Inequities in pre-pregnancy folic acid use in Central and South Auckland: secondary analysis from a postpartum contraception survey.

Introduction In Aotearoa New Zealand (NZ), there is inequity in rates of neural tube defects (NTDs). Among Maaori, NTD occur in 4.58/10 000 live births, and for Pacific peoples, it is 4.09/10 000 live births; this is compared to 2.81/10 000 live births for non-Maaori, non-Pacific peoples. Aim To describe self-reported pre-pregnancy folic acid supplementation and to determine the association between pregnancy intendedness, ethnicity, parity, maternal age, care provider and pre-pregnancy folic acid supplementation. Methods Secondary analysis of postpartum survey data collected at Te Whatu Ora Te Toka Tumai and Counties Manukau birthing facilities in 2020 was conducted. Descriptive analyses explored pregnancy intendedness and self-reported folic acid use by demographic variables. Multivariable logistic regression explored independent associations between demographic variables and folic acid use among intended pregnancies. Results In total, 398 participants completed the survey. The response rate was (140/149) 94% at Counties Manukau and (258/315) 82% at Te Toka Tumai. Pre-pregnancy supplementation was reported by 182 of 398 participants (46%). Use was higher among those who intended their pregnancy (151/262, 58%) compared to those who were 'pregnancy ambivalent' (9/33, 27%) or did not intend to become pregnant (22/103, 21%). Factors independently associated with supplementation among intended pregnancies included: 'Other ethnicity' (European, Middle Eastern, Latin American, African) compared to Maaori (aOR 5.3 (95% CI 1.3, 21.8)), age ≥30 years compared to Discussion Low rates of pre-pregnancy folic acid supplementation exist in Auckland with significant ethnic disparity. Mandatory fortification of non-organic wheat is important, but supplementation is still recommended to maximally reduce risk.

Pregnancy planning and barriers to accessing postnatal contraception in New Zealand.

OBJECTIVE: To estimate rates of pregnancy and contraceptive planning and to identify barriers and enablers to postnatal contraceptive use. STUDY DESIGN: Face-to-face survey of patients during their immediate postnatal stay at Middlemore Hospital, Auckland, or associated primary birthing units. Patients were approached by study investigators over designated 2-week study periods in 2019 and 2020. The primary outcome was the rate of pregnancy and contraceptive planning. The descriptive analysis explored differences between ethnicities. RESULTS: We were able to approach 332 of 497 eligible women (67%), and 313 of 332 (94%) of those who approached completed the survey. Fifty-three percent of pregnancies were reported to have been planned. Pregnancy was more often planned by European (72%), Indian (68%), and Other Asian patients (72%) compared with Maori (33%) and Pacific patients (39%) (p < 0.001). Thirty-seven percent of patients reported an antenatal contraceptive discussion, and these were more commonly reported by Maori and Pacific patients (p < 0.001). A quarter of patients reported never having a conversation about contraception during or immediately after pregnancy, a third of whom said they would have valued one. Fifty-nine percent of patients reported having made a contraceptive plan immediately after birth. Concern about the side effects of contraception was a barrier reported by 51% of patients. Cost, travel, finding time, and family views were less frequent barriers. CONCLUSION: Rates of pregnancy planning reported postnatally are consistent with previous NZ research at approximately 50%, and we also found ethnic differences. Concerns about side effects were the most significant barrier for patients accessing contraception and this needs to be addressed in a culturally useful format. IMPLICATIONS: Postpartum patients report low rates of pregnancy planning. A significant proportion of postpartum patients report having no conversations about contraception with clinicians, and concerns about side effects are their most common barrier to contraception.