Some wāhine Māori say they have either felt bullied or coerced into using a form of contraception that wasn’t their first choice, according to a new report released by Sexual Wellbeing Aotearoa.

One wahine reported feeling discriminated against by her general practitioner (GP) because of her age and because she was Māori.

“He started talking about statistics for Māori are so much higher with teen pregnancy, you should have been aware of contraception… 

“After that I didn’t want to go back to my GP, so my friend ended up taking me to hers.”

Barriers in accessing contraception services

Sexual Wellbeing Aotearoa commissioned the report to look into the experiences of wāhine Māori in contraception services, including those offered by the organisation itself, which was formerly called Family Planning.

The research was done to understand what wāhine Māori are experiencing and to help Sexual Wellbeing Aotearoa evolve as a service.

At the time of research, the organisation was still called Family Planning so participants were asked to give feedback on the Family Planning services they’ve used.

There were 91 wāhine and 8 tāne who participated in the research ranging from 17 to 70 years old.

While some wāhine reported good experiences with their GPs and Family Planning, the research highlights systematic and structural barriers that prevent wāhine from going to contraception services or use the contraceptives they prefer.

The barriers include stigma, cost, availability of services in their area, and limited access to information and services.

The report also found culturally unsafe care to be a barrier – such as providers not acknowledging cultural backgrounds or not being able to access information on natural family planning methods and traditional Māori practices.

Feelings of whakamā and judgement

Some wāhine reported feeling judged and being denied contraception as well as experiencing structural racism, sexism and ageism.

How women choose a contraception service, like their family doctor or Family Planning, depends on whether they can talk about birth control without feeling whakamā (ashamed), the report found.

A few wāhine were adamant they wouldn’t use Family Planning again because they felt judged or the service wasn’t culturally responsive. 

One wahine reported the nurses reacting negatively when she wanted to switch to condoms and remove her rod, a long-acting contraception inserted in the upper arm.

“Mentally, physically, [the rod] didn't agree with me, so I had to get it removed… The [nurses] were almost angry that I didn't have a plan after [removing it]. I kept telling them, ‘I'll just wear condoms. We'll use condoms. I don't like what it's doing to me emotionally. I don't like this’. 

“I really remember almost arguing with these Family Planning nurses that I didn't [want] something more permanent.” 

Another young woman said her doctor denied her request to get off the jab.

“I wanted to start trying to have a baby at a young age. I was in love, I wanted a baby to my man. When I told my doctor I was coming off the jab, he was just like, ‘No you’re not’. He wasn’t accept[ing] of my decision.”

Wrong assumptions about Māori

Lead researcher Dr Fiona Cram (Ngāti Pāhauwera, Ngāti Kahungunu) says wāhine Māori want good contraception choices that allow them bodily autonomy and to be in control of their fertility.

She says they want health practitioners who listen to them and understand that they know their bodies.

GPs and their staff, she says, are amazing at coping with a wide range of health issues, but sometimes they have wrong assumptions about Māori when talking to them.

“So I think [when] they come to an engagement, they’re trying to figure out how to provide the best care that sometimes they’re not hearing what wāhine say.”

Cram says these assumptions are about the patient being Māori, their age, their weight or if they have babies.

She points out weight as an example, saying the first thing some healthcare providers will do is weigh the wāhine and other women who are carrying a little bit of weight.

She says while some hormonal contraception can make someone put on weight or others don’t work as well if someone’s carrying a bit of weight, it shouldn’t be the primary focus.

“It’s almost like an access point to a conversation for some health practitioners rather than [focusing on] whakawhanaungatanga (process of establishing relationships) and just sitting down and getting to know you more fully.”

Lead researcher Dr Fiona Cram says wāhine Māori want health practitioners who listen to them and understand that they know their bodies. Photo: Supplied

Dr Samantha Murton, president of the Royal New Zealand College of General Practitioners, says it’s the College’s role to train GPs to practise empathetic and culturally safe medicine.

“Building relationships and whanaungatanga is an important part of our roles and allows us to have open and honest korero with our patients about their health and wellbeing, medications, and treatment plans.”

Murton says the College has been working to develop cultural safety skills in all their members and that this report is a good example of why they need to do so, and reflect on how their practise may impact people from other cultures, particularly Māori.

“The College will make this report available to its members along with a message from the College’s Medical Director on the importance of providing empathetic, informed and non-judgemental care to patients who come to us for advice on contraception which can sometimes be a difficult or embarrassing topic for some to discuss.”

Patients shouldn’t feel judged, uninformed or unheard after a consultation, she says.

“We encourage any patient who has an experience like this to make a follow-up appointment with their GP to discuss their concerns further (taking a pre-written list of questions can help as can taking along a support person to the appointment). 

“Alternatively, patients can speak with the practice manager of the general practice about their experience or make an appointment with another GP or community/service provider,” she says.

Health professionals need ‘to constantly strive to do better’

Sexual Wellbeing Aotearoa Hauora Māori and Equity director Dr Tania Huria (Ngāi Tahu, Ngāti Mutunga ki Wharekauri) says as providers, they need to acknowledge coercion and stigma are huge barriers for wāhine and to ensure they don’t experience any backlash or coercion.

“We need to make sure every conversation we have is a safe one.”

She says the research and publishing the report was “a little bit like putting out our dirty laundry”.

“We need to have grown-up adult conversations as health providers about what we do well and what we don’t do so well.”

In response to the report, she says they’re doing a “whole bunch of work around anti-racism” across the entire organisation, including a training package for all kaimahi, including those who aren’t clinical facing.

Sexual Wellbeing Aotearoa Hauora Māori and Equity director Dr Tania Huria says they’re doing a whole bunch of anti-racism work across the organisation. Photo: Supplied

Huria says the organisation has always strived to be an effective Te Tiriti o Waitangi partner which translates to the services and advocacy they provide.

“This research provides a narrative from wāhine as to what that means for them. It is now time for us to embed those recommendations into our services.

“[It’s] so we can support the sexual and reproductive health of all New Zealanders in Aotearoa.”

She says this report can be used by other health providers for their professional development because “as health professionals, we need to constantly strive to do better”.

“It’s not acceptable that we know about health inequities and don’t do anything about it - that’s the key message.

“It’s not acceptable just to keep reporting them actually, we need to start doing something about it.”

Where to get help:

• 1737: The nationwide, 24/7 mental health support line. Call or text 1737 to speak to a trained counsellor.
• Suicide Crisis Line: Free call 0508 TAUTOKO or 0508 828 865. Nationwide 24/7 support line operated by experienced counsellors with advanced suicide prevention training. 
• Youthline: Free call 0800 376 633, free text 234. Nationwide service focused on supporting young people.
• OUTLine NZ: Freephone 0800 OUTLINE (0800 688 5463). National service that helps LGBTIQ+ New Zealanders access support, information and a sense of community. 

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