Famous for their ka mate haka, or “the haka,” war dance used by the
New Zealand All Blacks rugby team since 1905, the Māori are the
indigenous people of New Zealand [1]. Despite this international
presence, Māori women today face significant health disparities. As a
country, New Zealand’s infant death rate is 5.2 deaths per 1,000 births.
This is high compared to Great Britain but low compared to the United
States. The interesting part though is that Māori women have higher
rates of neonatal death (i.e. stillbirth) and infant death within the
first year of life than do New Zealand European women. Pregnant/recently
pregnant Māori women also have a greater risk of dying from birth
related complications [2].
Furthermore, the incidence of breast cancer is far higher in Māori women than in other New Zealand ethnic groups. Even more concerning is that incidence seems to be increasing faster in Māori women. For example, breast cancer rates for Māori women rose between 1981 and 1986 from 123 to 210 per 1000,000 women per year while the rate for European/other New Zealand women rose in the same time period from 114 to 170 per 100,000 women per year. Thus, there seems to be not only a drastic difference in breast cancer incidence but in growth rate as well. Even though New Zealand has maintained a free national breast screening programme since 1998, Māori women use this free screening less than non-Māori women [3].
In addition to breast cancer, Māori women of New Zealand also face elevated risk of cervical cancer. In 2005, the incidence rates for cervical cancer were the following: European women 5.6 per 100,000 women, Pacific Islander women 16.3 per 100,000 women, and Māori women 9.0 per 100,000 women. Māori women have a higher overall mortality rate of 6.5 per 100,00 women compared to European women 1.4 per 100,000 women. Studies that have adjusted these results for socio-economic position, urban or rural residence, and stage at diagnosis found that these adjustments did little to account for the drastic differences. A study published in BMC cancer found that comorbidity contributes to survival disparities for cervical cancer. For instance, compared to non-Māori New Zealand women, Māori women have higher rates of chronic diseases (i.e. cardiovascular and diabetes), respiratory diseases, and smoking. However, the study said that comorbidity accounts “for only a moderate proportion of the ethnic differences in survival,” meaning that other factors such a health care treatment may play a role [4].
Finally, the last health disparity we will touch on today is the rate of intimate partner violence. Māori women have a 57.% lifetime prevalence of physical and/or sexual intimate partner violence (more than 1 in 2) compared to European women who have a prevalence of 34.3% (approximately 1 in 3). These results are similar to the higher prevalence of intimate partner violence experienced among indigenous populations in the United States, Canada, and Australia when compared with European ethnic groups [5]. Similar results have been found in other independent reports [6].
The quote above was provided by both men and women of the Māori Task force as they explored cases of domestic violence in Māori culture. As one can see from the quote, many Māori agree that there is no traditional reasoning for the abuse or mistreatment of women. However, it should be noted that the Maori culture does contain different expectations for men and women in certain situations. For example, New Zealand Parliament’s longest serving female MP Annette King and her colleague Maryan Street were asked to move from the front bench during the start of a powhiri, or Māori welcoming ceremony in 2014. As a result, the Speaker of Parliament has called for modernization of Maori protocols [8]. Maybe, there is more to explore in the direction of gender roles in Māori culture. Now we are faced with some big questions: Where do these health disparities originate? What are their contributing factors?
Different researchers have related these health disparities between Māori women and non-Māori women of New Zealand to a range of reasons such as limited access to primary health care and limited finances [2], a less healthy lifestyle among Māori women compared to non-Māori women [3], colonization processes such as racism, exploitation of resources, seizure of land, introduction of alcohol, and disease [5], and connotation of diseases like Human Papillomavirus which leads to cervical cancer with shame and stigma in cultural communities [9]. Next week, we will explore the reasons for these health disparities further and strategies to mitigate them such as addressing attitudes, poverty, racism, colonization, and engaging men.
Works Cited:
[1] Lai, Jessica Christine. "Indigenous Cultural Heritage and Intellectual Property Rights." Chapter 2 Māori Culture in the Contemporary World. Switzerland: Springer International, 2014. N. pag. Springer.com. Web. 13 Feb. 2014. <http://link.springer.com/
[2] Filoche, Sara, Susan Garrett, James Stanley, Sally Rose, Bridget Robson, C. Elley, and Bev Lawton. "Wāhine Hauora: Linking Local Hospital and National Health Information Datasets to Explore Maternal Risk Factors and Obstetric Outcomes of New Zealand Māori and Non-Māori Women in Relation to Infant Respiratory Admissions and Timely Immunisations." BMC Pregnancy and Childbirth 13.1 (2013): 145. 10 July 2013. Web. <http://www.biomedcentral.com/
[3] Mckenzie, Fiona, Lis Ellison-Loschmann, Mona Jeffreys, Ridvan Firestone, Neil Pearce, and Isabelle Romieu. "Healthy Lifestyle and Risk of Breast Cancer for Indigenous and Non-indigenous Women in New Zealand: A Case Control Study." BMC Cancer 14.1 (2014): 12. 10 Jan. 2014. Web. <http://www.biomedcentral.com/
[4] Brewer, Naomi, Barry Borman, Diana Sarfati, Mona Jeffreys, Steven T. Fleming, Soo Cheng, and Neil Pearce. "Does Comorbidity Explain the Ethnic Inequalities in Cervical Cancer Survival in New Zealand? A Retrospective Cohort Study." BMC Cancer 11.1 (2011): 132. 12 Apr. 2011. Web. <http://www.biomedcentral.com/
[5] Fanslow, J., E. Robinson, S. Crengle, and L. Perese. "Juxtaposing Beliefs and Reality: Prevalence Rates of Intimate Partner Violence and Attitudes to Violence and Gender Roles Reported by New Zealand Women." Violence Against Women 16.7 (2010): 812-31. July 2010. Web. <http://vaw.sagepub.com/
[6] Schluter, P. J., J. Paterson, and M. Feehan. "Prevalence and Concordance of Interpersonal Violence Reports from Intimate Partners: Findings from the Pacific Islands Families Study." Journal of Epidemiology & Community Health 61.7 (2007): 625-30. July 2007. Web. <http://www.ncbi.nlm.nih.gov/
[7] Kruger, Tamati, Mereana Pitman, Tahuaroa McDonald, Dennis Mariu, Alva Pomare, Teina Mita, Matehaere Maihi, and Keri Lawson-Te Aho. TRANSFORMING WHANAU VIOLENCE. Rep. Second Maori Taskforce on Whanau Violence, Sept. 2004. Web. <http://www.nzfvc.org.nz/
[8] NZ Herald. "Speaker Calls for Maori Protocols to Be Modernised." The New Zealand Herald. N.p., 4 Jan. 2014. Web. <http://www.nzherald.co.nz/
[9] Maar, Marion, Ann Burchell, Julian Little, Gina Ogilvie, Alberto Severini, Jinghao Mary Yang, and Ingeborg Zehbe. "A Qualitative Study of Provider Perspectives of Structural Barriers to Cervical Cancer Screening Among First Nations Women." Women's Health Issues 23.5 (2013): E319-325. 26 June 2013. Web. <http://ac.els-cdn.com/
Furthermore, the incidence of breast cancer is far higher in Māori women than in other New Zealand ethnic groups. Even more concerning is that incidence seems to be increasing faster in Māori women. For example, breast cancer rates for Māori women rose between 1981 and 1986 from 123 to 210 per 1000,000 women per year while the rate for European/other New Zealand women rose in the same time period from 114 to 170 per 100,000 women per year. Thus, there seems to be not only a drastic difference in breast cancer incidence but in growth rate as well. Even though New Zealand has maintained a free national breast screening programme since 1998, Māori women use this free screening less than non-Māori women [3].
In addition to breast cancer, Māori women of New Zealand also face elevated risk of cervical cancer. In 2005, the incidence rates for cervical cancer were the following: European women 5.6 per 100,000 women, Pacific Islander women 16.3 per 100,000 women, and Māori women 9.0 per 100,000 women. Māori women have a higher overall mortality rate of 6.5 per 100,00 women compared to European women 1.4 per 100,000 women. Studies that have adjusted these results for socio-economic position, urban or rural residence, and stage at diagnosis found that these adjustments did little to account for the drastic differences. A study published in BMC cancer found that comorbidity contributes to survival disparities for cervical cancer. For instance, compared to non-Māori New Zealand women, Māori women have higher rates of chronic diseases (i.e. cardiovascular and diabetes), respiratory diseases, and smoking. However, the study said that comorbidity accounts “for only a moderate proportion of the ethnic differences in survival,” meaning that other factors such a health care treatment may play a role [4].
Finally, the last health disparity we will touch on today is the rate of intimate partner violence. Māori women have a 57.% lifetime prevalence of physical and/or sexual intimate partner violence (more than 1 in 2) compared to European women who have a prevalence of 34.3% (approximately 1 in 3). These results are similar to the higher prevalence of intimate partner violence experienced among indigenous populations in the United States, Canada, and Australia when compared with European ethnic groups [5]. Similar results have been found in other independent reports [6].
“There is nothing in the Māori world that promotes and encourages the idea of whānau violence. No one can point to an ideological belief that talks about women being lower in the social order. Mana tangata is female in nature. Life itself is symbolised by women. Hence the terms like te whare tangata where humankind originates from.” -Second Māori Taskforce on Whānau Violence [7]
The quote above was provided by both men and women of the Māori Task force as they explored cases of domestic violence in Māori culture. As one can see from the quote, many Māori agree that there is no traditional reasoning for the abuse or mistreatment of women. However, it should be noted that the Maori culture does contain different expectations for men and women in certain situations. For example, New Zealand Parliament’s longest serving female MP Annette King and her colleague Maryan Street were asked to move from the front bench during the start of a powhiri, or Māori welcoming ceremony in 2014. As a result, the Speaker of Parliament has called for modernization of Maori protocols [8]. Maybe, there is more to explore in the direction of gender roles in Māori culture. Now we are faced with some big questions: Where do these health disparities originate? What are their contributing factors?
Different researchers have related these health disparities between Māori women and non-Māori women of New Zealand to a range of reasons such as limited access to primary health care and limited finances [2], a less healthy lifestyle among Māori women compared to non-Māori women [3], colonization processes such as racism, exploitation of resources, seizure of land, introduction of alcohol, and disease [5], and connotation of diseases like Human Papillomavirus which leads to cervical cancer with shame and stigma in cultural communities [9]. Next week, we will explore the reasons for these health disparities further and strategies to mitigate them such as addressing attitudes, poverty, racism, colonization, and engaging men.
Works Cited:
[1] Lai, Jessica Christine. "Indigenous Cultural Heritage and Intellectual Property Rights." Chapter 2 Māori Culture in the Contemporary World. Switzerland: Springer International, 2014. N. pag. Springer.com. Web. 13 Feb. 2014. <http://link.springer.com/
[2] Filoche, Sara, Susan Garrett, James Stanley, Sally Rose, Bridget Robson, C. Elley, and Bev Lawton. "Wāhine Hauora: Linking Local Hospital and National Health Information Datasets to Explore Maternal Risk Factors and Obstetric Outcomes of New Zealand Māori and Non-Māori Women in Relation to Infant Respiratory Admissions and Timely Immunisations." BMC Pregnancy and Childbirth 13.1 (2013): 145. 10 July 2013. Web. <http://www.biomedcentral.com/
[3] Mckenzie, Fiona, Lis Ellison-Loschmann, Mona Jeffreys, Ridvan Firestone, Neil Pearce, and Isabelle Romieu. "Healthy Lifestyle and Risk of Breast Cancer for Indigenous and Non-indigenous Women in New Zealand: A Case Control Study." BMC Cancer 14.1 (2014): 12. 10 Jan. 2014. Web. <http://www.biomedcentral.com/
[4] Brewer, Naomi, Barry Borman, Diana Sarfati, Mona Jeffreys, Steven T. Fleming, Soo Cheng, and Neil Pearce. "Does Comorbidity Explain the Ethnic Inequalities in Cervical Cancer Survival in New Zealand? A Retrospective Cohort Study." BMC Cancer 11.1 (2011): 132. 12 Apr. 2011. Web. <http://www.biomedcentral.com/
[5] Fanslow, J., E. Robinson, S. Crengle, and L. Perese. "Juxtaposing Beliefs and Reality: Prevalence Rates of Intimate Partner Violence and Attitudes to Violence and Gender Roles Reported by New Zealand Women." Violence Against Women 16.7 (2010): 812-31. July 2010. Web. <http://vaw.sagepub.com/
[6] Schluter, P. J., J. Paterson, and M. Feehan. "Prevalence and Concordance of Interpersonal Violence Reports from Intimate Partners: Findings from the Pacific Islands Families Study." Journal of Epidemiology & Community Health 61.7 (2007): 625-30. July 2007. Web. <http://www.ncbi.nlm.nih.gov/
[7] Kruger, Tamati, Mereana Pitman, Tahuaroa McDonald, Dennis Mariu, Alva Pomare, Teina Mita, Matehaere Maihi, and Keri Lawson-Te Aho. TRANSFORMING WHANAU VIOLENCE. Rep. Second Maori Taskforce on Whanau Violence, Sept. 2004. Web. <http://www.nzfvc.org.nz/
[8] NZ Herald. "Speaker Calls for Maori Protocols to Be Modernised." The New Zealand Herald. N.p., 4 Jan. 2014. Web. <http://www.nzherald.co.nz/
[9] Maar, Marion, Ann Burchell, Julian Little, Gina Ogilvie, Alberto Severini, Jinghao Mary Yang, and Ingeborg Zehbe. "A Qualitative Study of Provider Perspectives of Structural Barriers to Cervical Cancer Screening Among First Nations Women." Women's Health Issues 23.5 (2013): E319-325. 26 June 2013. Web. <http://ac.els-cdn.com/
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