The Chairperson of the Health Committee is calling for submissions on the Pae Ora (Healthy Futures) (3 Day Postnatal Stay) Amendment Bill.
This bill seeks to address the needs of women who have just given birth to access their choice of post-natal care for a minimum of 72 hours if desired. It also requires the Lead Maternity Carer to let the mother know what she is eligible for. In addition, it allows for mothers to stay for longer than 72 hours if the need arises.
Submission of Speak Up for Women
February 16th 2025
Speak Up for Women (SUFW) is an advocacy group seeking to ensure sex-based rights for women and girls in New Zealand.
We welcome the opportunity to submit on the Pae Ora (Healthy Futures) (3 Day Postnatal Stay) Amendment Bill.
The Pae Ora (Healthy Futures) Amendment Bill, particularly the provision for a 3-day postnatal stay, is a significant step towards recognising and addressing the unique needs of women who have recently given birth. From a feminist standpoint, this amendment is a commendable effort to ensure that the health system is equitable and responsive to the needs of New Zealand women.
We agree with the reasons for the proposed Amendment Bill as set out in the general policy statement:
“Women are not making informed choices about post-natal care and the first 48 to 72 hours are critical to ensure that mothers form a loving attachment to their baby. Women are currently entitled to up to 48 hours of funded inpatient post-natal care, but many women don’t realise this and at times are pressured to leave early.”
We strongly agree with the “mandatory requirement for mothers to be advised of their choices by the Lead Maternity Carer”. In fact, we were surprised to learn that this wasn’t already the case.
POSTPARTUM PHYSICAL AND MENTAL HEALTH
Of prime importance to us is that the extension of the postnatal stay to three days acknowledges the period immediately following childbirth which is so crucial for the mother’s physical recovery and her mental and emotional well-being. The extended stay allows for better monitoring of postpartum complications for both mother and baby. It also provides an opportunity for healthcare professionals to offer support and education on infant care, breastfeeding, and postpartum mental health.
The Best Practice Advocacy Centre provides some helpful context for our submission:
Studies in New Zealand using the Edinburgh Postnatal Depression Scale (EPDS, Appendix 1) have reported rates of postnatal depression of 8-13%.
Postnatal depression is a significant issue because of its impact on the health and well-being of mothers, partners, children and relationships.
Postnatal depression is associated with a reduced likelihood of bonding between the mother and infant as well as impaired cognitive and emotional development of the infant, especially in areas of socioeconomic deprivation.
Suicide is a concern in women with mental health disorders in the postnatal period. In the developed world, suicide is now the main cause of maternal death [emphasis added] in the first year after childbirth, mainly due to relapse of serious mental illness.
Early detection and collaborative management can significantly improve health outcomes for both the mother and infant.
Māori women appear to be at higher risk of postnatal depression than European women in New Zealand.
The overall rate of postnatal depression in Pacific peoples is at the upper end of previously reported rates in the general population.
The nature of the bonding between the mother and infant influences childhood neurodevelopment. Maternal nurturing and attention during the first postnatal year appears to be critical for optimal infant brain development.
The early postpartum checks provide an opportunity for practitioners to screen and identify most cases of postnatal depression.
And change is needed urgently. The 2020 report of the Perinatal and Maternal Mortality Review Committee states that in the period from 2006-2020 suicide was the largest single cause of maternal death in Aotearoa New Zealand, with wāhine Māori having both the highest number of deaths and highest rate of death due to suicide over this period. That is a shocking statistic attributed to wider issues of poverty, housing, employment and institutional racism, requiring not only individual interventions but also a systems-level response.
For all that we are getting right, the fact that the leading cause of maternal death in the developed world is suicide, and it seems New Zealand is no exception, is an indictment on the ‘care’ we are offering new vulnerable mothers. We support any initiatives to increase women’s access to healthcare, and we believe that this extra entitlement will play a significant role in the strengthening of the physical and mental health of both mother and baby. But we do wonder if this bill goes far enough.
EQUITABLE MATERNAL HEALTHCARE
The amendment bill aligns with the principles of the Pae Ora (Healthy Futures) Act, which aims to reduce health disparities and promote equity. Women, particularly those from marginalized communities, often face significant barriers to accessing healthcare. By ensuring a longer postnatal stay, the amendment helps to bridge the gap in healthcare access and provides a more supportive environment for new mothers.
However, there are real barriers still to overcome. A 2019 review identified six integrated factors as barriers to equitable maternal health in Aotearoa New Zealand: Physical Access, Political Context, Maternity Care System, Acceptability, Colonialism, and Cultural factors. “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 [emphasis added]. A complex set of underlying structural and systemic factors, such as institutionalised racism, serve to act as barriers to equitable maternity outcomes and experiences.”
Contributing to that, is the state of our midwifery services. According to the Health Workforce Taskforce Report of 2023, despite its role in the health system, midwifery is understaffed by 40% and, “New Zealand needs to triple the number of midwives it trains for four years [emphasis added] to address the current workforce deficit - and even then it will not close the gap until 2031, when they all graduate.” This seems to us an unacceptable and dangerous situation for New Zealand women.
INFORMED CHOICE
The feminist perspective emphasises the importance of autonomy and informed choice in healthcare. The option of an extended postnatal stay empowers women to make informed decisions about their health and the health of their newborns. It also fosters a sense of agency and control, which is essential for building trust in the healthcare system.
CONCLUSION & RECOMMENDATIONS
The Pae Ora (Healthy Futures) (3 Day Postnatal Stay) Amendment Bill is a progressive move towards a more equitable and supportive healthcare system. It recognizes the unique needs of postpartum women and takes a step towards reducing health disparities. From a feminist perspective, this amendment is a positive development that promotes the well-being and autonomy of women in New Zealand. Below are our recommendations.
CONCERN #1: RESOURCING - While we support this bill wholeheartedly and agree with the aim of improving healthcare for women and babies at this crucial time, we have the same concerns as Dr Ayesha Verrall at the first reading; that women are already being pressured to leave hospital early and resourcing could be an issue.
RECOMMENDATION - Assess the resources available in order to avoid this bill failing as a well-meaning but hollow gesture.
CONCERN #2: SCOPE - We are concerned this bill doesn’t go far enough.
RECOMMENDATIONS - Increasing mental health safety nets and encouraging midwives to join, and remain in, our health system would support the changes this bill in essence wants to achieve.
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