Knowledge and decisions about maternal immunisation by pregnant women in Aotearoa New Zealand.

BACKGROUND: Maternal vaccinations for influenza and pertussis are recommended in New Zealand to protect mothers and their infant from infection. However, maternal immunisation coverage in New Zealand is suboptimal. Furthermore, there is unacceptable inequitable maternal immunisation rates across the country with Maori and Pacific women having significantly lower maternal immunisation rates than those of other New Zealanders. METHODS: This research set out to explore what pregnant/recently pregnant Maori and Pacific women knew about immunisation during pregnancy and what factors influenced their decision to be vaccinated. A semi-structured interview guide was developed with questions focusing on knowledge of pertussis and influenza vaccination during pregnancy and decision-making. Maori and Pacific women aged over 16 years were purposively sampled and interviewed in Dunedin and Gisborne, New Zealand between May and August 2021. Interviews were analysed following a directed qualitative content approach. Data were arranged into coding nodes based on the study aims (deductive analysis) informed by previous literature and within these participant experiences were inductively coded into themes and subthemes. RESULTS: Not all women were aware of maternal vaccine recommendations or they diseases they protected against. Many underestimated how dangerous influenza and pertussis could be and some were more concerned about potential harms of the vaccine. Furthermore, understanding potential harms of infection and protection provided by vaccination did not necessarily mean women would choose to be vaccinated. Those who decided to vaccinate felt well-informed, had vaccination recommended by their healthcare provider, and did so to protect their and their infant's health. Those who decided against vaccination were concerned about safety of the vaccines, lacked the information they needed, were not offered the vaccine, or did not consider vaccination a priority. CONCLUSIONS: There is a lack of understanding about vaccine benefits and risks of vaccine-preventable diseases which can result in the reinforcement of negative influences such as the fear of side effects. Furthermore, if vaccine benefits are not understood, inaccessibility of vaccines and the precedence of other life priorities may prevent uptake. Being well-informed and supported to make positive decisions to vaccinate in pregnancy is likely to improve vaccine coverage in Maori and Pacific Island New Zealanders.

A tangata whenua (people of the land) approach to conceptualising Maori health and wellbeing.

From a Maori (Indigenous to New Zealand) perspective, health is not confined to the treatment of illness but also includes the philosophical concepts, structures and cultural practices which reinforce health and wellbeing. The ill-health of Maori is often the focus of health initiatives, particularly if there is an equity approach that centres on disparities between ethnic groups. However, an Indigenous approach prioritises health and wellbeing aspirations through strengthening self-determination, identity and connection with the environment. This article synthesises knowledge from Indigenous and Maori rights, matauranga (Maori ways of knowing) expressed in purakau (epistemological narratives), tikanga (Maori principles), te reo (Maori language) and lived experience to reflect a shared understanding of Maori health and wellbeing. Consideration is given to the status of Maori pre-colonisation, the ongoing impacts of colonisation, and Maori led responses to contemporary health issues. It is proposed that health for Maori, like many Indigenous peoples, should be informed by an enhanced understanding of Indigenous rights, an Indigenous worldview and notions of wellbeing. We argue that a tangata whenua (people of the land) approach is integral to the effectiveness of health policies and initiatives aimed at improving Maori outcomes sustainably. We propose that the current reorganisation of Aotearoa New Zealand's health system, as well as the COVID-19 pandemic response, provide opportunities to emphasise and embed Maori health leadership and knowledge, as well as a tangata whenua conceptualisation of health and wellbeing.