Health reforms a chance to improve our struggling maternity sector

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The latest report by the Perinatal and Maternal Mortality Review 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 15^th 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 14^th 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 27^th day of life
• A stillbirth is a baby who is born from 20 weeks’ gestation (pregnancy) without any signs of life.

Kei te pūrongo hou nā te Komiti Mate Kukune, Mate Whea (PMMRC) he rārangi tohutohu kāore anō kia tino whakamahia, i puta atu ana i tēnei rā, e whakaatu ana i ngā manarite-kore e noho rā i ngā rāngai ōmahu, rāngai tiaki pēpi hou.

I kitea i Te Pūrongo ā-Tau Tekau mā Rima o te Komiti Arotake Mate Pēpi, Mate Whaea Hoki kāore i tino iti haere ngā mate ā-hapū mai i te wā kohi raraunga i te tau 2007.

Ā, ahakoa ngā tini pūrongo a te PMMRC e whakaatu ana i ngā manarite-kore me ngā karanga kia tere tīni te pūnaha, ka rite tonu te kore āwhina a ngā pūnaha hauora me ngā pūnaha pāpori o Aotearoa i ngā pēpi o ngā whaea Māori, Pasifika me ngā whaea Īnia, ngā whaea i raro i te rua tekau tau te pakeke, me ērā e noho ana i ngā takiwā rawakore, katoa rātou e wheako ana i ngā putanga kino ā-hapū nei.

Ka arotake te PMMRC i ngā mate o ngā whaea me ngā pēpi i Aotearoa me te tohutohu atu i a Kupu Taurangi Hauora o Aotearoa mō te pēhea e whakaiti ai i aua matenga. Ka arotake hoki i ngā kēhi whakararu roro o ngā pēpi, ngā panoni ā-roro nā te korenga e whai hauhā te pēpi i te whare tangata i te whānautanga mai rānei.

I tana pūrongo 15 ka miramira i ngā tohutohu o mua i ngā pūrongo o mua kāore anō kia whakamahi katoatia.  Ka tohutohu atu me whakamahi i ngā mea whā i āiatonunei. Tae atu kia aro atu ki ngā pānga o te takaonge ā-ohapori nā te mate ā-hapu, kia whakaritea he ratonga e tūtuki ana ngā hiahia o ngā whaea taiohi, he manaakitanga e tika ana mā ngā wāhine e āhei ai te whakapai ake i ngā tūraru, me te mātauranga haumaru ā-ahurea nei mō te ahumahi whakawhānau pēpi, tiaki pēpi hou.

Ka mea mai a Hone Teite te Kaihautū o te PMMRC, ‘Ko ngā tohutohu o te PMMRC i ahu mai i ngā raraunga mō ngā tāngata, ngā whānau e noho tino okeoke ana. Me mātua whai te pūnaha i ā mātou mahi whakapai hauora o nā tata nei kia kore ētahi atu whānau e raru pērā i te tokomaha kei roto i te pūnaha.’

Ka kī mai a Tākuta Janice Wilson, te Tumuaki o Kupu Taurangi Hauora o Aotearoa, ‘Ko ā te PMMRC tohutohu e miramira ana i te hiahia kia kaha ake te tautoko i ngā tāngata me ngā rōpū e mahi ana i te rāngai whakawhānau pēpi, ā, kia whakatikaina ngā manarite-kore mauroa me te whakakore i ngā mamae ka taea. E ū ana te Kōmihana ki te mahi tahi me Te Whatu Ora me Te Aka Whai Ora i tēnei wā panoni no roto mai o te pūnaha kia kōkiritia ēnei panoninga.’

Ka mihia hoki te pūrongo i te kauneke o ā te PMMRC tohutohu maha mai i tana pūrongo 14^th i te tau 2021, tae atu hoki ki te mana whakahau mō te whakarite huaora ki rō parāoa mō waenga i te tau 2023, mā reira e whakaiti i ngā mate o ngā pēpi nā ngā hēhē o te whānautanga mai.

I te marama o Whiringa-ā-rangi o te tau 2021, hei urupare ki ā te PMMRC tohutohu, i pānuitia e te Manatū Hauora ngā kitenga o tētahi arotakenga ratonga hauora hinengaro o ngā whaea nā ngā poari hauora ā-rohe (ko Te Whatu Ora i āianei) i mahi. Ko te kitenga, he manarite-kore te tuku ratonga o āianei, he korenga nōna e whakatutuki wawata, he whāruarua hoki i te whānuitanga o te mahi tauwhiro. He awhero nui kia whakawhānui atu i te ahumahi hauora hinengaro o ngā whaea me te whakatū i ngā ratonga tauwhiro ā-kaupapa Māori nei kia whakapai ake i te hauora hinengaro o ngā whaea.

Hei tā matua Taite kua āhua tautoko ā-pūtea nei engari me nui atu. Ka whakaae mai te PMMRC me mātua whakaraupapa te hauora hinengaro o ngā whaea e Te Whatu Ora me Te Aka Whai Ora nō rāua e whakapiki tonu i te hauora, haere ake nei, haere ake.

I te marama o Whiringa-ā-rangi hoki i te tau 2021, nā te Minita Hauora, nā te Hōnore Tākuta Ayesha Verrall i pānui atu kua tīmata te para huarahi mō te pōuritanga. He mahi atu anō hei mahi kia tere ake te whakararau i tētahi huarahi pōuritanga ā-motu kia pai atu te tauwhiro me ngā ratonga mā ngā mātua – inā hoki, ngā mea Māori, Pasifika, Īnia, ngā whānau me ngā whaea i raro i te 20 tau te pakeke.

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