Obese, smok­ing and preg­nant

Waikato Times - - Front Page - RUBY NYIKA

Three poor ru­ral towns are home to some of the most vul­ner­a­ble preg­nant women in the coun­try.

And one point of that cen­tral North Is­land tri­an­gle is es­pe­cially wor­ry­ing.

In Tau­marunui, 70 per cent of preg­nant women are over­weight or obese.

Waikato DHB re­search shows the pro­por­tion of preg­nant women clas­si­fied as obese or over­weight in the three towns – Tau­marunui, Toko­roa and Te Kuiti – ranges from 50 to 70 per cent.

And that’s not the only star­tling statis­tic – one in two smoke dur­ing preg­nancy, more than three times the national av­er­age.

Smok­ing and obe­sity dur­ing preg­nancy can cause a range of health com­pli­ca­tions for moth­ers and ba­bies.

Poverty is a big part of the prob­lem, Tau­marunui mid­wife Karen Walker said.

‘‘We have a re­ally high depri­va­tion score,’’ Walker said. ‘‘We have a high num­ber of peo­ple with ad­di­tional risk fac­tors for things like obe­sity, smok­ing . . . [moth­ers] are at risk of hav­ing growth-re­stricted ba­bies.’’

Walker said ma­ter­nity ser­vices are dys­func­tional and too lim­ited for such a vul­ner­a­ble com­mu­nity.

Preg­nant women liv­ing in high-depri­va­tion ar­eas in gen­eral are more likely to be obese and smoke.

A sur­vey by the Waikato DHB found 66 per cent of Tau­marunui chil­dren live in con­di­tions con­sid­ered to be at the high­est depri­va­tion lev­els, com­pared with 25 per cent in the Waikato DHB dis­trict over­all.

There isn’t enough sup­port or ed­u­ca­tion and mid­wives are stretched too thin, Walker said.

‘‘These women don’t know what they don’t know . . . It puts us mid­wives in a pre­car­i­ous po­si­tion be­cause we can preach un­til the cows come home, but peo­ple don’t have the means.

‘‘It cer­tainly cre­ates an anx­i­ety and a pres­sure to us mid­wives. There are only two of us [in Tau­marunui]. It’s al­most that [the sys­tem is] set up to fail.’’

Dr Tim Mal­loy, Royal New Zealand Col­lege of Gen­eral Prac­ti­tion­ers pres­i­dent, said Ma¯ori liv­ing in iso­lated ru­ral ar­eas were par­tic­u­larly at risk for health com­pli­ca­tions so need more help.

‘‘Most of us go to a great deal of trou­ble to try to en­sure that we act and pro­vide our ser­vice in a man­ner that is cul­tur­ally sen­si­tive to the needs of Ma¯ori, in par­tic­u­lar,’’ Mal­loy said.

Typ­i­cally, re­mote ru­ral ar­eas have a higher pop­u­la­tion of Ma¯ori than ur­ban ar­eas. Tau­marunui is a case in point with a Ma¯ori pop­u­la­tion of over 47 per cent, ac­cord­ing to a 2013 cen­sus.

‘‘If we are to ad­dress the is­sues of equity in health care, then we have to ad­dress the is­sues of ac­cess for vul­ner­a­ble com­mu­ni­ties.

‘‘Iso­la­tion is just one of the is­sues. Poverty is an­other.’’

Ser­vices are of­ten hours away and too ex­pen­sive to get to, Mal­loy said.

‘‘You have to com­mit the whole day to your 15-minute ap­point­ment. But guess what? It doesn’t hap­pen.’’

Women miss out on ba­sics like get­ting their stom­achs checked and blood pres­sure checked, let alone ser­vices for smok­ing ces­sa­tion or obe­sity.

‘‘It places them at higher risk of a num­ber of out­comes, in­clud­ing pre­ma­ture labour and other com­pli­ca­tions.’’

But the Waikato DHB has recog­nised the prob­lem, spokes­woman Jill Dibble said.

‘‘The ma­ter­nity ser­vices in the South [Waikato] have been frag­ile,’’ Dibble said. ‘‘What we want to cre­ate is an ac­cess point for preg­nant women and their fam­i­lies. Ser­vices that are going to serve them over a longer pe­riod of time . . . We’ve got a longert­erm view.’’

The DHB will fo­cus on ad­dress­ing Ma¯ori health in­equal­i­ties and cre­at­ing an in­te­grated ma­ter­nity hub for the three prob­lem towns by adopt­ing a lead ma­ter­nity carer model (LMC).

Te Kuiti’s birthing unit will close due to lack of use. Money will be rein­vested back into pro­vid­ing closer and more ac­ces­si­ble sup­port ser­vices for all three towns and up­grad­ing fa­cil­i­ties in Toko­roa and Tau­marunui.

‘‘They’re pretty tacky . . . [We’ll] make them a more pleas­ant place to be.’’

The three com­mu­ni­ties will play a part in de­ter­min­ing what those changes will look like, with con­sul­ta­tions to be­gin in Novem­ber.

The process is ex­pected to take about 18 months from con­sul­ta­tion to im­ple­men­ta­tion.

‘‘Iso­la­tion is just one of the is­sues. Poverty is an­other.’’ Dr Tim Mal­loy Pres­i­dent of Royal New Zealand Col­lege of Gen­eral Prac­ti­tion­ers,

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