Previously published MCN Global Health and Nursing columns have focused on initiatives in developing countries. In a change of focus, this column is about childbearing in Australia, a country in which 92% of the population is white, the birthrate is 12/1,000 population, and the infant mortality rate is 4.57 deaths/1,000 live births (Central Intelligence Agency, 2008). Not only does Australia do an excellent job of educating women about childbearing but also the Australian government has implemented a "baby bonus" incentive for having a child because of their declining birthrate!!

Australia is a country with many policies in place to support the health and well-being of childbearing women and their families. In some cases prenatal care is free, and women can give birth without cost in public hospitals or birthing centers with certified midwives or in private hospitals attended by midwives, family physicians, or obstetricians. The government as a whole has emphasized education about childbearing. For instance, the Australian government has Web sites that highlight the importance of women learning about pregnancy in anticipation of making informed decisions and support women who may be experiencing a perinatal or neonatal crisis, including perinatal loss. "Pregnancy Help Australia" provides support, education, and resources to pregnancy support centers throughout the country. Australia also stands out by providing research-based evidence for childbearing women in each of their districts to empower them with the skills to make appropriate decisions about their healthcare. The three largest obstetrical hospitals in the district of Victoria have generated guidelines for evidence-based healthcare for mothers and infants, which can be viewed at http://www.3centres.com.au/. The Victoria government health information Web site ("Having a baby in Victoria"; http://www.health.vic.gov.au/maternity/index.htm) provides a complete listing of all resources available to women, ranging from preconception planning to social issues such as adoption to health issues such as gestational diabetes to relationships with providers. During pregnancy, women receive a maternal/ child health record that tracks maternal health, immunization status, well-child checkups, and other pediatric visits. The record can be found at http://www.bestart.vic.gov.au. Most interesting, a section of the Australian Web site summarizes research findings, complete with references to recent childbearing studies. This section, titled "What does research/evidence tell us?" provides current evidence on pregnancy and childbirth and educates women about how to evaluate research quality, strength, and relevance.

The effect of this education has been studied, and women experiencing their first pregnancy have described having a sense of control in making childbearing choices based on their new knowledge (Schneider, 2002). One woman on a listserve for Australian childbearing women (http://www.birth.com.au) said "The hospital I've chosen now has very friendly, warm, welcoming midwives and a very experienced doctor. I've informed them of what I would like and they've been very supportive of my choices." Another stated, "The information that is available today is tenfold what it was 20 years ago. I have used the Internet for information regarding the birthing process and seeing what choices other women make. I have options[horizontal ellipsis]to make an informed decision[horizontal ellipsis]My knowledge and support from my partner [gives] me the strength to make it through the entire process."

These Australian initiatives support Millennium Development Goal #3 in empowering women with knowledge. The outcomes include not only empowerment but also enhanced health literacy in women and their families. This goes beyond evidence-based health care to consumer evidence-based decision making!!

References