Dr Kiarna Brown (MBBS '06) is a First Nations obstetrician and gynaecologist living and working on Larrakia Country in the Northern Territory. A UWA Medicine graduate, her path from schoolgirl to medical specialist has taken her across much of Australia.
Her journey has taken her from her hometown in Darwin to secondary school in Ballarat, and then to Perth at 19, where she joined the Aboriginal pre-medicine program, before undertaking her medical degree.
"I was an ambitious kid who loved to learn, but I didn't graduate with the grades to study medicine," she said. "I had been out of school for a couple of years and was working in an Aboriginal Health Organisation when I discovered UWA's pre-medicine program for Aboriginal students."
The School of Indigenous Studies became her support network and a home away from home. Moving to Perth to study had left her isolated from her usual support systems, but the academic, social and well-being support she received made all the difference. Without it, Dr Drown said she would have been able to complete her studies.
"I now have the amazing privilege of working as an obstetrician in the place that I grew up in, and sometimes I'm looking after my cousins and my nieces in their pregnancies," she said.
While Dr Brown has an unwavering commitment to 'Closing the Gap' in First Nations health – specifically through the burden of preterm birth rates – alarmingly, First Nations women in the Northern Territory experience some of the highest rates of preterm birth in the world, with rates currently double that of non-Indigenous populations.
Preterm birth is the definition given to babies born alive before 37 weeks of pregnancy are completed. It remains the single greatest cause of childhood death and disability in Australia and, while the recently completed 'Every Week Counts National Preterm Birth Prevention Collaborative' – a three-year Commonwealth-funded program working to reduce early and pre-term births – has seen broad improvements across the country, these positive outcomes have not extended to First Nations women.
Dr Brown points to complex interactions between maternal and perinatal health outcomes and the social determinants of health as key factors influencing the poorer health outcomes First Nations mothers and babies continue to experience.
Her experience is that First Nations women have better birth outcomes when they feel safe and have trusting relationships with their maternity care providers. Taking part in a study that examined 10 years of births at the Royal Darwin Hospital, Dr Brown found the prevalence of many risk factors for preterm and early births were the same among First Nations women, compared to other expectant mothers.
Those risk factors included preterm membrane ruptures, diabetes in pregnancy, blood pressure conditions and having twins. But her research has found First Nations women are more likely to have shorter cervical lengths — an area Dr Brown said needed more study.
"It boils down to people's access to healthcare services," Dr Brown said. "We also need to find ways to engage and educate women — and I'm not saying we should tell women what to do — but actually getting their perspectives on how [health services] can do better."
To achieve this Dr Brown and her team are leading an innovative preterm birth prevention program in the Northern Territory and the hope is that it will provide a roadmap for improved outcomes for all First Nations women and their children. As a first step, the team is hosting a few yarning groups in remote communities, asking practical questions about how health services can do better, if they are aware of this issue of preterm birth, along with hearing about their own experiences with maternity care.
She said ensuring that the non-Indigenous workforce was culturally informed must be a priority, as Western medicine had long ignored how First Nations mothers had traditionally experienced pregnancy.
"When women feel safe and respected, they're going to engage with maternity services more often and they're going to have more meaningful relationships with their healthcare providers," Dr Brown said.
In 2018, Dr Brown was named Top Lead of the Australian Preterm Birth Prevention Alliance — a national partnership of clinical leaders, researchers, health departments working together to safely lower the rate of early birth.
The results of 'The Every Week Counts National Preterm Birth Prevention Collaborative' will be released in late 2024. For more information on the national preterm birth prevention efforts visit: https://pretermalliance.com.au/everyweekcounts
