Racism in maternity care as a determinant of First Nations women's health: a qualitative study with First Nations women and families in the Australian Capital Territory

First Nations women in Australia continue to experience disproportionately adverse maternal and infant outcomes. The ongoing legacy of colonisation and systemic racism shapes these outcomes. In the Australian Capital Territory (ACT), maternity services remain dominated by Western biomedical approaches that fail to deliver culturally safe and anti-racist care despite national standards that mandate such practices. This qualitative study was conducted using the Indigenous Research Method Kapati Time Yarning, a method that privileges relational storytelling and First Nations knowledge systems. Between October 2024 and March 2025, fourteen First Nations women, partners, and family members shared their experiences of maternity care in the ACT. Reflexive thematic analysis by Aboriginal researchers revealed racism as pervasive and multifaceted, encompassing normalised mistreatment, stereotyping, silencing, disempowerment, and at times overt abuse and denial of care. Fear of child removal was a recurring theme, contributing to mistrust, service avoidance, and perpetuation of intergenerational trauma. This is the first study to document First Nations women’s and families’ maternity care experiences in the ACT, exposing racism in all its forms as a significant cause of harm. The findings highlight the need for urgent system-wide reform, including investment in First Nations-led, restorative, anti-racist, and trauma-informed models of maternity care that not only repair harm but anticipate and prevent it. • Racism was experienced as normalised mistreatment, stereotyping and abuse. • Fear of child removal perpetuated cycles of harm, trauma, and mistrust. • Kapati Time yarning valued First Nations voices in storying maternity experiences. • Restorative, First Nations-led maternity care can anticipate and prevent harm.