Caring for Australia's most remote communities: obstetric services in the Indian Ocean Territories

The Indian Ocean Territories (IOT) comprising Christmas and Cocos (Keeling) Islands are situated over 2500 km from Perth, Australia, and are accessible by commercial aircraft only twice a week. The IOT Health Service (IOTHS) is administered from the Department of Transport and Regional Services in Canberra, ACT, Australia. Since 1998, all pregnant women have been required to leave the islands by 36 weeks gestation and travel to the mainland for birthing. Previously most women with low risk pregnancies were delivered on their island. Women and their partners regularly question medical staff as to reasons for the current obstetric service and, in particular, why they have to leave the Islands to give birth. While this is a common scenario in many remote parts of Australia, the vast distance involved and the cultural differences of the predominantly Chinese and Malay population make the IOT situation unique.

A study was conducted during 2005 to determine the requirements for providing a safe, cost-effective and socially-acceptable obstetrics service, and to identify possible areas for improvement in the current service, and to explore potential solutions. This article presents one aspect of the study, involving qualitative analysis of recorded interviews with 28 of the islands' women.

Having choice about where the baby would be born was the most significant category of data analysis. In making choice, a number of variables come into play, including positive and negative social, economic, logistical and cultural factors related to the decision. Women were also strongly influenced by issues of safety, and their response to these issues was largely based on their previous experience and understanding of the IOT obstetric service.

Many families expressed a desire for full obstetric services to be reinstated on the islands for low-risk pregnancies, particularly because of the difficulties they experience with the current service. Three recommendations were formulated in response to the social, economic, cultural and logistical difficulties faced by IOT women and their families.