Toitu te Tiriti: A Tiriti o Waitangi-led Approach to Public Health Curriculum Development.

At Te Kunenga ki Purehuroa (Massey University), Aotearoa New Zealand, we have declared our stance as a Te Tiriti o Waitangi-led institution. This necessitates the embodiment and enactment of the principles and provisions of Te Tiriti o Waitangi and the embedding of Indigenous Maori knowledge, values and belief systems in curriculum design and implementation. This article outlines the beginning of our journey toward indigenizing our postgraduate public health curriculum at Te Kunenga ki Purehuroa. We describe the redevelopment of the Master of Public Health curriculum that embeds matauranga Maori (Maori knowledge), te reo Maori (Maori language), tikanga Maori (Maori values and belief systems), and Maori pedagogy (culturally sustaining teaching and learning practices). Here, we focus on how curriculum redevelopment and pedagogy have enabled the utility of Maori knowledge and processes to be reflected at every level of the program and give life and relevancy to Te Tiriti o Waitangi. Te Tiriti o Waitangi guides our teaching practice and ensures that students can safely develop their confidence in Maori ways of knowing, being, and doing to effectively partner with Maori as Tangata Whenua. Our program aims to produce agentic graduates who are champions and advocates for Maori aspirations in health.

Reasons for Stopping Exclusive Breastfeeding Between Three and Six Months: A Qualitative Study.

PURPOSE: Scant published qualitative literature exists focusing on why exclusive breastfeeding rates decline between three and six months. This study aims to develop an understanding of why exclusive breastfeeding tails off so dramatically between three and six months after birth in New Zealand. DESIGN AND METHODS: A generic qualitative methodology was employed in this study and social constructionism selected as the main epistemological framework underpinning the research. This study was carried out between September 2013 and July 2014, involving face-to-face interviews with 30 women who were characterised as highly motivated to complete six months exclusive breastfeeding prior to the birth of their child. In order to gain an in-depth understanding of the research material, thematic analysis of the interview transcripts was completed using manual coding techniques. RESULTS: After thematic analysis of the data four key themes were identified: 1) The good employee/good mother dilemma. 2) Breastfeeding is lovely, but six months exclusively is demanding. 3) Exclusive breastfeeding recommendations should be individualised. 4) Introducing solids early as a cultural practice. CONCLUSIONS: Most studies have linked barriers to six months exclusive breastfeeding to difficulties within the mother-infant dyad, as well as negative maternal socioeconomic and socio-demographic characteristics. However, this study has shown that the maintenance of six months exclusive breastfeeding is also challenging for this group of mothers who were socially advantaged, well-educated and highly motivated to breastfeed their babies exclusively for six months.

New Zealand women talk about breastfeeding support from male family members.

AIM: Little research has been done to investigate the influence of male family members' support for breastfeeding. This article considers the influence of male partners and other male family members on the initiation and duration of exclusive breastfeeding. METHODS: Thirty heterosexual New Zealand women who had identified in a short antenatal questionnaire that they intended to breastfeed exclusively for 6 months were recruited. The qualitative research included a face-to-face postpartum interview followed by monthly audio-recorded telephone interviews that stopped at 6 months. The participants' narratives were analysed using thematic analysis. KEY FINDINGS: Five key themes related to breastfeeding support from male family members were identified: a) male partners did not have enough knowledge about breastfeeding, b) male partners wanted to share infant feeding, c) participants received emotional and practical support from their male partners, d) male partners supported breastfeeding in public, e) some women received crucial breastfeeding support from male family members who were not the father of the baby. CONCLUSION: Comments from participants suggest that some New Zealand men are actively involved in supporting breastfeeding in their nuclear and extended families. Several participants suggested that male support was as effective as support from female family members.

"I did a lot of Googling": A qualitative study of exclusive breastfeeding support through social media.

BACKGROUND: Little qualitative research has been done to explore the quality of breastfeeding support through social media in New Zealand. AIM: This article aims to explore the influence of social media on exclusive breastfeeding practice. METHODS: A qualitative study involving face-to-face postpartum interviews with 30 mothers who were recruited from the lower North Island of New Zealand. Each participant was followed via short monthly audio-recorded telephone interviews until giving up exclusive breastfeeding or until six months after the birth. The theories "strength of weak ties" and "landscapes of care" are applied to the thematic analysis of the interview material to illuminate the influence of social media on breastfeeding practices. RESULTS: Qualitative analysis of the interview material identified four themes: 1) Mothers need reliable online infant feeding information; 2) Smartphone apps can be a good option for promoting breastfeeding; 3) Information is accessed through weak ties among breastfeeding mothers on Facebook, and 4) the utility of geographically distant infant feeding support via Skype. DISCUSSION: Most participants sourced post-partum information and advice to support breastfeeding through the Internet, while those with geographically distant family members accessed emotional and practical breastfeeding support via Skype. IMPLICATIONS FOR PRACTICE: Breastfeeding advocates should use social media to promote and support exclusive breast-feeding practice. CONCLUSION: The influence of social media on breastfeeding points to the relational nature of breastfeeding which is embedded in 'real' world and virtual social networks as well as the cultural, geographic and social contexts of a mother's life.

The Inverse Response Law: Theory and Relevance to the Aftermath of Disasters.

The Inverse Care Law is principally concerned with the effect of market forces on health care which create inequities in access to health services through privileging individuals who possess the forms of social capital that are valued within health care settings. The fields of disaster risk reduction need to consider the ways in which inequities, driven by economic and social policy as well as institutional decision-making, create vulnerabilities prior to a disaster, which are then magnified post disaster through entrenched structural differences in access to resources. Drawing on key principles within the Inverse Care Law, the Inverse Response Law refers to the idea that people in lower socio-economic groups are more likely to be impacted and to experience disparities in service provision during the disaster response and recovery phase. In a market model of recovery, vulnerable groups struggle to compete for necessary services creating inequities in adaptive capacity as well as in social and wellbeing outcomes over time. Both the Inverse Care Law and the Inverse Response Law focus on the structural organisation of services at a macro level. In this article, the Inverse Care Law is outlined, its application to medical treatment following disasters considered and an explanation of the Inverse Response Law provided. Case studies from recent disasters, in London, New Zealand, Puerto Rico and Mexico City are examined in order to illustrate themes at work relating to the Inverse Response Law.

Resistance to breastfeeding: A Foucauldian analysis of breastfeeding support from health professionals.

BACKGROUND: Despite widespread consensus regarding the health benefits of breastfeeding, the prevalence of six months exclusive breastfeeding is very low in developed countries including New Zealand. AIM: This paper aims to evaluate the role that health professionals play in promoting exclusive breastfeeding in New Zealand. METHODS: Qualitative research involving face to face postpartum interviews conducted four to six weeks after the birth with 30 new mothers who lived in New Zealand and had identified in a short antenatal questionnaire that they intended to practice exclusive breastfeeding for six months. Themes related to exclusive breastfeeding support from health professionals were extracted from the interview transcripts and interpreted using Foucault's ideas about governmentality and bio-power. RESULTS: Four themes related to the quality of health care support were identified in the interview transcripts. 'Breastfeeding self-efficacy support from the community midwives', 'mothers need to know more about breastfeeding during pregnancy', 'experiencing difficulties breastfeeding' as well as 'pressure and resistance to breastfeeding'. DISCUSSION: Most mothers in this research spoke about feeling pressured to breastfeed within the New Zealand health system. However, the participating mothers acknowledged the effective support that they had received from community midwives who respected their autonomy, strengthened their self-esteem and encouraged them to breastfeed. CONCLUSION: Negative historical experiences related to the medicalization of infant feeding in Western countries suggests that health professionals need to provide effective skill support for breastfeeding mothers so that mothers do not consider it a form of "quiet coercion" or as an exercise of "power".

Gender, nursing and the PBRF.

Significant disparities between male and female academics exist with respect to remuneration, academic grading and PBRF scores--with women doing less well than men in each of these areas. There exists a range of gender-based distribution and outcome gaps within the university, and between universities and non-university tertiary education organisations. This situation, combined with a devaluing of academic subjects that have feminised knowledge bases, is suggestive of wider structural discrimination against women. In this article individualised explanations for the failure of women to progress are set in the context of a critical exploration of the PBRF evaluation methodology. It is argued that both academia and the PBRF research assessment exercise embody a form of academic masculinity that systematically disadvantages women in general and nursing in particular.

Synergising Public Health Concepts with the Sendai Framework for Disaster Risk Reduction: A Conceptual Glossary.

The Sendai Framework for Disaster Risk Reduction (2015) is a global strategy for addressing disaster risk and resilience that has been ratified by member countries of the United Nations. Its guiding principles emphasise building resilience through inter-sectoral collaboration, as well as partnerships that facilitate community empowerment and address underlying risk factors. Both public health and the emergency management sector face similar challenges related to developing and implementing strategies that involve structural change, facilitating community resilience and addressing individual risk factors. Familiarity with public health principles enables an understanding of the holistic approach to risk reduction that is outlined within the Sendai Framework. We present seven concepts that resonate with contemporary public health practice, namely: the social determinants of health; inequality and inequity; the inverse care law; community-based and community development approaches; hard to reach communities and services; the prevention paradox; and the inverse prevention law. These ideas from public health provide a useful conceptual base for the "new" agenda in disaster risk management that underpins the 2015 Sendai Framework. The relevance of these ideas to disaster risk management and research is illustrated through drawing on the Sendai Framework, disaster literature and exemplars from the 2010-2011 earthquakes in Canterbury, New Zealand.

Towards a relational model of decision-making in midwifery care.

OBJECTIVE: current individualistic ideas of autonomy and decision making do not fit within the context of decision-making in the midwife-woman relationship. This article critically explores current issues around decision-making and proposes a relational decision-making model for midwifery care. DESIGN: qualitative prenatal and postnatal interviews around decision-making within childbirth in general, and the third stage of labour in particular. PARTICIPANTS: eight midwife-woman pairs in urban settings in New Zealand. FINDINGS: a range of relational, social and political factors that are not present within existing decision-making models were highlighted. The themes included ontological and philosophical influences on decision-making; uncertainty, vulnerability and relational trust; and socio-political and cultural influences. Inconsistencies in knowledge arising from social, cultural and familial considerations as well as identities, beliefs, values, conversations, and practices were found to produce uncertainties around potential courses of action, expected consequences and outcomes. 'Unplanned' birth experiences decreased client autonomy and increased vulnerability thereby intensifying relational trust within decision-making. The political context may also open up or close down possibilities for decision-making at both national and local levels. CONCLUSION: decision-making for women and midwives is influenced by complex human, contextual and political factors. This study supports a relational model of decision-making that is embedded in understandings of choice as 'entangled'. A relational model enables consideration of how factors such as identity projects, individual practices, the organisation of maternity care, local hospital cultures, medicalised childbirth, workforce shortages, funding cuts and poverty shape the way in which care decisions are made.