Built with community: how Breathe for Bub is changing asthma care for Aboriginal and Torres Strait Islander women – HMRI

The Breathe for Bub program is implementing a community-led approach to asthma management for pregnant Aboriginal and Torres Strait Islander women to reduce health disparities in maternal and neonatal outcomes. Developed through a partnership involving the Human Molecular Research Institute (HMRI), the initiative focuses on improving asthma control during pregnancy to mitigate risks such as preterm birth and low birth weight.

Asthma management during pregnancy is critical because uncontrolled respiratory distress can limit oxygen delivery to the fetus and increase the likelihood of medical complications for the mother. For Aboriginal and Torres Strait Islander women, systemic barriers to healthcare and a lack of culturally safe services have historically contributed to higher rates of poorly managed asthma compared to non-Indigenous populations.

The Risks of Unmanaged Maternal Asthma

Medical research indicates that women with poorly controlled asthma during pregnancy face an increased risk of pre-eclampsia and gestational hypertension. When asthma is not managed, the resulting hypoxia—a deficiency in the amount of oxygen reaching the tissues—can negatively impact fetal growth and development.

According to public health data, these complications often lead to higher rates of premature delivery and infants born with low birth weights. These early life challenges can create a trajectory of lifelong health issues for the child, emphasizing the need for targeted prenatal respiratory care.

Despite the availability of standard asthma treatments, many Indigenous women report hesitation in using corticosteroid inhalers during pregnancy due to concerns about fetal safety or a lack of clear, culturally relevant guidance from healthcare providers.

A Co-Designed Approach to Care

Breathe for Bub distinguishes itself from traditional clinical interventions by utilizing a co-design model. This process involves Aboriginal and Torres Strait Islander women, community leaders, and healthcare professionals working together to build the program’s framework, ensuring that the care provided is culturally safe and accessible.

The program prioritizes the establishment of trust between patients and the medical system. By integrating community voices into the design, the initiative addresses the psychological and social barriers that often prevent women from seeking or adhering to asthma treatment.

Key components of the Breathe for Bub model include:

• The creation of personalized asthma action plans tailored to the specific needs and living conditions of the mother.
• Education on the correct use of inhalers and spacers to maximize medication efficacy.
• Integration of asthma screenings into routine prenatal check-ups to ensure early detection of symptom exacerbation.
• The use of culturally appropriate communication tools to explain the safety and necessity of asthma medications during pregnancy.

Improving Health Outcomes through Cultural Safety

Cultural safety in healthcare refers to an environment where there is no assault, challenge, or denial of a person’s identity. In the context of Breathe for Bub, this means moving away from a prescriptive medical model and toward a partnership model of care.

By providing care that respects the cultural identity and kinship structures of Aboriginal and Torres Strait Islander women, the program has observed an increase in patient confidence. This confidence manifests as a greater willingness to use preventer medications and a proactive approach to monitoring asthma symptoms.

The focus on community-led care helps dismantle the historical mistrust of institutional medicine, which has often led to the under-diagnosis and under-treatment of chronic conditions in Indigenous communities.

Broader Public Health Implications

The success of Breathe for Bub provides a blueprint for addressing other chronic conditions within Indigenous maternal health. By proving that co-design can improve clinical adherence and health outcomes, the model suggests that other prenatal services—such as those for diabetes or hypertension—could benefit from similar community-integrated frameworks.

Public health experts note that reducing the gap in asthma care is not merely about providing medication, but about addressing the social determinants of health. This includes improving access to clean housing and reducing environmental triggers that exacerbate asthma in rural and remote communities.

While the program has shown positive early results in symptom management and patient engagement, ongoing evaluation is necessary to determine the long-term impact on neonatal health metrics across larger populations of Aboriginal and Torres Strait Islander women.

As the program continues to evolve, the focus remains on empowering women to take control of their respiratory health, ensuring that both mother and baby have the best possible start in life.