Background: Access to midwifery caseload care for socially disadvantaged women has been identified as a public health issue in Australia. Identifying who can access services is critical for effective system change to address social gradient health inequality at start to life.

Current population studies demonstrate significant barriers and challenges to the provision of quality maternity services for Indigenous women; culturally and linguistically diverse women; those living in poverty, and those residing rural and remote. These groups and others also often experience chronic health inequity and co-morbidities across the life course. Poor outcomes are exacerbated by social determinants of health. Parallel to this, population data in Australia show complexity is increasing during pregnancy and childbearing for many women. The issues are multifactorial: rising levels of childhood obesity, pre-existing chronic illness during pregnancy (e.g. diabetes, heart disease, smoking), being pregnant and giving birth at an advanced age, greater use of assisted reproductive technologies, and avoidance/non-engagement with mainstream traditional maternity models which are not meeting many women's cultural expectations for safe care.

While there is compelling Cochrane-level evidence that continuity of midwifery care for pregnant women is associated with improved clinical and cost effectiveness and higher satisfaction with care, access to this model is limited. Identification and mapping of who gets access is therefore critical to reducing maternal and newborn health inequity in Australia.

Aim: To comprehensively analyse the socio-demographic profile of women with complex pregnancy who accessed midwifery caseload continuity model compared with those who accessed standard hospital care in Queensland using routine and population based data to identify differences.

Method: Access to the 360 Dataset (Health Economics Group, James Cook University) will be used to undertake comparative descriptive statistical analysis of socio-demographic characteristics of women who accessed care in different maternity models in Queensland.

Key findings: Reporting of maternal/newborn socio demographics and health status will include use of core national indicators.

Implications for practice and policy: Research on clinical and social outcomes of women with different socio-economic status has national and international implications for equitable access to quality, evidence-based maternity models for disadvantaged groups. The impact of alternative maternity service models on access, equity and outcomes at a population health level is an important objective to deliver value-based health care. Robust analysis of sociodemographic and cultural data, local conditions and population level need is critical to inform decision makers, address health inequity, and implement sustainable systems change.