This annual report - Taranaki District Health Board

attitudes, beliefs and preferences which may make healthcare inappropriate, feared or nota priority [231].A qualitative study examining perceptions of health and interactions with ‘mainstream’health services among a group of 38 Māori women, aged between 24 and 61 years, foundthat women’s beliefs and practices were frequently ignored and devalued by ‘mainstream’health care providers, and generally not included as part of their health care [232].Encounters with health services and health care providers were frequently problem-basedwith a biomedical focus, neglecting the socio-cultural dimensions influencing health andwellbeing. A systematic review in 2003 identified five interventions to improve culturalcompetence in healthcare systems: programmes to recruit and retain staff members whoreflect the cultural diversity of the community served, use of interpreter services or bilingualproviders for clients with limited English proficiency, cultural competency training forhealthcare providers, the use of linguistically and culturally appropriate health educationmaterials, and culturally specific healthcare settings [233]. However, the effectiveness ofthese interventions could not be established due to a lack of comparative studies, or afailure of the studies to examine outcome measures of interest, defined as: clientsatisfaction with care, improvements in health status, and inappropriate racial or ethnicdifferences in use of health services or in received and recommended treatment.Cultural competence is integrated into the Midwifery Council of New Zealandcompetencies for entry into the register of midwives and a statement on culturalcompetence is available on their website (http://www.midwiferycouncil.health.nz) [234].Other organisations in New Zealand that provide resources which may enhance theculturally appropriate provision of care for pregnant Māori and Pacific women include NgaMaia O Aotearoa Me Te Wai Pounamu (http://www.ngamaia.co.nz/), and TAHA, the WellPacific Mother and Infant Service (http://www.taha.org.nz/page/5-Home). Nga Maia OAotearoa Me Te Wai Pounamu was established by a group of Māori midwives in 1993, andis a national organisation that promotes mātauranga Māori, or traditional Māori knowledge,in pregnancy and childbirth. The organisation provides training for health professionalsworking with Māori whānau, including a tool for use by health professionals and whānau toconsider aspects of Māoritanga (Māori culture) that they may wish to encompass in theircare plan, and a set of guidelines for cultural competence adopted by the New College ofMidwives [235,236]. TAHA aims to improve the health and wellbeing of Pacific mothersand infants during pregnancy and the first year of life. The organisation provides resourcesfor parents and health professionals, including a training programme designed to assisthealth professionals to better understand SUDI and stillbirth within Pacific families, and arange of information to support health professionals who work with Pacific mothers, babiesand their families.Barriers to Maternity ServicesAccess to antenatal care encompasses both physical access to services, and effectivecommunication between women and care providers to ensure that women benefit from thecare they receive [139]. Good communication, between agencies and between careproviders and the women in their care, is essential for effective maternity care. Womenfeeling awkward or ill at ease, or fearing being judged, and staff being judgemental orhaving a poor attitude, having a lack of knowledge of support or services available, orhaving a lack of understanding of issues faced by the woman, have commonly beenidentified as barriers to services [139]. Internationally, a 2009 review of qualitative (mainlyNorth American) studies exploring the views of marginalised women living in high incomecountries who had failed to attend any antenatal care, or did so late or irregularly, identifiedfactors influencing initial access to care and continuation of care [237]. Late pregnancyrecognition, and subsequent denial or non-acceptance of pregnancy, were associated withlate initial access to antenatal care. Continuing access appeared to depend on a weighingup of the perceived gains and losses, and was influenced by personal resources such astime, money and social support, as well as perceptions of quality of care, trustworthinessand cultural sensitivity of staff and feelings of mutual respect.In-Depth Topic: Adversity in Pregnancy - 289