Media Releases

Improvements called for in maternity services for ‘hard-to-reach' and women with special needs

29 September 1999

“Care more tailored to the needs of key groups of New Zealand women is one of areas where improvements can be made to maternity services,” says Maggie Barry who chaired the National Health Committee's review of maternity services in New Zealand.

“In carrying out the review the NHC was specifically asked to consider the needs and experiences of different groups of women, in particular, Māori, Pacific and rural women. It is these women as well as those who have special needs - complex medical and/or obstetric histories, psychiatric disorders, co-existing drug and alcohol problems, English as a second language - who have needs that the system is currently not meeting well enough,” says Maggie Barry.

“In spite of the excellent response to our postal survey - 11,511 women returned our questionnaire which was followed by a telephone survey of 1,000 women – reaching traditionally hard-to-reach women in the six months we had to do our review was always going to be a big challenge.

“We commissioned Te Puni Kokiri to research the issues for Māori for us and we similarly contracted with a Pacific Islands reference group to consult with Pacific women. As well, the review team met with women who live in isolated rural areas, young teenage mothers, refugee and new immigrant mothers and women from Asian communities.”

“There are clearly areas in which the current system can be improved to better meet the needs of Māori women and their babies,” says Maggie Barry. “Maternity care needs for Māori women are higher than for the general population. But despite their higher needs, Māori women use less primary maternity care than other women.

“Māori women told us they are not receiving services that meet their cultural needs. There is both a lack of appropriate care by mainstream providers and insufficient Māori midwives in many areas. Māori women had problems with the information they were given to choose a lead maternity carer as well as with communication and co-ordination around the transfer of their care among different providers and with poor standards of cleanliness in hospitals. The high significance Māori place on birth means they find poor standards of cleanliness offensive.

“Pacific women would also like to be cared for by health professionals in ways more in keeping with their cultures. Pacific women found the information they received about the maternity care system inconsistent in both quality and comprehensiveness. Twelve percent of Pacific women had fewer than five antenatal visits compared with six percent of European women.”

In 1996, 20 percent of women aged 15 to 44 lived in rural areas. Distance from maternity facilities and specialist services, fewer locally available health professionals to choose from - with those available having high caseloads - are the main problems for rural women. “The situation is worse for rural women who don't have their own car or public transport,” says Maggie Barry.

Women with complex medical or obstetric histories can face difficulties due to LMC reluctance to take them on as clients. Such women require extra care and this may result in loss of income to the LMC if the women have to be transferred to secondary care during the pregnancy or labour and birth. “Our review heard from many women who had trouble engaging a lead maternity carer – something that caused them considerable concern.

Women with significant social or medical problems are often not well served. Such women may particularly benefit from the continued involvement of a general practitioner as well a midwife during pregnancy. Many of these women eg, women with co-existing drug and alcohol problems, refugee women with ongoing medical issues and English as a second language, may need specialist input but usually cannot afford private specialist care. Their social, emotional and physical needs are often not well served by the lack of continuity and institutional barriers posed by hospital-based care.

A third of women are paying for maternity services. Charging women for GP care, ultrasound where clinically indicated and emergency care from A&E clinics is contrary to the regulations relating to maternity services.