The urban–remote divide for Indigenous perinatal outcomes

Simon Graham, Lisa R Jackson Pulver, Yueping Alex Wang, Paul M Kelly, Paula J Laws, Narelle Grayson and Elizabeth A Sullivan
Med J Aust 2007; 186 (10): 509-512.


Objective: To determine whether remoteness category of residence of Indigenous women affects the perinatal outcomes of their newborn infants.

Design and participants: A population-based study of 35 240 mothers identified as Indigenous and their 35 658 babies included in the National Perinatal Data Collection in 2001–2004.

Main outcome measures: Australian Standard Geographical Classification remoteness category, birthweight, Apgar score at 5 minutes, stillbirth, gestational age and a constructed measure of perinatal outcomes of babies called “healthy baby” (live birth, singleton, 37–41 completed weeks’ gestation, 2500–4499 g birthweight, and an Apgar score at 5 minutes ≥ 7).

Results: The proportion of healthy babies in remote, regional and city areas was 74.9%, 77.7% and 77.6%, respectively. After adjusting for age, parity, smoking and diabetes or hypertension, babies born to mothers in remote areas were less likely to satisfy the study criteria of being a healthy baby (adjusted odds ratio [AOR], 0.87; 95% CI, 0.81–0.93) compared with those born in cities. Babies born to mothers living in remote areas had higher odds of being of low birthweight (AOR, 1.09; 95% CI, 1.01–1.19) and being born with an Apgar score < 7 at 5 minutes (AOR, 1.63; 95% CI, 1.39–1.92).

Conclusions: Only three in four babies born to Indigenous mothers fell into the “healthy baby” category, and those born in more remote areas were particularly disadvantaged. These findings demonstrate the continuing need for urgent and concerted action to address the persistent perinatal inequity in the Indigenous population.

  • Simon Graham1,3
  • Lisa R Jackson Pulver2
  • Yueping Alex Wang3
  • Paul M Kelly1
  • Paula J Laws3
  • Narelle Grayson3
  • Elizabeth A Sullivan3,4

  • 1 Master of Applied Epidemiology Program, National Centre for Epidemiology and Population Health, College of Medicine and Health Sciences, Australian National University, Canberra, ACT.
  • 2 Muru Marri Indigenous Health Unit, University of New South Wales, Sydney, NSW.
  • 3 Australian Institute of Health and Welfare National Perinatal Statistics Unit, University of New South Wales, Sydney, NSW.
  • 4 School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW.



Simon Graham and Lisa Rae Jackson Pulver are Aboriginal Australians and all authors recognise the Land on which this work was done and acknowledge the contribution Indigenous Australians make to this important work. The Australian Institute of Health and Welfare is the funding body of the National Perinatal Data Collection and a major funding provider of the AIHW National Perinatal Statistics Unit. These data are a distillation of the work of many collectors and data analysts in the states and territories. Simon Graham conducted this study as a part of his scholarship in the Masters of Applied Epidemiology (MAE) degree at the Australian National University. The MAE program is funded by the Australian Department of Health and Ageing. Paul Kelly’s salary is partly supported by the National Health and Medical Research Council.

Competing interests:

None identified.

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