Kia mau, kia ū : supporting the breastfeeding journey of Māori women and their whānau in Taranaki : a thesis presented in fulfilment of the requirements for the degree of Masters in Public Health at Massey University, Wellington, New Zealand

Abstract

The benefits of breastfeeding for maternal and infant health are well known to Māori. Yet inequities in breastfeeding rates between Māori and non-Māori exist. To understand some of the causes of these inequities, this qualitative study was designed to investigate some of the barriers to breastfeeding for wāhine Māori. It is grounded in Kaupapa Māori and Mana Wāhine research methodologies as a way of ensuring that the experiences of Māori women were prioritised and to provide transformative outcomes for whānau, hapū and iwi. The aims were to:

(1) Identify the barriers to full and exclusive breastfeeding for the recommended six months for wāhine Māori in Taranaki; (2) Identify ways to reduce these barriers; and (3) Understand how a breastfeeding culture can be enhanced within whānau Māori.

Semi-structured interviews were conducted with 11 Māori women and two whānau Māori living in Taranaki. Thematic analysis identified several intervention points to support breastfeeding: (1) access to high quality breastfeeding information (𝘍𝘪𝘭𝘭𝘪𝘯𝘨 𝘵𝘩𝘦 𝘬𝘦𝘵𝘦); (2) a compassionate and culturally-safe maternity healthcare workforce (𝘏𝘦𝘢𝘭𝘵𝘩 𝘴𝘦𝘳𝘷𝘪𝘤𝘦 𝘴𝘶𝘱𝘱𝘰𝘳𝘵); (3) active whanau involvement (𝘞𝘩𝘢̄𝘯𝘢𝘶 𝘴𝘶𝘱𝘱𝘰𝘳𝘵); (4) greater acceptance of breastfeeding by the wider community (𝘏𝘢𝘱𝘰𝘳𝘪 – 𝘴𝘶𝘱𝘱𝘰𝘳𝘵𝘪𝘷𝘦 𝘤𝘰𝘮𝘮𝘶𝘯𝘪𝘵𝘪𝘦𝘴); and (5) access to breastfeeding role models (𝘙𝘰𝘭𝘦-𝘮𝘰𝘥𝘦𝘭𝘭𝘪𝘯𝘨 𝘣𝘳𝘦𝘢𝘴𝘵𝘧𝘦𝘦𝘥𝘪𝘯𝘨). Partners and whanau provide important emotional and practical support to breastfeeding women (𝘛𝘩𝘦 𝘣𝘳𝘦𝘢𝘴𝘵𝘧𝘦𝘦𝘥𝘪𝘯𝘨 𝘴𝘶𝘱𝘱𝘰𝘳𝘵 𝘳𝘰𝘭𝘦) however the significance of this role needs to be acknowledged and encouraged (𝘚𝘶𝘱𝘱𝘰𝘳𝘵𝘪𝘯𝘨 𝘵𝘩𝘦 𝘴𝘶𝘱𝘱𝘰𝘳𝘵𝘦𝘳𝘴). Building whanau capacity and capabilities related to breastfeeding support must begin in the antenatal period (𝘈𝘤𝘤𝘦𝘴𝘴 𝘵𝘰 𝘪𝘯𝘧𝘰𝘳𝘮𝘢𝘵𝘪𝘰𝘯).

This thesis presents a Kaupapa Māori breastfeeding support framework that highlights two areas of action. 𝘛𝘪𝘢𝘬𝘪𝘯𝘢 𝘛𝘦 𝘜̄𝘬𝘢𝘪𝘱𝘰̄ describes the relationship between whānau and maternity providers and the ways in which they can protect the mother/infant dyad. It also offers a pathway for supporting Māori women in their breastfeeding aspirations. 𝘏𝘢̄𝘱𝘢𝘪 𝘛𝘦 𝘛𝘪𝘬𝘢𝘯𝘨𝘢 𝘜̄𝘬𝘢𝘪𝘱𝘰̄ describes the responsibilities of Government, the healthcare sector and the wider community to protect tikanga ūkaipō. Māori women aspire to breastfeed our babies, just as our tupuna did. As this thesis clearly shows, achieving these aspirations will require a commitment and reorientation of the maternity healthcare system towards whānau ora.