In Her Head is a Herald campaign for better women's health services. Health reporter Emma Russell investigates what's wrong with our system and talks to wāhine who have been made to feel their serious illness is a figment of their imagination or "just part of being a woman".
Thousands of women have received large taxpayer-funded payouts after being failed by our health system.
More than $27 million has been paid out in the past five years.
That includes compensation given to women who lodged an ACC claim after being harmed by either surgical mesh, contraception, gynaecological cancer treatment or childbirth.
Information obtained by the Herald reveals payouts from the 4182 claims have risen significantly. Surgical mesh payments soared from $500,000 in 2017 to $5.1 million last year, and birth injury payouts jumped from $500,000 in 2017 to $3.2 million last year.
The findings are part of a new Herald project called In Her Head. It follows the stories of women who say our health system has made them feel like their crippling illness was a figment of their imagination or "just part of being a woman".
The project aims to empower more wāhine to speak up and to provoke discussion about how we treat women in our health system.
It highlights serious problems in the way women have been treated including:
• Continuing misuse of surgical mesh in operations for childbirth injuries, despite bans on its use in other countries.
• Long and unpredictable waiting times for endometriosis, an often-crippling condition that leaves many women in extreme pain.
• Shocking accounts of poor medical understanding of women's health issues, such as one endometriosis sufferer who said her GP told her as a 15-year-old to get pregnant.
Auckland GP and women's health researcher Orna McGinn said the ACC payouts uncovered by the Weekend Herald were a very small snapshot of women being let down by our system.
Many weren't eligible for ACC coverage as it only covered a very small set of poor health outcomes women were experiencing, McGinn said.
For example, women who waited years, sometimes decades, to be diagnosed with endometriosis weren't entitled to make a claim. Likewise, many birth injuries were also not covered and the information the Herald received didn't include those suffering post-natal depression without effective support.
"Every single day I am seeing women let down by our system and there are so many areas that could be improved to better their outcomes," she said.
McGinn said she believed contraception was a basic human right and should be made free but there were so many barriers that immediately translated to poorer outcomes down the track.
"We have a very high rate of unintended pregnancies which are more likely to end in adverse outcomes like stillbirth, neonatal death and maternal suicide," she said.
One mother, who battled severe postnatal depression and then fell pregnant after a surgeon made an error when tying her tubes, described her ACC experience as "brutal" and said she could understand why people wouldn't go to the effort of lodging a claim.
Monique Cross said she had to undergo intense psychological assessments to see if she was "bad enough to need counselling".
"As a person who had internalised everything and had been saying it was all my fault, that whole ACC process did a lot of damage. It made me feel like I was being put on the stand to prove that actually I am a decent person and that my trauma was caused by my births and a treatment injury," Cross said.
ACC acting chief operating officer Gabrielle O'Connor said she recognised mental injury assessments could be difficult but they were necessary to ensure that appropriate treatment and therapy were provided.
McGinn said the pandemic had made accessing women's health services even worse. Waiting times were getting longer and there was a growing backlog because care had not been provided during lockdowns.
"At this stage it could be years until they are seen in the public system for their endometriosis, their prolapse or any other non-immediate-life-threatening gynaecological conditions," she said.
ACC payouts are made under a 'no fault' system, which implies no wrongdoing or blaming of individual health workers. Money can cover lost earnings, treatment cost and rehabilitation.
The data showed that each year hundreds of claims were paid out for surgical mesh and birth injuries but hundreds more were declined because they didn't meet ACC's requirements for compensation.
A 2021 ACC report found women were less likely to make ACC claims and more likely to be declined when they did. They also received far less compensation than men.
In response to that report, the Government took steps to increase cover for some birth injuries.
Advocates said this demonstrated what could be done to improve women's health but it was still a "Band-Aid approach" and little was being done to prevent these injuries.
"We really need a proactive and preventative approach," McGinn said.
Associate Health Minister Dr Ayesha Verrall said improving healthcare for women in New Zealand was a key priority and the Government was committed to delivering a wide range of initiatives to support this.
"In particular, there is a focus across the health sector on improving access and equity to sexual and reproductive health services like abortion care, long-acting reversible contraceptives (LARCs), maternity and maternal mental health services, and breast and cervical screening."
"Health reforms provide an opportunity to shift our approach to women's health," Verrall said.
Follow women's personal stories of poor healthcare in our interactive grid below. Click on a face to go to the full story.