Summary of Indigenous women’s health

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What is known about Indigenous women’s health?

In Australia, Aboriginal and Torres Strait Islander women have poorer health than non-Indigenous women. Indigenous women have higher levels of risk factors, earlier onset of disease, and lower survival rates. Improvements in the areas of prevention, early detection and treatment can help Indigenous women to have better health outcomes.

A new national women’s health policy has been developed by the Australian Government. It addresses Indigenous women’s health needs, noting that often it is the women who look after the health of other family members and forget about their own health needs. If Indigenous women are to have better health outcomes, their history, experience, culture and rights need to be understood.

It is also important to understand that Indigenous women see health as something that covers everything important in a person’s life, including land, environment, physical body, community, relationships and law. Thus health is viewed as the social, emotional, and cultural wellbeing of the whole community.

Non-Indigenous health treatment can reduce disease in Indigenous people, but it needs to be done in a culturally sensitive manner to help with both immediate and long-term health issues for Indigenous women.

What is known about the Indigenous female population?

A recent report states that by June 2012 there will be approximately 300,000 Indigenous females living in Australia, which is 2.5% of the Australian female population. New South Wales (NSW) and Queensland (Qld) have the highest numbers of Indigenous females, followed by Western Australia (WA) and the Northern Territory (NT) (See Figure 1).

Figure 1: Projected Australian Indigenous female population, by jurisdiction, by June 2012

Projected Indigenous female populations, by jurisdiction, June 2010

Data derived from the Australian Bureau of Statistics (2009) Experimental estimates and projections, Aboriginal and Torres Strait Islander Australians 1991 to 2021

This is where the Indigenous people of Australia live:

31% in major cities
22% in inner regional areas
23% in outer regional areas
8% in remote areas
16% in very remote areas

As the following statistics show, the Indigenous female population is much younger overall than the non-Indigenous female population (See Figure 2).

45% of Indigenous females are aged below 20 years, compared with 25% of non- Indigenous females.
4% of Indigenous females are aged 65 years or older, compared with 21% of non-Indigenous females.

Figure 2: Age groups of Australian Indigenous and non-Indigenous female populations at 30 June 2011

Indigenous and non-Indigenous female populations, by age group, at June 2011

Data derived from the Australian Bureau of Statistics (2009) Experimental estimates and projections, Aboriginal and Torres Strait Islander Australians 1991 to 2021 and Australian Bureau of Statistics (2008) Population projections, Australia, 2006 to 2101

What do we know about the background of Indigenous women’s health?

The poorer health outcomes of Indigenous people are rooted in history. Modern-day factors, such as money, physical environment and social conditions also influence the health of people, families and communities as a whole. These factors are linked with education, employment, income, housing, access to services, social networks, connection with the land, racism, and imprisonment. On all these measures Indigenous people suffer poorer outcomes than non-Indigenous people. The important measures in some of these areas for Indigenous females are summarised in the following sections.

Education

School records show us that in 2006 Indigenous females were less likely to attend school than non-Indigenous females across all age groups. The differences were the greatest in the 15 to 19 year-old age group. In 2006, school completion to year 12 was much lower for Indigenous females than for non-Indigenous females (See Figure 3).

Figure 3: Australian female school retention until year 12, by jurisdiction, 2006

Female school retention until year 12, by Indigenous status and jurisdiction, Australia, 2006

Data derived from the Steering Committee for the Review of Government Service Provision (2009) Overcoming Indigenous disadvantage: key indicators 2009

Number is per cent of females in total Indigenous/non-Indigenous population retained at school until year 12

A comparison of Indigenous and non-Indigenous females with respect to further education (past high school) is:

20% of Indigenous females had a post-school qualification compared with 37% of non-Indigenous females
5% of Indigenous females had graduated with a bachelor degree or above, compared with 17% of non-Indigenous females
15% of Indigenous females had a diploma-level or certificate-level qualification, compared with 20% of non-Indigenous females

Employment

Here is a comparison of the employment of Indigenous and non-Indigenous females:

16% of Indigenous females without any post-school qualifications were unemployed, compared with 5% of non-Indigenous females
Indigenous females with a bachelor degree or higher had employment levels similar to that of non-Indigenous females (close to full employment)
92% of Indigenous females with any non-school qualification were employed, compared with 97% of non-Indigenous females
The proportion of Indigenous females employed as ‘professionals’ or ‘managers’ was less than half that of non-Indigenous females
The most common industry of employment for both Indigenous and non-Indigenous females was ‘Health care and social assistance’

Income

Education and employment influence a woman’s level of income. The following statistics show that Indigenous women suffer financial difficulties, given their generally lower level of education and reduced participation in employment:

In 2006, the average income per week for Indigenous households was $521, compared with $730 for non-Indigenous households.
The income figures have improved slightly from 2001, where the household income was $484 per week for Indigenous people and $680 for non-Indigenous people (after figures have been adjusted for inflation).
These figures show that, although the income in Indigenous households has increased (by approximately 9%); there are still great differences between Indigenous and non-Indigenous household incomes.
In 2006, the weekly individual income for Indigenous females (aged 15 years or older) was $278, compared with $367 for non-Indigenous females; these differences were greatest in the NT (See Figure 4).

Figure 4: Median gross weekly individual income for females aged 15 years and over, by Indigenous status and jurisdiction, 2006

Median gross weekly individual income for females aged 15 years and over, by Indigenous status and jurisdiction, 2006

Data derived from the Steering Committee for the Review of Government Service Provision (2009) Overcoming Indigenous disadvantage: key indicators 2009

What do we know about the deaths of Indigenous women?

Life expectancy

Recent reports suggest that Indigenous females born in 2005-2007 can be expected to live to 72.9 years compared with 82.6 years expected for all females (See Figure 5). Life expectancy of Indigenous females was highest in NSW (75.0 years) and lowest in the NT (69.2 years). Due to changes in the methodology used to estimate Indigenous life expectancy, these figures are higher than previous estimates.

Figure 5: Female life expectancy in NSW, QLD, WA, NT and Australia, 2005-2007

Female life expectancy, by Indigenous status and jurisdiction, 2005-2007

Data derived from the Australian Bureau of Statistics (2009) Experimental life tables for Aboriginal and Torres Strait Islander Australians: 2005-2007

Death rates

Understanding Indigenous death rates can be a complex task. The following points may help to explain some of the terms used:

The Standardised mortality ratio (SMR) is the number of observed deaths divided by the number of expected deaths.
Adjustments are made for the differences in the age structures of the Indigenous and non-Indigenous female populations.
Adjustments are also made for the uncertainties about the completeness of both death and population numbers for the Indigenous population.
Data from some states and territories are not of suitable quality to be used in information statistics compiled by Australia’s two main statistical agencies, the Australian Bureau of Statistics (ABS) and the Australian Institute of Health and Welfare (AIHW).

In 2004-2008, Indigenous female deaths were between two and four times higher than age-specific death rates for the total Australian female population (See Table 1). The adjusted SMRs range from 2.16 for Indigenous females living in NSW to 3.52 for those living in the NT. This means that the actual deaths were twice as high as expected for NSW, and 3.5 times as high for the NT.

Table 1: Female Indigenous deaths and SMRs in NSW, Qld, WA, SA, NT and Australia, 2004-2008
	Registered deaths	SMR
	Registered	Number	Adjusted
Data derived from the Australian Bureau of Statistics (2009) Causes of death Australia, 2007
Notes: Registered SMRs (standardised mortality ratios) are the numbers of deaths registered divided by the numbers expected from the age-sex-specific death rates for the total Australian population at 30 June 2006 Adjusted SMRs use the ABS adjustment factors for each jurisdiction. These factors are based on a detailed assessment by the ABS of a linkage between Census and death records Due to the small numbers involved, the ABS did not make an estimate of the adjustment factor applicable to SA Caution should be exercised in the interpretation of these SMRs as some uncertainty persists about the completeness of both death and population numbers
NSW	1174	1.88	2.16
Qld	1269	2.29	2.42
WA	1028	3.47	3.12
SA	316	2.53	n/a
NT	1001	3.83	3.52
Australia	5056	2.40	2.61

Age at death

In 2005-2009, death rates were higher for Indigenous females than for non-Indigenous females across all age groups. The ratio of the Indigenous rate to the non-Indigenous rate was particularly high for the age groups between 25 and 64 years (See Figure 6). Rates and rate ratios were higher for Indigenous females living in WA, SA and the NT than for those living in NSW and Qld.

Figure 6: Indigenous-non-Indigenous death rate ratios, NSW/Qld and WA/SA/NT, by age group, 2005-2009

Indigenous:non-Indigenous death rate ratios, by jurisdictions, 2006-2008

Data derived from the Australian Bureau of Statistics (2010) Deaths Australia, 2009

Rate ratio is the Indigenous rate divided by the non-Indigenous rate

Infant deaths

In 2002-2006, of all infant female deaths in Qld, WA, SA and the NT, about one fifth were Indigenous. The infant mortality rate of 10.1 deaths per 1,000 live births for Indigenous females was 2.6 times the rate of 3.9 per 1,000 for non-Indigenous females. This means that deaths of Indigenous female infants were over two and a half times more than non-Indigenous female infants.

Causes of death

In 2001-2005, cardiovascular disease (i.e. diseases of the heart and circulatory system) was the leading cause of death for Indigenous females living in Qld, WA, SA and the NT. The number of Indigenous female deaths from this disease was almost three times the number of deaths expected from the rate for non-Indigenous females (SMR: 2.7)1. The next most common cause of death for Indigenous females was neoplasm (mainly cancers) (SMR: 1.6), external causes (SMR: 3.5), diabetes (SMR: 14.5), and respiratory diseases (SMR: 3.6).

Maternal mortality

In 2003-2005, of all 60 recorded maternal deaths, six were Indigenous women (10%), where Indigenous status was known (Indigenous status was not reported in 8% of the deaths).

In 2003-2005, the maternal mortality ratio for Indigenous women was 21.5 deaths per 100,000 confinements, almost three times higher than the ratio of 7.9 per 100,000 for non-Indigenous women. For direct maternal deaths, the ratio for Indigenous women was 7.2 per 100,000 compared with 3.6 per 100,000 for non-Indigenous women. This means that Indigenous women died twice as often from direct maternal deaths than non-Indigenous women.

What do we know about births and pregnancy?

In 2009, there were 15,825 2 births registered in Australia with one or both parents identified as Indigenous. Of these births, 7,688 were female (5% of all births registered). Indigenous status was identified as follows:

in 31% of these births both parents were identified as Indigenous
in 42% of these births (including births where paternity was not acknowledged and those where the father’s Indigenous status was unknown) only the mother was identified as Indigenous
in 27% of these births only the father was identified as Indigenous

Age of mothers

In 2009, Indigenous women had more babies than non-Indigenous women and had them at younger ages.

Approximately 20% of Indigenous mothers were teenagers, compared with only 4% of non-Indigenous mothers
The age of Indigenous mothers was around 24.5 years, compared with 30.6 years for all women
The highest birth rates (known technically as fertility rates) were for the 20-24 years age group for Indigenous women, and for the 30-34 years age group for non-Indigenous women (See Figure 7)
The fertility of teenage Indigenous women (79 babies per 1,000 women) was more than four times that of all teenage women (17 babies per 1,000)

Figure 7: Age-specific fertility rates for Australian women, by age group, 2009

Age-specific fertility rates, by Indigenous status of mother, Australia, 2008

Data derived from the Australian Bureau of Statistics (2010) Births Australia, 2009

Rates per 1,000 women in each age group

Total fertility rates

In 2009, total fertility rates were higher among the Indigenous female population. Rates for Indigenous women were 2,575 births per 1,000 and for all women were 1,901 per 1,000 (See Figure 8). The highest total fertility rates for Indigenous women were:

Queensland, 3,170 per 1,000
Western Australian, 3,058 babies per 1,000
South Australia, 2,552 per 1,000

Figure 8: Total fertility rates for Australian women, by jurisdiction, 2009

Total fertility rates, by Indigenous status of mother, selected jurisdictions, Australia, 2008

Data derived from the Australian Bureau of Statistics (2010) Births Australia, 2009

Total fertility rate is the number of children born to 1,000 women at the current level and age pattern of fertility
Figures in this table are restricted to those jurisdictions with estimated identification of Indigenous births of around 90% or higher

Birth weights

In 2008, the average birth weight of babies born to Indigenous mothers was 3,196 grams (g), almost 200g less than the average for babies born to non-Indigenous mothers (3,385g). Babies born to Indigenous women were twice as likely to be of low birth weight (LBW) (12.3%) than were those born to non-Indigenous women (5.9%). (LBW, defined as a birth weight of less than 2,500g, increases the risk of death in infancy and other health problems.) The amount of low birth weight babies born to Indigenous women were highest for SA (16.3%) and WA (14.8%) (See Table 2).

Table 2: Mean birth weights and percentage of low birth weight for babies born to Australian Indigenous and non-Indigenous mothers, by jurisdiction, 2008
	NSW	Vic	Qld	WA	SA	NT	Aust
Data derived from Laws P, Sullivan EA (2009) Australia’s mothers and babies 2008
Notes: Low birth weight is defined as less than 2,500 g Mean birth weights and low birth weight proportions for babies born to non-Indigenous mothers have been estimated from published figures for Indigenous and all mothers
Indigenous mothers
Mean birthweight	3217	3216	3214	3107	3067	3133	3182
% low birthweight	11.2	12.0	11.2	16.2	16.2	12.5	12.5
Non-Indigenous mothers
Mean birthweight	3386	3370	3394	3372	3366	3390	3381
% low birthweight	5.5	6.3	6.0	5.7	6.1	4.9	5.9

Risk factors for low birth weight babies include:

socio-economic disadvantage
the size and age of the mother
the number of babies previously born (the greater the number of babies the greater chance of a low birth weight baby)
the mother’s nutritional status
illness during pregnancy
duration of the pregnancy (the shorter the duration of pregnancy the greater the chance of having a low birth weight baby)
alcohol consumption and use of tobacco and other drugs during pregnancy are likely to reduce the size of the baby

Tobacco, in particular, has a major impact on birth weight. In 2001-2004, the birth weight of live babies born was:

3,037g for Indigenous women who smoked
3,290g for Indigenous women who did not smoke.

This means that babies born to Indigenous women who smoked were over 250g lighter than babies born to Indigenous women who did not smoke.

The comparable figures for live babies born to non-Indigenous women were:

3,210g for non-Indigenous women who smoked
3,416g for non-Indigenous women who did not smoke

Low birth weight live-born babies occurred in the following proportions:

16% of births to Indigenous women who smoked
10% of births to Indigenous women who did not smoke
10% of births to non-Indigenous women who smoked
5% of births to non-Indigenous women who did not smoke

In 2000-2001, the Western Australian Aboriginal Child Health Survey reported slightly higher average birth weights than those reported above:

3,310g for babies whose mothers did not use tobacco in pregnancy
3,100g for those whose mothers who used tobacco

The lowest average birth weights reported in the survey were:

3,000g for babies whose mothers used marijuana with tobacco
2,940g for babies who mothers used marijuana with both tobacco and alcohol

Why do Indigenous women go to hospital?

Hospitalisation rates

In 2009-10, over 171,000 Indigenous females living in NSW, Vic, Qld, WA, SA and the NT were admitted to hospital. The standardised rate for Indigenous females was 915 per 1,000, compared to 394 per 1,000 for non-Indigenous females. This means than Indigenous females were admitted to hospital more than twice that of non-Indigenous females.

In 2009-10, admission rates were higher for Indigenous females than for non-Indigenous females across all age groups, with rate ratios being particularly high for those aged between 5 and 14 years (See Figure 9).

Figure 9: Australia female Indigenous-non-Indigenous hospitalisation rate ratios, by age group, 2007-2009

Female Indigenous:non-Indigenous hospitalisation rate ratios, by age group, 2007-2009

Data derived from the Australian Institute of Health and Welfare (2009) Australian hospital Statistics 2007-08

Rate ratio is the Indigenous rate divided by the non-Indigenous rate

Causes of hospitalisation

The information needed to compare the causes of hospitalisation for Indigenous and non-Indigenous females is not available for recent years. It is likely that the causes for Indigenous females are similar to those documented for 1999-2000. The most common reason for hospitalisation of Indigenous females then was ‘care involving dialysis’, which was responsible for 30% of admissions. Many of these were repeat admissions; some of these people entered hospital for dialysis almost daily.

Apart from these admissions, the most common causes of hospitalisation for Indigenous females were:

childbirth related
respiratory disease (rate ratio: 3.2)
digestive disease (rate ratio: 3.2)
injury/poisoning (rate ratio: 7.3)

More recently (2009-10), there were 305,008 hospital separations, which were identified as Indigenous, in NSW, Vic, Qld, WA, SA and the NT (3.8% of the total hospital separations). For Indigenous people, the causes of hospitalisation were:

care involving dialysis (145,881 separations) (48%)
injury, poisoning and external causes (22,701 separations) (7.4% of all separations, and 14.2% of separations excluding those for dialysis)
pregnancy-related conditions ( 19,769 separations) (12.4% of separations excluding those for dialysis)
respiratory conditions (18,342 separations) (11.5% of separations excluding those for dialysis)
digestive diseases (14,687 separations) (9.2% of separations excluding those for dialysis)

Generally, separation rates were higher for Indigenous people than for non-Indigenous people for all main groups.

Summary

The information above shows that Indigenous women remain less healthy than non-Indigenous women. However, there is some evidence that the health status of Australia’s Indigenous females is improving slowly. For example, there have been significant reductions in recorded mortality in recent years in a number of states and territories and age-standardised death rates for Indigenous women living in WA, SA and the NT declined by around 15% over the period 1991-2006. The declines in death rates were less for Indigenous people than for non-Indigenous people, however, with Indigenous-non-Indigenous death rate ratios increasing for females.

The most recent estimate of life expectancy at birth for Indigenous females, 72.9 years in 2005-2007, is more than previous estimates, but the improvements may be due largely to revised statistical methods.

Indigenous infant mortality rates for WA, SA and the NT have declined significantly over the 16-year period 1991-2006. The Indigenous rate declined by 47% over that period, slightly more than the 34% decline of the rate for non-Indigenous people. The Indigenous-non-Indigenous rate ratio declined from 4.3 to 3.2.

There is no doubt other evidence of improvement in some measures of health status, and of deterioration in others. But, clearly, the gap between the health status of Indigenous females and that of non-Indigenous females is still unacceptably wide.

Endnotes

2001-2005 is the most recent period for which detailed information about causes of death is available.
This figure probably underestimates the true number slightly as Indigenous status is not always identified, and there may be a lag in birth registrations. The ABS estimated that 96% of Indigenous births in 2002-2006 were correctly identified as such. Completeness of identification varied across the country, with only Vic, Qld, WA, SA and the NT having levels above 90%.