July 02, 2024
Māori high risk in perinatal deaths
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Perinatal death rates in Aotearoa have remained static for 15 years – and the Health Quality and Safety Commission is blaming unaddressed inequities.
Perinatal and Maternal Mortality Review Committee chair John Tait says the committee’s latest report, an overview of the years 2006 to 2021, includes nearly 10,000 lives lost over that time.
There were also hundreds of babies diagnosed with moderate or severe neonatal encephalopathy causing brain dysfunction.
Despite the volume of data revealing significant inequities relating to factors such as ethnicity and poverty, there has been no meaningful action.
Māori, Pacific and Indian populations, those aged under 20 and those living in areas of high deprivation continue to have worse clinical outcomes and higher maternal mortality.
Wāhine Māori were 67 percent more likely to die by suicide than those of New Zealand European ethnicity as a direct result of maternal mortality in the 2006-21 period.
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.