13 Oct 2018

Report shows racial bias in resuscitating newborns

3:55 pm on 13 October 2018

Māori, Pacifica and Indian premature babies are less likely to recieve resuscitation attempts than babies of other ethnicities, a national report has found.

Newborn baby

Photo: 123RF

The finding is part of the twelfth annual report of the Perinatal and Maternal Mortality Review Committee (PMMRC).

The report found resuscitation was tried on 92 percent of Māori babies, 88 percent of Pacifica babies and 86 percent of Indian babies, born from 23-26 weeks.

Other babies, of Pākehā and other European ethnicities, had a 95 per cent resuscitation rate.

The committee said institutional bias was likely responsible for the varied results.

"While the reasons for these differences by ethnicity have not been made clear in the analyses in this report, previous analysis on inequities by ethnicity in New Zealand suggest that institutional bias or implicit biases are likely to play at least some part," the report read.

The committee acknowledged a large body of work in New Zealand, including the annual report, that described the inequalities in access to care, quality of care and health outcomes for Māori and Pacifica people.

It recommended regulatory bodies enforce cultural competency training for all staff working in the maternity and neonatal workforce to address implicit bias and racism.

But Matire Harwood, director of Auckland University's Tomaiora Research Group, said there was a difference between cultural competency and cultural safety.

"I'm a little bit concerned with this idea of being competent around somebody's culture as if, perhaps if you provided more cultural support during the birth process, this might actually improve outcomes. It's more about reflecting on our own practice; what is it that we're doing or not doing that contributes to inequity? What is it in the system that is allowing this to happen?"

The committee also recommended that the geographic differences in survival rates be investigated.

The report found there were statistically significant differences in survival rates by tertiary unit at gestations of 23 to 25 weeks.

The proportion of babies where resuscitation was attempted from 23 to 26 weeks ranged from 87 per cent at Middlemore Hospital, 93 percent in Christchurch, 94 percent at Auckland and 97 percent at Waikato, to 98 per cent and 99 percent at Wellington and Dunedin.

Ms Harwood said the report highlighted the differences in health care being delivered throughout the country.

She said the findings were an opportunity to adopt a "system approach" and ensure all district health boards were providing equal health care to all.

"It was very eye-opening and very heart-wrenching to think that babies, who through no fault of their own are born prematurely, don't receive equitable care. We should be looking at equal care in order for our babies to be able to have an opportunity to be with whānau and contribute to our world."

The report noted the proportion of women who were able to register with a Lead Maternity Carer (LMC) in the first trimester of pregnancy was also lower among Māori, Pacific and Indian mothers.

Leslie Dixon, a midwifery advisor with the New Zealand College of Midwives, said premature births were complicated and involved social and economic factors that could impact the care a mother and her baby received.

She said more research was needed to better understand the irregularties in resuscitation attempts across different ethnicities.

"I think it's really important to have this kind of information but I also think the report only provides part of the picture and that we need to explore more. We need to know a little bit more about what else is linked to these ethnicities that may also be causing concern."

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