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 Indige nous community in Northern Australia. Methods: A retrospective, cross-sectional analysis of case notes of 342 wom en 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 additi onal 3.3% of women had resolved infertility. Only 43% of the women had soug ht medical help for the problem. A history of ectopic pregnancy was recorde d in 2.6%, stillbirth in 1.8%. miscarriage in 14.3% and neonatal death in 1 2.3%. Depot steroidal contraception or tubal ligation were used by 50% of t he women but 45.9% used no contraception. A history of pelvic inflammatory disease (PID), T: vaginalis N. gonorrhoeae, genital C. trachomatis infectio n, syphilis or bacterial vaginosis was noted in 32%, 46%, 27%, 30%, 41% and 9% respectively. Current alcohol consumption was reported in 23% and cigar ette smoking in 76%. in multivariate analysis, infertility was strongly ass ociated with PID (adjusted OR 8.5), alcohol consumption (AOR 3.1), T: vagin alis (AOR 2.5), N. gonorrhoeae (AOR 2.2) and bacterial vaginosis (AOR 2.9). Conclusion: Reproductive health is poor In this community of Indigenous wom en, with endemic levels of STDs, PID and tobacco consumption. The absence o f barrier contraception (e.g. condoms, diaphragms) has implications for HIV and STD control. Clinical and public health interventions are urgently req uired but the implementation of these is hindered by a number of structural , social and economic barriers.