Social determinants and inequitable maternal and perinatal outcomes in Aotearoa New Zealand

Dawson, Pauline; Auvray, Benoit; Jaye, Crystal; Gauld, Robin; Hay‐Smith, Jean

doi:10.1177/17455065221075913

Cited by 24 publications

(23 citation statements)

References 61 publications

(92 reference statements)

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“…Disproportionate rates of hospitalisation could potentially be avoided with earlier primary care visits [16]. Māori and Asian mothers also have worse maternal and perinatal outcomes than NZ European/ European mothers, and lack of engagement with maternity care was one of the main determinants identified [17]. A systematic review also found that ethnic differences in pre-term birth can be explained by gaps in quality, continuity, and trust in maternity care providers [18].…”

Section: Introductionmentioning

confidence: 99%

Determinants of ethnic differences in the uptake of child healthcare services in New Zealand: a decomposition analysis

Lewycka

Dasgupta

Plum

et al. 2023

Int J Equity Health

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Background There are persistent ethnic gaps in uptake of child healthcare services in New Zealand (NZ), despite increasing policy to promote equitable access. We examined ethnic differences in the uptake of immunisation and primary healthcare services at different ages and quantified the contribution of relevant explanatory factors, in order to identify potential points of intervention. Methods We used data from the Growing Up in New Zealand birth cohort study, including children born between 2009 and 2010. Econometric approaches were used to explore underlying mechanisms behind ethnic differences in service uptake. Multivariable regression was used to adjust for mother, child, household, socioeconomic, mobility, and social factors. Decomposition analysis was used to assess the proportion of each ethnic gap that could be explained, as well as the main drivers behind the explained component. These analyses were repeated for four data time-points. Results Six thousand eight hundred twenty-two mothers were enrolled during the antenatal survey, and children were followed up at 9-months, 2-years and 4-years. In univariable models, there were ethnic gaps in uptake of immunisation and primary care services. After adjusting for covariates in multivariable models, compared to NZ Europeans, Asian and Pacific children had higher timeliness and completeness of immunisation at all time-points, while indigenous Māori had lower timeliness of first-year vaccines despite high intentions to immunise. Asian and Pacific mothers were less likely to have their first-choice lead maternity caregiver (LMC) than NZ Europeans mothers, and Māori and Asian mothers were less likely to be satisfied with their general practitioner (GP) at 2-years. Healthcare utilisation was strongly influenced by socio-economic, mobility and social factors including ethnic discrimination. In decomposition models comparing Māori to NZ Europeans, the strongest drivers for timely first-year immunisations and GP satisfaction (2-years) were household composition and household income. Gaps between Pacific and NZ Europeans in timely first-year immunisations and choice of maternity carer were largely unexplained by factors included in the models. Conclusions Ethnic gaps in uptake of child healthcare services vary by ethnicity, service, and time-point, and are driven by different factors. Addressing healthcare disparities will require interventions tailored to specific ethnic groups, as well as addressing underlying social determinants and structural racism. Gaps that remain unexplained by our models require further investigation.

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Section: Introductionmentioning

confidence: 99%

Determinants of ethnic differences in the uptake of child healthcare services in New Zealand: a decomposition analysis

Lewycka

Dasgupta

Plum

et al. 2023

Int J Equity Health

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“…Participants considered actions such as food vouchers, living wages, universal income, and tax-free fruit and vegetables. Integrating upstream initiatives into a maternal health promotion strategy holds promise, with interventions such as food subsidy programmes ( McFadden et al , 2014 ) being a first step towards acknowledging this shortcoming, yet not enough to address the systemic and structural changes needed ( Dawson et al , 2022 ).…”

Section: Addressing Upstream Determinantsmentioning

confidence: 99%

Towards a mother-centred maternal health promotion

Neely

Reed

2023

Health Promotion International

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Summary A transformative approach to maternal health promotion should be mother-centred, context-driven and grounded in lived experiences. Health promotion can achieve this by drawing on its disciplinary roots to extend and reorient maternal health promotion towards an approach of non-stigmatizing and equitable health promotion that has mothers’ well-being at the centre, particularly giving credit to marginalized, ‘non-normative’ maternities. This article draws on data from 18 workshops EN conducted across Aotearoa New Zealand, including 268 maternal health stakeholders. Drawing on design thinking, participants reimagined what a maternal health promotion approach informed by the Ottawa Charter action areas could comprise. The five themes included building connected systems close to home, developing mothering/parenting skills, addressing upstream determinants, mother-centred care and funding, and creating a collective mothering village. We discuss how these areas could better meet the unique challenges of transitioning to motherhood. Rather than focussing only on individual behaviours, many ideas reveal broader environmental and structural determinants. We link the themes to current literature and advance the agenda for centring the maternal in maternal health promotion.

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“…30 Anne ölümlerinin engellenmesi ya da anne sağlığı sonuçlarının iyileştirilmesi için, öncelikli olarak sağlık sonuçlarında yaşanan eşitsizliklerin ve sağlık hakkaniyetsizliklerinin ele alınması ve sağlık sonuçları üzerinde etkisi olduğu gösterilen temel belirleyicilerin bu sürece dahil edilmesi gerektiği vurgulanmaktadır. 31…”

Section: Anne Sağliği Sonuçlarina Etki̇ Eden Sosyal Beli̇rleyi̇ci̇lerunclassified

Anne sağlığının sosyal belirleyicileri üzerine kavramsal bir inceleme

ÖZÇELİK>¹

2022

SYBD

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Anne sağlığında temel bir gösterge olan anne ölüm oranı özellikle gelişmekte ve az gelişmiş ülkelerde küresel bir sağlık sorunu olmaya devam etmektedir. Bu ülkelerde üreme çağındaki kadınlar genellikle gebelik, doğum ve doğum sonrası dönemde görülen komplikasyonlar nedeniyle yaşamlarını kaybetmektedir. Sağlık hizmetlerinin ötesinde yer alan ve sağlık sonuçlarını etkileyen bir takım sosyal belirleyiciler anne sağlığının iyileştirilmesinde, ölüm oranlarının azaltılmasında, sağlık maliyetlerinin düşürülmesinde, hizmete erişim ve bakım kalitesinin artırılmasında sağlık sistemlerini destekleyici bir rol üstlenmektedir. Literatürde anne sağlığını etkileyen bir dizi yapısal ve ara belirleyiciler açıklanmıştır. Anne sağlığı, içinde yaşanan toplumun ekonomik, politik, sosyal ve kültürel yapı, aile özellikleri ve sağlık hizmetleri gibi bir takım sosyal ve ekonomik faktörden geniş ölçüde etkilenmektedir. Dünya Sağlık Örgütü anne sağlığının sosyal belirleyicilerine dikkat çekerek, annelerin yeterli sağlık hizmetlerine erişimini sınırlayan engellerin belirlenmesi ve sağlık sisteminin tüm seviyelerindeki hakkaniyetsizliklerin ele alınması gerektiğini vurgulamıştır. Ulaşılabilir ve kaliteli sağlık hizmetleri ile birlikte sağlıkta sosyal belirleyicilerin iyileştirilmesine dair politikalar anne sağlığını önemli ölçüde geliştirerek anne ölüm oranlarının azalmasına katkı sağlamaktadır.

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Social determinants and inequitable maternal and perinatal outcomes in Aotearoa New Zealand

Cited by 24 publications

References 61 publications

Determinants of ethnic differences in the uptake of child healthcare services in New Zealand: a decomposition analysis

Determinants of ethnic differences in the uptake of child healthcare services in New Zealand: a decomposition analysis

Towards a mother-centred maternal health promotion

Anne sağlığının sosyal belirleyicileri üzerine kavramsal bir inceleme

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