Considering Difference

Although te Tiriti o Waitangi (the Treaty of Waitangi) creates a relationship between Mäori and Päkehä that necessitates that policy formulation, implementation, and monitoring recognises and encompasses the values and principles of Mäori society, there is considerable silence surrounding the use of ART by Mäori in the ART policy discourse. Concerns have been raised by Manatu Mäori (Ministry of Mäori Affairs) in relation to the protection of whakapapa, informed choice and consent, and cultural safety. Nevertheless, specific attention to these concerns has not been forthcoming and ART policy continues to be influenced by the perceived needs and interests of the culturally dominant Päkehä population. This is highlighted in Chapter One by my analysis of the SCAA, which has institutionalised a definition of family that fails to recognise or accommodate social diversity in relation to family structure, especially the more diverse concept of whänau acknowledged by Mäori. Similarly, the CPAC contain standards of acceptable weight that are based on a western profile. The homogenous focus of ART policy is exacerbated by the contingent and incremental approach used to develop and implement any policy initiatives or changes. As mentioned earlier, this approach does not allow for in-depth analysis of the values and principles that underlie ART policy formulation. As I argue in Chapter Six, if Mäori perspectives on social relations and interaction, as well as their values and language, are not considered and acknowledged during the policy-making process, the dominant values and perspective will continue to be upheld as universal. As a result, the interests and needs of Mäori in relation to ART treatment will be assumed to correspond with those of the dominant Päkehä group.

The marginalisation of Mäori in the ART policy debate is aggravated by the lack of quantitative data on the prevalence of infertility in the Mäori population and information on the utilisation of ART services. The availability of such information would assist in the formulation of policy that accurately identified the needs of Mäori in relation to infertility treatment and would enable interested publics to effectively evaluate and monitor future ART policy initiatives. I acknowledge that there are difficulties in collecting and analysing accurate or useful quantitative data, especially in relation to ethnicity. The collection of data on ethnicity may be limited by inconsistencies in defining Mäori, the ability to make comparisons across data sets, and the use of statistics to undertake negative comparisons between Mäori and non-Mäori. Inadequate or irrelevant analysis of such information may further hinder its usefulness for informing policy.

Nevertheless, without accurate information relating to Mäori infertility and access to ART services, policy decisions will continue to be made without sufficient attention to the issues for Mäori and the ability of Mäori to access these services in the future will be affected. This is particularly relevant as available information on reproductive health issues for Mäori women, as well as changing demographics in relation to Mäori women’s childbearing patterns, indicate that there may be an increasing demand for ART services by Mäori women in the near future. The prediction of increased demand is not definite and other commentators have suggested that Mäori may use whängai as an alternative to ART practices in dealing with infertility. However, there is no empirical evidence to support this assumption. Although there is a diverse range of definitions associated with the practice of whängai in Mäoridom and it may be used by some Mäori as an alternative to ART, I would suggest that this concept is more accurately equated to the Päkehä concepts of fostering, guardianship, or ‘open’ adoption. Consequently, whängai should not be used to justify lack of policy attention to the use of ART by Mäori. Mäori men and women do currently use ART services and this raises important issues in relation to the protection of whakapapa and the retention of culturally appropriate information. Although access to information is ultimately dependent on parental openness about the circumstances of their children’s birth, existing legislation continues to promote secrecy through the provision of a ‘false’ birth certificate. Furthermore, the lack of legislation to ensure the collection of ethnically relevant information means that Mäori involved in donor ART practices must currently rely on clinical discretion to ensure that knowledge of whakapapa will be permanently available. The diversity of the Mäori population, as of any population, makes it difficult to establish policies that equitably address all the issues. Nonetheless, attention to the diverse nature of the Mäori population will destabilise the universal focus of ART policy initiatives and highlight the availability of alternative values and options. Although there has been some attention to Mäori specific policies to overcome existing inequalities and inconsistencies in access to the wider health system, there is a need for more research into the barriers Mäori experience in relation to accessing ART treatment for infertility. Similarly, the collection of accurate information in relation to the use of ART practices by Mäori and the consideration of Mäori values and principles are necessary if future ART policy is to be accurate in its attention to the needs and interests of Mäori individuals without marginalising them in relation to the needs and interests of the dominant Päkehä group.