Charrissa Makowharemahihi & Zara Hale Thrive Teen Parent Conference 24-25 September 2014 Auckland

1. Charrissa Makowharemahihi & Zara HaleThrive Teen Parent Conference 24-25 September 2014Auckland E Hine: The voice of Young Māori Mothers in a Māori teen pregnancy study Women’s Health Research Centre Research making a difference to women

4. A Gardeners Tale – Camara Jones

5. A Gardeners Tale – An allegory of racism Institutionalised racism Structural barriers, differential access, inaction in face of need, privilege Personally-mediated racism Intentional or unintentional, commission, omission Internalised racism Erodes individual sense of value Who is the gardener? Power to make decisions, to act, control resources, not concerned with equity Ref: Jones CP. Levels of racism: a theoretic framework and a gardeners tale. Am J Public Health. 2000 August; 90(8): 1212–1215.

7. E Hine Kaupapa Maori qualitative study exploring the lived realities young Māori womenthrough pregnancy, motherhood, and early childhood Within the context of policy environment

8. Disparities in Māori Maternal and Child Health Women’s Health Research Centre Research making a difference to women

10. System Provider/Clinician Provider/Clinician System

11. Methods/Participants • 44 Participants (41n at end of study) • Two case study sites (HB; WN) • Between 14 – 20 at time of birth • Retrospective & Prospective Cohorts • Between 2 – 5 interviews • In-depth interviews Data summary: • 160 participant interviews (includes 16 birth interviews) • 69 whanau interviews • 17 Sector interviews

12. Bridging what we do, with the lives of our people

13. RōpūMāmā Involve young Maori mothers in the study development & implementation Credibility with participants they feel their korero is received and used in context of their own worldview Ensure advice, recommendations, and subsequent policy decisions impacting on them are informed by their perspectives Permission of image use by Robyn Kahukiwa

19. Findings - published Finding out – Finding a Midwife • Majority of participants confirmed their pregnancy in the first trimester • Early interaction with primary care services • Proactive • Pregnancy tests Barriers • Identifying, confirming and enrolling with an LMC problematic • Lack of information and support about pathways • Over expectation on young pregnant women • Limited resources and knowledge to navigate system Structural & service changes to ensure a seamless maternity care pathway • Makowharemahihi C, Lawton B, Cram F, Ngata T, Robson B, Brown S. 2014. Initiation of maternity care for young Māori women <20 years. New Zealand Medical Journal. 127(1393)

20. Preliminary Findings – unpublished Contraception Before pregnancy • Majority (88%) had a contraception interaction with a health professional prior to pregnancy • Long term contraception methods (64% / 34%) • Quality of health interactions “have a little rest then hop back on it” (CCHB01.1 – age 18 at birth). Contraception After Pregnancy • Few received contraception from LMC (9%) • WellChild/TamarikiOra advising only • Evidence of piggy backing to avoid cost

22. NGA MIHI Advisory Groups Roopu Mama KaumatuaKāhui Funders Ministry Youth Development - RM Health Research Council – Preg –1 yr Ministry of Health – Year 2 Research Team Dr Bev Lawton, Tina Ngata, Selina Brown - WHRC Fiona Cram, Katoa Ltd Bridget Robson, EruPomare Acknowledgements Nuki Takao Robyn Kahukiwa