Maternity care and services in rural Tasmania : the perspectives of rural women and health professionals

Despite strong records of safety and quality maternity care, maternity care in Australia is not meeting the needs of rural and remote women as evidenced by poor access and outcomes. Rural communities have experienced substantial and ongoing loss of maternity services for more than a decade. Consequently, rural women have to leave their community and support networks to go to distant centres to give birth. The loss of these critical health services has adversely affected rural women, families and communities. Workforce shortages, safety and quality considerations and cost considerations are the three interrelated reasons which have led to the loss of small rural birthing services in Australia. To improve maternity services in rural communities, it is important that women's needs for the services are identified and catered for as much as possible. This study aims to: (i) identify the needs of women in maternity care in rural areas, (ii) examine the current available maternity health services in rural Tasmania and (iii) identify the gaps between the needs and services. A conceptual frame work based on a literature review was constructed to guide the study. The study employed a mixed methods design with a self-administered mailed survey and semi-structured interviews as data collection methods. Six rural communities which are representative of all rural Tasmania were chosen to conduct the study. Through the health care and child health centres in these communities, 600 survey questionnaires were sent out to women. The survey response rate was 35%. Semistructured interviews were conducted with 22 women and 20 health professionals. Descriptive statistics and Chi Square tests were used to analyse the survey data with the use of SPSS 15. The interview data were analysed using grounded theory and thematic analysis with the use of NVivo v8.0. The findings indicate a set of unmet maternity needs of women in rural Tasmania namely (i) access needs, (ii) safety needs, (iii) needs for small rural birthing services, (iv) information and support needs, and (v) needs for quality services. The study suggests that the lack of maternity services in the Tasmanian rural areas transfer risk from the health care system to rural families because of privileging of medical model over a feminist theorising or primary care approach. The study provides important recommendations for bridging the gaps between the women's needs and currently available maternity services. Firstly, antenatal, postnatal and support services should be provided in the local communities through outreach or visiting services. Secondly, rural hospitals without maternity services should be properly equipped and prepared to deal with unexpected emergency childbirths to ensure the safety for women and babies. Appropriately equipped and skilled ambulance services should be in place for all rural hospitals. In addition, further withdrawal of rural birthing services should be challenged and consideration given to reopening closed rural services. Furthermore, women should be informed about all options and services available through the collaboration of health professionals in local areas and the regional hospital. Finally, child health services in rural communities should provide quality services for women throughout their pregnancy and postnatal period as part of continuity of care. In summary, this study makes a contribution to the enhancement of maternity care and services in rural Tasmania and consequently to improve access and outcomes for rural women and their families.