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

Disparities in maternal health outcomes in Aotearoa New Zealand are well documented, with Māori and Pacific women experiencing disproportionately poorer outcomes. Early pregnancy care delivered through general practice offers an opportunity to reduce these inequities. The Best Start early pregnancy assessment tool, developed by the National Hauora Coalition, was implemented across four general practices in Whanganui to support timely, culturally safe care.

To implement and evaluate an equity-focused model of early pregnancy care in general practice using the Best Start assessment tool, with the goal of improving timely, culturally responsive support for pregnant Māori and Pacific women.

An iterative, co-designed implementation was carried out across a Very Low Cost Access clinic, an iwi health provider, and two general practices. The project was structured in three modules: (1) co-design with hapū māmā (pregnant Māori women), (2) clinical implementation, and (3) integration of wrap-around services. Mixed methods were used, including practice management data queries, clinical audits, and qualitative insights from community hui.

In the lead practice, 85% of estimated pregnancies were identified, with 84% identified in the first trimester. Of these, 79% received a Best Start assessment (74% of Māori pregnancies). Mental health concerns were the most common referral need (18%), while low attendance at external stop smoking services highlighted persistent barriers. Community feedback led to system improvements, including warm handovers (in-person referrals) and protected appointment slots.

The Best Start model demonstrates that early pregnancy care in general practice can be redesigned to better support equity, provided it is culturally responsive, co-designed with māmā, and supported by systemic change. Ongoing investment is needed to sustain and scale the model, especially for Māori and Pacific women.