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Following the appointment of the Honourable Simeon Brown as Minister of Health in Aotearoa New Zealand on 19 January, �鶹ֱ��has provided a comprehensive written summary outlining key critical issues currently impacting women’s health across the country.

30 January 2025

Hon Simeon Brown
Minister of Health


Dear Minister

Congratulations on your appointment as Minister of Health. Health is a challenging space, and also opportunity to deliver for New Zealanders and New Zealand women.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trains and provides professional development for doctors throughout Australia and New Zealand in the specialties of obstetrics and gynaecology. We have long advocated for a more strategic approach to women’s health, and for strong leadership of women’s health. Following wide sector consultation �鶹ֱ��developed a TOP 10 Actions to Improve Women’s Health briefing in preparation for release of the Women’s Health Strategy in 2023. Although there has been significant health system change since then, the gap between the sector’s vision for provision of women’s health in New Zealand and its reality has widened rather than closed. This view is supported by the Hologic Global Women’s Health Index¹ which shows an international decline in women’s health and a drop in New Zealand rankings over the last four years from 14th to 47th. The conversation we are interested in engaging in, is how to constructively close this gap.

�鶹ֱ��requests the opportunity to meet with your once you have settled into your portfolio. We recognise your immediate focus will be in understanding the key and critical issues in women’s health. We therefore provide below a summary.

Cervical cancer elimination

Cervical cancer is a preventable cancer which New Zealand should aim to eliminate. HPV immunisation and the recent introduction of HPV testing (including self-testing) is important progress however elimination is unlikely until HPV screening is fully funded like most other screening programmes in New Zealand.

Access to gynaecology care

Surgical waiting times do not provide a reliable measure of unmet need for non-cancer gynaecology because many hospitals, including some of our largest, are currently closed to referrals for non-cancer gynaecology. This means the unmet need of women with chronic conditions like heavy menstrual bleeding, pelvic pain, endometriosis, urinary incontinence and prolapse is unquantified and not reflected in monitoring of treatment or first specialist assessment waiting times.

Pelvic floor health and incontinence

Almost half of all women will experience some type of pelvic floor dysfunction. Interventions that help include a mix of prevention and surgical intervention. Both are constrained in the current environment. There is little investment in preventions such as education and pelvic floor physiotherapy during pregnancy and after birth which would have a significant impact on later pelvic floor dysfunction and the need for surgical treatment.

Access to surgical treatment is constrained by access to hospital care and the issues related to surgical mesh. Progress against the restorative justice actions overseen by the Mesh Roundtable has been slow and confounded by the pause in the use of surgical mesh introduced in August 2023 by the Director General of Health. Lifting the pause in the use of mesh, along with ensuring sufficient surgeons are credentialed is needed to ensure a full range of surgical options are available to women.

Obstetric ultrasound

O&G clinical leaders from around New Zealand have raised concern about lack of access to obstetric ultrasound for many years. Outdated funding arrangements and variable co-payments mean that many women cannot access scans that are necessary to manage a range of problems including assessing the risk of fetal growth restriction. Funding and access impacts on ability to deliver care according to national clinical guidelines. Review of funding arrangements is urgently required.

Maternity system reform

A broad strategic approach to the whole maternity system is urgently required. Te Whatu Ora’s principal maternity project, Kahu Taurima, focuses exclusively on the community components of the maternity system. Even that project appears to be at risk under the Te Whatu Ora’s Planning, Funding and Outcomes restructure. We call for a whole of maternity system approach that spans community and hospital-based services and includes a focus on outcomes measures including those with a patient centred view.

Pae Ora (Healthy Futures) (3 Day Postnatal Stay) Amendment Bill

�鶹ֱ��is supportive providing women with choice in their care. We believe it would be wise to consider the broader maternity system needs and capacity before considering funding a three day stay, which would require additional maternity facility capacity and workforce.

Workforce

The challenges facing the entire health workforce are well known. Feedback from our members, and the recent closure of Whakatane Obstetric Unit, suggests that resourcing of both O&Gs and midwives is impacting on the ability to provide quality care. New and innovative models of care, such as the rural generalist obstetricians (as in the West Coast of the South Island), are required to improve access to primary care (GP, pelvic physiotherapy and contraception services) and solve rural access issues.

We support your aspiration for health to deliver for New Zealanders, and we look forward to discussing women’s health with you.

Nāku noa, nā

Dr Susan Fleming
Vice President
Chair, Te Kāhui Oranga ō Nuku

References:

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For media enquiries

Bec McPhee
Head of Advocacy & Communications
bmcphee@ranzcog.edu.au
+61 413 258 166