Private Provision, Public Care? Community Based Postnatal Care in Neoliberal Times

As with many other high-income welfare states, maternity care in Australia is available through a system of universal health coverage available to all citizens. However, Australia is distinctive in its parallel private health insurance sector which operates alongside and in competition with the public sector. The private health insurance sector has been heavily subsidised through a range of government policies, many of which have been criticised as costly and inequitable insofar as they favour the most affluent segments of the Australian population and those in metropolitan regions. In addition, concerns about the impact of this stratified system of care on maternal outcomes have been increasing. For example, women birthing in the private sector are at substantially higher risk of instrumental delivery, caesarean birth, induction of labour, episiotomy and epidural analgesia; their stay in hospital following birth is, on average, twice as long as women birthing in public facilities (Australian Institute for Health and Welfare, 2011).  What do these differences mean for how women experience post-birth care following discharge from hospital? In this paper, we report on analyses from two Queensland studies of women’s experiences of care in the community following childbirth, with a particular focus on the impact of public and private care provision. We report findings from a Queensland survey of new mothers (N= 6,433) in terms of their experiences of care in the community, and their confidence and satisfaction with their health care. In addition, we report the findings of qualitative interviews with 70 new mothers and 49 health care professionals providing post-birth care in public and private health care sectors in Queensland. Together, these analyses demonstrate inequities in health care provision resulting from the current stratification between public and private systems of maternity care.