Frustration as inequities continue to impact Aotearoa New Zealand's perinatal death rates

Unaddressed inequities mean Aotearoa New Zealand’s perinatal death rates have remained static for 15 years.

The Sixteenth Report of the Perinatal and Maternal Mortality Review Committee (PMMRC) released today by Te Tāhū Hauora Health Quality & Safety Commission, covers the years 2006–21 and is the first report to examine reported COVID-19 infection in pregnancy in Aotearoa.

PMMRC chair, John Tait, says, 'I want to acknowledge the individuals, families and whānau affected by those represented in this report. The report includes nearly 10,000 lives lost and hundreds of babies diagnosed with moderate or severe neonatal encephalopathy. Our sincere thoughts are with each and every family and whānau grieving the loss of a life or life imagined.'

The report paints a stark picture of virtually unchanged perinatal death rates over a decade and a half due to persistent inequities within the perinatal sector.

Mr Tait said that, over the past 15 years, the PMMRC’s report series had produced a vast volume of data revealing significant inequities in perinatal clinical outcomes relating to demographic and socioeconomic factors, including ethnicity and poverty. 

There was ongoing frustration and exhaustion across the sector from reporting unchanged mortality year rates year in, year out, with significant inequitable ethnic disparities in almost all areas again a feature of the latest report. 

‘Reporting these disparities over a long period of time has not resulted in any meaningful action to address them. National guidelines previously recommended have not always been followed up with clear implementation plans or appropriate resourcing,’ Mr Tait said.

'Asking why we have not made progress and why certain groups have worse outcomes is appropriate after reading this report.’

Mr Tait said he agreed with the report’s statement that, although these were uncomfortable questions to answer, if the report led to the acknowledgement of the issues, a search for solutions, and system changes, then it could be considered successful.

Key clinical findings from the latest report include: 

• no significant decrease between 2007 and 2021 in overall perinatal related mortality rates including deaths during pregnancy and in the first 28 days after birth
• recognition that certain groups continue to have worse clinical outcomes compared with groups with the best clinical outcomes; for example:
  • Māori
  • Pacific peoples
  • Indian populations
  • those aged under 20 years of age
  • those living in areas of high deprivation
• a small, statistically significant trend upwards in neonatal encephalopathy rates
• a significant amount of mortality in the most disadvantaged groups
• wāhine Māori, Pacific women and those living in higher deprivation areas continue to suffer a disproportionate burden of maternal mortality
• those of New Zealand European ethnicity were 67 percent less likely than wāhine Māori to die by suicide – a direct result of maternal mortality in the 2006–21 period.

Mr Tait said the report’s four recommendations should be prioritised urgently. 

At-a-glance report recommendations:

Pre-term birth

Central government to provide adequate funding to support and strengthen current transdisciplinary work being undertaken in pre-term birth. This should be with a view to implementing national targeted initiatives to reduce rates of preterm birth rates and improve care and outcomes for babies born pre-term (including reducing mortality). Focus should be on those most affected including Indian, Pacific and Māori communities, and those living in areas of high deprivation.

National guidelines

Health New Zealand – Te Whātu Ora should resource national guidelines and ensure these are embedded into policies, protocols and practices in all regions. Guidelines and policies cannot influence outcomes unless:

• they have appropriate resourcing for both roll out and operation
• there is a good implementation plan that includes an audit loop to identify enablers and barriers to engagement and determine whether the guideline has led to desired outcomes
• buy-in from Health New Zealand, health professionals and whānau to ensure guidelines are accessible and acceptable to all communities.

Cultural safety

Health care regulatory authorities are responsible for setting standards for clinical competence, cultural competence (including competencies that will enable effective and respectful interaction with Māori) and ethical conduct to be observed by health practitioners of the profession in line with the Health Practitioners Competence Assurance Act section 118(1)(i). Responsible authorities should ensure the standards are complied with through provision of the required education, and audits of safe, effective and equitable care, regardless of the setting in which care is provided.

Missing data

As a matter of urgency Health New Zealand should prioritise the collection of complete and robust maternity and neonatal data to allow monitoring of equitable outcomes and allow the audit of quality and safety initiatives used to improve maternity and neonatal care. Data collection processes must recognise that Māori data is a taonga, therefore maintaining data sovereignty will ensure Māori have partnership in the collection, ownership and application of their data as outlined under Te Tiriti o Waitangi. 

The report can be downloaded below.