A review of Hawke's Bay's DHB maternity services has noted a "myriad of discriminatory practices that specifically target wāhine Māori''.
The "Hau Te Kura – Nurturing our treasures" review was commissioned in 2021 following a focus on the DHB's maternity services, including reports of institutional racism.
The report has 42 recommendations - many of which contain multiple recommendations within themselves.
The recommendations mostly require the DHB to "note" findings of the report and take action.
For example, the DHB is advised to note that the report found that hapū wāhine and their whanau have "highly variable experiences and outcomes" while experiencing HBDHB maternity services.
In some areas the service was noted as very good. The Wairoa-based maternity service received multiple accolades.
"The experience of hapū wahine accessing the Hastings service however was markedly different.
"The level of compliments for the Hastings service among Māori mama was outweighed by stories of a poor experience, and many shared stories (mama and their midwives) of mama and whanau being subjected to a myriad of discriminatory practices that specifically target wāhine Māori."
The report said mama felt that the support for themselves and their circle of whānau during their pregnancy and birthing experience, was lacking.
Cultural needs were not consistently met – not just for Māori but for other ethnic groups
as well such as Asian, Pacific and Indian women.
Among many of the Māori midwives, there was support for an independent Māori birthing unit that could serve the wāhine living within the Kahungunu rohe.
The review also noted that trauma existed among staff over a well publicised baby uplift incident in 2019, and recommends the DHB offer supervision or alternative healing support to impacted staff.
Midwife and member of the expert advisory group Beverly Te Huia said there will be mixed emotions regarding the review.
"This review will be difficult for some to read and for others, it will come as no surprise.
"However, what is most important is that the wāhine and whānau who shared their stories feel that they are heard and that we will and must do better.
"The recommendations from this review are specific and achievable. I am looking forward to champion this Kaupapa together with Health NZ and Māori Health Authority."
The review, led by a team of nationally recognised cultural experts in partnership with a local expert advisory group, focused on identifying areas to improve health service delivery, performance, equitable outcomes and Pae Ora (healthy futures) for whānau Māori.
The expert advisory group included Māori researchers, midwives, and Nga Maia o Heretaunga, as well as District Health Board cultural advisers and support from the DHB Planning, Funding and Performance Directorate.
"We knew we needed to look at ways to improve the experience of whānau in a safe and caring environment, and where Māori whānau particularly feel respected, listened to, cared for, and supported," says Karyn Bousfield-Black, DHB chief nursing officer.
The DHB says it has embraced the recommendations.
Acting director of midwifery Catherine Overfield said the recommendations will guide the maternity service to continue to improve levels of care and address well-documented inequities in maternal and infant health outcomes, as well as provide a greater experience for Māori staff and community.
"We know that the care provided to expectant parents throughout the pregnancy journey can have a profound and lasting effect on mama, pēpi and whānau.
The DHB is currently working through the recommendations and developing a work plan to address them in a timely manner.