Abstract
Background
In Aotearoa, New Zealand (NZ), avoidable health inequities for Māori persist as a result of deeply entrenched health and social systems that are designed to privilege the NZ European population. Perinatal mental health outcomes and maternal suicide rates demonstrate that Māori mothers and birthing parents have the worst outcomes relative to other ethnic groups. Whilst research is plentiful on the inequities experienced by Māori birthing parents with perinatal mental illness, little research exists that supports the development of solutions that can improve perinatal mental health outcomes for Māori.
Aim
The overall aim of this thesis is to investigate the experiences of Māori mothers and birthing parents of perinatal mental illness and explore the approaches and practices that effectively support Māori whānau in the perinatal period. To address this aim, a qualitative investigation of the experiences of Māori birthing parents who had experienced mental illness in the perinatal period was undertaken.
Method
A Mana Wāhine theory framework, Kaupapa Māori methodology, and qualitative methods were used to carry out interviews with 19 Māori mothers. A semi-structured interview schedule, informed by a systematic literature review was used to explore the impact of Aotearoa, New Zealand’s healthcare system on Māori experiences of perinatal mental health. Questions explored perspectives on the perinatal health system, experiences at the clinical interface, and experiences of Kaupapa Māori approaches to perinatal mental health. Health system and maternity frameworks were utilised to analyse the impact of clinical, and structural features of Aotearoa, NZ’s health system on perinatal mental health, to identify barriers and potential enablers to health equity at each level of healthcare for Māori with perinatal mental illness. Approaches to the research and analysis were underpinned by Mana Wāhine theory to ensure the centring and privileging of the Māori research participants’ voices.
Results
Analysis of structural factors within the health system identified equity barriers in the design of operational, environmental, workforce and navigation points to improve the accessibility, delivery and scope of perinatal services for Māori whānau. Recommended changes related to four areas: services; treatment; workforce; and communication and education. Analysis of experiences at the clinical interface identified inherent structural and organisational constraints within the health system that inhibit clinicians from practicing in ways that ensure the key enablers of clinical and cultural excellence: continuity of care, whānau centred care and cultural safety. Participants described the challenges they experienced at the clinical interface and offered insights around positive interactions they encountered with clinicians. An analysis exploring a Kaupapa Māori perinatal mental health group intervention offered insights around its effectiveness and responsiveness to the needs of Māori birthing parents. Results demonstrated that future service design of perinatal mental health services should consider the incorporation of whanaungatanga (relationship building), tikanga (cultural protocols) and customary practices to improve mental health outcomes and elevate the mana (dignity, prestige) of whānau Māori in the perinatal period.