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De Graaff E, Sadler L, Lakhdhir H, Simon‐Kumar R, Peiris‐John R, Burgess W, Okesene‐Gafa K, Cronin R, Mccowan L, Anderson N. Grouping women of South Asian ethnicity for pregnancy research in New Zealand. Aust N Z J Obstet Gynaecol 2023; 63:499-508. [PMID: 36285385 PMCID: PMC10952764 DOI: 10.1111/ajo.13626] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The New Zealand (NZ) Ministry of Health ethnicity data protocols recommend that people of South Asian (SAsian) ethnicity, other than Indian, are combined with people of Japanese and Korean ethnicity at the most commonly used level of aggregation in health research (level two). This may not work well for perinatal studies, as it has long been observed that women of Indian ethnicity have higher rates of adverse pregnancy outcomes, such as perinatal death. It is possible that women of other SAsian ethnicities share this risk. AIMS This study was performed to identify appropriate groupings of women of SAsian ethnicity for perinatal research. MATERIALS AND METHODS National maternity and neonatal data, and singleton birth records between 2008 and 2017 were linked using the Statistics NZ Integrated Data Infrastructure. Socio-demographic risk profiles and pregnancy outcomes were compared between 15 ethnic groups. Recommendations were made based on statistical analyses and cultural evaluation with members of the SAsian research community. RESULTS Similarities were observed between women of Indian, Fijian Indian, South African Indian, Sri Lankan, Bangladeshi and Pakistani ethnicities. A lower-risk profile was seen among Japanese and Korean mothers. Risk profiles of women of combined Indian-Māori, Indian-Pacific and Indian-New Zealand European ethnicity more closely represented their corresponding non-Indian ethnicities. CONCLUSIONS Based on these findings, we suggest a review of current NZ Ministry of Health ethnicity data protocols. We recommend that researchers understand the risk profiles of participants prior to aggregation of groups in research, to mitigate risks associated with masking differences.
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Affiliation(s)
- Esti De Graaff
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
| | - Lynn Sadler
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
- Te Toka Tumai Auckland, Te Whatu Ora HealthAucklandNew Zealand
| | - Heena Lakhdhir
- Counties Manukau District, Division of Women's Health, Te Whatu Ora ‐ HealthAucklandNew Zealand
| | - Rachel Simon‐Kumar
- The University of Auckland School of Population HealthAucklandNew Zealand
| | - Roshini Peiris‐John
- The University of Auckland Section of Epidemiology and BiostatisticsAucklandNew Zealand
| | - Wendy Burgess
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
| | - Karaponi Okesene‐Gafa
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
- Counties Manukau District, Division of Women's Health, Te Whatu Ora ‐ HealthAucklandNew Zealand
| | - Robin Cronin
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
- Counties Manukau District, Division of Women's Health, Te Whatu Ora ‐ HealthAucklandNew Zealand
| | - Lesley Mccowan
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
| | - Ngaire Anderson
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
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Soszyn N, Cloete E, Sadler L, de Laat MWM, Crengle S, Bloomfield F, Finucane K, Gentles TL. Factors influencing the choice-of-care pathway and survival in the fetus with hypoplastic left heart syndrome in New Zealand: a population-based cohort study. BMJ Open 2023; 13:e069848. [PMID: 37055204 PMCID: PMC10106067 DOI: 10.1136/bmjopen-2022-069848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES To better understand the relative influence of fetal and maternal factors in determining the choice-of-care pathway (CCP) and outcome in the fetus with hypoplastic left heart syndrome (HLHS). DESIGN A retrospective, population-based study of fetuses with HLHS from a national dataset with near-complete case ascertainment from 20 weeks' gestation. Fetal cardiac and non-cardiac factors were recorded from the patient record and maternal factors from the national maternity dataset. The primary endpoint was a prenatal decision for active treatment after birth (intention-to-treat). Factors associated with a delayed diagnosis (≥24 weeks' gestation) were also reviewed. Secondary endpoints included proceeding to surgical treatment, and 30-day postoperative mortality in liveborns with an intention-to-treat. SETTING New Zealand population-wide. PARTICIPANTS Fetuses with a prenatal diagnosis of HLHS between 2006 and 2015. RESULTS Of 105 fetuses, the CCP was intention-to-treat in 43 (41%), and pregnancy termination or comfort care in 62 (59%). Factors associated with intention-to-treat by multivariable analysis included a delay in diagnosis (OR: 7.8, 95% CI: 3.0 to 20.6, p<0.001) and domicile in the maternal fetal medicine (MFM) region with the most widely dispersed population (OR: 5.3, 95% CI: 1.4 to 20.3, p=0.02). Delay in diagnosis was associated with Māori maternal ethnicity compared with European (OR: 12.9, 95% CI: 3.1 to 54, p<0.001) and greater distance from the MFM centre (OR: 3.1, 95% CI: 1.2 to 8.2, p=0.02). In those with a prenatal intention-to-treat, a decision not to proceed to surgery was associated with maternal ethnicity other than European (p=0.005) and the presence of major non-cardiac anomalies (p=0.01). Thirty-day postoperative mortality occurred in 5/32 (16%) and was more frequent when there were major non-cardiac anomalies (p=0.02). CONCLUSIONS Factors associated with the prenatal CCP relate to healthcare access. Anatomic characteristics impact treatment decisions after birth and early postoperative mortality. The association of ethnicity with delayed prenatal diagnosis and postnatal decision-making suggests systemic inequity and requires further investigation.
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Affiliation(s)
- Natalie Soszyn
- Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Elza Cloete
- The University of Auckland Liggins Institute, Auckland, New Zealand
- Neonatal Unit, Christchurch Women's Hospital, Te Whatu Ora - Health New Zealand, Waitaha Canterbury, Christchurch, New Zealand
| | - Lynn Sadler
- Women's Health, Auckland City Hospital, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
- The University of Auckland Department of Obstetrics and Gynaecology, Auckland, New Zealand
| | - Monique W M de Laat
- Women's Health, Auckland City Hospital, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Sue Crengle
- Otago Medical School Department of Preventive and Social Medicine, Dunedin, New Zealand
| | - Frank Bloomfield
- The University of Auckland Liggins Institute, Auckland, New Zealand
| | - Kirsten Finucane
- Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Thomas L Gentles
- Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
- Faculty of Medical and Health Sciences, The University of Auckland Department of Paediatrics Child and Youth Health, Auckland, New Zealand
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Gilchrist CA, Chelimo C, Tatnell R, Atatoa Carr P, Camargo CA, Morton S, Grant CC. Vaccination information fathers receive during pregnancy and determinants of infant vaccination timeliness. Hum Vaccin Immunother 2021; 17:5214-5225. [PMID: 34797748 DOI: 10.1080/21645515.2021.1932212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The information fathers receive about infant vaccination may influence their decision to vaccinate. We describe fathers' sources of vaccination information and paternal determinants of timely infant vaccinations. Participants were from a child cohort study in New Zealand. The child cohort was established by enrolling pregnant women and their partners. During pregnancy, fathers (n = 4017) of the cohort children born 2009-2010 described information sources that encouraged or discouraged infant vaccination. The National Immunization Register provided infant vaccination data. Independent associations of the vaccination information received by fathers with the timeliness of their infant's vaccination were determined using multivariable logistic regression. Associations were described using adjusted odds ratios and 95% confidence intervals. One-third of fathers (1430/4017 [36%]) recalled receiving vaccination information, 64% of which encouraged vaccination. Most infants (2900/4017 [72%]) received all their vaccinations on time, however only 58% of Māori infants were vaccinated on time. Paternal determinants of vaccination timeliness were the father receiving discouraging or conflicting information about vaccination, father's ethnicity, father's vaccination hesitancy, and whether the mother received vaccination information. To improve vaccination uptake and timeliness, a vaccination conversation with mothers, fathers and whānau could be included in routine antenatal care, informing and supporting decision-making, and addressing concerns. Vaccination education should address present and historic distrust of the health system. Framing vaccination within a Māori model of health and including fathers and whānau in decision-making will address vaccination inequities in New Zealand.
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Affiliation(s)
- Catherine A Gilchrist
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Carol Chelimo
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Ryan Tatnell
- General Paediatrics, Starship Children's Health, Auckland, New Zealand
| | - Polly Atatoa Carr
- Growing up in New Zealand, The University of Auckland, Auckland, New Zealand.,National Institute of Demographic and Economic Analysis, University of Waikato, Hamilton, New Zealand
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Susan Morton
- Growing up in New Zealand, The University of Auckland, Auckland, New Zealand.,Centre for Longitudinal Research - He Ara Ki Mua, The University of Auckland, Auckland, New Zealand
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.,General Paediatrics, Starship Children's Health, Auckland, New Zealand.,Centre for Longitudinal Research - He Ara Ki Mua, The University of Auckland, Auckland, New Zealand
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4
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Neely E, Raven B, Dixon L, Bartle C, Timu-Parata C. "Ashamed, Silent and Stuck in a System"-Applying a Structural Violence Lens to Midwives' Stories on Social Disadvantage in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9355. [PMID: 33327578 PMCID: PMC7765080 DOI: 10.3390/ijerph17249355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 01/12/2023]
Abstract
Historical and enduring maternal health inequities and injustices continue to grow in Aotearoa New Zealand, despite attempts to address the problem. Pregnancy increases vulnerability to poverty through a variety of mechanisms. This project qualitatively analysed an open survey response from midwives about their experiences of providing maternity care to women living with social disadvantage. We used a structural violence lens to examine the effects of social disadvantage on pregnant women. The analysis of midwives' narratives exposed three mechanisms by which women were exposed to structural violence, these included structural disempowerment, inequitable risk and the neoliberal system. Women were structurally disempowered through reduced access to agency, lack of opportunities and inadequate meeting of basic human needs. Disadvantage exacerbated risks inequitably by increasing barriers to care, exacerbating the impact of adverse life circumstances and causing chronic stress. Lastly, the neoliberal system emphasised individual responsibility that perpetuated inequities. Despite the stated aim of equitable access to health care for all in policy documents, the current system and social structure continues to perpetuate systemic disadvantage.
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Affiliation(s)
- Eva Neely
- School of Health, Te Herenga Waka—Victoria University of Wellington, Wellington 6140, New Zealand
| | - Briony Raven
- Maternity Equity Action, Haumoana 4102, New Zealand;
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch 8014, New Zealand; (L.D.); (C.B.)
| | - Carol Bartle
- New Zealand College of Midwives, Christchurch 8014, New Zealand; (L.D.); (C.B.)
| | - Carmen Timu-Parata
- Ngati Kahungunu, Department of Public Health, Otago University, Wellington 6242, New Zealand;
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Dawson P, Jaye C, Gauld R, Hay-Smith J. Barriers to equitable maternal health in Aotearoa New Zealand: an integrative review. Int J Equity Health 2019; 18:168. [PMID: 31666134 PMCID: PMC6822457 DOI: 10.1186/s12939-019-1070-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/04/2019] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Pauline Dawson
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Chrys Jaye
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Otago Business School, University of Otago, Dunedin, New Zealand
- Centre for Health Systems and Technology, University of Otago, Dunedin, New Zealand
| | - Jean Hay-Smith
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
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6
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Battin M, Sadler L. Neonatal encephalopathy: How can we improve clinical outcomes? J Paediatr Child Health 2018; 54:1180-1183. [PMID: 29873135 DOI: 10.1111/jpc.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Malcolm Battin
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Lynn Sadler
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
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7
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Duncan L. Editorial - Māori's women's health in New Zealand. Aust N Z J Obstet Gynaecol 2018; 58:E21-E22. [PMID: 30288734 DOI: 10.1111/ajo.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Leigh Duncan
- Hawke's Bay Hospital, Hawke's Bay District Health Board, Hastings, New Zealand
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8
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Teixeira JA, Castro TG, Wall CR, Marchioni DM, Berry S, Morton SMB, Grant CC. Determinants of folic acid supplement use outside national recommendations for pregnant women: results from the Growing Up in New Zealand cohort study. Public Health Nutr 2018; 21:2183-2192. [PMID: 29708087 PMCID: PMC11106014 DOI: 10.1017/s1368980018000836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/14/2018] [Accepted: 03/06/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the sociodemographic and lifestyle factors associated with insufficient and excessive use of folic acid supplements (FAS) among pregnant women. DESIGN A pregnancy cohort to which multinomial logistic regression models were applied to identify factors associated with duration and dose of FAS use. SETTING The Growing Up in New Zealand child study, which enrolled pregnant women whose children were born in 2009-2010. SUBJECTS Pregnant women (n 6822) enrolled into a nationally generalizable cohort. RESULTS Ninety-two per cent of pregnant women were not taking FAS according to the national recommendation (4 weeks before until 12 weeks after conception), with 69 % taking insufficient FAS and 57 % extending FAS use past 13 weeks' gestation. The factors associated with extended use differed from those associated with insufficient use. Consistent with published literature, the relative risks of insufficient use were increased for younger women, those with less education, of non-European ethnicities, unemployed, who smoked cigarettes, whose pregnancy was unplanned or who had older children, or were living in more deprived households. In contrast, the relative risks of extended use were increased for women of higher socio-economic status or for whom this was their first pregnancy and decreased for women of Pacific v. European ethnicity. CONCLUSIONS In New Zealand, current use of FAS during pregnancy potentially exposes pregnant women and their unborn children to too little or too much folic acid. Further policy development is necessary to reduce current socio-economic inequities in the use of FAS.
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Affiliation(s)
- Juliana A Teixeira
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
| | - Teresa G Castro
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Clare R Wall
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
- Discipline of Nutrition and Dietetics, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Sarah Berry
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
| | - Susan MB Morton
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
| | - Cameron C Grant
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Starship Children’s Hospital, Auckland District Health Board, Auckland, New Zealand
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9
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Gould GS, Patten C, Glover M, Kira A, Jayasinghe H. Smoking in Pregnancy Among Indigenous Women in High-Income Countries: A Narrative Review. Nicotine Tob Res 2017; 19:506-517. [PMID: 28403465 PMCID: PMC5896479 DOI: 10.1093/ntr/ntw288] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 02/08/2017] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Pregnant women in socioeconomically disadvantaged circumstances, such as Indigenous women, have a high prevalence of smoking. Tobacco smoking is the most significant reversible risk factor for the health of Indigenous pregnant women and their babies. METHODS As researchers working in this specialized area, we conducted a narrative review of the literature on smoking among Indigenous pregnant women in the United States, Canada, New Zealand, and Australia. We summarize prevalence and factors influencing tobacco use, interventions, and evidence gaps for tobacco control and smoking cessation. Recommendations are made for future interventions, policy changes, and much-needed research. RESULTS Common themes emerging across the four countries reveal opportunities for cross-cultural collaborative studies and trials. These include the social-normative use of tobacco as barriers to quitting in pregnancy and the need for evaluations of interventions at the family and community level. Socioeconomic disparities underscore the importance of enhancing the implementation and reach of strategies to prevent and reduce prenatal tobacco smoking among Indigenous women. Elders and community health care providers as role models for nontobacco use could be explored. Qualitative work is needed to understand the barriers and opportunities, such as cultural strengths supporting quitting tobacco to develop more effective approaches. CONCLUSIONS Although a high-priority group, there remains a dearth of research on Indigenous women's smoking in pregnancy. Studies have assessed knowledge and attitudes to smoking in pregnancy, and small feasibility studies and a few empirical trials have been conducted. Recommendations for promising culturally appropriate cessation interventions have been made. Larger trials are warranted. IMPLICATIONS Strategies to support quitting among pregnant Indigenous women need to be multifactorial and take account of the social determinants of smoking including historical antecedents, community norms, cultural strengths, and recognition of individual and community needs. Cross-country research collaborations have the potential to leverage funding, share expertise, and strengthen approaches to tackle an important and poorly attended health disparity that has a profound impact on the entire life course for Indigenous peoples.
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Affiliation(s)
- Gillian S Gould
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Marewa Glover
- School of Public Health, College of Health, Massey University, Auckland, New Zealand
| | - Anette Kira
- Independent Researcher, Manawatu, New Zealand
| | - Harshani Jayasinghe
- University of Adelaide, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
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10
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Bartholomew K, Morton SMB, Atatoa Carr PE, Bandara DK, Grant CC. Provider engagement and choice in the Lead Maternity Carer System: Evidence from Growing Up in New Zealand. Aust N Z J Obstet Gynaecol 2015; 55:323-30. [PMID: 26172320 DOI: 10.1111/ajo.12319] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 01/04/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND New Zealand (NZ) has a unique choice-based model of maternity care. AIMS To examine how engagement in antenatal care and choice of Lead Maternity Care provider (LMC) vary with maternal demographics. MATERIALS AND METHODS Our sample consisted of 6822 women enrolled during 2009 and 2010 into a longitudinal cohort study Growing Up in New Zealand. We asked if women had engaged a LMC, the type of LMC and whether they had a choice of LMC. Associations with maternal ethnicity, age, parity and education and household deprivation were determined. RESULTS Ninety-eight per cent of women had engaged a LMC provider. Twelve per cent reported not experiencing choice and 11% not receiving their first choice of LMC provider. The reported LMC provider type was independent midwife (66%), hospital midwife (15%), private obstetrician (8%), shared midwife and general practitioner (GP) (5%) and GP-only care (<1%). LMC provider type and choice varied with maternal demographics. Women not engaging a LMC were more likely to be non-European, <20 years or >40 years old, with poorer educational attainment, or living in more deprived households. Women not experiencing choice of provider were more likely to be non-European, <20 years old, or living in more deprived households. CONCLUSIONS The current unequal distribution of provider engagement and choice in NZ has relevance for a number of specific maternity policies, including policies seeking to improve engagement in antenatal care. The study findings have international relevance as an example of the impact of choice policies on equity.
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Affiliation(s)
- Karen Bartholomew
- Centre for Longitudinal Research - He Ara ki Mua, Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand.,School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand.,School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Polly E Atatoa Carr
- Centre for Longitudinal Research - He Ara ki Mua, Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand.,Waikato Clinical School, The University of Auckland, Auckland, New Zealand
| | - Dinusha K Bandara
- Centre for Longitudinal Research - He Ara ki Mua, Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand.,Waikato Clinical School, The University of Auckland, Auckland, New Zealand
| | - Cameron C Grant
- Centre for Longitudinal Research - He Ara ki Mua, Growing Up in New Zealand, The University of Auckland, Auckland, New Zealand.,Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.,Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
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