Health And Disability Commissioner Remains Concerned By Lack Of Progress To Address Inequities In Maternity Care

The Health and Disability Commissioner Morag McDowell says she is concerned by the continued lack of progress in reducing inequitable outcomes in maternity care as noted in the latest Perinatal and Maternal Mortality Review Committee report released today.

The report, released by Te Tāhū Hauora | Health Quality & Safety Commission, covers the years between 2006-21. It showed unaddressed inequities have resulted in Aotearoa New Zealand’s perinatal death rates remaining static for 15 years.

"I share the frustrations about a continued lack of meaningful action to address disparities in care. It is unacceptable that Māori, Pacific and Indian families, as well as babies born to mothers under the age of 20, and those living in areas of high deprivation continue to experience significantly worse outcomes in the maternity system."

Ms McDowell says the concerns noted in the report mirror the complaints HDC receives about maternity care. "While the number of complaints is small - around 150 a year - the profile of complaints is more serious than is seen for other services and the frequency with which the same issues recur shows a concerning lack of progress over time and a failure to implement multiple recommendations. Fundamental issues remain unaddressed and the outcomes for the family or whānau involved can be tragic and have enduring consequences."

"A common issue seen in complaints to HDC is a failure to appropriately follow clinical guidelines. I agree with the Committee that national guidelines have not always been implemented successfully, and support their recommendation that Health New Zealand must resource these guidelines appropriately. Similarly, a failure to engage people in their care in a culturally safe way is also seen in complaints to my Office and I agree with the committee that further work is required to achieve the outcome of culturally safe care."

Ms McDowell commented that she has been pleased to see Health New Zealand has begun work on developing a new approach to primary maternity care and early years services. "This presents an important opportunity to remove some of the systemic barriers to care and improve equity of outcomes. However, it is also important that focus is placed on improving specialist maternity services, including addressing workforce issues, improving integration between primary and specialist care, and ensuring a whole of maternity system approach is taken to quality improvement."

"I will continue to raise my concerns in this area with Health New Zealand and other relevant agencies and to emphasise the need to prioritise collaborative action to improve outcomes for families and whānau in the maternity care system."

Common issues seen in complaints to HDC about maternity care include;

- Inadequate management and assessment of risk during labour, and in particular inadequate monitoring of the baby’s heart rate

- Poor cultural safety and inequities in care

- Inadequate coordination between primary and secondary care

- Inadequate postnatal monitoring

- Lack of adherence to guidelines

- Geographical disparity in access to and quality of care

- The impact of workforce issues on the standard of care

- Inadequate informed consent processes.

HDC promotes and protects the rights of people using health and disability services as set out in the Code of Health and Disability Services Consumers' Rights (the Code).

Background

Established in 2005, the PMMRC is one of the Commission’s five mortality review committees initially established under the New Zealand Public Health and Disability Act 2000 (the Act), and now sits under the Pae Ora (Healthy Futures) Act 2022.

The PMMRC reports on mortality trends in babies and mothers and serious morbidity from neonatal encephalopathy, in order to reduce these deaths and improve the quality and safety of Aotearoa New Zealand’s health care system

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