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Inequity in timing of prenatal screening in New Zealand: Who are our most vulnerable?

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Authors:
Summary:

This study sought to determine the relative contribution of demographic factors (ethnicity, deprivation, DHB of domicile and maternal age with timing of prenatal screening, i.e. first versus second trimester) in pregnant women screened in New Zealand between 2010 and 2013. The majority (88%) of completed prenatal screens were completed in the first trimester. Ethnicity, age, deprivation and DHB were all significant predictors of completed first versus second trimester screening. In multivariate analyses, Māori women were almost 60% less likely (adjusted OR 0.37; 95% CI, 0.35 to 0.39) and Pacific women almost 80% less likely (adjusted OR 0.23; 95% CI, 0.21 to 0.24) than NZ European women to have completed first versus second trimester screening. Women aged <30 years and those living in more deprived areas were less likely to have completed first trimester screening. There was variation by DHB, with women living in Whanganui DHB less likely to have completed first versus second trimester screening than women living in Auckland (adjusted OR 0.76; 95% CI, 0.71 to 0.81). Women living in Bay of Plenty DHB were more likely to be screened in the first versus second trimester compared with women living in Auckland (adjusted OR 1.55; 95% CI, 1.38 to 1.74). In analyses adjusting for ethnicity, deprivation and maternal age, women living in Counties Manukau DHB were less likely to be screened in the first versus second trimester than women living in Auckland DHB.

Comment:
t would be good to follow these results up with further quantitative analysis but also qualitative research with women who have not received best practice care. As the authors conclude, a number of factors are at play but each should be addressed. (I also had a couple of issues with the language used – women aren’t deprived, they live in neighbourhoods of deprivation!)
Reference: Aust N Z J Obstet Gynaecol. 2017; 57(6):609-16
Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

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