Written By
Rachelle McCabe
College/Division
College of Healthcare Sciences
Publish Date
3 November 2022
Related Study Areas
Bush tucker proves nourishing for pregnant First Nations mums
‘You are what you eat’. It's an often-used catchcry aimed at encouraging healthy eating. But what if you're eating for two or more? And what if you're a First Nations pregnant woman living on country?
The nutritional habits of pregnant Indigenous women are being examined by JCU Researcher Dr Janelle James-McAlpine as part of a broader body of work.
The clinically trained midwife has teamed with Cairns’ Aboriginal controlled health organisation Mookai Rosie Bi-Bayan to carry out part of her research. The facility provides accommodation and health care for Aboriginal and Torres Strait Islander women from Cape York and the Torres Strait.
“We are looking at the diet and determinants for First Nations women from these areas. We are documenting what these pregnant women are eating both on country and when they are based in Cairns for medical reasons,” Dr James-McAlpine says.
Dr James-McAlpine says the research is about ascertaining if First Nations women are meeting their nutritional requirements during pregnancy, and if not, giving them access to information and support to ensure their needs are met.
The dietary data is collected using an online nutrition screening tool developed by Dr James-McAlpine. Mookai Rosie staff interview participants using the online tool, allowing them to compare how the women eat in their remote homes and how their diets change when they are relocated to Cairns for compulsory pre- and post-natal care.
And some of the results have proven surprising, Dr James-McAlpine says.
Traditional sourcing proving safe for pregnant women
“Using the online screening tool, we identify any issues and what the determinants of their nutrition related choices are. We can then identify risks for conditions like anaemia, we can assist in managing diabetes, and with unborn babies who are identified as being small we can encourage mums to incorporate the kind of dietary support that would help them grow their babies,” Dr James-McAlpine says.
Dr James-McAlpine says her research is also about establishing what drives dietary choices and identifying areas that need improvement.
“We are finding out how First Nations women manage their own nutrition in their communities and looking at how we can support that in an ongoing way.
“Many of the women are telling us up to 40 per cent of their protein is coming from wild harvested sources, so bush tucker, and by doing that they are managing some of the food security issues that come with remoteness in far North Queensland and managing the environment as well.
“They are not reporting any problems accessing the kinds of foods they traditionally source themselves. So that provides an overview of the place of traditional foods in the diet.”
Dr James-McAlpine says although her research focused solely on pregnant women, the data collected has given insight into the resource management of Indigenous people living in remote parts of Cape York and the Torres Strait.
“One of the things that is coming out of this is how important environmental sustainability is for the diet of Aboriginal people,” she says.
The research has found nutrition declined when First Nation’s women travelled to the city. Dr James-McAlpine says such factors in nutrition decline include a tendency to rely on processed and takeaway foods and skipping meals while awaiting treatment.
The downsides of relocating for birthing
First Nations pregnant women living on country are required to relocate to Cairns, Weipa, or to the health facility on Torres Strait Island in the third trimester. This national policy exists to ensure pregnant women have access to emergency health care and specialists should they be required. But Dr James-McAlpine says the policy has downsides.
“It is safer in terms of emergency care but there are also a lot of things that aren't safer for these women, such as diet, their cultural connections, connection to country and family support. Psychosocial and emotional well-being aren’t as good when these women are away from home,” she says.
Strategies afoot to improve outcomes
Dr James-McAlpine says the health challenges facing rural and remote Indigenous communities have been well documented. For pregnant women, a major challenge is access to folate supplementation prior to and in the early stages of pregnancy. Folic acid supplementation is recommended before conception and in the early stages of pregnancy to help prevent serious birth defects.
“In the Aboriginal population, women are less likely to engage with pregnancy planning and attend early antenatal care and as such, miss out on vital information and access to folate supplementation,” she says.
“These pregnancy challenges in remote communities are known and each community share a common set of challenges. However, what we are finding about early postnatal nutrition especially is new and unexpected, and I haven’t seen anything about it before.”
Ideas are being explored to improve the diets of First Nations and Torres Strait women whilst they lodge in Cairns during the pre and postnatal period. These include a “Meals on Wheels” food delivery service.
Dr James-McAlpine’s research is also making way for research in other areas of health services, as her screening tool and the findings of her research can be applied across the health sector.
A different approach to Indigenous research
Dr James-McAlpine is one of many researchers pioneering a move away from traditional Western research with Indigenous people. New methods embody a collaborative approach with Western research and traditional knowledge working together.
“It's most appropriate if Indigenous people lead research with their own people and their own priorities, with their own goals and endpoints in mind, using traditional research methods,” she says.
“That being said, there is a big gap in the First Nation's workforce around research partially because it has been a dirty word. Indigenous people have been the subject of too much research, they've been experimented on, people have taken their data and their samples and nothing ever gets back to them.
“Our approach is to work together. We find out what's important to First Nations communities, health workers and researchers, what they want to achieve, and ensure that it's sustainable for them and that they learn the processes and how to merge their methods.
“It's not just the participant getting the feedback. It's the health worker that's getting the confidence to have these yarns around nutrition, it’s a very primary health approach,” she says.
The proof is in the pudding at Mookai, where women are being exposed to research in a culturally safe environment. The research is conducted by their peers and women have choice over their participation.