Presentation to IUSTI Asia Pacific Sexual Health Congress 2018, Tāmaki Mākaurau
The term Te Toka Tūmoana is one that is used widely by Māori in reference to Māori leadership. It is referred to in hapū and iwi mōteatea, traditional chants, pūrākau, our cultural forms of storytelling and storywork, whakataukī, our proverbial sayings. In the report Ngā Toka Tū Moana the authors write:
“The metaphor of “he toka tū moana” has come from the heritage of the people. It is not a new metaphor, but it is an old one to bring forward and apply to the leaders of the future. The strong leaders of iwi were described this way. Ko rātou ngā toka tū moana. Ka ākina rātou e ngā ngaru o te moana. Ka ākina e te tai, ka ākina e ngā hau. Engari ahakoa pēhea ka tū tonu, ka tū tonu. They are the rocks standing in the sea. They are bashed by the waves of the ocean. They are dashed by the tide. They are struck by the winds. But no matter what hits them, they stand and they stand. (p.56)”
In the health sector, including the Sexual and reproductive health sector the role of Māori leadership is essential but is more often than not it is ignored, marginalized, not consulted or consulted rather than engaged in meaningful ways, underfunded and under-resourced, or is denied, rejected.
This may not be the story that many people wish to hear, but it is a story that must continue to be voiced. This is an position that has been embedded across many sectors and is has been a part of approaches taken by successive governments.
We know that the evidence is clear that health disparities experiences by Māori in the health sector and across all domains of life continue to impact significantly on the lives of whānau, hapū, iwi both individually and collectively. There are many statistics in the sector that indicate this is the case. This is also the case for many Indigenous and People of Colour globally, including our relations from Te Moana nui a kiwa, the great ocean of Kiwa, the Pacific ocean.
For generations the stories of how we have come to this context have been made invisible, and continue to be invisibilised in our education system across the country. Not knowing our histories means, as a colleague Rihi Te Nana has stressed to us continually in our work “that we do not know our own backstory”. To every individual and collective story, there are many back stories. Few people, I would assert, know the stories of the Indigenous nations upon which they live, walk and work every day, and just as few will know the history of People of Colour, of takatāpui, two-spirit, queer or lgbtiq communities. That is certainly the case here in Aotearoa.
And even those that may know something or consider themselves ‘experts’ about gender identity, sexual identity or sexual and reproductive health, or the histories of oppressions and struggles for takatāpui, two-spirit or LGBTIQ in a mainstream heteronormative context often fail to incorporate an analysis of the intersection of colonization, of Indigenous dispossession, or of capitalist imposed class systems. These tend to be untold stories. This is also the experience of many Indigenous Peoples in this room.
Why… you may ask is this important?
I want to tell you a very small part of our story. I am from Taranaki. From Waitara. The place of the first colonial invasion wars. Some of you will know the history of Taranaki, but many of you will not. It is a history that is rarely spoken of outside of Māori contexts and is not required to be taught in our conventional western schooling system. Both the invasion of Parihaka and the attacks on hapū and iwi in Waitara were deliberate act of colonial aggression and oppression of our people. The following excerpts from the Waitangi Tribunal reports gives us a glimpse into the violence of that time.
On 5 November 1881, the militia and volunteers arrived at the gates of the undefended settlement. Although a colonel was nominally in command, the force was led by the Native Minister, mounted on a white charger. The troops were equipped with artillery and had been ordered to shoot at the slightest hint of resistance. Mounted on a nearby hill and trained on the village was a six-pounder Armstrong gun. (p.236)
When the cavalry approached, there were only two lines of defence; the first, a chorus of 200 boys, the second, a chanting of girls. On Te Whiti’s clear orders, there was no recourse to arms, despite the rape of women, theft of heirlooms and household property, burning of homes and crops, taking of stock, and forced transportations that ensued. There was no resistance again when Tohu and Te Whiti were imprisoned and charged with sedition. (p.8)
The impact of the Pāhua (the invasion of Parihaka), is one example of the impact of Historical Trauma events intergenerationally upon our people. The violence of such events is remembered in our whānau, hapū, iwi and communities. Recent research provides some understanding of the intense pain suffered by and remembered intergenerationally by our people, for example,
This old kuia used to when this particular men, used to go past, she would see them she would go ‘nasty’ men, he was a nasty man and he would walk back, nasty, I didn’t then what that meant, but they were the soldiers. Look at them ‘nasty men’ and come back with the Pākehā diseases, it was either syphilis, gonorrhea that type of diseases and that why, there were called the ‘nasty diseases’ because the wahine got it. (Reinfeld, Pihama & Cameron, 2015, p.43)
These forms of colonial and intergenerational impacts are the consequence of the invasion of our territories (Wirihana & Smith 2014; Pihama et.al. 2014). Historical trauma as an impact of colonization has for over 200 years included the dispossession and theft of Māori land and resources; the subjugation of Māori knowledges and practices; and the imposition of colonial, western knowledge ways of being, knowledge, systems and structures upon Māori whānau, hapū, iwi and communities.
The marginalization of mātauranga Māori and Indigenous knowledges continues today. Across Aotearoa, Australia and the Pacific, Western systems and structures of health, including sexual and reproductive health continue to foster, maintain and reproduce 21st century colonialism. Programmes implemented here continue to deny the history of violence that underpins the extremely high rates of Family violence and Sexual violence in this country. The denial of such history can be described as selective amnesia. It is an act of erasure. It serves to deny the role of both colonization and successive colonial governments in the reproduction of violence, and as such reinforces the deficit, colonial views of Māori people.
Despite a host of international rights instruments and the United Nations Declaration on the Rights of Indigenous peoples, Aotearoa, Australia and the United States governments and aid and development NGOs continue to traffic discourses of Western superiority – the representation of Indigenous peoples as ‘problem’ and ‘risk’, as incapable of making good choices, as living chaotic and unplanned lives, as peoples without knowledges and values, and as beholden recipients of sexual and reproductive health aid and development funds.
I want to speak of two contemporary examples of this in Aotearoa.
Firstly, In 2011 I was asked to contribute to review by the Families Commission related to a request by the then Minister of Social Development into ‘Teen Pregnancy” and what she referred to as “Repeat Teen Pregnancy”.It became quickly evident clear that most of literature maintained the notion that Teen pregnancy in Aotearoa is a ‘problem’, and that Māori young people in particular are ‘the’ problem.
In the article titled ‘Teenage Pregnancy: Cause for Concern’ Woodward et al. (2001) provide an overview of teenage pregnancy issues from a sample of 533 participants drawn from the longitudinal Christchurch Health and Development study. Of the 533 participants it is noted that 26% of the sample had been pregnant, and 14% had become parents. The article indicates the impact of teenage pregnancy as follows:
It has been well documented that an early transmission to parenthood has far reaching physical, social and emotional consequences for young women, including an increased risk of antenatal complications and mortality, failure to complete schooling, socio-economic disadvantage, welfare dependence, martial difficulties, maternal depression, and less competent parenting. (Woodward et al., 2001, p. 3)
A particular issue in regards to the Woodward et al. (2001) study is the level of Māori participation. Contact with the authors noted that there were 61 Māori participants amongst the 533 women. Of these numbers, 30 became pregnant and 23 became parents. However, the age range for these statistics is 17-21 years with no indication by the authors of how many participants were actually teenagers (17-19 years old) at the time of their pregnancy.
The authors state that using statistical trend analyses, ‘Māori ethnicity’ was found to be a ‘risk factor’ in itself in increasing the likelihood of early pregnancy and to becoming a teen parent, yet they then follow with the statement, however, that “these trends failed to reach statistical significance” (Woodward et al., 2001, p. 7). Yet, in spite of such key issues and a clear lack in the research, Woodward et al. (2001) make broad generalised statements that early pregnancy rates are elevated amongst those whom identify as Māori.
What is clear from such a small sample size, and the fact that the participants are drawn from one specific geographical area, is that there are methodological issues in regards to statistical validity and generalisability to the Māori population as a whole. Woodward et al. (2001) present a fundamentally ‘deficit’ approach to teenage pregnancy more generally, and to Māori ethnicity specifically. As mentioned earlier, Māori ethnicity is listed as a ‘risk factor’ for teenage pregnancy along with adolescent conduct problems, poor school achievement, and family adversity. Such constructions reproduce the stigmatistion of young Māori parents and whānau (Waetford, 2008).
This is not new and is not restricted to Māori and teen pregnancy rather it highlights the broader pathological discourses that dominate in regards to Māori sexual health, as Nash (2001) states:
The Public Health discourse provides linguistic resources that construct early childbearing as pathological; a pathology that extends to all areas of teenage mothers’ lives. This discourse offers a dominant framework for research in this area and additionally suggests a requirement for public health surveillance and intervention to manage individuals (p. 310).
Māori ethnicity itself is thereby posited as an unfavourable ‘deficit’ variable, in-line with dominant deficit discourse and whilst there is not consideration of the ways in which Māori are systematically and historically positioned in regards to colonization. The focus of our people as ‘deficit’ continues to be privileged across the health sector however our people have articulated for many years that we are not the problem, we are the solution. The risk factors are in fact colonisation and systemic racism and the ways in which they continue to impose oppressive structures upon our people. As Alison Green states,
The representation of Māori as ‘problem’ is more than an imagining. Instead, it has a materiality in the form of how knowledge and power are produced and how these are implemented in the health policy sector. Smith describes problematising indigenous peoples as a Western obsession (1999). The representation of Māori as ‘problem’ justifies the growth of the institutions and instruments involved in the surveillance, the management, and the control of Māori sexual and reproductive health. (Green, 2011; p.38)
Nash (2001) states that this contributes to the construction of key barriers in regards to research and discussions related to Māori including:
(i) the privilege given to forms of statistical explanation that favour a positivist over a hermeneutic account, embedded in the practical-theoretical “at risk” concept; (ii) the preference for behaviourist and reductionist models that isolate behaviour from its social context; and (iii) the support given to an authoritative concept of culture that inhibits recognition of actual and lived cultural practices. (p. 202)
Breheny and Stephens (2010) critique the construction of ethnicity within research related to teenage pregnancy. They highlight that Māori ethnicity has been presented as deficient thereby “affording a way of indicating culture as problematic (p. 313)”.
Data related to the sexual health of Māori including teen pregnancy is regularly compared to that of Pakeha, with the assumption that Pakeha experiences are the ‘norm’ or standard against which other ethnic groups are to be benchmarked.
In contrast to the limitations of much of the existing ‘scientific’ medical research, the work undertaken by Mantell, Craig, Stewart, Ekeroma, and Mitchell (2004) examining pregnancy outcomes for Māori women highlights some key findings in regards to Māori and teenage pregnancy. As part of a broader study of ethnicity and birth outcomes, Mantell et al. (2004) explore trends for over 65,000 live Māori singleton births during the period of 1996-2001. Their data focuses on three key areas, (i) age of childbearing; (ii) the effect of young motherhood on birth outcomes and (iii) prevalence of small babies – both preterm and small for gestational age (SGA). The research challenges some of the fundamental assumptions made about Māori teen parents, and in particular, Māori teenage mothers. Mantell et al. (2004) state that
Teenage pregnancy is not a risk factor for adverse outcomes for Māori women once socioeconomic status has been taken into account. For both preterm birth (OR 1.05) and small for gestational age (OR 1.00), teenage pregnancy appears to confer no additional risk when compared to women 30- 34. (Mantell et al. 2004, p. 538)
Rawiri (2007) investigated the role of social support in helping adolescent Māori mothers cope with pregnancy, birth and motherhood. It highlights the importance of social support and the continuation of education noting that by combining the efforts of positive social networks and social support, services can improve the lives of adolescent Māori mothers and their children. Importantly, the study notes the impact of colonization and the breakdown of communal whānau living as a significant issue.
Both Mantell and Rawiri provide us with understandings that include collective, historical and cultural understandings from specifically Māori approaches that call for transformative change across micro, meso and macro or systemic levels.
I want to turn now to my 2nd example that relates to Māori and sexual health education, in particular the ACC developed and funded ‘Mates and Dates’ programme.
‘Mates and Dates ‘ is described by ACC as follows:
Mates & Dates is a best practice, multi-year programme designed for NZ secondary school students across years 9-13 to promote safe, healthy and respectful relationships. (ACC, p.3)
The sole reference to Māori in the Educational Resource information in regards to how the programme will work in ‘your school’ states
Mates & Dates supports the National Education Goals (NEG):
NEG 9 – It is culturally appropriate for all and supports success by Māori (p.6)
The initial evaluation by Duncan & Kingi (2015) raised issued about the content of the programme, highlighting the following findings:
When the programme was assessed for its ability to meet best practice in relation to specific groups (i.e. Māori, Pacific peoples, Gay, lesbian, bi-sexual, transgender and intersex (GLBTI), people with disabilities), the following areas for improvement were identified:
• kaupapa Māori best practice is missing from the programme, although some of the principles are implicit
• there is little acknowledgment of the principles and values of Pacific society, and this needs to be explicitly articulated
• the needs of people with disabilities were not addressed, specifically the accessibility requirements of deaf students and students on the autism spectrum (p.ii)
Furthermore it was stated:
Kaupapa Māori principles need to be explicitly articulated in course materials. There must be acknowledgement and inclusion of the needs of Pacific participants. The needs of deaf students, students on the autism spectrum and students with other disabilities must also be acknowledged – course design should be improved to enable access, engagement, and learning. Resources need to reflect their audience if they are to resonate and have meaning. (p. v)
One must question how the notion of ‘best practice’ is claimed within the Educational Resource when substantial issues were raised about the programme and where little change is evident. Rather, the only “improvements’ to the programme noted by ACC are as follows:
Subtitles have been added to all films for hearing impaired students.
• Films have been updated to reflect the New Zealand context.
• Worksheets have been replaced with workbooks for students.
• All role plays and continuums have been reviewed by a subject matter expert and have also been peer reviewed.
• Certain worksheet based activities have been replaced with discussion based or interactive activities.
Such “improvements” fall far short of any meaningful or substantive changes to the programme and do nothing to deal with the cultural issues raised in regards to the lack of Kaupapa Māori and Pasifika approaches.
The ‘Report on the 2016 Mates & Dates survey’ by Appleton-Dyer, Soupen and Edirisuriya (2016) is equally problematic. The lack of knowledge of the context within Aotearoa is evident throughout the report which raises even more issues in regards to the programme, not least what ACC considers to be acceptable evaluation methodologies and reporting. Where there have been critical issues raised in regards to the programme content and the failure to engage Māori in the sector in terms of the programme development there is no discussion of these issues in the 2016 report.
What is evident in the Appleton-Dyer et.al. (2016) report is a lack of cultural and methodological knowledge.The report is constructed in ways that call into question the capacity of ACC to adequately document and evaluate the programme.For example, the discussion of ethnic groups is as follows:
Anyone who has any knowledge of quantitative research in this country should be appalled at the construction of ‘ethnic differences’ within the report.
What is a non-Māori or a non-Pacific or a non-asian student? How can these groups be constructed in this manner? The term ‘Pākehā’ does not appear anywhere in the report. So does that mean that Pākehā responses are somehow not ‘ethnic’ or not informed by ‘ethnicity’ or ‘culture’. The term NZ European appears once in the report. Just on this fundamental issue in terms of the report we have grounds to be highly skeptical of its contents. So lets look at this finding:
Most students suggested that they would not get angry with their partner if they did not do what they wanted them to do. However, Māori students (n=665) were more likely than non-Māori students (n=2449) to say they would “probably” get angry and yell at their partner/not talk to them if they didn’t do what they wanted them to do:
14% of Māori students said they would probably do this, compared to 8% of non- Māori students. This difference was statistically significant (p=0.000). (p.23)
So who is this difference statistically significant to? Who is non-Māori?
How has non-Māori, non-Pacific, and non-Asian become an ethnic grouping that one can compare to?
The evaluation team, Synergia continue to make the following finding:
What’s working well?
Overall, Mates & Dates is working well. It has improved students’ understanding across all the course content areas.
Most of the students did not hold stereotyped views and intended to engage in healthy relationships behaviours.
In more broad terms the programme has been clearly critiqued by a number of key organisations and researchers in the sector. Dr Katie Fitzpatrick states,
We absolutely must invest in relationship, consent and sexuality education in every school and it needs to be delivered by teachers.
It is irresponsible that such a significant sum of money is being used to fund this programme when it is being taught in a way that is inconsistent with effective education practice and education policy.
(NZ Herald August 8, 2018)
Te Whaariki Takapou, A Māori sexual and reproductive health promotion and research organisation, further highlights,
Sexual violence, like so many forms of violence experienced by Māori, will not be reduced by programmes like Mates and Dates. The programme is unconnected to the realities of Māori and fails to draw on the wealth of historical and contemporary Māori knowledges and practices associated with healthy relationships. August 7, 2018
What is required is an evidence-based national plan for culturally appropriate comprehensive sexuality education that includes consent and sexual violence. There are programmes underway in some schools where teachers are already addressing consent and sexual violence as part of comprehensive sexuality education. However, the road block to rolling out a national plan and programmes across all schools, including Māori-medium schools, is the lack of specific policy, funding and the political ‘will’ to lead the charge. August 7, 2018
In closing it is important that IUSTI18 conference think deeply about how you engage with Māori and Indigenous Peoples in this sector, how you consider the historical, colonial and intergenerational trauma that impacts on our communities, how do you all as participants take the opportunity to advocate for the rights of Māori and Indigenous peoples to self-determine our own sexual and reproductive health across research, policy, funding and services in Aotearoa, Australia and the Pacific, and how do you challenge the continued systemic racism that enables agencies and organisations to continue to reproduce the ongoing marginalization and under resourcing of Indigenous initiatives in this sector.
References
Appleton-Dyer,S. Soupen, A. Edirisuriya, N (2016) Report on the 2016 Mates & Dates survey : Report for the Violence Prevention Portfolio at ACC
Breheny, M. & Stephens, C. (2008). `Breaking the Cycle’ : Constructing intergenerational explanations for disadvantage. Journal of Health Psychology, 13(6), 754-763.
Breheny, M. & Stephens, C. (2010). Youth or disadvantage? The construction of teenage mothers in medical journals. Culture, Health & Sexuality, 12(3), 307-322.
Duncan, Anne and Kingi, Venezia (2015) Evaluation of ACC’s Mates and Dates: School-based Healthy Relationships Primary Prevention Programme. Lighthouse Consulting
Green JA (2011) A Discursive Analysis of Māori in Sexual and Reproductive Health Policy (Masters of Māori and Pacific Development). Hamilton, New Zealand: The University of Waikato.
Luker, K. (1996). Dubious conceptions: The politics of teenage pregnancy. Harvard University Press, Cambridge, MA.
Mantell, C.D., Craig, E.D., Stewart, A.W., Ekeroma, A.J., & Mitchell, A. (2004). Ethnicity and birth outcome: New Zealand trends 1980-2001: Part 2. Pregnancy outcomes for Māori women. Australian and New Zealand Journal of Obstetrics and Gynaecology, 44, 537-540
Nash, R. (2001). Teenage pregnancy: Barriers to an integrated model for policy research. Social Policy Journal of New Zealand, 17, 200-213.
Pihama, L., Te Nana, R., Reynolds, P., Smith, C., Reid, J., Smith, L.T. (2014) Positioning historical trauma theory within Aotearoa New Zealand in AlterNative: An International Journal of Indigenous Peoples, 10(3), 248–262.
Rawiri, C. (2007). Adolescent Māori mothers experiences with social support during pregnancy, birth and motherhood and their participation in education. Master of Social Science thesis, University of Waikato, Hamilton.
Waetford, C. H. (2008). The knowledge, attitudes and behaviour of young Māori women in relation to sexual health: A descriptive qualitative study. Master of Health Science thesis. Auckland University of Technology.
Wirihana, R. & Smith C. (2014) ‘Historical Trauma, Healing and Well-being in Māori Communities’ in MAI Journal, Volume 3, Issue 3.
Woodward, L. J., Horwood, L. J., & Fergusson, D. M. (2001). Teenage pregnancy: Cause for concern. New Zealand Medical Journal, 114(1135), 301-303.