SRH system failing wāhine Māori: study
New Zealand's sexual and reproductive healthcare (SRH) system is leaving many Māori women feeling "dehumanised and disempowered".
A new University of Otago (Christchurch) study has highlighted potential areas of improvement in the quality of sexual and reproductive healthcare services delivered to wāhine in New Zealand.
Lead author, primary care doctor and department of primary care and clinical simulation teaching fellow Dr Chelsea Harris said 12 Māori women, aged 25-57, were interviewed about their experiences interacting with the healthcare system for SRH issues.
The research found most received insufficient information when making decisions about issues such as contraceptive options and diagnostic procedures, and they had concerns about not being kept "in the loop" when experiencing stressful events such as abnormal cervical smear results, or childbirth not progressing according to plan.
It left many feeling dehumanised, disempowered, scared and dismissed, which affected their psychological wellbeing and trust in the medical system, Dr Harris said.
"Being uninformed perpetuates health inequities, both indirectly by eroding the trust wāhine have in healthcare services, and directly by limiting the effectiveness of healthcare encounters.
"Our data showed that wāhine benefit from services and care that make them feel comfortable and respected, but that dehumanising care can impact their future engagement with services.
"How and when information is provided is so important."
She said receiving information immediately before a procedure could be distressing, and it was already known women who underwent gynaecological or obstetric procedures without adequate consent were at risk of developing post-traumatic stress disorder.
Dr Harris said the research highlighted it could be difficult to identify and access reliable SRH information.
"Health literacy is often seen as the responsibility of the individual.
"However, previous researchers have argued it's the responsibility of health professionals to support the health literacy of our patient."
She believed the wider dissemination of reliable SRH information to wāhine Māori could improve outcomes, particularly if it was Māori-led by design.
The research also found healthcare professionals and environments played a vital role in helping wāhine Māori feel empowered or, conversely, disempowered during SRH encounters.
It found clinics and hospital environments could be intimidating and counterproductive to maintaining confidentiality.
"The spaces we create in healthcare — not just their physical qualities, but also their warmth, non-judgementalism and safety — play an important role in setting the tone for healthcare encounters.
"This begins in the waiting room.
"Do patients absolutely need to speak to the receptionist in front of a waiting room full of other people? Are they greeted by a friendly face?"
She said many women reported a preference for female staff when accessing SRH healthcare, but showing kindness and respect helped wāhine feel more comfortable seeing male healthcare staff, Dr Harris said.
"Also, regardless of gender, the participants reported that a sense of humour was an added bonus."
The research concluded SRH care should support the mana (status or prestige) of the patient.
john.lewis@odt.co.nz
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