Forty Years in the Making: Reporting on the Co-Creation of a National Roadmap for Birthing on Country Services for the Best Start to Life

For over 40 years, First Nations communities in Australia have called for community-controlled birthing and maternal–infant health programs that restore First Nations-led, community-controlled birthing systems grounded in cultural authority and sovereignty. ‘Birthing on Country’ services have demonstrated improved First Nations maternal–infant health outcomes, more babies kept out of the child protection system, and reduced health system costs. Restoration and expansion of Birthing on Country services across regions has been inconsistent, and has lacked support for national implementation. In 2022, a large national gathering (‘Best Start to Life’) was co-hosted in Mparntwe (Alice Springs). The focus was Birthing on Country service implementation to address inequities in birthing service provision for First Nations communities. A deliverable of this gathering was the National Roadmap for Birthing on Country Services 2026–2036 (the Roadmap). The co-creation of the Roadmap maintained enhanced engagement from a range of stakeholders, to produce inclusive and democratic solutions to perpetual perinatal inequities in health. A two-phased process facilitated national co-creation where national priorities in the reclamation of First Nations Birth Rights were upheld. The Roadmap builds on an evidence-informed and First Nations knowledge-grounded framework, the RISE Implementation Framework. The formation of the Roadmap contrasts against traditional policy creation, transitioning from an evidence-based proposal to a First Nations-endorsed national framework, ready for implementation and government adoption. This novel, national strategic approach to upscale Birthing on Country services has received formal endorsement nationally. The Roadmap provides detailed strategies to address structural reform, and its foundational co-creation process demonstrates that to change practice, researchers must do more than publish evidence in journals for policy change and knowledge translation. The 10-year key deliverables in the Roadmap are a call to action to recognise Birthing on Country as an inherent sovereign right grounded in First Nations Law and governance.