'You just don't give up'

The health sector is reporting frustration at unchanging mortality rates for babies and mothers in Aotearoa.

A report, released this week by the Perinatal and Maternal Mortality Review Committee, revealed about 10,000 deaths in hundreds of babies diagnosed with moderate or severe neonatal, disturbance of brain function.

Committee chairperson John Tait says he’s disappointed the inequities continue, particularly in Māori, Pasifika, and Indian women under the age of 20.

“Those in high deprivation have continued to be high compared to other population groups. And we're not going to be able to get our perinatal rate down until these inequities are addressed,” Tait told Pacific Mornings’ William Terite.

“This is the fourth report that I've been involved in, and it's the fourth time we've been saying these inequities are basically unacceptable. And everyone says, oh gosh, isn't that terrible? And then nothing substantial changes.

“So that's our aim and goal and passion is that there will be some changes made, systemic changes. Sorry to keep rabbiting on, but there are some really good individuals and good communities who are doing great work. But systemic change is not happening.”

Perinatal is the period when you become pregnant and up to a year after giving birth.

So where is it all going wrong? It’s multifactorial, Tait thinks and he has called out the various stakeholders - the government, the Ministry of Health, Te Whatu Ora, “it's resourcing.

“It's actually where you prioritiae it. And until people start to prioritise it properly, things are not gonna change. An example is that 17 per cent of these losses are due to pre-term delivery.

“And there's an opportunity to look at models of care, change involving the consumers, involving the communities of working out how are we going to manage this across New Zealand.

“Again, good work being done in places like Auckland, but it needs to be done right across the country.”

He said the main issue with Pacific health was blood pressure and pregnancy which results in quite high perinatal loss.

He said it was important to engage with health professionals early in the pregnancy, within the first 12 weeks, to be able to access scanning and ante-natal appointments.

“Things like that have to change, particularly ultrasound scanning and co-payments that really have to go.

“I think what we really need is to develop trust, which is probably not there, in the health professionals and to go and see the health professionals early in the pregnancy. And I think that is important.

“We understand that and right across these groups that not necessarily trust is there. And health professionals have to develop that trust as well or deserve that trust. But that's where it needs to come.

“You need to see your health professional and you need to take notice of what they say. And that's either a midwife or an obstetrician.”

He said women look after everybody else and they don't look after themselves. “And the powers that be look at maternity and say, oh, it's a natural process, and we only get worried about it when it hits the papers”.

But Tait warned that women's health was at the “bottom of the cliff”, and that was due to women taking care of other people and not spending enough time looking after themselves.

“The ones under 20, unless you have actual special clinics and you actually provide proper wraparound services, they feel a bit neglected. They're talking to a slightly different generation.

“So it is important and grandmothers in particular are really important here, to provide proper wraparound services for this very vulnerable group.

“I'd certainly like to see more effort made in looking at premature labour and premature delivery.

We've also made a recommendation about guidelines because we're very good at sort of putting guidelines out there, but we never follow up to see whether they're being implemented properly or if there's a proper audit and whether the consumers and the health professionals buy into them.

“Cultural safety is also another one of our strong recommendations. We know it is happening at an individual level. We know it's supposed to happen at an organisational level. We know it happens at a regulatory level. But there are no consequences for bad behaviour. And that's the other issue.”

Tait said proper data collection was also key.

He said while there were frustrations at trying in the face of a brick wall, it was important that they continued. “You just don't give up.”