This annual report - Taranaki District Health Board

IN-DEPTH TOPIC: SERVICES AND INTERVENTIONSFOR WOMEN EXPERIENCING MULTIPLEADVERSITIES IN PREGNANCYIntroductionPregnancy and the early years lay critical foundations for the health and development of achild’s entire lifecourse [136,137]. Adverse social conditions during pregnancy have beenlinked to adverse outcomes for women and their babies, including increased risks of bothmaternal mortality and perinatal mortality [138,139,140]. In New Zealand, the 2012Perinatal Mortality and Maternal Review Committee (PMMRC) report demonstrated asocioeconomic gradient in perinatal mortality: women living in the most deprived areas(NZDep quintile 5) had significantly higher rates of stillbirth and neonatal death than thosein less deprived areas [138]. Perinatal mortality rates were also higher for Māori andPacific mothers compared to European mothers. A variety of factors have been implicatedin this increased risk including: poverty, unemployment, homelessness, young age,underlying mental illness, substance abuse and domestic violence; and vulnerablepregnant women may experience several such factors at once [140].Investment in the early childhood and the prenatal period has been identified as havingone of the greatest potentials to reduce health inequities [136]. In New Zealand, recentreports have called for improvements in services to address the socioeconomic and ethnicdisparities in maternal and child health [137,138,141]. The Child and Youth MortalityReview Committee has recommended that families under significant social and economicstress, for example those coping with several children in difficult economic circumstances,should be identified and provided with support [141]. While it is recognised that thesefamilies may be involved with a number of agencies, the committee recommended thatone agency should take the lead in coordinating services. The 2012 PMMRC report madea number of recommendations regarding identifying and addressing barriers to antenatalcare for at risk women and improving services for teenage mothers [138].Antenatal care is generally considered an effective method of improving outcomes forpregnant women and their babies, although there has been little rigorous evaluation ofroutine antenatal care [140,142]. Non-attendance and under-attendance at free antenatalcare have been linked to adverse pregnancy outcomes including low birthweight, and fetaland neonatal deaths [143]. Barriers to accessing or engaging with antenatal care wereidentified as the most common contributory factor to perinatal related deaths in 2010 bythe PMMRC [138]. This in-depth topic considers services and interventions for pregnantwomen who experience multiple adversities.Aims and ObjectivesThis in-depth topic aims to review the extent to which New Zealand women are exposed tomultiple adversities during pregnancy, and the impact such adversities have on theirpregnancy outcomes. The evidence base for services and interventions that have beendeveloped to address these adversities, and the poorer pregnancy outcomes they arelinked to, is also reviewed, with a particular focus on meeting the needs of youngerwomen. In addressing these aims, this in-depth topic is divided into three main sections:1. Section one reviews a range of social adversities affecting women during pregnancyand the adverse pregnancy outcomes that have been associated with them.2. Section two provides a brief overview of maternity services in New Zealand, includingpotential barriers to accessing services, the pregnancy–early childhood continuum, andsome examples of local services for women experiencing adversity in pregnancy.3. Section three reviews the evidence base for interventions that aim to address adversesocial factors during pregnancy and improve pregnancy outcomes. This section startsIn-Depth Topic: Adversity in Pregnancy - 277