Jean Te Huia says pregnant women with no fixed abode have been known to "rock up to A and E and sit there for hours and hours" to access care. Photo / Paul Taylor
Jean Te Huia says pregnant women with no fixed abode have been known to "rock up to A and E and sit there for hours and hours" to access care. Photo / Paul Taylor
Pregnant Hawke's Bay women living in emergency accommodation and social housing are struggling to access antenatal care until after their critical first trimester.
The inequities already present in the health system compound themselves when women fall pregnant with no fixed abode, says Jean Te Huia, a Hastings-based midwife with closeto 30 years' experience.
The women she's seen are struggling to get GPs because of a significant shortage of them in the region.
On top of that, they have higher acute health needs than the general population.
And crucially, under the current midwifery scope of practice, midwives are unable to apply for funding to provide maternal care to them until women are 12 weeks pregnant.
This funding model is set to change in November, much to Te Huia's relief, but it's come too late for some women, she says.
A recent study by Dr Brodie Fraser, a research fellow at the university's He Kainga Oranga - the Housing and Health Research Programme, found homeless women had "distinct, more acute healthcare needs", particularly in relation to maternity care.
NO_FIXED_ABODE
Homeless women don't just go to the hospital more often because they have a higher average number of children - each birth hospitalises them at a higher rate than the average woman, Fraser said.
"They are not simply seeing more maternal hospitalisations than the [estimated resident population] because they have a higher number of children— each birth, on average, sees them hospitalised at a higher rate than for [estimated resident population] women."
The region's housing crisis has exacerbated health inequities for women and children, Te Huia said.
"People ask why these women keep having babies if they can't afford to ... if they're living in shelters and emergency housing.
"It's because there's no access to free contraception."
She said without a fixed abode many women were unable to enrol in GP clinics where they could access alternative antenatal care or other health services.
Even those that were registered might experience long wait times or have trouble getting an appointment - this also limited the women's ability to access termination of pregnancy services, she said.
Jean Te Huia says inequities in the health system are exacerbated by Hawke's Bay's housing crisis. Photo / Paul Taylor
"Their alternative is to rock up to A & E and sit there for hours and hours to be served."
Neville Saunders, medical centre manager of The Doctors in Hastings, Gascoigne and Waipawa, said his clinic was one of the centres that would take on people who weren't enrolled at the practice.
He said if a pregnant woman came into the clinic they'd check to see if she was enrolled, directing her to the clinic where she was enrolled in the first instance, otherwise offering services themselves.
"It costs nothing for that person," he said. "If they presented here we are able to see that person."
He said the problem was many women might not know that or where to go.
Due to a shortage of GPs across the country, other clinics might not be able to offer the same service, he said.
Neville Saunders, medical centre manager of The Doctors in Hastings, Gascoigne and Waipawa, said his clinic would people who weren't enrolled at the practice, including pregnant women. Photo / NZME
Phillipa Blakey, chief executive of Health Hawke's Bay, the region's public health organisation, said she was aware that it could be hard for people to find a general practice they can enrol with, due to the workforce shortages.
"People with the added challenges associated with homelessness may find this even more difficult.
"But it is important to note that there are practices accepting new patients that are not enrolled in other practices."
She encouraged people, particularly pregnant women, who are not enrolled with a general practice to seek enrolment with one of these practices.
New Zealand College of Midwives midwifery adviser Lesley Dixon said it had been working alongside the Ministry of Health and had been trying to encourage women to book earlier in pregnancy.
"Often, women who are living in economic deprivation will be late in registering for care because there are access issues. When they do they might find their midwives are unavailable."
Midwives providing care for homeless women also had to provide additional social services such as letter writing and filling out forms, she said.
The changes to Section 88 of the New Zealand Public Health and Disability Act (2000), which come into effect from November 29, would establish more equitable funding arrangements to address this work and provide more equitable care for women living in "difficult circumstances".
