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The
latest report by the Perinatal and Maternal Mortality
Committee (the PMMRC), released today, paints a stark
picture of the persisting inequities that exist within the
maternity and neonatal sectors.
The Fifteenth Annual
Report of the Perinatal and Maternal Mortality Review
Committee | Te Pūrongo ā-Tau Tekau mā Rima o te Komiti
Arotake Mate Pēpi, Mate Whaea Hoki has found there has been
no significant reduction in perinatal-related deaths since
it started collecting data in 2007.
Also, despite
repeated reporting by the PMMRC showing persistent
inequities and calls for urgent system change, the health
and social systems in Aotearoa New Zealand continue to fail
babies of Māori, Pacific and Indian mothers, of mothers
aged under 20 years, and those living in areas of high
deprivation, all of whom experience worse perinatal
outcomes.
The PMMRC reviews deaths of mothers and
babies in Aotearoa New Zealand and advises the Health
Quality & Safety Commission on how to reduce those
deaths. It also reviews cases of neonatal encephalopathy,
changes in the brain that can be caused by lack of oxygen in
babies during pregnancy or birth.
In its 15th report,
the PMMRC highlights previous recommendations from past
reports that have not been fully implemented. It recommends
four of these be prioritised urgently. These include
addressing the impacts of socioeconomic deprivation on
perinatal death, providing services that meet the needs of
young mothers, providing care that is accessible and
appropriate to women with modifiable risk factors, and
mandated cultural safety education for the maternity and
neonatal workforce.
Mr John Tait, Chair of the PMMRC,
says, ‘The recommendations by the PMMRC are informed by
data that has real people, real whānau and real suffering
behind them. It’s imperative that the system takes
advantage of our recent health reforms to implement
recommendations that will prevent other whānau and
communities having to deal with the heartbreak already being
experienced by many in the system.’
Dr Janice
Wilson, Chief Executive of the Health Quality & Safety
Commission, says, ‘The PMMRC’s recommendations highlight
the need to better support the people and organisations
working within the maternity sector, address long standing
inequities and eliminate preventable harm. The Commission is
committed to working with Te Whatu Ora – Health New Zealand
and Te Aka Whai Ora | Māori Health Authority at this time
of change within the health system to drive and enact these
changes.’
The report also acknowledges the progress
on several of the PMMRC’s recommendations since the
release of its 14th report in 2021, including the mid-2023
introduction of mandatory folate in bread, which is expected
to directly result in a reduction of perinatal deaths
related to congenital anomalies.
In November 2021, in
response to the PMMRC’s recommendations, the Ministry of
Health published findings of a stocktake of maternal mental
health services provided by district health boards (now Te
Whatu Ora). It found that current service delivery is
inequitable, with unmet need and gaps in the continuum of
care. There is a particular need for the maternal mental
health workforce to be expanded and for kaupapa Māori
models of care to be provided to improve maternal mental
health.
Mr Tait says some investment has occurred, but
significantly more is needed. The PMMRC agrees that maternal
mental health should be prioritised by Te Whatu Ora and Te
Aka Whai Ora as they continue to build the future of
health.
Also in November 2021, the Associate Minister
of Health Hon Dr Ayesha Verrall announced that work had
begun on a bereavement pathway. Further work is needed to
expedite and embed a national bereavement pathway to improve
access and reduce local inconsistencies in care and services
received by parents – particularly for Māori, Pacific
peoples and Indian families and whānau and mothers under 20
years old.
Definitions
- A maternal death is
the death of a woman while pregnant or within 42 days of the
end of pregnancy. - A perinatal death is the death of
a baby from 20 weeks’ gestation (pregnancy) up to 28 days
after birth. This includes stillborn babies. - A
neonatal death is the death of a live born baby from 20
weeks’ gestation (pregnancy) up to 28 days after
birth. - An early neonatal death is the death of a
live born baby from 20 weeks’ gestation (pregnancy) up to
7 days after birth. - A late neonatal death is the
death of a live born baby from the seventh and the 27th day
of life - A stillbirth is a baby who is born from 20
weeks’ gestation (pregnancy) without any signs of
life.
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