Optimising cultural safety and comfort during gynaecological examinations: Accounts of indigenous Māori women

Abstract

In Aotearoa (New Zealand), the Cartwright Report from the Cervical Cancer Inquiry (1988) highlighted clinicians' disregard for the spiritual significance of areas of the body associated with sexuality and fertility for Māori women. Although subsequent cervical screening initiatives and epidemiological research have focused on the demographic needs and vulnerabilities of Māori women, there is scant research about the extent to which non-indigenous staff in mainstream services demonstrate cultural competency that fosters Māori women's participation and engagement. International research highlights that women commonly find gynaecological examinations unpleasant; physically uncomfortable and emotionally demanding. Typically the focus of research on psychometric analysis aimed at understanding women's reluctance, rather than on exploring clinician and service-related aspects of care that act as facilitators, or barriers, to women's engagement. Data presented in this article are drawn from interviews with ten women identifying as Māori, as part of a larger study about women's experiences of gynaecological examinations. Women were recruited from two sexual health clinics in Aotearoa; one urban and one provincial. Data were collected through semi-structured interviews. A thematic analysis was undertaken to highlight Māori women's perspectives on health and wellbeing and (dis)connections with mainstream health services. Six key themes were identified in the data mihi (initial engagement); whakawhānaungatanga (belonging through relationships of shared experience); kaupapa (consultation's main purpose); tapu (sacred and set apart); embodied memories; mana wāhine (women's knowledge and authority). Women identified approaches used by non-indigenous clinicians, receptionists and service providers incorporated that enhanced their experiences of cultural safety during sexual health consultations and gynaecological examinations.