April 13, 2019 05:30:22
Ten stillborn babies have been lying in Northern Territory morgues for more than three months, an ABC investigation has found.
- Both the Federal Coalition and the Labor Party have promised millions for a national stillbirth strategy
- A Senate inquiry made a series of recommendations about stillbirth policies last year
- Stillbirth rates are twice as high among Australia’s Indigenous population
Data from the Northern Territory Health Department obtained under Freedom of Information laws has revealed the stillborn infants are currently held at six NT hospital morgues.
However, the department would not disclose the exact length of time each body had been in the morgue nor how many bodies were at each hospital, saying this may lead to a breach of its confidentiality obligations.
The issue has long been documented in the Territory, and last year Katherine Hospital clinical nursing midwife Sara Potter told a Senate committee investigating stillbirth there had been six stillborn Aboriginal babies lying in the Katherine Hospital morgue for four years, although that had recently dropped to three.
The head of Darwin’s Aboriginal-controlled Danila Dilba health service, Olga Havnen, said the issue “absolutely” represented stark cultural gaps in the nation’s health systems.
“There would be multiple and complex reasons as to why that might be occurring,” Ms Havnen said.
“I think in terms of how we deal with this for Aboriginal mothers, that has also got to change and it has got to get better.
The Northern Territory Health Department said it did not consider the bodies had been abandoned and Ms Havnen said more needed to be done to understand the wishes of the bereaved parents involved.
“I don’t wish to be critical of the health system, I think the hospital system generally has tried in the Territory here in more recent years to work much better with Aboriginal patients and to provide much better levels of support to Aboriginal clients,” she said.
“But that’s not perfect, we’re a long way from that.”
The problem is not isolated to the Territory — Pathology Queensland executive director Brett Bricknell said as of last December, the bodies of two stillborn children had been in the Townsville Hospital morgue for more than two years.
Last year, a Senate inquiry provided a series of recommendations designed to prevent stillborn babies being left in morgues.
While the Federal Government has not yet tabled its response to these recommendations, both it and the Labor Opposition have pledged millions to develop a national strategy aimed at reducing stillbirth rates.
Funeral costs, tyranny of distance, lack of cultural support
Ms Havnen said a range of complex factors fed into the problem — from poor health literacy among Aboriginal mothers, to their distance from hospitals, to the high costs of funerals.
Some mothers had to travel more than 600 kilometres to give birth in Katherine and often made the journey alone.
Ms Havnen said many were then unfamiliar with hospital systems and had no idea about how to deal with a stillbirth.
“And I think understanding, I suppose at a deeper level, some of the traditional beliefs and practices of different Aboriginal people and groups [is important],” Ms Havnen said.
“It’s not uniform, it’s not homogenous across the Territory.
“What might be culturally and socially acceptable say in the top end, in terms of how you deal with stillborn babies and any sort of rituals or ceremonies that people might want to have, could be completely different to somebody in an urban context or someone from, say, Central Australia.
“It’s a piece of work that’s got to be done but I think it’s got to be very locally specific, and I think done in a very sensitive and culturally appropriate way.”
Ms Havnen also pointed out there were not enough Aboriginal liaison officers — people who provided cultural and language support to Aboriginal patients — or hospital staff who spoke Aboriginal languages.
The inquiry heard that last year, after an Aboriginal liaison officer and a social worker at the Katherine Hospital worked with the families of stillborn babies left at Katherine morgue, they halved the number of cases from six to three.
But the Katherine Hospital was reported to have only one Aboriginal liaison officer last year, despite dealing with a high number of Aboriginal patients.
And earlier this year the Northern Territory was found to be the only place in Australia where the number of registered Aboriginal health workers was falling, even though Aboriginal people make up one-third of its population.
The NT Health Department was unable to provide figures on how many Aboriginal liaison officers, Aboriginal social workers or midwives it employed at each of its hospitals, citing privacy reasons.
Funeral costs were another barrier, particularly if an air charter was required to return the body home — which Ms Havnen said could add $3,000 or 4,000 to the expense.
“What you are talking about here are Aboriginal people who have the lowest incomes of any population group in the country with the highest cost of living, and just that exercise alone, getting people home for burial, is a terrible burden and stress on families,” she said.
While the Government offers a stillborn baby payment — $2,199.83 for a first stillborn baby and $1,100.55 for others — it was not enough to cover these costs.
A Northern Land Council spokesperson said it provided grants of up to $2,000 to assist with funeral and burial costs and had long been concerned by their high costs in the top end.
Ms Havnen said preventing the problem would require bringing in better procedures for counselling and emotional support following a stillbirth.
She also pointed out that responses to stillbirth among the broader population had evolved only in recent times, with mothers previously not being able to see or hold their stillborn babies.
During the Senate inquiry into stillbirths last year, Katherine midwife Sara Potter said Aboriginal perspectives around stillbirth warranted further investigation, particularly as stillbirth rates were twice as high among Aboriginal mothers.
“As a health professional and from my experience, I’m not sure that we, as care providers, have a comprehensive understanding of what Aboriginal people see as a stillbirth, what their feelings are around stillbirth and, therefore, what their ideas would be around bereavement and care after their babies are born,” she said.
“To have knowledge around that would be invaluable — I don’t think we do at the moment.”
‘People are naturally horrified’
Last year Northern Territory senator Malarndirri McCarthy chaired the Senate committee inquiry which found stillbirth rates in Australia had not changed in the last 20 years and were twice as high among Indigenous people.
“There does need to be a focus [within the health system] on the fact we have over 100 Aboriginal languages,” she said.
“There needs to be a closer concentration of how we interact and communicate in relation to cultural considerations.”
After discovering that stillborn bodies were spending years in morgues, she wrote to each of the state and territory health ministers to warn them about it.
“People are naturally horrified at the idea that babies are in morgues for years and years,” she said.
“But what we’ve tried to do in this report is say ‘we’ve actually done that work, you can actually do something about it’.”
Her committee made a number of recommendations about how the issue could be better addressed by the Federal Government, after noting that state and territory policies about babies held in morgues varied.
“The committee is concerned that there is no nationally consistent approach in public hospitals and community health services as to how they care for stillborn babies held in morgues; how they communicate with the parents of those babies, particularly for parents who may live long distances away from the hospital where their baby was stillborn; and how they assist those parents who may find the cost of a funeral service prohibitive and require advice on other options,” the report stated.
One recommendation was that the Australian Government should bring in culturally and linguistically appropriate protocols for public hospitals and community health services about caring for stillborn babies held in morgues and communicating with bereaved parents.
Another was that the Australian Government bring in a national stillbirth public awareness campaign, similar to the successful SIDS campaign, aimed at demystifying stillbirth, educating parents and encouraging public conversations about stillbirth.
Funding promised from federal Coalition and Labor
The Federal Government has not yet tabled a response to the committee’s stillbirth report, nor set a date for when that would be likely.
- $7.2 million to reduce stillbirths
- $3 million for stillbirth education and awareness programs
- $4.2 million for stillbirth research
- $26 million over four years for a new perinatal mental health and wellbeing program, which will include stillbirth supports
Labor Opposition:$5 million to reduce stillbirth rates if it wins the next election, including:
- $150,000 to develop a national stillbirth strategy
- $1.85 million for an education campaign to encourage pregnant women to fall asleep on their sides
- $1.5 million for research focused on the 50 to 65 per cent of stillbirths with no known cause
- $1.5 million to create a platform and free app for real-time pregnancy monitoring via wearable technologies.
But late last year, the Federal Government announced it would develop a stillbirth plan and both major parties have committed funding to reducing stillbirths.
During the past year, NT Health Minister Natasha Fyles said the Royal Darwin Hospital had piloted new guidelines for working with those affected by stillbirth, which would see a social worker actively manage and make arrangements with the family.
She said similar guidelines would be rolled out across Territory hospitals.
“A stillbirth is an incredibly difficult and sensitive time for families,” Ms Fyles said.
“There is no time limit on grief and some families take a longer time to make a decision about what to do with their child’s body.
“It is no one’s place to judge how long any mother or family may take to reach a decision.”