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Te Ao Māori in sexual and reproductive health
In the following presentation Dr Jo Lambert, Ngāti Maniapoto, Te Ati Awa, and a Fellow of the NZCSRH, presents an overview of Te Ao Māori in sexual and reproductive health.
Tikanga in sexual and reproductive health
One of the ways we honour and respect our obligations to Te Tiriti o Waitangi and tangata whenua (the indigenous people of the land) is through the appropriate use of tikanga. Tikanga is following specific protocols and procedures with the intent to honour Māori holistic cultural practices. These practices reflect spirituality and indigenous values such as tapu, noa and mana. Māori beliefs, values and concepts are inherited and practiced from generation to generation. Important values are also te reo (the language), whenua (the land) and the concepts of whānau, hapū and iwi (family and extended family group). Integral to tikanga are Māori world views encompassing the atua (gods), creation story and a holistic approach to health spanning the realms of wairua (spirituality), hinengaro (psychological), tinana (physical) and whānau (family).
The connection to wairua (spirit) is particularly intrinsic to Māori traditional beliefs and in healthcare settings we can maintain and protect a person’s wairua, tinana and hinengaro with specific practices such as karakia (incantations, blessings, prayers). Behaviour and practices not consistent with beliefs, values and concepts can distress Māori and cause lack of confidence and hence participation in health care services.Practicing tikanga with the intent to honour a person’s beliefs may enhance care for both Māori and non-Māori.
Practicing tikanga safely can often feel overwhelming for health care professionals. The best way to work through this is asking for help from colleagues, learning more from your local iwi, seeking formal training and learning from the people you see in your health care setting. As in any culture, no two people will believe, value or practice in the same way and there are whanau, iwi, and regional differences to be aware of. Be guided by the person in front of you, acknowledging their sovereignty (tino rangatiratanga) in deciding what path, karakia, supports they would like during their care. When using and offering tikanga in the right way with the right intention it is mana enhancing for you, the pregnant person and their whānau.
The following audio-visual aid discusses how the concepts of tapu (restricted), noa, (free from restriction) and mana are used to guide tikanga.
Meeting Te Tiriti obligations to Māori
The NZCSRH recognises and respects Te Tiriti o Waitangi as Aotearoa New Zealand’s founding document, which captures the fundamental relationship between the Crown and Iwi. In doing so, we commit to the intent of Te Tiriti o Waitangi that established Iwi Māori as equal partners alongside the Crown and its agencies. We prioritise health gain for Māori based on the rights that Māori hold as tangata whenua. A major objective during the development of training programmes is to identify ways to meet Tiriti obligations when providing sexual and reproductive health care.
The New Zealand Aotearoa Abortion Clinical Guideline outlines the following actions to take to meet Tiriti obligations in abortion care:
- Tino rangatiratanga (Article 2 – Mana motuhake, self-determination) - Health practitioners support the right of Māori to undergo an abortion, conceptualising the person’s decision to have an abortion as a continuation of a much older, Māori collective-endorsed practice of determining one’s own health and wellbeing and that of the whānau.
- Equity (Article 3 – Oritetanga, Māori health equity, justice and action) - Health practitioners can contribute to equitable abortion health outcomes for Māori by ensuring that at a minimum abortion outcomes match those of other New Zealanders. Equitable abortion outcomes will be achieved when the guideline recommendations are implemented in ways that give effect to the principles of Te Tiriti o Waitangi, and relevant professional competencies and Ngā Paerewa are met.
- Active protection (Article 4 – Te Ritenga, right to beliefs and values) - Health practitioners share evidence-based information about abortion so that Māori can make decisions and prepare themselves to uphold their tikanga or cultural practice (eg, karakia, rongoā, support person, container for and a location to place products of conception).
- Options – Health practitioners ensure that Māori process are able to uphold their tikanga or cultural practice throughout the abortion process, whether the abortion takes place at a kaupapa Māori or a mainstream service. The process must complement a Māori person’s mana or inherent authority and dignity, support their tikanga or cultural practice, and be culturally safe as defined by Māori.
- Partnership (Article 1 – Kāwanatanga, governance) – Health practitioners work in partnership with Māori, including a person’s whānau if requested, before, during and following an abortion. A partnered approach to the process and decision-making ensures Māori can enact their rangatiratanga or self-determine their futures while exercising mana motuhake or authority over their bodies and reproductive health.
Understanding Te Tiriti o Waitangi
Recent teachings on Te Tiriti have moved away from the three “Ps” (partnership, participation and protection) to a broader and deeper understanding of what Te Tiriti o Waitangi means in both historic and contemporary settings. This is influenced by the Waitangi Tribunal findings of Wai 2575 and its recommendations for achieving equitable health in Aotearoa. NZCSRH expects health care practitioners to have up to date knowledge of the interpretation of the articles of Te Tiriti o Waitangi. When health care practitioners understand how pre-colonial Māori lived, the influence of colonisation and the tools/laws that were used to systematically dilute mātauranga Māori (Māori knowledge), it is easier to understand why there are such disparities and inequities in health in Aotearoa New Zealand. This is particularly important in relation to pre-colonial and post-colonial attitudes to abortion and its impact on Māori. Understanding Te Tiriti o Waitangi and applying this to our individual roles is central to achieving health equity.
The impact of Wai 2575
The Waitangi Tribunal report Hauora: Report on Stage One of the Health Services and Outcomes Kaupapa Inquiry (Wai 2575, Waitangi Tribunal 2019) found that the existing primary healthcare framework did not meet the Crown’s obligations under Te Tiriti o Waitangi and was failing Māori, who experience severe health inequities. One of the primary purposes of the Pae Ora (Healthy Futures) Act 2022 is to strive to eliminate this health inequity and to protect, promote and improve the health of all New Zealanders.
The Waitangi Tribunal recommended the use of five principles derived from Te Tiriti when working to fulfil the health care rights of Māori, expanded on below (from the Manatu Hauora Ministry of Health Te Tiriti o Waitangi Framework):
Tino rangatiratanga: The guarantee of tino rangatiratanga, which provides for Māori self-determination and mana motuhake in the design, delivery, and monitoring of health and disability services.
Equity: The principle of equity, which requires the Crown to commit to achieving equitable health outcomes for Māori.
Active protection: The principle of active protection, which requires the Crown to act, to the fullest extent practicable, to achieve equitable health outcomes for Māori. This includes ensuring that it, its agents, and its Treaty partner are well informed on the extent, and nature, of both Māori health outcomes and efforts to achieve Māori health equity.
Options: The principle of options, which requires the Crown to provide for and properly resource kaupapa Māori health and disability services. Furthermore, the Crown is obliged to ensure that all health and disability services are provided in a culturally appropriate way that recognises and supports the expression of hauora Māori models of care.
Partnership: The principle of partnership, which requires the Crown and Māori to work in partnership in the governance, design, delivery, and monitoring of health and disability services. Māori must be co-designers, with the Crown, of the primary health system for Māori.
Mana whenua status
Mana whenua refers to the mana upheld by local Māori people who have historic and territorial rights over the land in a particular area and is derived through whakapapa links to that area. It differs from tangata whenua (people of the land, indigenous people) in that is refers to the people who have local tribal or sub tribal authority.
It is important to understand who holds mana whenua status in your area when planning and providing any health service in Aotearoa New Zealand. Mana whenua have a special cultural and spiritual relationship with the environment and so may be able to provide advice or support in some instances.
Further resources
Te Kāhui Raraunga is a Māori data governance collective providing resources and leadership on Māori data sovereignty — visit their website here: Te Kāhui Raraunga
Further resources are available through the Council of Medical Colleges Cultural Safety Kete.