Unintended pregnancy among Aboriginal and Torres Strait Islander women: where are the data?

To the Editor: In Australia, up to 40% of women have experienced an unintended pregnancy,1 which can be associated with suboptimal pre‐conception health behaviour and reproductive health care engagement and adverse maternal and neonatal outcomes.1

Aboriginal and Torres Strait Islander women experience higher rates of pregnancy risk factors, adverse perinatal outcomes, and adolescent pregnancy compared with non‐Indigenous women.2 However, little is known about the prevalence and impact of unintended pregnancy among Aboriginal and Torres Strait Islander women. While two related national studies have been undertaken over the past decade, Aboriginal and Torres Strait Islander people were underrepresented1 or Indigeneity was unreported.3 Access to sexual and reproductive health care is a government priority,4 but without adequate data, dealing with issues or evaluating change will be impossible.

This knowledge gap must be addressed. We need to better understand the prevalence, experiences and outcomes of unintended pregnancy for Aboriginal and Torres Strait Islander people (acknowledging that unintended does not necessarily mean unwanted), including issues relating to pregnancy intentions, decision making, and health care access. Meaningful engagement and collaboration with Aboriginal and Torres Strait Islander communities and researchers are required to confirm priority issues, design culturally appropriate data collection processes, and achieve a nationally representative sample. Data sources such as those held by primary health care providers and Aboriginal Community Controlled Organisations have an untapped potential to highlight the needs and priorities of Aboriginal and Torres Strait Islander people, should they be used with appropriate consultation and respect for Indigenous data sovereignty.

Furthermore, knowledge gained must inform the national policy gap that exists in the area of holistic reproductive health. A national reproductive health policy and an implementation plan that address unintended pregnancy, decision making and management are urgently needed. These must be developed with due consideration to the needs of Aboriginal and Torres Strait Islander peoples from a strengths‐based paradigm and a decolonising approach that recognises historical reproductive rights violations.5

Data collection within a supportive policy framework will inform service provision, education and health promotion initiatives to improve maternal and infant outcomes and support Aboriginal and Torres Strait Islander women and families in choosing whether and when they have children.