Taumarunui peaks in smoking and obese pregnant women
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.
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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, president of Royal New Zealand College of General Practitioners, said Māori people living in isolated rural areas were particularly at risk for health complications and therefore 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 Māori, in particular," Malloy said.
Typically, remote rural areas have a higher population of Māori than urban areas. Taumarunui is a case in point: has a Māori 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 longer-term view."
The DHB will focus on addressing Māori 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.