Provider engagement and choice in the Lead Maternity Carer System: Evidence from Growing Up in New Zealand

Aust N Z J Obstet Gynaecol. 2015 Aug;55(4):323-30. doi: 10.1111/ajo.12319. Epub 2015 Jul 14.


Background: New Zealand (NZ) has a unique choice-based model of maternity care.

Aims: To examine how engagement in antenatal care and choice of Lead Maternity Care provider (LMC) vary with maternal demographics.

Materials and methods: Our sample consisted of 6822 women enrolled during 2009 and 2010 into a longitudinal cohort study Growing Up in New Zealand. We asked if women had engaged a LMC, the type of LMC and whether they had a choice of LMC. Associations with maternal ethnicity, age, parity and education and household deprivation were determined.

Results: Ninety-eight per cent of women had engaged a LMC provider. Twelve per cent reported not experiencing choice and 11% not receiving their first choice of LMC provider. The reported LMC provider type was independent midwife (66%), hospital midwife (15%), private obstetrician (8%), shared midwife and general practitioner (GP) (5%) and GP-only care (<1%). LMC provider type and choice varied with maternal demographics. Women not engaging a LMC were more likely to be non-European, <20 years or >40 years old, with poorer educational attainment, or living in more deprived households. Women not experiencing choice of provider were more likely to be non-European, <20 years old, or living in more deprived households.

Conclusions: The current unequal distribution of provider engagement and choice in NZ has relevance for a number of specific maternity policies, including policies seeking to improve engagement in antenatal care. The study findings have international relevance as an example of the impact of choice policies on equity.

Keywords: delivery of health care; maternal health services; midwifery; pregnancy; prenatal care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Longitudinal Studies
  • Midwifery
  • New Zealand
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Patient Participation / statistics & numerical data
  • Pregnancy
  • Prenatal Care / statistics & numerical data*