was designed to find new ways to improve the responsiveness of universal maternity and early child health services for women and families of refugee background with the codesign and implementation of iterative quality improvement and demonstration initiatives. One goal of this ‘whole-of-system’ approach was to improve access to antenatal care. The objective of this paper is to report refugee women’s access to hospital-based antenatal care over the period of health system reforms.

Methods and findings

The study was designed using an interrupted time series analysis using routinely collected data from two hospital networks (four maternity hospitals) at 6-month intervals during reform activity (January 2014 to December 2016). The sample included women of refugee background and a comparison group of Australian-born women giving birth over the 3 years. We describe the proportions of women of refugee background (1) attending seven or more antenatal visits and (2) attending their first hospital visit at less than 16 weeks’ gestation compared over time and to Australian-born women using logistic regression analyses.

In total, 10% of births at participating hospitals were to women of refugee background. Refugee women were born in over 35 countries, and at one participating hospital, 40% required an interpreter. Compared with Australian-born women, women of refugee background were of similar age at the time of birth and were more likely to be having their second or subsequent baby and have four or more children. At baseline, 60% of refugee-background women and Australian-born women attended seven or more antenatal visits. Similar trends of improvement over the 6-month time intervals were observed for both populations, increasing to 80% of women at one hospital network having seven or more visits at the final data collection period and 73% at the other network. In contrast, there was a steady decrease in the proportion of women having their first hospital visit at less than 16 weeks’ gestation, which was most marked for women of refugee background. Using an interrupted time series of observational data over the period of improvement is limited compared with using a randomisation design, which was not feasible in this setting.


Accurate ascertainment of ‘harder-to-reach’ populations and ongoing monitoring of quality improvement initiatives are essential to understand the impact of system reforms. Our findings suggest that improvement in total antenatal visits may have been at the expense of recommended access to public hospital antenatal care within 16 weeks of gestation.

Klíčová slova:

Antenatal care – Birth – diabetes mellitus – Child health – Language – Network analysis – Pregnancy – Gestational diabetes


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2020 Číslo 7

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