title: Initiation of maternity care for young Maori women under 20 years of age.
abstract: OBJECTIVE
  To explore the lived realities of pregnant Maori women <20 years through pregnancy and motherhood, to identify barriers to, and facilitators of, access to maternity care.
  
  
  METHODS
  Using a Kaupapa Maori research paradigm, 44 pregnant or recently pregnant Maori woman <20 years of age were recruited in two case study sites. Participants completed a series of interviews during different stages of pregnancy and motherhood. Interview transcripts were read, re-read and cross-compared by the two interviewing researchers to identify emergent themes, and organised using the software programme Nvivo. Thematic data was grouped, and re-grouped into topic areas for further analysis.
  
  
  RESULTS
  Participants engaged early with health care services both to confirm their pregnancy and to initiate maternity care. Barriers to access occurred at the first contact with a lack of information, and support along the maternity care pathway to mainly community based midwifery care. Many participants felt inadequately supported to be able to identify, confirm, and enrol with a midwife or hospital care. Participants who received proactive support at the first interaction with health services had an appropriate maternity care pathway toward obtaining early and seamless maternity care.
  
  
  CONCLUSIONS
  Interviews with participants identified that contrary to published literature young Maori women are engaging early with health services (GP services, school and community based youth health services) for maternity care, but system barriers from this first health contact lead to avoidable delays to them accessing a seamless maternity care pathway. There is a lack of sufficient and appropriate information and support for this young population group who have limited resources and experience to navigate through health services. These inequities in access to maternity care could be reduced through an integrated model of care that sees maternity care beginning at the first interaction with health care services. The service, primarily general practitioners, would then take responsibility for first trimester screening and navigation to a lead maternity carer.
authors.forename: Charrissa
authors.initials: C
authors.lastname: Makowharemahihi
authors.affiliation: Women's Health Research Centre, Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand. bev.lawton@otago.ac.nz.
authors.forename: Beverley A
authors.initials: BA
authors.lastname: Lawton
authors.forename: Fiona
authors.initials: F
authors.lastname: Cram
authors.forename: Tina
authors.initials: T
authors.lastname: Ngata
authors.forename: Selina
authors.initials: S
authors.lastname: Brown
authors.forename: Bridget
authors.initials: B
authors.lastname: Robson
mesh_terms: D002648:Child; D005260:Female; D006297:Health Services Accessibility; D006303:Health Services, Indigenous / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011247:Pregnancy; D036301:Qualitative Research; D012189:Retrospective Studies; D055815:Young Adult