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Implementing an equity-focused model for early pregnancy care in general practice.

J P McMenamin1, G White1

  • 1Health and Research Collaborative (HARC), 190 Wicksteed Street, Whanganui, New Zealand.

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|October 24, 2025
PubMed
Summary

Implementing the Best Start tool in general practice improved early pregnancy care for Māori and Pacific women. Co-design and cultural responsiveness were key to reducing inequities in maternal health outcomes.

Keywords:
Best Start modelMāori healthculturally responsive careearly pregnancyequitygeneral practicematernal healthprimary care

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Area of Science:

  • Maternal Health Equity
  • General Practice Innovation
  • Public Health Interventions

Background:

  • Significant disparities exist in maternal health outcomes for Māori and Pacific women in Aotearoa New Zealand.
  • Early pregnancy care in general practice presents a crucial opportunity to address these inequities.
  • The Best Start assessment tool was introduced to facilitate timely and culturally safe care.

Purpose of the Study:

  • To implement and evaluate an equity-focused early pregnancy care model using the Best Start tool.
  • To enhance timely, culturally responsive support for pregnant Māori and Pacific women.
  • To reduce disparities in maternal health outcomes within general practice settings.

Main Methods:

  • Iterative, co-designed implementation across diverse primary care settings.
  • Inclusion of modules for co-design with pregnant Māori women (hapū māmā), clinical implementation, and wrap-around services.
  • Utilized mixed methods: practice data, clinical audits, and community feedback (hui).

Main Results:

  • High identification rates of pregnancies (85%) and early first-trimester identification (84%).
  • Successful application of the Best Start assessment tool in 79% of identified pregnancies, including 74% of Māori pregnancies.
  • Identified mental health as a primary referral need (18%), with challenges noted in smoking cessation service engagement; community feedback drove improvements like warm handovers.

Conclusions:

  • The Best Start model demonstrates the potential for redesigned general practice care to improve equity.
  • Culturally responsive, co-designed care and systemic support are essential for success.
  • Sustained investment is critical for scaling the model, particularly for Māori and Pacific women.