Exploring Approach 3: Tāngata whenua perspective

What things are valuable to people who support Approach 3?

In my point of view, I think the most important thing to people who support this approach is to recognise the value of having various ways to see the world. People who have different cultures have different perspectives when considering the same thing. In Maori custom and rules, it is important to them to protect and keep their customs and rules (tikanga) that are different to Pakeha customs as to them they are related to their spirituality and reflect the way they see the world. What will happen if some day their customs are lost and they do not have any identification with the other customs? A better health service does not mean to force all the different groups of people to receive the same services in the same way, but to satisfy different groups of people.

I agree with @Wendy Nguyen that the government must respect Maori customs and traditions. this step supported by providing easy access for Maori women to get pre-birth testing. In my opinion, the most important thing in using this approach is providing information to Maori women. It is important to provide knowledge to Maori women to get their pregnancy checked as early as possible even though the pregnancy is not the first pregnancy. the role of health professionals, community leaders, churches and Mäori agencies is vital in the dissemination of this information.

Personally, I don't really have a lot of knowledge about Maori, but from what I read, people who support this view are those who respect the Treaty of Waitangi and equity for all groups. They want to ensure that the Treaty will be held as it should be to create fair access for everyone. This means the right of Maori should be respected by the health system in the country. Furthermore, due to the fact that Maori often be as a subject for research but they do not really get benefits from it, then I think it will be fair if they can take benefits by implementing this approach.

I think New Zealand's Māori Health Strategy, He Korowai Oranga, is a useful reference for considering Approach 3. For example it includes the following threads, both of which are incredibly valuable to people who support this approach:

• Rangatiratanga, which captures people’s right to participate in making decisions about their health and to have meaningful ways to decide how health services might be provided for their benefit; and

• Equity, which acknowledges that not only are differences in health status unfair and unjust, but they are also the result of differential access to the resources necessary for people to lead healthy lives.

The Treaty of Waitangi principles partnership, participation, and protection, are also very important to people who support this approach. The Ministry of Health explains these per the following:

• Partnership involves working together with iwi, hapū, whānau and Māori communities to develop strategies for Māori health gain and appropriate health and disability services.

• Participation requires Māori to be involved at all levels of the health and disability sector, including in decision-making, planning, development and delivery of health and disability services.

• Protection involves the Government working to ensure Māori have at least the same level of health as non-Māori, and safeguarding Māori cultural concepts, values and practices .

Thank you @Tasha Waris for trying to see things from a point of view you don't know much about. This is an important democratic skill, just like listening ... I see is it as an appreciative and active way of listening ... which is critical for understanding and relationships.

And @Beth Hampton , sharing He Korowai Oranga is very relevant and, for me, heartening - it appears that the health system has moved on since the pre-birth testing project in 2007/8! - though I guess there are always questions about the effectiveness of the strategy.

Approach Three recognises and asserts that the pre-birth screening and testing system, must take in to consideration the needs, customs and values of all mothers/parents/family.

Things that are valuable from a Maori perspective include pre-birth testing practitioners possessing an in-depth understanding of the “Core values for Maori” and implementing this knowledge into their practice. 

For example, understanding and demonstrating the concept of whakapapa, recognises that the unborn child belongs to the family/whanau, not just to the mother/parents.  Practitioners demonstrate this knowledge in their practice by ensuring mothers/parents can, if they choose, include their family/whanau in all information sharing, discussion and decision-making about pre-birth testing and screening procedures, options and considerations. 

In summary, it is my view that mothers/parents/family who support Approach 3, value a pre-birth testing and screening system that adjusts to the needs of mothers/parents/family, rather than require mothers/parents/family to assimilate to "the system" to access required pre-birth testing information and services.

At the heart of Approach 3, Tangata Whenua and specifically Maori women and their whanau are engaged as early as possible and in a way that respects their Mana and Dignity in relation to pre-birth testing. Maori core values as stated in the Treaty of Waitangi are upheld in good faith and their tikanaga is respected. 

To summarize, below are additional points that are valuable to Maori women and whanau in relation to Approach 3: 

1. Meaningful engagement needs to occur at an iwi level and the way the messages are delivered has to be culturally appropriate.  Time and support to understand what is being shared has to also be given to help make informed decisions. 

2. Acknowledge that within the Maori culture, both the individual and whanau decisions are valued.  It recognizes that Maori women belong to a network of support and that the unborn child is an important member of the whanau.  

3. Blood tissue is used with consent and respected. Within the Maori culture, the body is treated with a high level of sacredness and appropriate care and cultural responses may be conducted. 

4. Access to medical services, counselling and cultural appropriate specific services early in the pregnancy for both the Maori women and whanau.   This includes material in Te Reo and fully funded pre-birth testing. 

5. Involvement in research and conversations to help shape and inform policy and set priorities that impact on Maori women and Whanau re: pre-birthing.  Growing Maori leadership within research and policy is important to ensure that cultural specific values and tikanaga are embodied in decisions that influence practice going forward. 

When I consider what is important to Tangata Whenua, I think about the importance of designing an engagement approach and services that respects the cultural aspects of maori women and their whanau. This means existing practices have to embrace a different worldview from what is commonly practiced. Funding and research are importance enablers to help bring understanding of what these perspectives are important.

You've been working hard and very well together so let's put a line under the question of what a supporter of this approach values and move onto the questions of cost, consequences, tensions and conflicts.

I'm really impressed by the amount of ground you've covered in a very short time and I hope you feel that you are learning things from each other about each other, about pre-birth testing and about this deliberative dialogue process.

Summary of things a supporter of Approach 3 values

Here's a quick summary. Please let me known what needs to the added, deleted, modified if I've missed something or got anything wrong.

• Having a system that caters to the needs of Maori, e.g. upholds customs, rules, beliefs and the Treaty of Waitangi and its principles – this seems to be the intend of He Korowai Oranga

• Services should meet the needs of the communities that they are for.

• Easy, equal and fair access to pre-birth testing, information and support services – this should be done through people and organisations trusted by Maori

• That Maori benefit from any research about them or that uses them

• Early and meaningful engagement in all decision making and at all levels (e.g. iwi, hapu, whanau)