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The sexual and reproductive health and rights of Māori men and boys


tewhariki

TE WHĀRIKI TAKAPOU TE WHĀRIKI TAKAPOU
Te Whāriki Takapou (formerly Te Puāwai Tapu) is a cloud-based kaupapa Māori sexual and reproductive health promotion organisation governed and operated by Māori. Contracted by the Ministry of Health, we provide nationwide sexual and reproductive health promotion services and leadership in Māori sexual and reproductive health issues. The organisation works to achieve sexual and reproductive health and wellbeing for Māori, and we work with both Māori and mainstream sexual and reproductive health organisations, iwi, and diverse Māori communities.

nzppdProceedings from an Open Hearing – New Zealand Parliamentarian’s Group on Population and Development (NZPPD)

On 29 June 2015 at Parliament in Wellington, Alison Green and Tawhanga Nopera, made an oral presentation regarding the sexual and reproductive health and rights of Māori men and boys as part of the “Engaging boys and men in sexual and reproductive health and rights (SRHR) initiatives in the Pacific” Open Hearing. The NZPPD is a voluntary cross-party group of parliamentarians who share an interest in increasing awareness of and prioritisation for sexual and reproductive health and rights issues in the Pacific region.

What follows are key points from the proceedings.

E te Rōpū, e ngā mana, tēnei mātou o Te Puāwai Tapu e mihi kau ana ki a koutou, tēnā koutou.

Background

Māori make up 15% of the total New Zealand population, and of that, Māori men and boys make up approximately 48%, or 7% of the total New Zealand population (Statistics New Zealand, 2013).

Statistics New Zealand collects population data on the basis of sex as defined at birth; either male or female, but no statistical information is collected about gender identity. This is described as the deeply felt internal and individual experience of gender, which may or may not correspond with the sex assigned at birth, and may or may not involve some form of transition (Statistics New Zealand, 2014). ‘Māori men and boys’ are defined by sex, not by gender identity. Therefore, Māori men and boys who would want to be part of the grouping if it were defined by gender identity are excluded.

Gender identity and gender attributes, not just one’s sex, were important organising principles in the traditional, pre-Christian Māori world and this is supported by Māori research. The word ‘takataapui’, for example, describes a person’s gender identity, not their sex, nor their sexual identity or sexual preference. There is no single English-language word or concept that conveys the same breadth of meaning and inclusivity as the word ‘takataapui’.

The experience of Te Puāwai Tapu is that Māori have not advocated for better sexual and reproductive health using international rights-based approaches (Note 1: Approaches that draw upon New Zealand’s international sexual and reproductive health-related covenants and agreements i.e. ICPD 1984, UNGASS, CERD). Instead, Māori have linked health advocacy to the Crown’s Treaty of Waitangi responsibilities. However, the United Nations Declaration on the Rights of Indigenous Peoples may provide a useful rights-based platform going forward.

Introduction

Te Puāwai Tapu has serious concerns for the sexual and reproductive health of Māori men and boys. These can be summarised as:

  1. Lack of appropriate school-based information about how to maintain good sexual and reproductive health, and;
  2. Lack of appropriate information about the benefits of early STI testing and treatment for Māori men and boys and their sexual partners, and;
  3. A dearth of evidence-based, kaupapa Māori information about the sexual and reproductive health of Māori men and boys, and insufficient funds to support a nationwide programme of work to address these concerns.

Lack of appropriate school-based sexual and reproductive health information for Māori boys

Māori traditional understandings and approaches to sexual and reproductive health reflect values of respect, responsibility, sex-positivity, joy, inclusivity, and consideration for oneself but also one’s whānau and community (Note 2: sourced from pre-Christian haka, waiata, mōteatea, and oriori (Karetu, 1995), and reflected in the carvings that were taken from New Zealand in the late 1700s by explorers and are currently housed in museums in Europe (Hutchings and Aspin, 2007).

Past government policies damaged Māori language and Māori traditional knowledges (Waitangi Tribunal, 1986) and education policies disadvantaged Māori, consistently failing whānau, hapū and iwi over many generations (Office of the Auditor-General, 2012).

As a result, Māori men and boys have been unable to benefit from traditional whānau, hapū and iwi knowledge about good sexual and reproductive health. At the same time, school-based contemporary knowledge and information has not fostered the maintenance of good sexual and reproductive health.

Mainstream media portray distorted and racist representations of Māori men and boys (Hokowhitu, 2008). Pākehā men have evolved from the ‘rugged outdoors man’, or ‘rugga bugga’, to the sensitive, caring and sexually mature ‘new age guy’. By comparison, the media has limited representations of Māori men to sports fields, building sites, or criminal justice systems. Here, they are portrayed as physically strong although lacking intelligence, with hard-drinking, macho, sexually immature, and violently abusive attitudes (2008).

Positive representations of Māori men and boys are not easy to find. They are rarely represented as members of whānau, as sexually mature and responsible partners, parents, teachers, trades people, hapū and iwi leaders, through the media of wider New Zealand society. Within Māori communities, events such as waka ama, kapa haka, Ngā Manu Kōrero are positive and affirming for Māori men and boys, as are Kōhanga Reo, Kura Kaupapa Māori, Wharekura, Rūnanga meetings, Māori conferences, and a range of marae-based events.

A recent community-based research project in Huntly, a small town in the north Waikato, interviewed young Māori men who had recently left school. The majority reported a low level of knowledge about their bodies and sexual health. Most said they were reluctant and felt ‘whakamā’ or uncomfortable and ashamed about seeking help for their sexual and reproductive health (King, 2014).

In 2014 Te Puāwai Tapu, with support from a Māori sexual health promotion organisation in Hamilton and a youth health centre in Whangarei, interviewed young Māori men and women school leavers about their knowledge of sexually transmitted infections (STIs). The majority reported they knew little about what STIs are, how you get an STI, and when you should get tested.

A 2012 survey of secondary schools in New Zealand reported a number of persistent inequities. It involved 1,700 Māori students aged 12 to 19 years old, 47.2 % of whom were Māori boys and young Māori men (n = 801). Of concern was the high number of Māori students who reported inconsistent use of contraception which increased the risk for young Māori men and women of becoming teenage parents, but also increased the risk of transmitting or acquiring an STI (Crengle et al, 2012).

From this evidence, it should come as no surprise that young Māori men have significant gaps in their knowledge about reducing sexual risk-taking and looking after their own and their sexual partner’s sexual and reproductive health. Many young Māori men leave school with no qualifications, suggesting they are only weakly engaged with learning.

In theory, schools should be one of a number of places where young Māori boys and men can learn about fostering and maintaining good sexual and reproductive health. In practice, many parents and communities throughout New Zealand report they lack accurate, age-appropriate information about sexual and reproductive health.

Suppression of traditional language and knowledge, as well as barriers to contemporary education, has denied Māori men and boys good information about sexual and reproductive health. In the past, Māori men and women were the primary sources of information for younger people.

Schools, therefore, have a very important role as a source of accurate and culturally appropriate information about sexual and reproductive health for Māori young men and boys. There is evidence that schools are effective learning sites for Māori students when their learning positively reinforces their cultural knowledge and identity; when this happens they are more likely to remain at school and succeed (Ministry of Education, 2008).

Notwithstanding the important role that schools can play, there is work to be done by the Ministries of Education and Health. Both ministries need to ensure that all schools can deliver on comprehensive sexuality education, and that the needs of young Māori boys and men are addressed. A 2007 report of sexuality education identified that most schools were not meeting student needs, particularly the needs of diverse groups of students, including Māori (Education Review Office, 2007); Comprehensive school-based sexuality education that works for Māori boys and young men.

Sexuality education programmes in English, te reo Māori, or a mix of both, provide an excellent opportunity for schools. Traditional Māori knowledges and approaches strengthen the cultural identities of young Māori men affirm, and traditional approaches can increase their sexual and reproductive health knowledge and all round educational success.

Programmes should include words like ‘takataapui’ as part of promoting inclusive schools. A 2012 study of school students reported around 1% of students self-described as transgender (Clark et al, 2011). International estimate the number of trans people in a population as ranging from 1 in 500 people, to 1 in 2000 people (World Health Organisation, 2013). Takataapui Māori are important members of whānau, hapū and iwi because, like everyone else, they are parents, partners, aunties, uncles and kaumātua. They have valued roles and responsibilities as members of our communities.

Māori strengths-based approaches to improving sexual and reproductive health are well received by Māori leaders, Māori communities, whānau, and schools. Te Puāwai Tapu uses whakatauki as a source for strengths-based approaches. Whakatauki (traditional, pre-Christian sayings) transmit positive values and responsibilities. They can be used to envision the kinds of communities Māori want to create, as well as principles for best practice when carrying out community projects. The national conference ‘He Kai Ata Rau: Māori strengths-based approaches to ending HIV-related stigma and discrimination’ is a good example (Note 3: He Kai Ata Rau refers to the strength, knowledge and potential in Māori communities to end HIV-related stigma and discrimination. The whakatauki reminds us that tasks are completed successfully through collective endeavours, Māori values are a source of strength and knowledge, and Māori community wellbeing assures individual wellbeing).

Lack of appropriate information about the benefits of early STI testing and treatment for Māori men and boys and their sexual partners

There is a dearth of published research about the sexual and reproductive health of Māori men and boys; in particular their perceptions of what it means to have an STI, how STIs are transmitted, and what happens at STI testing and treatment. Little is known of the barriers and enablers to testing and treatment for them and their sexual partners, or effective ways to work with young Māori men that facilitate timely STI testing and treatment.

The patterns of STIs appear to differ between Māori and other New Zealanders. Available data suggest wide ethnic inequalities in the burden of STIs for Māori, particularly among the most ‘at risk’ age group of 15 to 25 years (Sherwood, 2006; Terry et al, 2012; Rose, et al 2012). The burden of STIs is considerable. Epididymitis in men up to 35 years of age is commonly caused by chlamydia or gonorrhoea, and there are indications that these infections, untreated, are linked to male infertility (Morgan, 2013).

STI inequalities for Māori are likely due to multiple factors including poor access to STI information. In particular, information about the asymptomatic nature of STIs, but also late testing and incomplete treatment result from both structural and other determinants (Rose, et al 2012; Terry, Braun and Favid, 2012).

Māori men and boys who are sexually attracted to other men (Māori MSM) are at risk of late testing and treatment for STIs, including testing and treatment for HIV (Ministry of Health, 2010). Late testing among Māori MSM is linked to homophobia and transphobia and although these were not a feature of traditional pre-Christian Māori communities, these are unfortunately well-established nowadays (Hutchings and Aspin, 2007).

The Government’s last extensive national consultation with whānau, hapū and iwi about sexual and reproductive health identified a community priority; to reduce the incidence of sexually transmitted disease among young Māori men and women (Ministry of Health, 1997). This was not surprising given the extent of ethnic inequality and the fact that untreated and recurrent STIs create an increased risk of infertility among young Māori men and women.

While the reproductive sequelae of untreated and recurrent STIs are personally devastating, these are also completely at odds with whānau, hapū, iwi and Māori community aspirations (Note 4: As expressed recently at Te Pae Roa 2040. At the heart of concerns expressed at the hui were the importance of whakapapa, intergenerational capacity building, and flourishing future generations (Closing address)). Despite the impetus among Māori leaders and community organisations to improve the sexual and reproductive health of Māori, little support has been provided by government, and research gaps remain.

A significant challenge appears to be the lack of culturally relevant and age-appropriate STI-related sexual health information for Māori men and boys. Comprehensive sexuality education in schools, which draws upon traditional and contemporary Māori knowledges to strengthen the identities of Māori men and boys, is critical. So too is information for Māori communities, including targeted health literacy campaigns that build knowledge about STIs, testing and treatment. Campaigns should be supported by school-based and community-based testing and treatment services, including promoting partner-testing and self-testing STI kits.

The research undertaken in Huntly with young Māori men indicates the uneven costs associated with accessing STI testing and treatment; this primary care issue creates a major barrier for young Māori men (King, 2014). Variations in pricing and services among primary care providers is a national phenomenon that potentially creates confusion and shame for all young New Zealanders, and particularly young Māori men and women with limited finances.

In 2014, Te Puāwai Tapu held two consultation hui with young Māori, including takataapui. Participants reported that most young Māori have little knowledge of STIs and this is a major barrier to accessing STI testing and treatment services for them and their sexual partners.

Research suggest that Māori men and boys would benefit from culturally appropriate comprehensive sexuality education. Information in schools and community about STIs, campaigns to build the sexual health literacy of Māori men and boys are necessary. As part of these campaigns, stigma and discrimination education related to homophobia and transphobia requires attention. This can reduce barriers to testing and treatment for Maori boys and men who are takataapui and MSM.

Currently there are no nationally-focused initiatives that are specific to Māori men and boys. It is imperative that research and evaluations of current programmes are conducted to learn what works, what doesn’t work, and what can be improved.

Earlier this year the New Zealand Sexually Transmitted Infections Education Foundation (NZSTIEF) launched a website (www.justthefacts.co.nz); it aims to educate young people about STIs, testing, and treatment. The website involved extensive research with the target audience, investigating the informational needs and knowledge seeking habits of young New Zealanders.

The research conducted by Te Puāwai Tapu for the STIEF website found that young Māori at risk of STIs like online information that is concise, uses graphics and sound clips to communicate information, and is culturally relevant to their age group. This information is potentially useful to other organisations wanting to attract young Māori men and women to sexual and reproductive health information.

The evaluation of the 2004/2005 Ministry of Health-funded STI prevention campaign called ‘No Rubba, No Hubba Hubba’ noted that whakamā or shame about STIs reduced the likelihood of engagement with health professionals; where young Māori wouldn’t talk about STIs nor ask for help. However, the report noted that the campaign’s hip-hop slogans and Māori youth-friendly animations were positively received and reduced feeling of whakamā (TNS, 2005).

Evidence-based kaupapa Māori research about the sexual and reproductive health of Māori men and boys, and funds to support a nationwide programme of work to address these concerns

Research is required that focuses on improving the sexual and reproductive health of Māori men and boys, particularly research that draws upon traditional Māori knowledges and approaches toward good outcomes.

Effort is required to develop community-level and individual sexual and reproductive health literacy, particularly information that promotes positive, Māori strengths-based representations of Māori men and boys.

Māori young men and boys would benefit from comprehensive sexuality education programmes that build their cultural identity and simultaneously fosters their knowledge of traditional and contemporary approaches to good sexual and reproductive health.

Programmes are required that actively challenge stigma and discrimination related to homophobia and transphobia experienced by Maori men and boys, thereby reducing barriers to early testing and treatment for STIs and HIV

Support for legislative change that removes binary definitions, and instead, promotes the collection of statistical information using gender identity, thereby recognising takataapui and all other Māori men and boys as important and valued members of Māori whānau, hapū and iwi.

References

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