Health Reforms A Chance To Improve Our Struggling Maternity Sector

The latest report by the Perinatal and Maternal Mortality Committee (the PMMRC), released today, paints a stark picture of the persisting inequities that exist within the maternity and neonatal sectors.

The Fifteenth Annual Report of the Perinatal and Maternal Mortality Review Committee | Te Pūrongo ā-Tau Tekau mā Rima o te Komiti Arotake Mate Pēpi, Mate Whaea Hoki has found there has been no significant reduction in perinatal-related deaths since it started collecting data in 2007.

Also, despite repeated reporting by the PMMRC showing persistent inequities and calls for urgent system change, the health and social systems in Aotearoa New Zealand continue to fail babies of Māori, Pacific and Indian mothers, of mothers aged under 20 years, and those living in areas of high deprivation, all of whom experience worse perinatal outcomes.

The PMMRC reviews deaths of mothers and babies in Aotearoa New Zealand and advises the Health Quality & Safety Commission on how to reduce those deaths. It also reviews cases of neonatal encephalopathy, changes in the brain that can be caused by lack of oxygen in babies during pregnancy or birth.

In its 15th report, the PMMRC highlights previous recommendations from past reports that have not been fully implemented. It recommends four of these be prioritised urgently. These include addressing the impacts of socioeconomic deprivation on perinatal death, providing services that meet the needs of young mothers, providing care that is accessible and appropriate to women with modifiable risk factors, and mandated cultural safety education for the maternity and neonatal workforce.

Mr John Tait, Chair of the PMMRC, says, ‘The recommendations by the PMMRC are informed by data that has real people, real whānau and real suffering behind them. It’s imperative that the system takes advantage of our recent health reforms to implement recommendations that will prevent other whānau and communities having to deal with the heartbreak already being experienced by many in the system.’

Dr Janice Wilson, Chief Executive of the Health Quality & Safety Commission, says, ‘The PMMRC’s recommendations highlight the need to better support the people and organisations working within the maternity sector, address long standing inequities and eliminate preventable harm. The Commission is committed to working with Te Whatu Ora - Health New Zealand and Te Aka Whai Ora | Māori Health Authority at this time of change within the health system to drive and enact these changes.’

The report also acknowledges the progress on several of the PMMRC’s recommendations since the release of its 14th report in 2021, including the mid-2023 introduction of mandatory folate in bread, which is expected to directly result in a reduction of perinatal deaths related to congenital anomalies.

In November 2021, in response to the PMMRC’s recommendations, the Ministry of Health published findings of a stocktake of maternal mental health services provided by district health boards (now Te Whatu Ora). It found that current service delivery is inequitable, with unmet need and gaps in the continuum of care. There is a particular need for the maternal mental health workforce to be expanded and for kaupapa Māori models of care to be provided to improve maternal mental health.

Mr Tait says some investment has occurred, but significantly more is needed. The PMMRC agrees that maternal mental health should be prioritised by Te Whatu Ora and Te Aka Whai Ora as they continue to build the future of health.

Also in November 2021, the Associate Minister of Health Hon Dr Ayesha Verrall announced that work had begun on a bereavement pathway. Further work is needed to expedite and embed a national bereavement pathway to improve access and reduce local inconsistencies in care and services received by parents - particularly for Māori, Pacific peoples and Indian families and whānau and mothers under 20 years old.

Definitions

• A maternal death is the death of a woman while pregnant or within 42 days of the end of pregnancy.
• A perinatal death is the death of a baby from 20 weeks’ gestation (pregnancy) up to 28 days after birth. This includes stillborn babies.
• A neonatal death is the death of a live born baby from 20 weeks’ gestation (pregnancy) up to 28 days after birth.
• An early neonatal death is the death of a live born baby from 20 weeks’ gestation (pregnancy) up to 7 days after birth.
• A late neonatal death is the death of a live born baby from the seventh and the 27th day of life
• A stillbirth is a baby who is born from 20 weeks’ gestation (pregnancy) without any signs of life.

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