A report from NZIER has confirmed that urgent changes are needed to funding for community midwives in order to address health and pay inequities.
The report, “Sustainable midwifery: Supporting improved wellbeing and improved equity” comes in the days following a landmark pay equity decision for Canadian midwives.
Released today (Thursday 5 March), the NZIER report identifies that the current funding model is not fit for purpose and needs an overhaul. It confirms the College’s concerns that community midwives pay fails to remunerate them sufficiently for the work they do.
Chief Executive of the College, Alison Eddy, says midwives now have definitive economic evidence to support their position.
“The report shows that due to the needs of mothers, midwives are working 17–26% more than a full-time equivalent role, and that role is now far more complex than it was,” she says. “However, the issues we have been consistently raising are not only about remuneration. It was essential for us to show how effective New Zealand’s midwifery-led maternity system is in providing significant health gains to women and babies in terms of improved outcomes and cost effectiveness (when properly funded), and this report undeniably does that.”
Ms Eddy says communicating this to bureaucrats and politicians over the years, has been challenging.
“How effective we are at our jobs is linked to how invisible we are,” she says. “Midwives just get on and do the work – important and specialised work, and that can make it difficult for decision makers and those who sign off funding, to understand exactly what we do.”
The NZIER report clearly shows that more targeted funding needs to be put into community midwifery so women with greater needs can get the care they need.
“Midwives provide a personalised healthcare service which lowers barriers for parents, and relieves pressure on hospitals. We are constantly in homes and communities across the country.
When you see that the rate of perinatal mortality (the death of a baby in the weeks preceding or following birth), is 34% higher in the most-deprived neighbourhoods, it’s evident we must resource midwives appropriately so they can reach those women,” says Ms Eddy.
The report also says properly resourcing midwives will aid the retention of the workforce and support the recruitment of new midwives.
A parliamentary breakfast was held in Wellington this morning to celebrate the International Year of the Midwife.
The College’s Media Kit is available here
NOTE: There are two different ways in which midwives are employed / paid:
• Hospital/birthing unit midwives are employed by DHBs and privately owned birthing units. Most are contracted under the DHB MECA. These can be referred to as “core” midwives when they work in DHBs.
• Lead Maternity Carer midwives (LMCs) also known as community-based midwives, work in small group practices and are publicly funded under the Section 88 Primary Maternity Services Notice (legislative mechanism). These midwives are fully funded by the Government and unable to charge co-payments (anything extra / additional) for the midwifery services they provide. They attend women in all locations for labour and birth, including hospital, and provide pregnancy and postnatal care in women’s homes and clinic rooms.
An appropriate number of both hospital and community midwives are needed for the maternity service to work well for women and whānau. When there are shortages in one area, this will impact on the other.
For example, if there is a shortage of community LMC midwives, DHB services pick up the care for women who are unable to access a midwife, which stretches hospital midwives.
When there is a shortage of hospital midwives, community LMC midwives may find it challenging to get the additional support they need in hospital when they are caring for women during labour and birth. The workforces are symbiotic.
Both groups have been subject to gender discrimination and historic undervaluation.
Employed midwives are undergoing a formal structured pay equity process as a result of the MECA settlement earlier this year. (MECA = Multi Employer Collective Agreement). The majority of these midwives are members of MERAS (the Midwives Union).
Self-employed community LMC midwives, represented by the College of Midwives, have been in negotiations with the Ministry of Health for over 4 years to resolve fair and reasonable pay issues, following a court case taken by the College in 2015 against the Crown, alleging discrimination on the basis of gender under the Human Rights Act.
The Ministry apologised to the College in 2018 at their conference in Rotorua.
Keriana Brooking, Ministry of Health Deputy Director of Service Commissioning, is speaking.
On the video: In at 17’30” for apology
In at 19’36” MoH commitment made, dates have passed
24 February 2020:
“Human Rights Tribunal of Ontario orders government to end gender pay gap for midwives”
Refer to Canadian case here