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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2019

Open Access 01-12-2019 | Review

Barriers to equitable maternal health in Aotearoa New Zealand: an integrative review

Authors: Pauline Dawson, Chrys Jaye, Robin Gauld, Jean Hay-Smith

Published in: International Journal for Equity in Health | Issue 1/2019

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Abstract

Background

The 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.

Method

A 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.

Results

Six 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.

Conclusions

The 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.
Footnotes
1
Set of people bound together by descent from a common ancestor or ancestors; literally: bone; modern meaning: tribe (132)
 
2
local people, hosts, indigenous people - people born of the whenua, i.e. of the placenta and of the land where the people’s ancestors have lived and where their placenta are buried. In Aotearoa New Zealand – Māori.
 
3
House/home
 
4
Widespread cultural term meaning a woman who may or may not be related but has community standing. Often older and provides guidance and assistance.
 
5
Māori post-neonatal mortality is 3 times that of non-Māori. Māori place considerable cultural value on bed-sharing and also have high rates of maternal smoking (53% vs 8%) (151)
 
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Metadata
Title
Barriers to equitable maternal health in Aotearoa New Zealand: an integrative review
Authors
Pauline Dawson
Chrys Jaye
Robin Gauld
Jean Hay-Smith
Publication date
01-12-2019
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2019
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-019-1070-7

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