Abstract
Māori are the Indigenous peoples of New Zealand and comprise around 15% of the total population. This paper reviews literature on antenatal care and care during labour and delivery for Māori, along with Māori experiences, with particular reference to access and knowledge gaps. It also considers the links between access to care and health outcomes for Māori babies from a life course perspective. The maternity care needs of Māori women are much greater than for non-Māori women and inequalities in birth outcomes between Māori and non-Māori persist.
This is in part a reflection of higher prevalence of maternal risk factors. Māori mothers are more likely to have babies at a very young age, have high risk pregnancies, smoke during pregnancy, have health problems such as diabetes during their pregnancies, and be of low socioeconomic status. The situation is further compounded by persistent ethnic inequalities in Māori experiences of and access to maternity services. Despite their high relative needs, Māori women are less likely to receive antenatal education classes and have fewer cumulative antenatal visits than non-Māori women. Māori women have reported lower levels of satisfaction with their antenatal, labour, and birth care and inequities in access to obstetric care as well. Certain key barriers to adequate antenatal care and/or care during labour and delivery have been identified among Māori women, including access to information to make informed choices, insufficient numbers of independent practicing Māori midwives, inadequate access to culturally responsive care including whānau1- centred services, and cost barriers.
Evidence from international studies indicates that multiple conventionally recognized maternal risk factors, even when considered in combination, do not account for the full extent of ethnic disparities in birth outcomes. It has been proposed that the determinants of ethnic inequalities in birth outcomes are multifactorial and accumulate over the life course of the mother. The implication is that poor access to antenatal care and care during labour and delivery may be only one of a number of important factors that contribute to inequalities in birth outcomes for Māori. In addition, there is strong evidence that adverse birth outcomes, in particular low birthweight, affect a baby’s health outcomes in later life. For example, there is much evidence demonstrating the association between low birthweight and hypertension, diabetes, and coronary heart disease in adulthood. Important knowledge gaps in this field include understanding the extent, underlying contributing factors, and ways to address ethnic inequalities in receipt of antenatal, labour, and delivery care. Research is also required to understand the causes of inequalities in birth outcomes for Māori, and what constitutes optimal antenatal care for Māori from a life course perspective.
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