Looking at the reasons some Māori māmā hold back from childhood immunisations
Māori māmā views and experiences of vaccinating their pēpi and tamariki explores the complex reasons why childhood vaccination services have not managed to engage all Māori māmā. The work is supported by Te Hiringa Hauora | Health Promotion Agency, produced by The New Zealand Work Research Institute at Auckland University of Technology via WotMatters Consulting and research lead Associate Professor Dr Terryann Clark, University of Auckland.
While most families immunise their children in New Zealand, the rate of children being immunised against serious childhood diseases has been dropping since late 2016, with widening gaps in coverage rates for Māori pēpi and tamariki. New research is illuminating the lived experience of 87 Māori māmā in Te Tai Tokerau (Northland).
“These māmā were not opposed to vaccination itself. They were opposed to how it was delivered, the coercive nature of how information was shared,” says researcher Shirleyanne Brown from WotMatters, “For example māmā were frustrated by the transactional nature of vaccination, calling it a ‘tick box exercise’.”
Māmā in this research saw appointments as missed opportunities to build relationships with health professionals, to celebrate their pēpi, check on maternal wellbeing and their whānau. Trust could be earned by having ‘straight up’ conversations about vaccination options, choices and previous experiences. Māmā also urged health professionals to address mistrust, develop consistent services, nurture ongoing relationships and listen to their concerns.
“If we start by recognising that Māori Māma want the best for their pēpi/tamariki, as their ‘fierce protectors’, we can build on what we’ve been told, to develop positive messaging, clinical service delivery and policy. The emphasis on protecting tamariki is important. It should be strengths-based and not shaming of whānau when they have genuine concerns” says Dr Terryann Clark.
As kaitiaki of their children, māmā in this research felt a duty to find the best care for their tamariki. That included ‘shopping around’ for people who were genuinely interested in the welfare of the child. For example two māmā said:
“The people are important. I went through three previous people before I had someone I could relate to. They are coming into my space”.
“It makes it easier for me to give my babies over because I know them now and trust them to care”.
“These māmā have felt judged, patronised, rushed and vulnerable. They have been put off getting healthcare for their tamariki and are suspicious of trying again. That is a problem because it leads to inequity, which is a fast track to a poorer quality of life” says Tanya Radford, First 1,000 Days Programme Lead at Te Hiringa Hauora.
“The desire of māmā to protect their pēpi and understand vaccination should be celebrated and supported. It’s their willingness to share their experience that will inform the health system on how to adjust its service to earn trust and confidence, and deliver equity to all.”
Other kaupapa they raised was that pamphlets or websites were not trusted sources of information, they often turned to whānau, friends or māmā networks for advice. Māori māmā want ‘relational’ information through their own trusted networks – a peer-support type strategy based on ‘people who look and feel like them’. They suggest utilising these trusted networks to share information would be a much more effective strategy.
The Māori māmā in this study want to access immunisation services for their tamariki but have been dissuaded by culturally inept practices. For example, some māmā in this research reported feeling pushed and judged:
“What stopped me is [Doctor], I don’t like her. She calls my kid obese. Fully judged me for being late. It was a negative experience.”
“I don’t like the push – for both sides, that push is everywhere, and it divides. Immunisation is a big divide ‘your kids aren’t immunised, stay away’. It’s vicious.”
There were accounts of positive and culturally safe experiences during vaccination. Some māmā recalled times where breastfeeding, karakia or rongoā was encouraged during vaccination appointments, and māmā were encouraged to take an active and equal role in the care of their tamariki.
Te Hiringa Hauora is now working with a Māori design agency who are centring Māori whānau as direction setters in a design solution which will support the sector to meet the needs of Māori māmā.
The report makes several recommendations for policy, practice, programmes, services and campaigns related to Māori childhood immunisations. Many of the findings can be transferred to other programmes, including engaging whānau Māori around COVID-19.
Media contact:
Nicole Adamson, Senior Advisor Communications, Te Hiringa Hauora
021 459 167 n.adamson@hpa.org.nz