The editorial by Matheson and Ellison-Loschman1 rightly suggest that “more attention must be given to prioritising, measuring and responding to unmet need”. Arguably, the most cost-effective screening/public health programme that we use is ante-natal care. In Primary Care we have targets for other screening and public health programmes like cervical screening, smoking cessation and immunisation with sanctions applied if we fail to meet targets. It is remarkable that until recently there has been no similar programme for the provision of ante-natal care. Worse than the lack of a programme is the fact that the Ministry of Health does not routinely provide accurate information on how many women did not receive any or sufficient antenatal care. While there is data on the number of women registered with a lead maternity carer in the first trimester, there is no information on the 30% who had not registered by that time, some of whom had no care.2 The new Better Public Services target of “90 percent of pregnant women registered with a lead maternity carer (LMC) in the first trimester” is a welcome focus on this problem, but was introduced without adequate consultation with midwives who have major reservations about being able to achieve the target.3 Many hospitals report difficulty recruiting sufficient midwives, and retention of midwives in the profession has fallen from working for 15 years to only working for six years.4 It is the hospital midwives who provide care for women who cannot find a community midwife, so this problem should be ringing alarm bells. If we do not count how many women do not receive antenatal care it is entirely plausible that progress towards the minister’s target could be made without affecting the numbers receiving no care who should be the first focus of our attention. I have argued elsewhere5 that there is a fundamental problem with our system of providing antenatal care, but without information on those women who do not access this care it is impossible to respond sensibly.

The editorial by Matheson and Ellison-Loschman1 rightly suggest that “more attention must be given to prioritising, measuring and responding to unmet need”. Arguably, the most cost-effective screening/public health programme that we use is ante-natal care. In Primary Care we have targets for other screening and public health programmes like cervical screening, smoking cessation and immunisation with sanctions applied if we fail to meet targets. It is remarkable that until recently there has been no similar programme for the provision of ante-natal care. Worse than the lack of a programme is the fact that the Ministry of Health does not routinely provide accurate information on how many women did not receive any or sufficient antenatal care. While there is data on the number of women registered with a lead maternity carer in the first trimester, there is no information on the 30% who had not registered by that time, some of whom had no care.2 The new Better Public Services target of “90 percent of pregnant women registered with a lead maternity carer (LMC) in the first trimester” is a welcome focus on this problem, but was introduced without adequate consultation with midwives who have major reservations about being able to achieve the target.3 Many hospitals report difficulty recruiting sufficient midwives, and retention of midwives in the profession has fallen from working for 15 years to only working for six years.4 It is the hospital midwives who provide care for women who cannot find a community midwife, so this problem should be ringing alarm bells. If we do not count how many women do not receive antenatal care it is entirely plausible that progress towards the minister’s target could be made without affecting the numbers receiving no care who should be the first focus of our attention. I have argued elsewhere5 that there is a fundamental problem with our system of providing antenatal care, but without information on those women who do not access this care it is impossible to respond sensibly.