Women’s reproductive health: informing improvements in health care for those at risk

My research aims to inform improvements in health care provision for three populations of reproductive-age women considered to be at risk. Women with Polycystic Ovary Syndrome (PCOS) are at risk of health complications by virtue of the condition, while women from refugee backgrounds and Aboriginal and Torres Strait Islander (Indigenous) women have elevated risks due to socio-economic determinants of health. The consistent theme throughout this thesis is the interaction between women and health services, for example in diagnosis experience, attendance for care and receiving recommended care. An understanding of whether women receive adequate, professionally recommended health care will inform potential changes in health systems or educational resources to better address women’s needs. PCOS is an increasingly common condition with metabolic, reproductive and psychological complications. Part One of this thesis describes survey-based research involving women with PCOS and general practitioners, and finds that the PCOS diagnosis experience can be lengthy, involve many health professionals, and leave women’s information needs unmet. Additionally, the name “Polycystic Ovary Syndrome” is perceived as confusing, with general support for a name change to enhance understanding of the syndrome. These findings can inform strategies to improve PCOS care and engagement in health behaviours. Maternal origin (e.g. country of birth or ethnicity) influences health and pregnancy outcomes, however whether a refugee background confers additional risks is unknown. Part Two describes development of a rigorous approach for using country of birth as an indicator of refugee and non-refugee background in order to examine this question. This approach is subsequently applied in an observational, retrospective study of Victoria’s largest public maternity service which compares maternal health, pregnancy care and pregnancy outcomes for women born in humanitarian source countries (HSCs) and in non-HSCs. Worldwide, this is one of the largest studies of pregnancy outcomes in women of refugee background and finds that, in general, women born in HSCs have poorer general health, lower pregnancy care attendance, more risk factors for adverse pregnancy outcomes and that maternal birth in an HSC is independently associated with some adverse pregnancy outcomes. Regional variations are also observed and are the first reports of pregnancy outcomes for migrant women from some world regions. This research suggests a need for refugee-focused strategies to support engagement in pregnancy care and to address maternal health needs. Large disparities in pregnancy outcomes exist between Indigenous and non-Indigenous women in Australia. Part Three describes longitudinal analysis of a continuous quality improvement initiative implemented by primary health care centres in Indigenous communities. I find that participation in the initiative is associated with greater screening and follow-up of lifestyle-related and metabolic risk factors for adverse pregnancy outcomes. This research also identifies areas where further improvements in provision of pregnancy care are needed for Indigenous women. This thesis addresses important gaps in our understanding of reproductive health care provision for Australian women at risk of short and long-term health problems. It generates new insights regarding women’s interactions with health services and makes a significant contribution to identifying areas for improvement in health care provision.