Di Sheil, Hunter New England Health

Date project undertaken: June 2004 – November 2004

Gamillaroi Community Midwifery Service, Moree, together with an Arts-Intervention organisation, has successfully targeted and engaged young Aboriginal women - encouraging participation in group activities, enhancing trust in their health providers and working to improve self-confidence and inspire creativity. This has been achieved whilst providing opportunities for health education and care.

Workshops were delivered encouraging the young women to participate in a creative process in which plaster casts were made of their pregnant bellies and the hands of the Midwifery team and P&EC manager. Aboriginal aunt and grandmother elders provided cultural stories relating to family and birthing and with the young women were involved in painting the moulds, connecting health care back into the community.

Ongoing involvement has brought improved participation in the Young Mothers Group, increased comfort with the Health Service and the community art activities have led to the launch of the 'Mubali' (pregnant) project as a local exhibition.

Using Arts-based interventions to increase regular group attendance of young Aboriginal pregnant women (15-21yrs) by 50%, enabling health education and peer support; to encourage breastfeeding initiation by 80% of women; to involve Aboriginal artists from the local community to inspire creative arts participation by group members thereby improving self-esteem.

The NSW Aboriginal Perinatal Health Report (NSW Health, 2002) identified that morbidity and mortality statistics amongst Aboriginal mothers and babies were twice that of non-Aboriginal Australians. Consequently the NSW Maternal & Infant Health Strategy (AMIHS) was initiated with clear guiding principles and performance measures, which the Gamillaroi Community Midwifery team follows. Locally a Young Mothers' Group was initiated to target the at risk pregnant Aboriginal women (15-21yrs), however during the first 12 months, only 3 non-Aboriginal women over 21 years regularly participated. In spite of weekly personal invitations and offers of transport, the target group would not regularly attend.

1. Gamillaroi Community Midwifery Team includes two local Aboriginal Health Workers who provide insight and knowledge into the needs and cultural ways of the local community. Discussions were held as a team to ascertain why the young women were not comfortable attending this non-familial group. Further discussions and brainstorming, as to how to better engage them, included members of the Young Mothers' Group, the local co-ordinator of Schools as Community Centres, the P&EC Manager, and the GCMS Operational Committee, which included Aboriginal community members. The local Aboriginal grandmothers' group was also consulted. Plans were discussed at the Aboriginal Mothers and Babies area meetings.
2. It was decided to approach an Arts co-ordinator who had been involved in successful arts-intervention and who was familiar with working in the Moree community. By engaging an Arts Intervention Organisation, clinicians could work alongside the women to focus on the particular health needs of the individuals within a creative supportive environment. The decision was made to make moulds of the pregnant women’s bellies in order to engage the women, to improve connections with the health staff and increase opportunity for education and support.

1. The Dept Health, through the AMIH Strategy, allocated funds specifically for Community Development (NSW Health, 2003). The Team contacted the Arts Co-ordinator to discuss the possibility of an arts-based intervention to target and engage a high risk group (of young pregnant women) within the Aboriginal Community of Moree.
2. Project objectives and activities were developed in consultation with the Community Midwifery Operational Committee and Moree Young Mothers Group, the Schools as Communities Coordinator and the Arts Co-ordinator.
3. The local Grandmothers support group ('the Granniators') was invited to tell their stories of birth and parenting. A video was made and lots of laughs were had.
4. A series of workshops was held for the making and painting of belly moulds, transport was provided and light refreshments and arts materials were supplied on the campus of Moree Health Service.
5. Government and Non-Government Organisations and individuals within the community were invited to observe the creative process at different stages.
6. A promotional community launch was held in November to display the art work at the Health Service and to celebrate the involvement of the young women, many of whom had since birthed their babies and were receiving postnatal follow-up from the Gamillaroi Community Midwifery service.

Health outcomes

As a result of the arts project, attendance and participation in the group immediately increased, interest has been maintained and new participants are continuing to be attracted to the well functioning group. Attendance of nine teenage pregnant Aboriginal women was achieved on the first day (an increase of over 90%), with continued attendances of 3-9 each week for 12 months. Health education provision has been possible to women who are not easily accessible.

Peer support has taken place. Breastfeeding has been initiated by 100% of new mothers involved in the project, many continuing for 6-12 months, encouraged by peers. Information and experiences have been exchanged between the women, Aboriginal grandmothers and the health workers.

Arts outcomes

3 Local Aboriginal artists (grandmothers and aunts) painted the belly moulds and 5 of the original 9 young women (56%) have been involved in the production of art works. Mouldings and Art works have been produced and the project display 'Mubali' was first launched at the Moree Health Service in November 2004 and displayed in Sydney at the annual AMIHS conference. Participation has involved the young women, aunts, grandmothers, some young fathers, a professional artist, the Midwifery Team and the P&EC Manager.

The Mubali project has been very well received throughout the Moree Aboriginal Community and will provide an ongoing opportunity for engaging future clients, through the expertise, skills and knowledge gained. Through the presentation at the AMIHS Conference other services have adopted the concept of arts intervention within a health setting.

As a result of the successful strategy, a Stage 2 Mubali has been developed which will include a musical CD of lullabies in Gamillaroi language and an educational gestational calendar featuring photographs of local Aboriginal women, aiming to engage our clients in the outlying communities of Boggabilla, Toomelah and Mungindi.

• NSW Department of Health, 2003, The NSW Aboriginal Perinatal Health Report, Sydney, NSW.
• NSW Health, 2003, Funding and Performance Agreement NSW Aboriginal Maternal and Infant Health Strategy, Guiding Principles 2003-2006, Sydney, NSW