BackgroundThe purpose of this review was to examine the literature for themes of underlying social contributors to inequity in maternal health outcomes and experiences in the high resource setting of Aotearoa New Zealand. These ‘causes of the causes’ were explored and compared with the international context to identify similarities and New Zealand-specific differences.MethodA structured integrative review methodology was employed to enable a complex cross disciplinary analysis of data from a variety of published sources. This method enabled incorporation of diverse research methodologies and theoretical approaches found in the literature to form a unified overall of the topic.ResultsSix integrated factors – Physical Access, Political Context, Maternity Care System, Acceptability, Colonialism, and Cultural factors – were identified as barriers to equitable maternal health in Aotearoa New Zealand. The structure of the maternal health system in New Zealand, which includes free maternity care and a woman centred continuity of care structure, should help to ameliorate inequity in maternal health and yet does not appear to. A complex set of underlying structural and systemic factors, such as institutionalised racism, serve to act as barriers to equitable maternity outcomes and experiences. Initiatives that appear to be working are adapted to the local context and involve self-determination in research, clinical outreach and community programmes.ConclusionsThe combination of six social determinants identified in this review that contribute to maternal health inequity is specific to New Zealand, although individually these factors can be identified elsewhere; this creates a unique set of challenges in addressing inequity. Due to the specific social determinants in Aotearoa New Zealand, localised solutions have potential to further maternal health equity.

Objectives: Aotearoa New Zealand has demonstrable maternal and perinatal health inequity. We examined the relationships between adverse outcomes in a total population sample of births and a range of social determinant variables representing barriers to equity. Methods: Using the Statistics New Zealand Integrated Data Infrastructure suite of linked administrative data sets, adverse maternal and perinatal outcomes (mortality and severe morbidity) were linked to socio-economic and health variables for 97% of births in New Zealand between 2003 and 2018 (~970,000 births). Variables included housing, economic, health, crime and family circumstances. Logistic regression examined the relationships between adverse outcomes and social determinants, adjusting for demographics (socio-economic deprivation, education, parity, age, rural/urban residence and ethnicity). Results: Māori (adjusted odds ratio = 1.21, 95% confidence interval = 1.18–1.23) and Asian women (adjusted odds ratio 1.39, 95% confidence interval = 1.36–1.43) had poorer maternal or perinatal outcomes compared to New Zealand European/European women. High use of emergency department (adjusted odds ratio = 2.68, 95% confidence interval = 2.53–2.84), disability (adjusted odds ratio = 1.98, 95% confidence interval = 1.83–2.14) and lack of engagement with maternity care (adjusted odds ratio = 1.89, 95% confidence interval = 1.84–1.95) had the strongest relationship with poor outcomes. Conclusion: Maternal health inequity was strongly associated with a range of socio-economic and health determinants. While some of these factors can be targeted for interventions, the study highlights larger structural and systemic issues that affect maternal and perinatal health.

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Aim This study aims to provide an overview of the association between being in the custody of the chief executive of Oranga Tamariki (the child welfare agency of the New Zealand (NZ) government) and all‐cause hospitalisation and mortality. Methods This was a national retrospective cohort study using linked administrative data from the Integrated Data Infrastructure. Data were obtained for all 0–17 year‐olds living in NZ on 31 December 2013. In‐care status was ascertained at this point. Outcomes of all‐cause hospitalisation and all‐cause mortality were assessed between 1 January 2014 and 31 December 2018. Adjusted models incorporated age, sex, ethnicity, level of socioeconomic deprivation and rural/urban status. Results There were 4650 in‐care children and 1 009 377 not‐in‐care children in NZ on 31 December 2013. Of those in care, 54% were male, 42% lived in the most deprived areas and 63% identified as Māori. Adjusted models showed that in‐care children were 1.32 (95% CI 1.27–1.38) times more likely to be hospitalised than not‐in‐care children and 3.64 (95% CI 2.47–5.40) times more likely to die. Conclusion This cohort study highlights that the care and protection system prior to 2018 was not preventing children in its care from experiencing severe adverse outcomes. Overseas research has previously been relied on when making practice and policy decisions around child care and protection in NZ, so this research will provide valuable insight into best practice in an NZ context.

<p>The objective of this mixed method piece of descriptive research is to analyse travel patterns of New Zealand women relating to their selected place of birth, focusing on residents of the Southern District Health Board. It also explores the motivations of a sample of women in this area regarding their birth place choices.   Data extracted from Southern District Health Board 2013 electronic records, were analysed using geographic information system software. Spatial modelling was also conducted using this dataset. The second part of the study involved a questionnaire issued to women in Southern District Health Board maternity facilities during a three month period in 2014.   In the analysis of 2013 data that women appeared to be by-passing smaller primary maternity units in preference for larger complex care facilities. Spatial modelling examined some possible geographic reasons for this and improved service placement was also modelled based on 2013 demand. Survey results were congruent with other similar research, in that the main reasons for women choosing birth place were a combination of seeking out a safe place whilst remaining as close to home as possible. These priorities caused a tension of distance for rural women. There was no significant statistical variance in the responses between demographic groups.  Women are prioritising safety when they choose their birth place. In a large sparsely-populated District Health Board like Southern, this results in some women making long journeys to their chosen birth place as they select complex care facilities over closer primary maternity units or home.</p>