Mapping methodological approaches in perinatal health and wellbeing research involving Aboriginal and Torres Strait Islander women: a scoping review protocol

Abstract

Background

Perinatal health research on, with or by Aboriginal and/or Torres Strait Islander women has grown in recent decades. Research methodologies comprise theoretical frameworks, researcher standpoints and chosen methods, which inform research processes and outcomes. For maximum research benefit and impact for Aboriginal and Torres Strait Islander communities, methodologies should be culturally authentic and rigorous. This paper aims to examine research methodologies used to inform the body of evidence regarding perinatal health and/or well-being for Aboriginal and Torres Strait Islander women in Australia.

Methods and analysis

This protocol follows a process as described by Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (the PRISMA-ScR). A team approach will be used throughout the review process. A preliminary search of databases for peer-reviewed research articles was undertaken on 10 February 2026, from inception up until this date, and included PubMed, CINAHL (EBSCOhost), Informit Indigenous Collection (Informit) and Scopus. Independent double screening will occur, where title and abstract screening will locate Australian research articles focusing on Aboriginal/Torres Strait Islander women during the perinatal period (up to 1 year post birth), with no date limit. Data extraction will be guided by the Population/Concept/Context (PCC) framework and use a standardised data extraction form. Multi-method analysis will include descriptive data, tables and/or visual graphs and qualitative content analysis.

Ethics and dissemination

A research ethics application was not required for this scoping review. The voices of Aboriginal and Torres Strait Islander women should inform and be embedded throughout the design, delivery and evaluation of maternity services aiming to serve Aboriginal and Torres Strait Islander women. It is anticipated that findings from this scoping review will be disseminated publicly at conferences and with community research partners, to support the development and adoption of research approaches that are ethical, culturally grounded and meaningfully aligned with Aboriginal and Torres Strait Islander community priorities.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• In response to voices of Aboriginal and Torres Strait Islander People, this review was conceptualised based on feedback from the Aboriginal and Torres Strait Islander academic community.

• The review is limited to Australian published research studies and may therefore exclude transferable insights from other Indigenous contexts.

• The focus of our search terms is limited to women only, potentially framing our findings within colonial gender binaries.

• Our search terms are English only, potentially excluding articles written in Torres Strait Islander or Aboriginal languages.

• This scoping review only includes peer-reviewed publications in journal articles, excluding methodologies that may be used in grey literature.

Introduction

Globally, Indigenous (‘Indigenous’ will be used when collectively referring to First Peoples across international contexts, and ‘Aboriginal and/or Torres Strait Islander’ refers specifically to the First Peoples of Australia) women and babies experience disproportionate maternal and child health inequities that are rooted in the enduring systemic structural inequities of colonisation. These inequities reflect deliberate marginalisation of Indigenous knowledges, governance and cultural authority, rather than a deficit within Indigenous peoples themselves.^{1 2} Highlighting the inherent strengths and resilience of Indigenous communities, evidence supports that when Indigenous-led care, cultural continuity and self-determination are embedded within maternal and infant health systems, outcomes improve.^3–5 For Aboriginal and Torres Strait Islander peoples across the lands now commonly referred to as ‘Australia’, statistical inequities shown in government data outcome reports must be contextualised to a structural environment whereby access to culturally safe and community-driven programmes is problematic.^{6 7} The need to address this is recognised in Australian maternity policy,^8–10 and despite successive policies that are principled on accessible, culturally safe care for Aboriginal and Torres Strait Islander women^{8 11} progress remains incremental and lacks urgency.^{6 12}

In Australia, delivery of maternity care is largely underpinned by a Euro-Western, biomedical, approach¹ that largely excludes Indigenous ways of knowing and doing and thus has been described as an imposition.¹³ Biomedical approaches promote system conformity during a significant life event with momentous social, cultural and biophysiological implications.¹⁴ In recent decades, Indigenous scholars have critiqued Western medical knowledge hegemony, articulating the harmful impacts on Aboriginal and Torres Strait Islander communities, such as ‘deficit discourse’ that position Indigenous people as the subject and a problem to be fixed,^15–18 influencing health policy and practice that shapes the continual denial of rights to Aboriginal people to self-determine their futures.^{17 19 20} The deficit narrative of Aboriginal women and babies as higher risk of poor outcomes^{1 13} actively prevents progress towards self-determination for communities who desire improved outcomes through community-led, culturally grounded, accessible, maternity and birthing services (ie, Birthing on Country models of care).²¹

Health and well-being research for Indigenous women should be underpinned by Indigenous methodologies.^{15 22 23} Indigenous methodologies have been defined as a ‘vigorous and active field of knowledge production involving Indigenous peoples…applying their own lenses, perspectives and understandings to social research and methodologies’ (24, p.2). Indigenous ways of knowing (epistemology) are ecological, observational, relational and informed by Indigenous ways of being (ontology) that recognise the meta-physical connections between human and more-than-human entities.^24–26 In contrast, Western positivist epistemology ‘reasons’ through measurement of what can be detected by the human senses,^{27 28} and ‘rigour’ is strengthened through disconnection between the researcher and the research.²⁹ Western interpretive paradigms that reject a positivist worldview (ie, feminism or ethnography) still do not necessarily account for power imbalances rooted in a dynamic of researcher as ‘educated knower’ and colonised insider as ‘subject’.^{30 31} Decolonising research approaches offer researchers seeking social justice a framework for addressing such power imbalances through prioritising Indigenous values and worldviews.³²

The inception of this scoping review was informed by a previous literature search undertaken by author RM during her doctoral studies,³³ that privileged the experiences of Indigenous women with their maternity care. The search found that the experiences of Indigenous women are commonly interpreted and re-presented by non-Indigenous researchers who adopt Western methodologies. The literature often did not name a theoretical research framework, and critical self-awareness through ‘reflexivity’³⁴ was not always discussed. This raised questions regarding the epistemological basis of the current body of evidence, how it shapes outcomes for Aboriginal and Torres Strait Islander communities and to what degree important issues of Indigenous women’s rights to self-determination and sovereignty are addressed. When lead author, RM, presented this publicly at an Aboriginal and Torres Strait Islander-led health research conference in June 2025, members of the Aboriginal and Torres Strait Islander health and academic community commented on the need for further work in this area.

In recent years, scoping reviews of evidence regarding Indigenous women and their maternity care have been undertaken focusing primarily on the outcomes or research findings,^35–38 rather than on the methodologies used to produce the evidence. One scoping review has explored theoretical frameworks used in research on, with, or by Indigenous women in North America,¹⁵ that reported quantitative, positivist approaches have been commonly used, while approaches of the social sciences, such as critical theory or Indigenous feminism are not as prominent. To our knowledge, no scoping review has shifted the attention to the methodologies used in the field of perinatal health and well-being research focusing on Aboriginal and Torres Strait Islander women in Australia.

This scoping review will map the methodologies (Indigenous or otherwise) used by researchers who publish studies relating to the health and well-being for Aboriginal and Torres Strait Islander women during the perinatal period. We define ‘methodology’ as being comprised of the standpoint of the researcher, the chosen theoretical framework (as an argument for why the research is important) and the methods used (Morten-Robinson, as cited in McCalman).³³ As has been done in a similar scoping review examining theoretical frameworks in research on Indigenous women and their health in North America,¹⁵ we aim to map some of the key methodological characteristics which underpin research in this area. A scoping review methodology is most appropriate to provide an overview of the methodologies informing the studies that underpin the current body of evidence of this field.³⁹ We will examine how research is conducted and identify key characteristics or factors and trajectories of the available health and well-being research relating to Aboriginal and Torres Strait Islander women during the perinatal period.³⁹

Methods and analysis

Positionalities of the research team

The positionality of the researchers is an important declaration and so we address this in detail, with a focus on relationality as fundamental to Indigenous epistemologies.²⁹ Authors RM, SMK, AB, IG and YR are a group of academic learners at the Molly Wardaguga Institute for First Nations Birth Rights, Charles Darwin University, working in a transdisciplinary team across Australia which includes researchers in the field of First Nations methodology and knowledge holders, intercultural communication, midwifery, doulas, decolonised participatory action research, translational research and includes the lived experience of our First Nations staff. First author RM is a Noongar woman with Celtic heritage, a Western university-trained midwife with research subject knowledge of First Nations women’s experiences of their maternity care, and a strong research interest in decolonising maternity care and research practices. RM invited second author SMK to work closely with her on this research, because of a longstanding trusting relationship that predates their more recent positions as research colleagues. SMK is a second-generation migrant Chinese Malaysian woman born in Naarm, on Wurundjeri Country, a midwife and a researcher with interest in maternal equitable modes of care which includes community-based doulas. SMK works alongside Yolŋu senior researchers in Galiwin’ku.⁴⁰ Senior author YR is a Njikena Jawuru woman, grandmother and scholar, who has provided mentorship to first author RM and leadership and direction to all authors in her position as the director of the Molly Institute. IG is an African migrant living and working in Australia, a midwife and health services researcher with an interest in midwifery and strengthening culturally responsive care in Australia. AB is a woman of Scottish heritage and a UK migrant who has worked in research for two decades, including as a senior researcher supporting research with Aboriginal families. The Molly Institute values which inform our work include Truth Telling, Justice, Custodianship, Trusting Relationships and Accountability and our chosen methodologies focus on redesign of healthcare systems, investment in culturally appropriate community workforce, privileging First Nations knowledge and governance, and recognising self-determination. We take the view that the birthing experience of Aboriginal and Torres Strait Islander women is fundamentally and culturally distinct from non-Indigenous women, and that ‘Aboriginality’ is not inherently a risk factor for ill-health, while living in the social and political landscape of the current colonial structure poses risks to the health of Aboriginal peoples.

Protocol design

This protocol has been informed by the JBI methodological guidance for scoping reviews,⁴¹ and a six-step scoping review process as outlined by Arksey and O’Malley.⁴² We will also report on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (the PRISMA-ScR).⁴³

Stage 1: identifying the research question

This scoping review aims to answer the following questions:

1. What methodologies are used in the production of evidence regarding health or well-being for Aboriginal and Torres Strait Islander women during the perinatal period?

2. What are the key characteristics or factors relating to the methodologies used in health and well-being research focusing on Aboriginal and Torres Strait Islander women during the perinatal period?

The population of interest is Aboriginal and/or Torres Strait Islander women and concept is health, well-being or medical research and the context is during the perinatal period. We consider methodology to be comprised of the standpoint of the researcher, the chosen theoretical frameworks and research methods used. These components of a methodology shape epistemological, ontological and axiological orientations, which influence research processes, outcomes and conclusions.^{44 45}

Stage 2: identifying relevant studies—search strategy and information sources

To inform the search strategy the PCC (Population/Concept/Context) framework (table 1) will be used as a recommended framework to identify the main concepts in the primary review questions.⁴⁶

Table 1. Search terms using a Population Concept Context template.

Population (First Nations women in Australia)	Concept (Research about health and well-being)	Context (During the perinatal period)
Indigenous	Health	Perinatal
Aborigin*	Well-being	Pregnan*
‘First Nations’	Experience*	Birth*
‘Torres Strait Islander*’	Outcome*	Postpartum
‘Aboriginal and Torres Strait Islander*’	‘Maternal infant health’	Postnatal
ATSI	Maternal-infant health	Maternity
	Healthcare experience*	Antenatal
	Care experience*	‘Antenatal care’
	Perinatal outcome*	Midwi*
	Satisfaction	Obstetric*
	Evaluat*
View*

Some search terms were truncated with an asterisk

‘ATSI’ is sometimes used an abbreviation for ‘Aboriginal and Torres Strait Islander’

Search strategies based on the search terms (table 1) were developed in collaboration with a university librarian and will be applied to each database (see online supplemental file 1). Key search terms comprise both Medical Subject Headings, keywords, subject headings and free terms. In order to reach medical, nursing, midwifery and multidisciplinary repositories, we will undertake a defined search via the following databases: CINAHL (EBSCOhost), PubMed, Informit Indigenous Collection (Informit), and Scopus.

Table 2 shows the inclusion and exclusion criteria for screening articles. Included articles will be focused primarily on Aboriginal and Torres Strait Islander women. Research articles that include Aboriginal and Torres Strait Islander women but are not focused on Aboriginal and Torres Strait Islander women will not be included. The concept of ‘health or well-being’ includes research articles that report on physical or psychosocial outcomes, such as maternal health outcomes or experiences. The context will be the perinatal period, (ie, during pregnancy, birth, postnatally) up to 1 year post birth (as per a previous scoping review on a similar topic).³⁶ ‘Maternity care’ may refer specifically to formal care from a formal health provider (ie, Registered Midwives, Aboriginal Health Practitioners, Obstetricians or General Practitioners) from a formal health service (ie,. antenatal clinic, Aboriginal Community Controlled Health Organisation (ACCHO) or maternity unit in a hospital) or care from unregulated providers (ie, cultural caretakers, traditional birth attendants or doulas). The search will be limited to Australian studies, and the time limit was from inception of each database up until the date of the search (10 February 2026). Due to our language limitations, non-English publications will be excluded. As the aim of this scoping review is to examine the methodologies used by researchers, only peer-reviewed articles published in academic journals will be included and grey literature will not be included.

Table 2. Inclusion and exclusion criteria.

Inclusion criteria	Exclusion criteria
Published in the English language	Non-English
Primary research articles in peer-reviewed journals	Grey literature and secondary analyses (ie, systematic reviews)
Research conducted in Australia	Research conducted outside of Australia
Research is about ‘health or well-being’ outcomes for Aboriginal and Torres Strait Islander women during the perinatal period	Research not about ‘health or well-being’ outcomes for Aboriginal and Torres Strait Islander women during the perinatal period.

*No time limit applied.

Stage 3: study selection

Complete title and abstract screening will be undertaken independently by first author RM, and then double screening will be shared by authors SMK, AB and IG. Prior to this, the database search results will be imported into Covidence systematic review software⁴⁷ where duplicates will be removed. The following steps will be adhered to:

1. Title and abstract screening based on the inclusion and exclusion criteria (table 2).

2. Full text screening of all studies included by both researchers will be reviewed in Covidence.⁴⁷

3. Manual examination of reference lists of the included articles will be ‘hand searched’ to identify additional literature that was not found in the electronic search.⁴⁸

In the case of inconsistencies, the reviewers (RM, SMK, AB, IG) will meet to discuss the discrepancy. If at this point consensus cannot be reached, reviewer (AB, YR) will review against the inclusion and exclusion criteria and resolve the discordance. An individual study with a suite of publications will be considered as one study.

Stage 4: data collection (data extraction and analysis)

Based on a previous search undertaken by author RM,³³ and a similar scoping review,¹⁵ characteristics of each study will be extracted and summarised using a standardised data extraction sheet. Independent screening will occur, and first reviewer (RM) will extract data which will be reviewed by one of the second reviewers (SK, AB, IG) against the included articles to ensure the accuracy of extraction. Data from full-text articles using an Excel spreadsheet template with variables that include but are not limited to: title, author(s), year, population, study setting (eg, urban, rural), Indigenous methodologies used (Y/N), theoretical framework discussed (Y/N), research design (eg, qualitative, quantitative, mixed-methods), Indigenous senior authorship (Y/N), Indigenous authorship (Y/N), reflexivity discussed (Y/N), overall impressions as to whether the article meets inclusion criteria or not, supported by a rationale. Monthly meetings will be scheduled to review data extraction progress and refine the process if required. Discussion with other reviewers (AB, YR) will take place to resolve extraction disputes that may arise.

Stage 5: data summary and synthesis of results

The aim of a scoping review is not to critically appraise included studies,⁴¹ and so an overview of included studies will be provided, along with key concepts and aspects of interest. Identified records and papers meeting eligibility criteria will be presented using the PRISMA-ScR flowchart.⁴³ Data will be condensed from data extraction tables and reported on using qualitative narrative and quantitative tables and/or visual graphs. We anticipate that the following themes will be identified, categorised and analysed according to authors, positionality, year, country, context, design, study population, methodology, theoretical framework, reflexivity, Indigenous methodologies included.

Stage 6: stakeholder consultation

The Molly Wardaguga Institute for First Nations Birth Rights Executive Leadership team which comprises First Nations-led governance provided institutional approval for this study. This study was deemed beneficial and aligns with the Molly Institute in strengthening First Nations ways of knowing, being and doing within the Australian research context. Members of the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

Discussion

To our knowledge, this scoping review is the first to examine methodologies used in health and well-being research regarding Aboriginal and Torres Strait Islander women during the perinatal period. Our analysis will describe the types and frequency of the lenses that are applied when interpreting and contextualising research on Aboriginal women’s perinatal health. Applying decolonising frameworks in Indigenous women’s health research is useful to prioritise Indigenous values and worldviews and facilitate autonomy while enhancing community well-being.³² While Western research methods may be useful in facilitating health and well-being research for Aboriginal and Torres Strait Islander communities,^{23 25 49} using Western research methodologies alone is recognised as methodologically inadequate and potentially harmful.^{26 45} It is therefore crucial to examine which methodologies underpin the current body of evidence in relation to Aboriginal and Torres Strait Islander women during the perinatal period. The results of this scoping review will map out the current field of research in Indigenous women’s health research in Australia.

Ethics and dissemination

A research ethics application was not required, as the data are publicly available via peer-reviewed publications. The findings of this scoping review will be written into a manuscript for publication, presented at conferences and shared with community research partners of the Molly Wardaguga Institute for First Nations Birth Rights.

Data availability statement

No data are available.