Maternal socio-economic disadvantage in Aotearoa New Zealand and the impact on midwifery care

on 25 February 2021

Dixon L, Neely E, Eddy A, et al (2020), New Zealand College of Midwives Journal vol 56, December 2020, pp 26-34.


Maternal socio-economic disadvantage affects the short- and long-term health of women and their babies, with pregnancy being a particularly vulnerable time.


The aim of this study was to identify the key factors that relate to poverty for women during pregnancy and childbirth (as identified by midwives), the effects on women during maternity care and the subsequent impact on the midwives providing that care.


Survey methodology was used to identify Aotearoa New Zealand midwives' experiences of working with women living with socio-economic disadvantage.


A total of 436 midwives (16.3%) who were members of the New Zealand College of Midwives responded to the survey, with 55% working in the community as Lead Maternity Care midwives, or caseloading midwives, and the remainder mostly working in maternity facilities. The survey results found that 70% of the cohort of midwives had worked with women living with whānau (family) /friends; 69% with women who had moved house during pregnancy due to the unaffordability of housing; 66% with women who lived in overcrowded homes; and 56.6% with women who lived in emergency housing, in garages (31.6%), in cars (16.5%) or on the streets (11%). The cohort of midwives identified that women's non-attendance of appointments was due to lack of transport and lack of money for phones, resulting in a limited ability to communicate. In these circumstances these midwives reported going to women's homes to provide midwifery care to optimise the chances of making contact. The midwives reported needing to spend more time than usual referring and liaising with other services and agencies, to ensure that the woman and her baby/ family had the necessities of life and health. This cohort of midwives identified that women's insufficient income meant that midwives needed to find ways to support them to access prescriptions and transport for hospital appointments. The midwives also indicated there was a range of social issues, such as family violence, drugs, alcohol, and care and protection concerns, that directly affected their work.


Recognising the impact of socio-economic disadvantage on maternal health and wellbeing is important to improving both maternal and child health. This cohort of midwives identified that they are frequently working with women living with disadvantage; they see the reality of women's lives and the difficulties and issues they may face in relation to accessing physical and social support during childbirth. (Author)

Find out more about the research here.

Search pack of the month

P44 Poverty and socioeconomic factors | (493) abstracts 

This search pack contains information on the effects of low income, employment status and educational achievement on maternal health outcomes. Excludes homelessness (see search pack MS25). 

Find this literature search and more here.

Maternity and Infant Care (MIC) Database 

When you subscribe to MIDIRS you can get all of our literature search packs in the Maternity and Infant Care (MIC) database. Subscribe today to receive access and MIDIRS Midwifery Digest here.