Maori Women Research Articles

Gender and Austronesian Indigenous Identities: Narratives of Women in Seediq Bale and Utu

Abstract As early as 1989, Kimberlé Crenshaw had proposed investigating the interconnection between gender and ethnic identities, especially in her work about black identities. Subsequently, many scholars have extended investigation of the interconnection to the field of Indigenous studies. However, most studies focus on women’s suffering, rather than their active engagement in the process of anti-colonial resistance and Indigenous identity formation. Despite painful colonial histories—including displacement and assimilation—Indigenous peoples have resisted and survived and have been revived. Indigenous women played a crucial part in these processes, but their contributions were often neglected or forgotten. Through analyses of two renowned post-colonial films—Seediq Bale (dir. Wei Te-sheng, 2011) from Taiwan and Utu (dir. Geoff Murphy, 1983) from New Zealand—this essay explores how Seediq and Maori women showed great strength in Austronesian indigenous people’s resistance to colonialism and in their campaign to rewrite history.

Desecration of the Body and the Maori Cultural Invasion: A Perspective in Patricia Grace

The subversion of patriarchal literary forms is an important aspect of postcolonial women’s writing. From Patricia Grace’s example, the young Maori writers somewhat present a socially subversive identity for themselves, telling stories of women who challenge social norms and female stereotypes. Their narratives reflect a strong interest in social issues – issues such as the way power is asserted and distributed in society, issues of legitimate authority, and strategies for effective management. The stories presented by Maori women in their stories are often constructed as social or cultural problems rather than as individual, personal problems. Grace also incorporates this important function of the expression, construction and exploration of a distinct identity of Maori/indigenous women in society. By challenging Western feminism’s basis in liberal humanist thinking and its assumptions of a shared marginality of the gendered individual, Grace puts an emphasis on a common experience of oppression. The mutilation of a female body in her fiction projects an unholy and complicitous dynamics of the male, imperialism, power system, sex, education, and erasure of the Indigenous identity.

P9 Ethnic variability in Post-Mastectomy Breast Reconstruction (PMBR)

Background Current evidence for best practice indicates breast reconstruction post-mastectomy is associated with greater quality of life and psychological well-being.1 However, rates of reconstruction many not be equivalent across all ethnicities, which contributes to disparities in health outcomes.2 Methods A retrospective review of patients diagnosed with breast cancer between January 1st and December 31st, 2017 at Counties Manukau District Health Board (CMDHB) was performed. Patient demographics, eventual breast cancer treatment, and evidence of whether a reconstruction discussion took place were collected. This data was analysed to assess rates of reconstruction by ethnic group. Results 386 patients were diagnosed with cancer in CMDHB Breast cancer clinic in 2017. Of these women, 190 underwent mastectomy as primary treatment with 30 of these women also receiving reconstruction (either immediate or delayed) giving a reconstruction rate of 15.8%. Indigenous Maori women represented only 10% of the total immediate and delayed reconstructions in CMDHB in 2017. European women comprised 70% of total reconstructions but only represented 50% of all mastectomies. 34.7% of patients receiving mastectomy in 2017 were of Maori or Pasifika ethnicity. Of these patients, only 31.8% of women met eligibility criteria for immediate breast reconstruction at CMDHB (Body Mass Index (BMI) < 35 and non-smoker). There was a statistically significant difference between eligibility in Maori, Pasifika, European and Asian ethnicity groups for post-mastectomy reconstruction at BMI values below 35 (p < 0.05). Conclusion Eligibility rates for post-mastectomy reconstruction are significantly lower (p < 0.05) in Maori and Pasifika women when compared with European and Asian populations. This difference reflects higher smoking rates and higher BMI values in Maori and Pasifika women. Changing eligibility criteria such as having a higher BMI threshold for Maori and Pasifika women may improve access to breast reconstruction in these populations. 1. Cagli B, Cogliandro A, Barone M, Persichetti P. Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg. 2014 Apr;133(4):594e–5e2. Schumacher JR, Taylor LJ, Tucholka JL, Poore S, Eggen A, Steiman J, et al. Socioeconomic Factors Associated with Post-Mastectomy Immediate Reconstruction in a Contemporary Cohort of Breast Cancer Survivors. Ann Surg Oncol. Springer International Publishing; 2017 Aug 1;24(10):3017–23.

Potential for HPV vaccination and primary HPV screening to reduce cervical cancer disparities: Example from New Zealand

BackgroundCervical cancer rates are over twice as high, and screening coverage is lower, in Māori women compared to other women in New Zealand, whereas uptake of HPV vaccine is higher in Maori females. We aimed to assess the impact of HPV vaccination and the proposed transition to 5-yearly primary HPV screening in Māori and other women in New Zealand, at current participation levels; and additionally to investigate which improvements to participation in Māori females (in vaccination, screening, or surveillance for screening-defined higher-risk women) would have the greatest impact on cervical cancer incidence/mortality. MethodsAn established model of HPV vaccination and cervical screening in New Zealand was adapted to fit observed ethnicity-specific data. Ethnicity-specific models were used to estimate the long-term impact of vaccination and screening (vaccination coverage 63% vs 47%; five-year screening coverage 68% vs 81% in Maori vs European/Other women, respectively). ResultsShifting from cytology to HPV-based screening is predicted to reduce cervical cancer incidence by 17% (14%) in Maori (European/Other) women, respectively. The corresponding reductions due to vaccination and HPV-based screening combined were 58% (44%), but at current participation levels long-term incidence would remain almost twice as high in Māori women (6.1/100,000 compared to 3.1/100,00 in European/Other women). Among strategies we examined, the greatest impact came from high vaccine coverage and achieving higher attendance by Māori women under surveillance for screen-detected abnormalities. ConclusionRelative reductions in cervical cancer due to vaccination and HPV-based screening are predicted to be greater in Maori than in European/Other women. While these interventions have the potential to substantially reduce between-group differences, cervical cancer incidence would remain higher in Maori women. These findings highlight the importance of multiple approaches and the potential influence of factors beyond HPV prevention.

Transitions in Smoking Across a Pregnancy: New Information from the Growing Up in New Zealand Longitudinal Study.

Introduction Maternal smoking remains a modifiable cause of adverse maternal and child health outcomes. This study investigated smoking transitions across pregnancy. Methods Data from the contemporary child cohort study Growing Up in New Zealand (n = 6822) were used to analyse smoking status across three points across a pregnancy: pre-pregnancy, during pregnancy and after pregnancy. Odds-ratios (OR) were calculated for maternal, socio-economic and pregnancy-related factors associated with each transition using multivariate logistic regression. Results The prevalence of smoking pre-pregnancy was 20.3%. The cessation rate during pregnancy was 48.5%, while the postpartum relapse rate was 36.0%. Heavy smokers were less likely to quit during pregnancy (OR 0.13, 95% CI 0.08-0.20), and more likely to relapse at 9months (OR 2.63, CI 1.60-4.32), relative to light smokers. Women in households with another smoker were less likely to quit during pregnancy (OR 0.35, CI 0.25-0.48), and more likely to relapse postpartum (OR 2.00, CI 1.14-3.51), relative to women in a smoke-free household. Women without high school qualifications were less likely to quit during pregnancy than women with bachelor degrees (OR 0.21, CI 0.11-0.41) but no more likely to relapse. Maori women were less likely to quit during pregnancy than European women (OR 0.35, CI 0.25-0.49) but no more likely to relapse. Conclusion Heavy smokers and those with another smoker in the household are at high risk of smoking during pregnancy or relapsing after pregnancy. Decreasing smoking across a pregnancy therefore requires a focus on cessation in all households with heavy smokers of child-bearing age. The association between smoking and ethnicity may be confounded as it not consistent across the pregnancy.

Investigating antenatal nutrition education preferences in South-East Queensland, including Maori and Pasifika women.

Little is reported about the nutrition-related needs and preferences of women seeking maternity services, particularly Maori and Pasifika (M&P) women who have higher chronic disease rates in Queensland. Nutrition-related knowledge, needs, behaviours and education preferences were compared between women of M&P ancestry and non-Maori and Pasifika women (NMP). Women (≥18 years) admitted to the postnatal ward were surveyed. Anthropometry, dietary quality, nutrition education preferences, country of birth and ancestry were collected. Analysis included chi-squared and t-tests. The survey was completed by 399 eligible women. Country of birth data suggested 4% of respondents were Pasifika and failed to separately identify New Zealand Maori, whereas 18% of respondents (n=73) reported M&P ancestry. Descriptors were similar between groups (28±5 years; 91% any breastfeeding; 18% gestational diabetes mellitus; p>0.05). However M&P women were less often university educated (M&P:6(9%); NMP:71(22%), p<0.01) and more likely had >2 children (M&P: 30(54%); NMP:70(30%), p<0.01). M&P women reported heavier weight at conception (M&P:79.0±20.2kg, 29.2±7.5kg/m2; NMP:71.3±18.9kg, 26.3±6.5kg/m2, p<0.01), and were more likely to report excess gestational weight gain (M&P:30(56%), NMP:96(36%), p<0.05). Most (>75%) women did not know their recommended weight gain. Many respondents reported inadequate intake of vegetables (95%), fruit (29%) and dairy (69%) during pregnancy. Two-fifths (38-41%) reported interest in perinatal nutrition education, with topics including healthy eating postpartum. Findings enable targeted service delivery according to women's preferences. Collecting ancestral and maternal data to facilitate the provision of appropriate nutrition education may be critical for achieving optimal maternal outcomes in Maori and Pasifika women.

Unplanned pregnancies in New Zealand.

Unplanned pregnancies can bring risk. It is important to have an accurate count of unplanned pregnancies, but to date there is no precise number for New Zealand or Australia. This analysis estimates the number and proportion of pregnancies in New Zealand that are unplanned. Estimates were generated using information about unplanned births from the Growing Up in New Zealand study, combined with data on the number of births and abortions from Statistics New Zealand and estimates of miscarriages. These were further refined by age and ethnic group. Of an estimated 95335 pregnancies in New Zealand in 2008, over half (53%) were unplanned. Unplanned pregnancies resulted in 24131 births. As a percentage of all pregnancies, 25% were births from unplanned pregnancies, 19% were abortions and 8% were unplanned pregnancies that ended in miscarriage. There were a high number of unplanned pregnancies among younger women as well as among Maori and Pacific women, and a low number among women in their 30s and European women. Programs, policy and practice should be designed to accommodate women with unplanned pregnancies. Ensuring accessible pregnancy care such as antenatal care and abortion and making preconception care programs widely available, particularly for women with chronic health conditions, will reduce the health risk posed by unplanned pregnancies. Reducing the number of unplanned pregnancies through comprehensive sexuality education and contraception is important for those in their teens and early 20s, and continues to be important throughout the reproductive lifespan.

Children of Empire: Rereading Katherine Mansfield’s ‘How Pearl Button was Kidnapped’ (1912)

Katherine Mansfield’s story of a white (Pakeha) child kidnapped by Maori women and taken to their community is formally distinguished by its creation of a ‘naive’ perspective on colonialism through the use of a young child as the narrative focalizer. The story illuminates and problematizes the historical question of the place of children in empire. With reference to works by Stevenson and Ballantyne, this essay discusses the relation between Mansfield’s short story and the nineteenth-century tradition of imperial adventure fiction featuring child protagonists. It additionally compares the childhood perspective on colonialism offered by Mansfield with the ‘authorized’ perspectives presented in imperial literature specifically produced for child readers by publishing outlets such as the Religious Tract Society. Mansfield’s story, it will be seen, unsettles a hegemonic tradition of using children to filter an ‘innocent’ perspective on the colonial other. The question of the other is the major theoretical issue explored in this story, which explores the dynamic of ‘othering’ in an imperial context as a two-way, mutually determining process. Pearl is as exotic to her Maori hosts as they are to her. By leaving unresolved the question of the kidnappers’ motives, the story presents empire as an indeterminate space of mutual fear and desire between colonizers and colonized.

Inequity in timing of prenatal screening in New Zealand: Who are our most vulnerable?

In New Zealand (NZ), Maori and Pacific women are less likely to complete prenatal screening for Down syndrome and other aneuploidies than other ethnic groups. Young women <20 have low rates of completed screening compared with women >20years. Women living in deprived areas have lower completed screen rates than women living in more affluent areas. Combined first trimester screening has a superior sensitivity (85%) compared with second trimester screening (75%) for trisomy 21. The relative contribution of demographic factors to timing of screening uptake (first vs second trimester) has not previously been examined. To evaluate the association of ethnicity, deprivation, District Health Board (DHB) of domicile and maternal age with timing of prenatal screening (first vs second trimester) in pregnant women screened in NZ from 2010 to 2013. Univariate logistic regression analyses were used to explore the association between timing of completed screening and each of ethnicity, deprivation index, DHB of domicile and maternal age. Multivariate logistic regression models were developed to calculate odds ratios (OR) and 95% confidence intervals (CI). Statistical analyses were performed using SAS v9.3 RESULTS: Of completed prenatal screens, 88% were completed in the first trimester. Ethnicity, age, deprivation and DHB were all significant predictors of completed first versus second trimester screening. Maori women were almost 60% less likely (adjusted OR 0.37, CI 0.35-0.39) and Pacific women almost 80% less likely (adjusted OR 0.23, CI 0.21-0.24) than NZ European women to have completed first versus second trimester screening. Women <30years were less likely to have completed first trimester screening, as were more deprived women. Variation was also seen by DHB with women living in Whanganui DHB less likely to have completed first versus second trimester screening than women living in Auckland (adjusted OR 0.76, CI 0.71-0.81). Women living in Bay of Plenty DHB were more likely to be screened in the first versus second trimester compared with women living in Auckland (adjusted OR 1.55, CI 1.38-1.74). Within Auckland itself, women living in Counties Manukau DHB were less likely to be screened in the first versus second trimester than women living in Auckland DHB even after adjusting for ethnicity, deprivation and maternal age. Maori and Pacific women have the lowest uptake of completed first versus second trimester screening after adjusting for age, deprivation and DHB. Research is required to understand if this relates to characteristics of the carer making the offer of screening, language and/or cultural barriers to care or specific collective cultural or religious views held by women from these ethnicities. The lower completed first trimester versus second trimester prenatal screening in deprived areas, as well as variation by DHB, may relate to the availability of ultrasound and/or laboratory services in specific regions. Cost may be a contributing factor to inequity in timing of completed prenatal screening uptake, as first trimester screening incurs a part-charge to the individual, while second trimester screening is fully funded. Systemic factors within the NZ maternity model of care may also be contributory with a potential disconnect occurring for the woman between primary medical care and later registration with a Lead Maternity Carer in the first trimester.

Do New Zealand Women’s Age and Ethnicity Contribute to Achieving Physical Activity Guidelines?

Regular participation in physical activity (PA) has overwhelming positive implications on long-term health and on disease prevention. Despite established government guidelines to improve health through PA, over half of New Zealand women reportedly fail to meet these criteria. Barriers to achieving minimum physical activity levels may include demographic characteristics (i.e. age, ethnicity), but the contribution of each factor is unclear. PURPOSE: To understand how age and ethnicity affect a New Zealand woman’s ability to meet PA guidelines. METHODS: Healthy New Zealand women (n = 350) of three ethnicities (Māori, Pacific, European) aged 16-45y (stratified as 16-25y, 26-35y, 36-45y) wore triaxial accelerometers for 7 days. Levels of moderate-vigorous PA (MVPA; ≥2020 counts.min-1) were assessed. Participants were categorised as achieving or not achieving PA guidelines. PA guidelines are commonly reported as either ≥150 min.wk-1 MVPA (Basic) or ≥150 min.wk-1 MVPA in bouts of 10+ min (Basic10+), therefore both of these classifications were considered. RESULTS: Basic10+ guidelines were met by only 32% of New Zealand women; a further 34% of women (66% in total) met Basic guidelines. There were no significant differences between the three age groups when ethnicity was not also considered. Achievement of Basic guidelines was lower in Pacific women (37%) than Maori (65%; p=0.001) or European (75%; p<0.001) women. Specifically, fewer Pacific women in the 16-25y and 36-45y age groups achieved Basic PA guidelines than women of the same age but different ethnicity. More European women (38%) met Basic10+ guidelines than Maori (22%; p=0.011) or Pacific (22%; p=0.012) women. These differences between ethnicity were not specific to any age group. CONCLUSION: Although only two-thirds of New Zealand women achieved Basic PA guidelines, the prevalence was substantially higher than overall national statistics (48%). Given the extremely low rates of PA for periods of 10 or more minutes, a strategy is needed to increase the length of time women spend in bouts of MVPA. The findings further suggest that ethnicity, more so than age, is a contributing factor to achieving PA guidelines. Funding Sources: Nutricia Research Foundation

Ka ora kainga rua: Finding a home in the academy. A study into the experiences of four maori women in the academy

The article is a brief summary of a larger project that studied the experiences of four Maori women in the academy. The project attempted t o identify practices that limited and/or supported Maori women's participation within the academy. The project suggested five emerging themes that relate t o these women's experiences: motivation to pursue and maintain tertiary study; the entry experiences of Maori women into the academy; being supported within the academy; women in the academy and the multiplicity of roles; and learning from the experiences of others.

"Coming to know" in teaching physical education: Moving across cultural boundaries

This article explores a number of methodological and procedural issues surrounding research across cultural and gender boundaries. The research involves narrative inquiry in one collaborative Kaupapa Maori context, exploring the experiences of mature-aged Maori women teachers as they implement the new health and physical education curriculum in their schools. Their construction of meaning is informed by both western and traditional Maori world views, at times leading to contradiction and conflict. The process whereby the participants story and re-story their personal narratives in coming to know how to teach physical education illustrates other ways of knowing. Research issues related to initiation, benefits, representation, legitimation and accountability are addressed through a collaboratively negotiated research agenda sensitive to Maori cultural aspirations, practices and preferences.

Invited Commentary – management of Polycystic Ovarian Syndrome in the Pacific Islands

&lt;p&gt;Polycystic Ovarian Syndrome (PCOS) is affects 6-10% of women. A cross-sectional study in Auckland showed rates of PCOS in European, Maori and Pacific Island women to be in proportion to the general population. Pacific women had little or no acne but other signs of PCOS were similar among all ethnic groups. Maori and Pacific women were more obese compared to Caucasian women and had highest rates of insulin resistance and lipid abnormalities. This article is based on the treatment options available in the Pacific Islands.&lt;/p&gt;&lt;p&gt;The main treatment goals are for hyper-androgenic symptoms (hirsutism, acne, scalp hair loss), anovulatory infertility, endometrial protection and management of underlying metabolic abnormalities or metabolic risk factors such as obesity, insulin resistance, dyslipidaemia and IGT. &lt;/p&gt;

Abstract C18: The burden of cancer in indigenous people globally and the World Indigenous Cancer Conference 2016 (WICC16)

Abstract Introduction: Cancer prognosis for Indigenous peoples, who represented 6% of the world population, is largely unknown. The rights of indigenous people, including their right to equality in health, have become a focus of the U.N. and other agencies, but little attention has been given to their cancer burden. Data from countries such as Australia, New Zealand Canada, and the United States, which have relatively well resourced cancer registries, show that cancer is now the second leading cause of death among Indigenous people in those countries. Greater understanding of the burden of cancer among indigenous populations is of major importance to public health, given that poorer outcomes contribute to the lower life expectancies. Methods: We conducted an overview of the literature surrounding cancer burden, including screening, epidemiology, treatment and survivor-ship among indigenous people globally. Results: Globally, the research work has been piecemeal and focused on the colonized inhabitants of the four former British or French colonies with higher Human Development Indexes (HDI), namely Australia, New Zealand, Canada and the United States (U.S.). Overall, cancer incidence and mortality among Indigenous Australians is greater and survival is significantly poorer than among non-Indigenous Australians, as is the case among Maori in New Zealand. First Nations people in Ontario are reported to have poorer survival for breast, prostate, cervical, colorectal (male and female) and male lung cancers compared to their non-First Nations peers and cancer mortality is higher for both American Indian and Alaska Native than for U.S. Whites. Maori women and Indigenous Australian women are less likely to participate in National Screening Programs; the rate of mammography in the latter group are 36% for Indigenous women and 55% for non-Indigenous women and rates of cervical screening in Maori women are also lower. There has been a dearth of research into the cancer burden of Indigenous people in other regions. The dearth of information, and lack of international collaboration, highlighted the need for an international multidisciplinary meeting, inviting participation from researchers, public health practitioners, clinicians, nurses, advocacy groups, allied health professionals, and related professionals from around the globe. The World Indigenous Cancer Conference 2016 will provide opportunities to foster new collaboration, enhance capacity and increase knowledge about cancer and Indigenous people nationally and internationally. Networks and partnerships can bring together the combined expertise and efforts of many to focus on the critical challenge of cancer among Indigenous peoples. By enabling those who work in or are interested in this area to connect, communicate and collaborate, this conference will encourage high quality cancer research and partnerships across the spectrum of cancer among indigenous people: from prevention, to psycho-social and health services research aimed at improving the quality of life for survivors, their family and friends. The conference will contain a number of streams including ‘Screening and Prevention’, ‘Cancer Data’, ‘Health Services’, ‘Psycho-social/survivorship’ and ‘Advocacy and capacity building’ Conclusion: Establishing networks and partnerships is an important method to raising the profile and addressing cancer disparities. Our aim is to overcome inequalities in cancer care for Indigenous peoples through the establishment of international collaborations of researchers with experience in areas such as epidemiology of chronic disease, social determinants of health, and health systems research. Citation Format: Suzanne P. Moore, Bronwyn Morris, Joan Cunningham, Gail Garvey. The burden of cancer in indigenous people globally and the World Indigenous Cancer Conference 2016 (WICC16). [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C18.

A Successful Midwifery Model for a High Deprivation Community in New Zealand: A Mixed Methods Study

In August 2011, the Ministry of Health (MOH) commissioned a report to provide information, evidence, and analysis regarding an integrated lead maternity care model for a midwifery practice situated in Counties Manukau, New Zealand, a high deprivation area. The final report was entitled “A Successful Lead Maternity Care Midwifery Practice in Counties Manukau” (Priday &amp; McAra-Couper, 2011). The project was both qualitative (qualitative descriptive) and quantitative (descriptive statistics) in its review and audit of the Midwifery Practice. The midwives from this practice have been providing continuity of midwifery care for 17 years, and the MOH was interested in how this group of midwives (“the Midwifery Practice”) was working and the implications of this style of practice. The report demonstrated that the Midwifery Practice provides continuity of care for predominantly Pacific and Maori (indigenous) women and young women, including adolescents. The socioeconomic indicators of these women place them in the high deprivation index group. Given these three factors—ethnicity, age, and deprivation decile—high perinatal mortality and other adverse outcomes could be expected. However, statistics demonstrate low perinatal mortality and morbidity, with most women booking for care before 20 weeks’ gestation and recording optimal birth outcomes. The Midwifery Practice is integrated into the community facilitating a connected and accessible service for women and families. These findings are significant in light of the repeated call from the Perinatal and Maternal Mortality Review Committee (PMMRC, 2013), urging stakeholders who provide health and social services to identify the reasons why women are failing to engage with care and to identify interventions to address barriers. This article summarizes the findings from the report.

Karanga mai ra: Stories of Māori women as leaders

This paper takes a fresh look at Maori women and leadership through individual and collective storytelling. Stories or pūrākau about Maori women leaders involved in environmental sustainability, employment rights, and sport are used to reveal the often silenced realities of Maori women’s leadership and challenge dominant leadership discourse. Findings suggest mana wahine/the power and authority of women is a critical element of Maori women’s leadership as well as values and concepts that feature in traditional pūrākau and cultural roles for women. The holistic nature of Maori leadership was captured by considering three interrelated and fluid spheres – leadership as influence, leadership in context and the performance of leadership. These stories are a preface and we invite others to join the dynamic process of storytelling so that the plurality of Indigenous women’s leadership perspectives, experiences and performances are recognised and celebrated.

Cultural responsiveness and the family partnership model

IntroductionCultural responsiveness is contingent on the relationships developed between nurses and clients, and is necessary for the clients' and whanau (extended family) cultural needs to be incorporated into care delivery. The health and wellbeing of Maori children and their whanau is an ongoing concern for the delivery of health and social services in New Zealand. The Royal New Zealand Plunket Society (known as Plunket) provides well child services to 90% of children and their families nationwide, and to 65% of Maori children born in 2010 (Royal New Zealand Plunket Society, 2012). Plunket is committed to the Family Partnership Model, developed in the United Kingdom (Davis, Day, & Bidmead, 2002). The Family Partnership Model is based on establishing relationships and communication for working with others, and informs a programme to develop knowledge, skills and techniques for those working with children and their families. Plunket nurses undertake a 10-session Family Partnership Model training that aims to enhance their communication and ability to establish partnerships with families. However, it is not clear if the Family Partnership Model supports culturally responsive nursing practice. In this article we report the findings of a study investigating whether the Family Partnership Model influenced culturally responsive practice for nurses working with Maori whanau.BackgroundMaori, indigenous peoples of New Zealand, experience persistent inequities in health status and outcomes, similar to other Indigenous peoples who have histories of colonisation. They comprise 14.9% of the New Zealand population (Statistics New Zealand, 2013). Ninety percent of Maori live in households with other family members, and of these, 42.9% are couples with children, 26.5% are single adults with children and 11.5% in multi-family households (Te Puni Kokiri, 2011). Many Maori women have children at a younger age than other women living in New Zealand, are disconnected from their iwi and lack wider whanau support (Ritchie, 2007). Consequently, Maori whanau and children are often deemed at risk and vulnerable. For example, Maori children suffer health disparities and inequities at higher rates than other children living in New Zealand (Ministry of Health, 2012a, 2012b).Health inequities occur within a complex context that includes being indigenous; experiencing discrimination, poverty and unemployment; and having low levels of education. Many Maori children live in areas of high deprivation, with 41% of Maori whanau living in neighbourhoods with high deprivation (NZDep 2006 deciles 9 and 10) compared with 15% of non-Maori, while 73% of Maori live in deciles 6 to 10 neighbourhoods compared with 44% of non-Maori (Ministry of Health, 2010). There is a high likelihood that Maori children will live in poverty, an adverse experience that impacts lifelong health and social outcomes (Marie, Fergusson, & Boden, 2008; Poulton et al., 2002). The health system has a role to manage improvement in the poor health status of children (Tipene-Leach, 2012). Yet, despite Maori reporting good health in the 2012/13 New Zealand Health Survey, ongoing health inequities for parents and their children are evident, such as unmet health needs (Ministry of Health, 2012b).Providing culturally safe and responsive care is crucial for reducing health disparities and inequities for Maori (Robson & Harris, 2007; Wilson & Barton, 2012). Cultural responsiveness is grounded in worldviews, relationships, cultural contexts, and connecting in 'culturally-normed' ways of functioning (WerkmeisterRozas & Klein, 2009). Werkmeister-Rozas and Klein go further, stating cultural responsiveness is a cocreated reality between worker and client (p.6). This concept defies the adoption of universal or one-size-fits-all approaches. In addition to practitioners' awareness of their own cultural positions, cultural responsiveness is informed by a critical analysis of Maori whanau realities in terms of equity, social justice, rights, intersectionality, and complex interactions that impact their daily lives (Anderson et al. …

Whatu: Weaving Māori Women Educators’ Pedagogy.

Whatu was the starting point for a metaphor that emerged as a representation of three Maori women educators’ pedagogy. The Whatu metaphor was developed as a way of understanding the complexities of the Maori women’s pedagogy and to show that the strength of that pedagogy is in the interweaving of the strands. Concepts of Maori pedagogy are becoming more accessible in Aotearoa/ New Zealand: for example, the notion of ako as a means of explaining the connectedness of learning and teaching; and tuakana-teina as a form of peer support and learning. However, the pedagogy that umbrellas those two concepts is less accessible and was the subject of a small kaupapa Maori research project involving three Maori women educators. In response to a research question: ‘What is Maori women educators’ pedagogy?’ this article describes the Whatu metaphor; a metaphor that represents the research participants’ pedagogical ways of being, knowing and doing, and advances a new way of viewing Maori women educators’ pedagogy.

Photography’s long shadow: Ekphrasis and Maori literature

This article explores how Indigenous novelists use ekphrastic engagements with photography and painting to undermine the status of ethnographic images that show their culture as fixed on paper and unchanging in white-authored books. Paula Morris’s Rangatira (2011) and Kelly Ana Morey’s Bloom (2003), two novels by Aotearoa/New Zealand Maori women writers that raise doubt about the representative ability of the photograph to reflect the “truth” of a person or a culture, are the starting point of a reflection on the dual role of photography, and especially portraiture, to express fixity and permanence (we always are) as well as flux and movement (we are changing). The images described in the narratives are textual artefacts, and it is argued that the author’s ekphrastic relationship with them aims at uncovering “real” identity through self-representation and the rejection of outside representations. It is suggested that, while photographs of Maori subjects by European photographers create erroneous representations which contemporary Maori authors seek to correct, photographs of Maori subjects by Maori photographers destabilize established representations and highlight photography’s failure to capture their “real” essence as well as its potential to express the instability of identity constructs.

Breast Cancer Characteristics and Survival Differences between Maori, Pacific and other New Zealand Women Included in the Quality Audit Program of Breast Surgeons of Australia and New Zealand

The Quality Audit (BQA) program of the Breast Surgeons of Australia and New Zealand (NZ) collects data on early female breast cancer and its treatment. BQA data covered approximately half all early breast cancers diagnosed in NZ during roll-out of the BQA program in 1998-2010. Coverage increased progressively to about 80% by 2008. This is the biggest NZ breast cancer database outside the NZ Cancer Registry and it includes cancer and clinical management data not collected by the Registry. We used these BQA data to compare socio-demographic and cancer characteristics and survivals by ethnicity. BQA data for 1998-2010 diagnoses were linked to NZ death records using the National Health Index (NHI) for linking. Live cases were followed up to December 31st 2010. Socio-demographic and invasive cancer characteristics and disease-specific survivals were compared by ethnicity. Five-year survivals were 87% for Maori, 84% for Pacific, 91% for other NZ cases and 90% overall. This compared with the 86% survival reported for all female breast cases covered by the NZ Cancer Registry which also included more advanced stages. Patterns of survival by clinical risk factors accorded with patterns expected from the scientific literature. Compared with Other cases, Maori and Pacific women were younger, came from more deprived areas, and had larger cancers with more ductal and fewer lobular histology types. Their cancers were also less likely to have a triple negative phenotype. More of the Pacific women had vascular invasion. Maori women were more likely to reside in areas more remote from regional cancer centres, whereas Pacific women generally lived closer to these centres than Other NZ cases. NZ BQA data indicate previously unreported differences in breast cancer biology by ethnicity. Maori and Pacific women had reduced breast cancer survival compared with Other NZ women, after adjusting for socio-demographic and cancer characteristics. The potential contributions to survival differences of variations in service access, timeliness and quality of care, need to be examined, along with effects of co- morbidity and biological factors.