Unaddressed inequities mean Aotearoa New Zealand’s perinatal death rates have remained static for 15 years.
The Sixteenth Report of the Perinatal and Maternal Mortality Review Committee (PMMRC) released today by Te Tāhū Hauora
Health Quality & Safety Commission, covers the years 2006-21 and is the first report to examine reported COVID-19 infection in pregnancy
in Aotearoa.
PMMRC chair, John Tait, says "I want to acknowledge the individuals, families and whānau affected by those represented
in this report. The report includes nearly 10,000 lives lost and hundreds of babies diagnosed with moderate or severe
neonatal encephalopathy. Our sincere thoughts are with each and every family and whānau grieving the loss of a life or
life imagined".
The report paints a stark picture of virtually unchanged perinatal death rates over a decade and a half due to
persistent inequities within the perinatal sector.
Mr Tait said that, over the past 15 years, the PMMRC’s report series had produced a vast volume of data revealing
significant inequities in perinatal clinical outcomes relating to demographic and socioeconomic factors, including
ethnicity and poverty.
There was ongoing frustration and exhaustion across the sector from reporting unchanged mortality year rates year in,
year out, with significant inequitable ethnic disparities in almost all areas again a feature of the latest report.
‘Reporting these disparities over a long period of time has not resulted in any meaningful action to address them.
National guidelines previously recommended have not always been followed up with clear implementation plans or
appropriate resourcing,’ Mr Tait said.
‘Asking why we have not made progress and why certain groups have worse outcomes is appropriate after reading this
report.’
Mr Tait said he agreed with the report’s statement that, although these were uncomfortable questions to answer, if the
report led to the acknowledgement of the issues, a search for solutions, and system changes, then it could be considered
successful.
Key clinical findings from the latest report include:no significant decrease between 2007 and 2021 in overall perinatal related mortality rates including deaths during
pregnancy and in the first 28 days after birthrecognition that certain groups continue to have worse clinical outcomes compared with groups with the best clinical
outcomes; for example:MāoriPacific peoplesIndian populationsthose aged under 20 years of agethose living in areas of high deprivationa small, statistically significant trend upwards in neonatal encephalopathy ratesa significant amount of mortality in the most disadvantaged groupswāhine Māori, Pacific women and those living in higher deprivation areas continue to suffer a disproportionate burden of
maternal mortalitythose of New Zealand European ethnicity were 67 percent less likely than wāhine Māori to die by suicide - a direct
result of maternal mortality in the 2006-21 period.
Mr Tait said the report’s four recommendations should be prioritised urgently.
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 operationthere 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 outcomesbuy-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.
The report can be downloaded here .