The long game
In an exciting new phase in its development, the University of Otago, Wellington Women's Health Research Centre is embarking on a strategy to ensure its future sustainability.
Founded in 2005 by internationally-regarded expert in women's health Dr Bev Lawton, the University of Otago, Wellington (UOW) Women's Health Research Centre is dedicated to improving the health outcomes of New Zealand's women and children through life-saving research and initiatives.
It has an outstanding track record, with $7 million of project funding achieved in the last five years. But the nature of that funding means there can be “stumbling times” between projects, Lawton says, and the centre is exploring ways to help continue to build momentum and give the centre – and its staff – more certainty.
“It's about future-proofing. We are the only centre of our kind in New Zealand dedicated to women's health research into issues that matter to women and families.
"We've gained terrific momentum that we want to maintain and build on to ensure we can continue to have an impact, and achieve our mission of making a real difference to the health of mothers and babies.”
That momentum has been created through work that aims to reduce inequalities and health-care disparities for women, with a particular focus on Māori health.
“By focusing on those mothers and children with the greatest disadvantage, we are more likely to find solutions to improve the health of all women and children,” Lawton explains.
The essence of the centre's work is captured in its motto: “Healthy women, health mothers, healthy children, healthy communities”. Already it has the unwavering support of former Governor-General Dame Silvia Cartwright, who has been patron since the centre's inception and an integral part of its support networks since then. Now the centre is enjoying the added experienced leadership of Emerita Professor Dame Linda Holloway as chair of its recently established advisory board, and former Wellington mayor and midwife Kerry Prendergast who has become a board member.
Through the support of this committed trio, the centre is beginning to strategise on ways to establish central funding that will counteract the intermittent uncertainty that goes hand-in-hand with being solely project-funded.
Having spent 25 years as a practising midwife, Prendergast knows just how important a pregnant woman's health is in the months before conception and throughout the pregnancy.
“I am honoured to have been asked to help smooth out the lumpiness in project-type funding for the centre. The research being done by this group will have huge benefits for women and children's health, particularly Māori families' health, and therefore will benefit society immensely – both in New Zealand and offshore,” she says.
“This is a cause which many wealthy benefactors will support and our job will be the pursuance of them. I welcome that challenge.”
Some of the centre's fundraising efforts will also be targeted at the general public: for example, through a website invitation to become a “friend” of the centre.
Lawton believes women will be interested in supporting the work of the centre, much of which is focused on systems and clinical outcomes and what can be done to improve them.
“I think a lot of women want us to be sitting there putting the microscope on the system. We're seeing exactly what's happening and how we can improve it. We're not in there just to do the data collection; we're in there to make the data make a difference – to translate it into a better service, that's accessible for people. People are really engaged with making maternal and infant health better, and our hope is that they'll see support of our centre as a very real and effective way to help achieve that.”
While the centre's focus is on the continuum of health and wellness, from reproductive health to pregnancy and childbirth, to infant and child health, its overarching principal is taiahoahotia. Taiahoahotia is a whakataukī (proverb) gifted to the centre that says: “E Hine, taiahoahotia tōku ara i te pō” (Hineteiwaiwa, illuminate my pathway through the night). Hineteiwaiwa is the goddess of childbirth and has kaitiaketanga (guardianship) over wāhine (women) and me ngā pēpi (babies). She is also the goddess of the moon.
“This whakataukī guides our vision of illuminating those areas of Māori maternal and child health that require investigation, understanding and appropriate intervention to benefit Māori women, their children and whānau,” Lawton says.
“Our job is to show the pathway to improve the outcomes – it's our responsibility to make a difference and our whakataukī has been an amazing driving force in doing this.”
Lawton reiterates that, although the centre has a particular focus on Māori health, its bigger aim is to reduce inequalities and health-care disparities for all women, maternity and otherwise.
“In New Zealand we need to look very carefully at the performance of our maternity system. But we also want to improve the health outcomes for everyone – to get it right where it's not working.”
To date, the centre's work on sexual and reproductive health has been widely reported and has contributed to policy changes. Phase one and two of its study of severe acute maternal morbidity (SAMM), for example, looked at severely ill pregnant women to explore how severe harm can be prevented. The review of 98 cases of SAMM in four District Health Board regions found most were either preventable or improvement in care was needed. This study has now gone national. Meanwhile, the centre's current E Hine study involves qualitative research with young pregnant Māori (under 20), and is creating new knowledge about maternal-care pathways that contradict commonly held views about Māori accessing delayed maternity care.
“It's about finding the gaps and problems in the systems, processes and providers available so we can create a systemic long-term impact for all women in New Zealand,” Lawton says.
The Women's Health Research Centre works on projects with the greatest impact for women in New Zealand. It focuses on the systems, clinical issues and processes, and providers available in New Zealand to find the gaps and problems, in order to create a systemic long-term impact.
Current projects include:
Wāhine Hauora: Reducing barriers to care for pregnant mums and their whānau
Routinely collected hospital data pertaining to births over a 15-year period is being studied and linked (via NHI) to national databases to assess rates of post-natal admissions, immunisations and access to health services for Māori and non-Māori mothers and infants. Differences in outcome measures will be analysed to identify possible explanatory factors such as maternal age, parity, deprivation, smoking and a range of other risk factors. By identifying women most at risk for poor maternal and infant health outcomes, interventions can be better targeted to reduce these inequalities.
E Hine: Reducing barriers to care for pregnant Māori women under 20 and their infants
This qualitative research will identify barriers to, and facilitators of, appropriate health care and wellness, and examine the social, economic and policy factors that may impact on health outcomes. The findings will inform policy and, together with results of the Wāhine Hauora study above, will provide essential information for the design of an appropriate whānau ora intervention to improve health outcomes (reduced mortality and disability) for Māori infants.
Diabetes: the impact of maternal care disparities on Māori mothers and their infants
This study will explore whether Māori women diagnosed with gestational diabetes, and their babies, are more likely to have adverse outcomes than non-Māori and non-Pacific women.
Severe Acute Maternal Morbidity – phase three (national)
This research builds on regional work already undertaken, and will explore how maternal morbidity and mortality can be greatly reduced through changes to clinical and system factors.
Photo: Michael Roberts