Health And Disability Commissioner Remains Concerned By Lack Of Progress To Address Inequities In Maternity Care

The Health and Disability Commissioner Morag McDowell
says she is concerned by the continued lack of progress in
reducing inequitable outcomes in maternity care as noted in
the latest Perinatal and Maternal Mortality Review Committee
report released today.

The report, released by Te
Tāhū Hauora | Health Quality & Safety Commission,
covers the years between 2006-21. It showed unaddressed
inequities have resulted in Aotearoa New Zealand’s
perinatal death rates remaining static for 15
years.

“I share the frustrations about a continued
lack of meaningful action to address disparities in care. It
is unacceptable that Māori, Pacific and Indian families, as
well as babies born to mothers under the age of 20, and
those living in areas of high deprivation continue to
experience significantly worse outcomes in the maternity
system.”

Ms McDowell says the concerns noted in the
report mirror the complaints HDC receives about maternity
care. “While the number of complaints is small – around 150
a year – the profile of complaints is more serious than is
seen for other services and the frequency with which the
same issues recur shows a concerning lack of progress over
time and a failure to implement multiple recommendations.
Fundamental issues remain unaddressed and the outcomes for
the family or whānau involved can be tragic and have
enduring consequences.”

“A common issue seen in
complaints to HDC is a failure to appropriately follow
clinical guidelines. I agree with the Committee that
national guidelines have not always been implemented
successfully, and support their recommendation that Health
New Zealand must resource these guidelines appropriately.
Similarly, a failure to engage people in their care in a
culturally safe way is also seen in complaints to my Office
and I agree with the committee that further work is required
to achieve the outcome of culturally safe care.”

Ms
McDowell commented that she has been pleased to see Health
New Zealand has begun work on developing a new approach to
primary maternity care and early years services. “This
presents an important opportunity to remove some of the
systemic barriers to care and improve equity of outcomes.
However, it is also important that focus is placed on
improving specialist maternity services, including
addressing workforce issues, improving integration between
primary and specialist care, and ensuring a whole of
maternity system approach is taken to quality
improvement.”

“I will continue to raise my concerns in
this area with Health New Zealand and other relevant
agencies and to emphasise the need to prioritise
collaborative action to improve outcomes for families and
whānau in the maternity care system.”

Common issues
seen in complaints to HDC about maternity care
include;

– Inadequate management and assessment of
risk during labour, and in particular inadequate monitoring
of the baby’s heart rate

– Poor cultural safety and
inequities in care

– Inadequate coordination between
primary and secondary care

– Inadequate postnatal
monitoring

– Lack of adherence to guidelines

–
Geographical disparity in access to and quality of
care

– The impact of workforce issues on the standard
of care

– Inadequate informed consent
processes.

HDC promotes and protects the rights of
people using health and disability services as set out in
the Code
of Health and Disability Services Consumers’ Rights (the
Code).

Background

Established in 2005, the
PMMRC is one of the Commission’s five mortality review
committees initially established under the New Zealand
Public Health and Disability Act 2000 (the Act), and now
sits under the Pae Ora (Healthy Futures) Act 2022.

The
PMMRC reports on mortality trends in babies and mothers and
serious morbidity from neonatal encephalopathy, in order to
reduce these deaths and improve the quality and safety of
Aotearoa New Zealand’s health care
system

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