16 Feb 2021

Baby mortality for young Māori, Pacific, Indian mothers needs urgent action - report

From Nine To Noon, 9:08 am on 16 February 2021

A newly released maternity mortality report has found unacceptable levels of maternal deaths for specific ethnic groups.

Soft focus of newborn tiny baby hand on parent hands.

Photo: 123RF

In the release of its 14th annual report, the Perinatal and Maternal Mortality Review Committee (PMMRC) found babies of Māori, Pacific and Indian mothers aged less than 20 years were still more likely than babies of NZ European mothers to die in pregnancy or within the first 28 days.

PMMRC chairperson John Tait, said among other issues highlighted, "urgent action is required" of DHBs and the government.

Only 60-70 percent of women have their first antenatal visit before 12 weeks, a number considered still "far too low" by Tait. 

"We're putting out the challenge... DHB's should be looking at going into our local communities to make it easy for pregnant women to access a health professional in the first 12 weeks."

The way the system was set up was not working for significant number of mothers and so far there had been no response to change it, he said.

Approximately half of the recommendations made over the past 13 years were yet to be fully implemented and "much more work needed to be done," he said. 

Tait called for a national perinatal bereavement pathway and more funding for maternal and infant mental health. 

The report also found mortality increased somewhat for babies of mothers aged 40 years and over. These mortality rates varied significantly by the level of socioeconomic deprivation in the areas where mothers lived.

Rates of mortality from stillbirth, neonatal death and perinatal related death overall were higher for babies of women who were smoking at the time of registration with a lead maternity carer (LMC) compared with those who were not.

The decrease in the rate of stillbirths was largely driven by a reduction in stillbirths in babies of New Zealand European women. There was also a significant decrease in stillbirths for babies of Middle Eastern, Latin American, or African (MELAA) women, but no change in any other ethnic group.

Since 2007, when PMMRC began collecting data, deaths overall (perinatal related deaths) had reduced significantly. 

Perinatal mortalities (fetal and early neonatal deaths) had a major drop among babies of New Zealand European mothers, but not for any other ethnic group.

The report also found barriers to access and/or barriers to engagement with care were the most common contributing factor.

The group's recommendations called on the help of health practitioners, DHBs, colleges and regulatory bodies, government and research groups to make changes.

It asked for a stocktake of mental health services available across New Zealand for pregnant women to identify the strengths of services and gaps or inequities in services and skills in the workforce, as well as a national pathway for accessing maternal mental health services including cultural appropriateness.

'I don't see any urgency'

Meanwhile, a leading Māori health academic said the government was not acting with any urgency to help prevent the deaths of Māori mothers and babies.

University of Auckland Te Kupenga Hauora lecturer Dr Donna Cormack - also on the PMMRC - told Midday Report: "We're still not seeing reductions for Māori and for other communities in terms of deaths for mothers and babies.

"There's a persistent inequity that we're still not acting with any sense of urgency (on)."

Over the years, earlier reports had made recommendations that had not been acted on, she said.

"Some of those recommendations are ones that would really make a difference if we took them seriously. So I think the message is that we actually have to take urgent steps to address the drivers of inequity and to make sure that these tragic outcomes - where they are preventable - we do something as a society to prevent them."

The report had tried to highlight the urgent steps required, Cormack said.

"Things like the Waitangi report and the health and disability system review ... they give us really clear direction for what we need to do at a systems level and as a society to address these, yet I don't see an urgency yet."

The government had the power to act immediately to make a difference, she said.

For example, the un-used recommendations from the Welfare Expert Advisory Group.

"We can do a lot now if we actually choose to take this seriously and I'm not seeing a clear alignment between the rhetoric about caring for child welfare and actually taking tangible steps to do something about it."