Firstly, mahalo to the state of Hawaii and city of Honolulu for hosting the 13th Festival of Pacific Arts & Culture, the reason I was on Oahu recently. It was an incredible mana uplifting Pacific experience — I thank and honor you.
While there, I read with interest your reporting of midwifery in Hawaii. In particular, the Star-Advertiser’s June 13 editorial, “Midwife law needs cultural infusion,” shared statistics that were a sobering read and not dissimilar to Aotearoa/New Zealand. An active way to make a difference? Have a workforce that reflects its community; this is evidenced to improve health outcomes for “at risk” communities.
I am a midwife in Aotearoa/New Zealand, co-chair of Pasifika Midwives Aotearoa, and national coordinator of Tapu Ora, the Pasifika midwifery workforce initiative alongside indigenous Maori Te Ara o Hine (TAoH). I want to acknowledge the New Zealand Ministry of Health/Manatu Ora that has enabled this initiative.
I also am an educator at Auckland University of Technology midwifery school, the largest of six schools in Aotearoa/New Zealand. This month, about 50 Pasifika student midwives (11.5%) will be enrolled throughout the four-year program.
Integral to akonga/student learning and our teaching is cultural safety/competency alongside clinical competency. Foundational is to know oneself — “ko wai au — who am I” — in order to understand how your perspective as a health worker can affect how you work within the community.
In 2006, the Maori midwifery organization Nga Maia gifted an indigenous framework called Turanga Kaupapa. The principles have general headings that contain deep concepts: whanau/ohana past, present and future in whakapapa (geneology) and mokopuna (grandchildren); karakia/pule and use of Te Reo Maori/indigenous language; hau ora, the holistic dimensions of health and well-being; the importance of relationship with the land; te whare tangata, the womb or house of the people and being respectful of wahine who carry the future; the midwife, who has a key role and provides manaakitanga (kindness and support). Mana for the dignity of the wahine, her whanau (family group), the midwife and others involved is maintained.
This framework has been adopted by the New Zealand College of Midwives and regulatory Midwifery Council of New Zealand, and is an intrinsic educational part of registration.
The Midwifery Council maintains the Register of Midwives, sets the competencies and educational program in Aotearoa/New Zealand. Recently it has included up to 100 cultural hours annually in the pre-registration program, hours interpreted independently by each midwifery school. The significant elevation supports an ideological view that indigeneity embraces and enriches midwifery practice.
Aotearoa/New Zealand’s statistical profile is very similar to Hawaii’s, with poor outcomes for indigenous Maori and Pacific peoples as a migrant group. It is a part of the solutions-focused approach to change that demographic.
We’re working to expand on Tapu Ora-TAoH workforce initiative’s three pou (pillars): recruitment, retention and successful completion. The strength of the initiative is having Pasifika midwives as role models who understand the Pasifika student perspective. This key role is to provide wrap-around support as a kahu pokai/midwife with the cultural nuances in an advocacy and academic space.
I have focused on the midwifery/birthworkers/carers, and the important voice and view to be heard is that of ohana/whanau/family and whom we are here to serve. To ensure they have a choice of who can provide care and how they are to be cared for. The cultural thread that binds, informs and ensures our engagement as carers is deeply embedded in ancient ancestral ways of being and knowing.
Our journey as a midwifery profession is not perfect, but the bravery to explore the possibilities is encouraging whereby all structures — tertiary institutions, professional bodies and users — can gather together to korero/talk/kama’ilio toward solutions.
I applaud the editorial, “Midwife law needs cultural infusion,” and hope your view and voice continue to uphold the mana “that promotes cultural considerations, not diminishes them.”
Ngatepaeru Marsters is co-chair of Pasifika Midwives Aotearoa (a member of the New Zealand College of Midwives National Board) and national coordinator of the Pasifika midwifery workforce initiative, Tapu Ora alongside indigenous Maori Te Ara o Hine.
