This annual report - Taranaki District Health Board

In New Zealand, information on factors influencing access to antenatal care is moredifficult to ascertain. Since July 2007 funding changes under the new section 88 PrimaryMaternity Services Notice mean that DHB employed midwifery teams no longer submitclaims to the Ministry of Health for their services. Information on the antenatal carereceived by women who access DHB midwifery services is therefore not captured in theNational Maternity Collection (MAT). In the MAT during 2009 to 2010, 16% of babies bornin New Zealand were born to mothers who were not registered with a LMC at the time ofdelivery (see page 188). Many of these women are likely to have accessed DHB basedmaternity services although some may not have accessed antenatal care at all duringpregnancy. Registration with a LMC was not evenly distributed in the population. Pacific,Asian/Indian and Māori babies were significantly more likely than European babies to havemothers who were not registered with a LMC at delivery, as were the babies of youngermothers, and those from more deprived areas. There was also large variation by DHB,reflecting local organisation of services. Of those women that were registered with an LMCat the time of delivery in 2010, 58.5% had initially registered during the first trimester(before 15 weeks), while 34.2% had registered during the second trimester (15 to 28weeks) [213]. Having registered in the first trimester was more common amongEuropean/other (70.0%) and Asian (58.0%) women than Māori (42.2%) and Pacific(32.7%) women, suggesting the Māori and Pacific women were more likely to haveregistered late [213]. An audit based on the PMMRC dataset of the 137 women whosebabies had died result of congenital anomalies in 2010, found that 114 (83%) were seenby a health professional before 14 weeks completed gestation [238]. However, only 90 ofthese women (66%) actually booked with a LMC before 14 weeks.There is however, a limited literature addressing barriers to antenatal care in New Zealand.The Maternity Consumer Survey 2011 found that over three-quarters (78%) of women whoresponded to the survey reported they were satisfied with the overall maternity care theyreceived [215]. However, almost one in five women (19%) found it difficult to find a LMC toprovide care for them, compared with 11% in 2002. Satisfaction among young women, andMāori and Pacific women was similar to the average satisfaction among all women.However, response rates were low (41% overall), particularly among young women (15.8%for women under 20 years of age and 21.8% for women aged 20–24) and Māori andPacific women were under-represented. Although weighting was used to account for thisunder-representation, the survey remains prone to selection bias. Similarly, Low et al.found that the majority (99.1%) of mothers in the Pacific Island Family cohort study hadattended at least one antenatal appointment [239]. However, 26.6% of these womeninitiated their antenatal care late (defined as first antenatal visit at 15 weeks or later) and10.7% of the mothers attended fewer than the recommended number of visits (defined asat least six visits). Maternal factors associated with late initiation of antenatal care includedlack of formal qualifications (OR 1.82, 95% CI 1.34 to 2.47), lack of fluency in English (OR1.68, 95% CI 1.32 to 2.15), and not being employed before pregnancy (OR 1.74, 95% CI1.36 to 2.22). A recent review on maternity services at Counties Manukau DHB found thatmany women could not access co-ordinated lead maternity care through a self-employedLMC midwife or a specific allocated DHB midwife and concluded that gaps in maternityservices (including insufficient numbers of midwives offering LMC services) and a lack ofknowledge about how to access care left some vulnerable women at risk of avoidableharm [240]. The review also identified that the current funding mechanism for LMCservices, with set fees paid for each module of care, was a disincentive to providing care towomen with complex needs.Current Services for Vulnerable Women in New ZealandA number of DHB and community providers provide antenatal services for women withspecific needs, for example teenage pregnancy services and services for women at risk offamily violence. There are very few published trials or evaluations of these services. Someexamples of such services are described in box 3 below. Antenatal parent education, witha focus on young parents, is discussed in the section which follows.In-Depth Topic: Adversity in Pregnancy - 290