Djäkamirr: Exploring principles used in piloting the training of First Nations doulas ...

Sarah Ireland, Dorothy Yuŋgirrŋa Bukulatjpi , Evelyn Djotja Bukulatjpi , Rosemary Gundjarraŋbuy , Renee Adair, Yvette Roe, Suzanne Moore, Sue Kildea, Elaine Ḻäwurrpa Maypilama explore and describe the approach and principles used in piloting the training of First Nations doulas in remote, multilingual Northern Australian community settings.

In the vast and remote Northern Territory of Australia, First Nations women and babies face significant challenges in accessing perinatal healthcare services. With limited access to comprehensive reproductive health services and childbirth facilities located in only four regional hospitals, women from remote communities often endure lengthy journeys to give birth, sometimes alone, without the presence of their partners or family members. This practice not only exacerbates existing social, economic, and health inequities but also leads to profound sociocultural disconnection and distress.

In response to this urgent need for reform, a groundbreaking research project called Caring for Mum on Country was initiated. The project aimed to empower First Nations women from the Yolŋu community in Northern Australia to provide continuity of care for women from their own remote communities during pregnancy and childbirth. Central to this project was the introduction of a culturally sensitive and community-led approach to maternity care, involving the training of First Nations women as doulas, or as they are known in the Yolŋu Matha Djambarrpuyŋu language, djäkamirr – meaning 'caretaker'.

The research setting for this project is a remote island community in North East Arnhem Land, where access to maternity care is limited, and preterm birth rates are alarmingly high. Despite strong Yolŋu identity and language within the community, healthcare services often fail to respond to the cultural diversity and linguistic needs of the population. English, the minority language spoken by a small percentage of the community, remains the primary language of communication in most medical settings, further alienating many Yolŋu individuals from accessing skilled employment opportunities.

Over a four-year period, the research team adopted a decolonising participatory action research (D-PAR) approach, prioritizing relational responsiveness and collaboration with the Yolŋu community. The djäkamirr training curriculum was developed based on formative data collected from Yolŋu perspectives and experiences around pregnancy and childbirth. The training sessions were delivered using a developmental approach, with constant feedback and adaptation to meet the needs of the participants.

The Caring for Mum on Country project represents a significant step towards empowering First Nations women to take control of their reproductive health and childbirth experiences. By providing culturally sensitive maternity care led by trained First Nations doulas, the project aims to reduce perinatal inequities and strengthen community-led maternity health services planning. This innovative approach not only acknowledges and values First Nations knowledge and practices but also challenges existing colonial structures within the healthcare system. As the project continues to evolve, it holds promise for improving perinatal outcomes and fostering resilience within First Nations communities across Australia.

READ THE ARTICLE: https://www.sciencedirect.com/science/article/pii/S1871519223003189