Background. In Australia, 35% of women giving birth were born overseas (2), and more than 400 languages are spoken nationally (1). Studies demonstrate disparities in perinatal outcomes for migrant women in Australia (3, 4), however most utilise country of birth as a proxy for disadvantage rather than directly measuring language or Medicare-eligibility status. Non-English-speaking and Medicare-ineligible women may face compounding barriers to care.
Methods. A retrospective cohort study was conducted of all singleton births at an Australian tertiary maternity hospital over four years (2021–2025). Women were grouped as A (English-speaking, Medicare-eligible), B (non-English-speaking, Medicare-eligible), C (English-speaking, Medicare-ineligible) or D (non-English speaking and Medicare-ineligible). A pre-specified panel of obstetric and neonatal outcomes was compared using parity and age-adjusted relative risks/odds ratios, with Benjamini–Hochberg correction and a language-Medicare interaction.
Results. Among 27,870 women, those facing both barriers were more likely to deliver small-for-gestational-age (SGA) infants (adjusted RR 1.67, 95% CI 1.25–2.23), with similar findings from language alone (RR 1.39). Large-for-gestational-age birth was correspondingly less frequent, indicating a downward shift in fetal growth. Disadvantaged women also booked substantially later (dual-disadvantage RR 2.55) and had more gestational diabetes (RR 1.80). Labour and birth outcomes were similar in all groups.
Conclusions. Women facing language and Medicare barriers, especially both, were more likely to have SGA infants, later engagement in antenatal care, and develop gestational diabetes, driven mainly by language barriers. Intrapartum care appeared equitable. Impaired fetal growth, language barriers and delayed antenatal access emerge as equity priorities.