Reproductive health, infertility and sexually transmitted infections in Indigenous women in a remote community in the Northern Territory

Objective: To investigate markers of reproductive health in a remote Indigenous community in Northern Australia. Methods: A retrospective, cross-sectional analysis of case notes of 342 women between the ages of 20 and 45 years, living in one community in a remote region of the Northern Territory. Results: The total rate of current infertility in the community was 26.3%; 8.2% for primary infertility and 18.1% for secondary infertility. An additional 3.3% of women had resolved infertility. Only 43% of the women had sought medical help for the problem. A history of ectopic pregnancy was recorded in 2.6%, stillbirth in 1.8%. miscarriage in 14.3% and neonatal death in 12.3%. Depot steroidal contraception or tubal ligation were used by 50% of the women but 45.9% used no contraception. A history of pelvic inflammatory disease (PID), T: vaginalis N. gonorrhoeae, genital C. trachomatis infection, syphilis or bacterial vaginosis was noted in 32%, 46%, 27%, 30%, 41% and 9% respectively. Current alcohol consumption was reported in 23% and cigarette smoking in 76%. in multivariate analysis, infertility was strongly associated with PID (adjusted OR 8.5), alcohol consumption (AOR 3.1), T: vaginalis (AOR 2.5), N. gonorrhoeae (AOR 2.2) and bacterial vaginosis (AOR 2.9). Conclusion: Reproductive health is poor In this community of Indigenous women, with endemic levels of STDs, PID and tobacco consumption. The absence of barrier contraception (e.g. condoms, diaphragms) has implications for HIV and STD control. Clinical and public health interventions are urgently required but the implementation of these is hindered by a number of structural, social and economic barriers.