Identifying better systems design in Australian maternity care: a Boundary Critique analysis

Roslyn Donnellan-Fernandez, Lareen Newman, Kerreen Reiger, Sally Tracy

    Research output: Contribution to journalArticlepeer-review

    2 Citations (Scopus)


    This paper examines the background and limitations of maternity care policy and provision in Australia using the Boundary Critique (BC) method from critical systems thinking. We argue that the historical legacy of funding maternity care within medically dominated fee-for-service structures and acute hospital budgets is seriously flawed. Furthermore, it cannot deliver the policy goals of healthy and socially equitable birth practices. Despite the 2009 national Maternity Services Review (MSR) and progress of a National Maternity Services Plan (2011), most mainstream Australian maternity services remain out-of-step with both health service research and evidence-based ‘best practice’. The present system drives unnecessary clinical interventions, increased expenditure, short-term adverse health outcomes and the potential for a larger, unacknowledged legacy of future chronic disease. By contrast, BC analysis suggests that redesigning for good maternity service provision can act as a population-level preventative health strategy, offering better value, better health and improved equity in maternity care.

    Original languageEnglish
    Pages (from-to)213-225
    Number of pages13
    JournalHealth Systems
    Issue number3
    Publication statusPublished - 1 Nov 2013


    • Australian maternity services
    • Boundary Critique
    • health equity
    • health policy
    • health system interventions


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