Maternal and early childhood health and development

When children are connected to community and family they do much better, the evidence suggests.

- Professor Muriel Bamblett, Victorian Aboriginal Child Care Agency


National data suggests that the gap in infant survival and health is closing and that Aboriginal kindergarten participation rates are nearing parity with other Victorian children. Gains are evident in perinatal and infant health, and large strides have been achieved across early childhood and kindergarten participation in Victoria, but we still have some way to go to supporting families.

Delivering enhanced maternal and early childhood services means removing system barriers, promoting genuine and effective partnerships and supporting Aboriginal families to access culturally safe services. Research has shown that the first five years of a child's life are fundamental to shaping a child’s future. Ongoing investment in community-led responses to optimise maternal health and the development of Aboriginal children is an essential platform for self-determination; ensuring that all children have an equal chance to thrive and grow.

Headline Indicator 1. Improve Aboriginal infant survival and health

Target: Close the gap in the perinatal mortality rate by 2023.

Since 2007–09, the gap in perinatal mortality has been cut by two-thirds.

Perinatal mortality is 1.4 times higher for babies born to Aboriginal mothers compared to non-Aboriginal mothers; however, this gap is closing. While rates can vary significantly from year to year due to the small numbers, recent data shows a decrease in perinatal mortality rates, with a rate of 13.6 per 1,000 babies born to Aboriginal mothers in 2013–15, a decrease from 21.2 per 1,000 in 2007­–09.

Perinatal mortality rates per 1,000 births

Target: Close the gap between Aboriginal and non-Aboriginal babies with a birth weight below 2,500 grams by 2023.

Since 2007–­08, the gap in low birth weight has been cut by half.

Proportionately, low birth weight affects babies born to Aboriginal mothers at more than 1.5 times the rate for babies born to non-Aboriginal mothers. However, the gap is closing. Since 2007–­08, the gap has closed by half from 8.2% to 3.8% in 2014­–15. The health risks of low birth weight in babies are well established and include a greater risk of dying during an infant’s first year of life, poorer health in childhood and the development of chronic disease as adults.

Babies with birth weight below 2,500 grams

Other measure: The rate of reported smoking in pregnancy by mothers of Aboriginal babies.

Rates of smoking during pregnancy are resistant to change; rates of smoking during pregnancy are almost 5 times the rate of non-Aboriginal mothers.

38% of Aboriginal women smoke during the first half of pregnancy—almost 5 times the rate of non-Aboriginal mothers. By the end of pregnancy, 30% of Aboriginal mothers still smoke. The Australian Institute of Health and Welfare estimates that in 2009­–11, 51% of low birth weight births to Aboriginal mothers were attributable to smoking, compared with 19% for other Australian mothers. Smoking is one of the key determinants of poorer perinatal health for Aboriginal women and infants.

Smoking during second half of pregnancy

Other measure: The proportion of Aboriginal children attending Maternal and Child Health Services at key age milestones.

Higher rates of perinatal mortality and low birth weight reflect social factors such as education, nutrition, smoking, alcohol use in pregnancy and socioeconomic disadvantage that disproportionately affect Aboriginal mothers. Early access to care through community-led programs such as Koori Maternity Services (KMS) is associated with better identification and management of maternal and foetal risk factors and reduced preterm births and low birth weights.

The role of KMS in providing flexible, holistic and culturally safe antenatal and postnatal care is critical to improving outcomes and increasing participation in maternity care for Aboriginal women, babies and families. In 2015­–16, approximately 75% of women or babies who identified as Aboriginal received antenatal care through KMS, with almost 50% of women accessing KMS at less than 13 weeks gestation.

KMS delivers culturally appropriate care for Aboriginal women or women having Aboriginal babies, and their families, in 14 sites across Victoria, including 3 in public hospitals. KMS outcomes include:

  • more Aboriginal women accessing antenatal care earlier in their pregnancy
  • fewer Aboriginal women smoking during pregnancy
  • fewer Aboriginal babies born premature
  • fewer Aboriginal babies dying during pregnancy or soon after, with a consistent and significant decline in the mortality rate for babies of Aboriginal mothers

Policy directions

The circumstances into which we are born can influence our lives right through to adulthood. Research shows that children born into a challenging family environment often have poorer health and education outcomes, which in turn can negatively impact adult life. Conversely, improving a child’s social environment can reduce entrenched inequalities. In response, Victoria is trialling new culturally responsive models across the state to improve access to Maternal and Child Health Services for Aboriginal families. Community-led efforts are vital to ensuring families and caregivers are supported during the early years of a child’s life.

Cradle to Kinder

Cradle to Kinder is a targeted antenatal and postnatal support service that provides intensive and long-term parenting support to vulnerable mothers. The target groups for the Aboriginal Cradle to Kinder program are young pregnant Aboriginal women or women under 25 who are pregnant with an Aboriginal child. The program provides support to families from before birth until the child reaches the age of four and targets younger mothers and parents, providing an opportunity to break the intergenerational cycle of disadvantage.

Mallee District Aboriginal Service early years services

Mallee District Aboriginal Service (MDAS) provides specialist services to support local mothers and families through early parenthood. The development of the early years program was based on an identified gap between health and education and learnings from other MDAS programs. This included a strong understanding of local community needs and circumstances, including an understanding of the effects of attachment and trauma. The program has been working alongside families to set their own Headline Indicators and has seen success, particularly among high-risk cohorts, in areas such as immunisation, regular attendance at check-ups, and home safety.


Headline Indicator 2. Increase Aboriginal kindergarten participation

Target: The gap between Aboriginal and non-Aboriginal 4-year-old children having access to a high-quality kindergarten program will be closed by 2014.

Since 2008, the gap in kindergarten participation has been cut by 80%. Aboriginal kindergarten participation is approaching parity with other Victorian children.

The number of Aboriginal children enrolled in 4-year-old kindergarten continues to grow. In 2016, 1,211 Aboriginal children (90.5%) were enrolled, up from 525 children (62%) in 2008. The Victoria-wide kindergarten participation rate is 96.2%, putting Aboriginal kindergarten participation at near parity with other Victorian children.

Kindergarten enrolment

I sent my children to kinder because I wanted them to be ready for school. Kinder made them smart, proud, strong and resilient. Now they're sending their children too.

- Aunty Esme, President, Aborigines Advancement League

Policy directions

The gains in kindergarten participation have been made, and are made, through community-led early childhood programs and through creating inclusive spaces for Aboriginal children and families in mainstream programs. In the mainstream, Koorie Education Workforce and Koorie Preschool Assistants work with kindergarten providers and schools to enhance the access, inclusion, participation and attendance of Aboriginal children in kindergarten programs, as well as provide information and support to Aboriginal families and communities to support their engagement in their children’s learning.

The Education State Early Childhood Reform Plan outlines the Victorian Government’s vision for early childhood to create a higher quality, more equitable and inclusive early childhood system. Under this plan, the government will work closely with local government, the early childhood services sector and the Aboriginal community to support higher quality services and reduce disadvantage in early education; provide more support for parenting; and make early childhood services more accessible and inclusive.

Best Start is a prevention and early intervention initiative to improve the health, development, learning and wellbeing of all Victorian children from conception through to transition to school (usually 0 to 8 years old). It aims to strengthen the capacity of parents, families, communities and early years services to better provide for the needs of children and their families. There are 30 Best Start sites, 6 of which are Aboriginal Best Start sites. Aboriginal Best Start is community-led and ensures local Aboriginal communities and organisations have every possible opportunity to influence outcomes for their children and families. These projects are designed to empower communities and families and develop broad cross-sectoral partnerships across all early years services.


It is important to highlight work targeting 'mainstream' kinder and early childhood services to create culturally safe places for Aboriginal families and children. Targeting inclusion is important particularly in a Victorian context because of the low concentration of Aboriginal children across kinder and early childhood centres

- Victorian Aboriginal Education Association Incorporated.

Koorie Education Workforce works with kindergarten providers and schools to develop strategies to support improved outcomes for Aboriginal learners, build local partnerships with Aboriginal communities and engage with parents and families. This includes cultural inclusion initiatives and strengthening community partnerships.


Headline Indicator 3. Reduce the rate of Aboriginal child protection substantiations

Target: By 2023, reduce the gap in the rate of Aboriginal and non-Aboriginal child protection substantiations by 75%.

… past government policies have impacted on Aboriginal children, their families and community … we saw generations of connection with the criminal justice and child protection systems … and the over-riding impact of the past impacting on the present.

- Andrew Jackomos, PSM Commissioner for Aboriginal Children and Young People on the findings of the Taskforce 1000 review

Aboriginal children and young people are vastly over-represented in child protection substantiations and out-of-home care.

From 2007­–08 to 2015­–16, the number of child protection substantiations more than doubled from 681 children to 1,708, widening the gap. The number and rate of substantiated child protection notifications also increased for non-Aboriginal children during the same period. Increases in child protection notification are placing enormous burden on services to respond and leading to significant increases in the number and rate of children in out-of-home-care .

While Aboriginal children represent less than 2% of the Victorian population under 18 years of age, they comprise nearly 20% of the children and young people in out-of-home care. In Victoria, 1-in-12 Aboriginal children are in out-of-home care compared to 1-in-200 non-Aboriginal children. Between 2014 and 2016, the rate of Aboriginal children in out-of-home care in Victoria increased from 71.5 to 87.4 per 1,000 children, an increase of 22%—the largest increase of all Australian jurisdictions during that time.

Family violence is a major driver of demand for child protection services in Victoria. Taskforce 1000 findings, which were drawn from a review of the circumstances of 980 Aboriginal children and young people in the out-of-home care system, documented that over 80% of Aboriginal children and young people had experienced family violence. Evidence of the link between Aboriginal women and children’s experiences of family violence and a disproportionate rate of contact with the child protection system is undeniable.

Champion’s Strategy is a localised initiative designed to enhance the cultural competency of the child protection workforce across the service’s East Division. Culturally sensitive and dedicated practitioners receive specialised coaching and mentoring and are assisted to develop strong relationships with local Elders, Aboriginal communities and organisations. These ‘champions’ provide peer support and develop a community of culturally appropriate practice focused on improving the outcomes for Aboriginal children and their families involved with child protection, as well as enhance the cultural safety of the Victorian Child Protection Service.


Children in out-of-home-care per 1,000

Policy directions

The number of Aboriginal children and young people in out-of-home care has continued to grow since 2014, the year Taskforce 1000 commenced. Many of the children are witness to intergenerational family violence and have histories of intergenerational child removal.

Victoria is proud to have championed the broad, overarching right of self-determination that underpins approaches to supporting vulnerable families, children and young people, but it is clear that more needs to be done.

The recent systemic inquiries into the child protection system—Always was always will be Koori children and In the child’s best interests—contain 133 recommendations that have, at their core, the principle of self-determination and the belief that Aboriginal organisations are best placed to look after vulnerable Aboriginal children and keep them connected to kin, culture and community.

Many of the recommendations target support for the Aboriginal Child Placement Principle and related cultural connection programs and initiatives within the child protection system.

Implementing these recommendations is further supported by Roadmap for Reform: strong families, safe children which has a specific focus on Aboriginal children, including culturally sensitive support; increasing the number of Aboriginal carers; and supporting Aboriginal self-management regarding decisions on vulnerable Aboriginal children, young people and families.

Roadmap for Reform identifies that more must be done to prevent the need for out-of-home care placements and provide intensive home visiting and structured parental support to maximise opportunities for reunification. This goes hand in hand with culturally sensitive training and enhancing Aboriginal carer recruitment and supports, as well as building the capacity of Aboriginal organisations that wish to assume responsibility for contracted case management of Aboriginal children in out-of-home care.

Section 18 of the Children, Youth and Families Act 2005 enables the Secretary of the Department of Health and Human Services to authorise the principal officer of an Aboriginal agency to undertake functions and powers in relation to a protection order for an Aboriginal child. Through authorisation, an Aboriginal agency will hold parental responsibility for children on protection orders rather than the department. The Victorian Aboriginal Child Care Agency (VACCA) is on track to be fully authorised under Section 18 of the ‘Children, Youth and Families Act’ in October 2017.

Work has also commenced through the Aboriginal Children’s Forum, to build the capacity of Aboriginal organisations that wish to assume responsibility for contracted case management of Aboriginal children in out-of-home care.

Our practice approaches incorporate understandings of the impact of past polices on families today; understanding how intergenerational trauma and racism must be addressed as part of effective responses. We know that providing Aboriginal services for the Aboriginal community is what works.

- Victorian Aboriginal Child Care Agency

VACCA has renamed Section 18 of the Children, Youth and Families Act 2005 ‘Nugel’, a Woi wurrung word meaning ‘belong’. Built on the learnings of a pilot project that concluded in 2015, Nugel will initially be authorised for 35 children and young people from Melbourne’s Northern Metropolitan Region. The evaluation of this pilot showed positive outcomes for all children involved, particularly in relation to cultural connectedness, with several children also returning home. The transfer of responsibility for Aboriginal children to Aboriginal organisations is a key action in progressing self-determination. Addressing the over-representation of Aboriginal children in child protection and out-of-home care can only be achieved through systemic change based on the leadership of the Aboriginal community.