Biology and gender are both factors that shape life experience and health. The experiences of women and men tend to differ not only because of women’s capacity to bear children and the associated hormonal flows, but also in terms of their paid and unpaid work, recreation and socialising, and even their readiness to consult doctors.
Ethnicity affects health. The health experiences of Māori and Pākehā women have been very different over the whole period since colonisation. Māori women have been far more likely to suffer ill health and die at an earlier age. The health of Pacific Island women has not, generally, been as good as that of Pākehā, although was often better than that of Māori.
The 19th and first half of the 20th centuries saw a major improvement in the health of Pākehā women. Driving this shift were the benefits of colonial life for settlers, including better nutrition, along with a greater understanding of hygiene and infectious disease, and new drugs. These factors caused what is known as an epidemiological transition – a major change in the pattern of illness during life and as a cause of death. Rates of infectious diseases such as polio and measles dropped, and infant mortality also reduced, while rates of degenerative diseases (such as cancer and heart disease) increased.
This epidemiological transition occurred in the second half of the 20th century for Māori women. It followed earlier transitions. The first, during the 19th century, was from relatively good health prior to European settlement to very poor health. From the end of the 19th century another transition began, as immunity to introduced diseases built up.
Changes in life expectancy – the number of years a newborn baby can expect to live – gives an indication of how women’s health has improved.
A non-Māori girl born in 2007 could expect to live 83 years (a non-Māori boy, 79 years). In 1876 life expectancy for non-Māori girls was 54 (three and a half years more than that of non-Māori boys). Two thirds of the increase in female life expectancy was gained by 1921, when it reached 72.1. Decreases in infant mortality and infectious and respiratory diseases contributed to this leap.
Pākehā life expectancy in the late 19th century was internationally the highest ever recorded up to that time. Delighted politicians trumpeted New Zealand’s status as the healthiest country in the world.
A Māori girl born in 2007 could expect to live 75.1 years (and a Māori boy, 70.4 years). Before European arrival, life expectancy for a Māori woman at birth was about 28 to 30 years – this matched life expectancy in many European countries at the time. In the 19th century Māori women had a lower life expectancy than men. In 1891, for example, a newborn girl could expect to live 25 years, a boy, 28 years.
Pacific Island girls born in 2007 had a life expectancy of 77.5 years (73.2 for boys), and that of Asian girls was 84.2 (81.2 for boys).
Socio-economic status also affects female life-expectancy rates. In 2005–7 the most economically deprived women could expect to live 5.9 years less than the most advantaged (78.7 versus 84.6 years). For males the difference was even greater: 8.8 years between most and least deprived (73.3 versus 82.1).
Ill health has tended to concentrate in particular communities or groups of people. Some women endured multiple difficulties: childhood deprivation, ill health, accidental injury, and interpersonal violence and abuse. This effect is compounded by difficulties in accessing health care and sometimes lower quality of care.
Māori health in the pre-European period can be only broadly sketched, due to a lack of information. In the late 18th century the Māori population was about 90,000–100,000. Estimates of the birth rate suggest that each woman had an average of about five births. The rate of maternal mortality (death during or as a result of childbirth) is unknown, but it, combined with the burden of childbearing, may have meant that women did not live as long as men.
Māori were free of many of the infectious diseases Europeans suffered from. Heart disease and cancer, both diseases of older age, were probably uncommon. Skin diseases (such as scabies), arthritis and rheumatism were present, and dental problems were a serious threat to health.
While some hospitals refused to admit Māori, many Māori refused to go to hospital. Hospitals were where you went to die, where you were cut up after death, where a baby’s iho (umbilical cord) and whenua (placenta) were not treated with respect.
Since European colonisation, the health of Māori women has been notably worse than that of New Zealand women generally.
From the mid-19th century infectious disease, loss of resources and, to a much lesser extent, wars caused the Māori population to more than halve. At its lowest, in 1891, Māori numbered barely 42,000.
During these years of catastrophic population loss, more adult women than men died. One result was fewer women than men in the Māori population: in 1857–58, for example, there were 130 men for every 100 women. (Although the ratio changed, women continued to be outnumbered until the mid-20th century.)
In addition to killing people, infectious disease limited births. The result of syphilis and gonorrhoea for Māori women was a high level of infertility – around 35% had no children in the 1850s. In a culture that favoured high fertility, and valued children and women’s childbearing capacity, this, combined with the high death rate at the time, was a disaster.
The importance of women within Māori society was vividly expressed by the traditional proverb: mate i te tamaiti he aurukōwhao; mate i te wahine he takerehāia. (The death of a child may be overcome, but the death of a woman is a calamity.)
Rates of maternal mortality in 19th- and early 20th-century Māori communities are unknown, as the first figures were not collected until 1920. In that year nearly 23 Māori women died for every 1,000 live births. (The rate amongst Pākehā women was 6.5 per 1,000 live births.) This figure, high as it is, was probably an underestimate: Māori deaths were not reliably reported until after the Second World War.
Increasing immunity and a high birth rate saw the Māori population recover. The number of children per 100 women rose from 87 in the mid-19th century to 127 in 1901. By 1945, the population reached 115,646.
Māori women’s access to medical help was limited by a number of factors:
Public perceptions and beliefs about women’s health in 19th- and early 20th-century New Zealand were contradictory. Women were seen as weaker than men and more prone to ill health, yet many women were vigorous and able, undertaking activities that had been thought impossible or inappropriate, such as mountain climbing or political campaigning. Class played a part – some middle- and upper-class women might be delicate, but domestic servants and factory workers were expected to be sturdy and hard-working.
Many women, like men, benefited by moving to New Zealand as colonists. The improvement in diet was often remarked on, and the relative freedom delighted in. For European women (and men), New Zealand led the world in terms of health.
‘Those awful corsets! How did women stand for them?’ asked Dr Eleanor McLaglan, born in 1879. They put ‘tremendous pressure’ on the liver, pancreas and spleen, and immobilised the lower chest. Many girls were ‘languid, breathless and of a greenish pallor’, suffering from ‘chlorosis’.1 Although it was thought to be an iron deficiency, Dr McLaglan noticed that chlorosis vanished once tight corseting was no longer fashionable.
Infectious diseases, particularly tuberculosis, were a leading cause of death among Pākehā women in the mid-19th century, along with cardiovascular disease and death associated with childbirth. Women of childbearing age had a higher rate of death than men of the same age, but in some ways their health was better than that of men. Women’s rates of committal to mental asylums were lower, as were rates of accidental injury and death, and industrial accidents and disease.
Causes and rates of death are not the only way to measure health, but sickness that didn’t kill was not recorded. It was often dealt with at home, by a general practitioner, or a healer.
The health of Pākehā women was tightly bound to maternity: pregnancy, childbirth and abortion caused a variety of illnesses and difficulties, and sometimes death. An estimate for the mid-19th century suggests that maternal mortality accounted for 9% of deaths among women. Between the late 1870s and the 1930s the rate moved up and down between just over 3% and nearly 7%, dropping quickly once antibiotics were introduced in the 1940s.
Dr Ferdinand Batchelor, a specialist in women’s diseases at Dunedin Hospital, reported in 1909 that 50% of the ‘decent married women’ admitted were suffering from venereal disease.2 Those women were working class – middle and upper class people were usually cared for at home. Batchelor regarded husbands as the source of infection, and argued that as the behaviour of well-to-do men was no better than that of their poorer brothers the rate among better-off women was probably similar.
The rate of birth in the 19th century was extraordinarily high – between 7 and 9 children for each Pākehā married woman. It dropped sharply to 3.4 per married woman in 1921, and 2.1 in the 1930s. With each child the risk of death for the mother increased. There was also the possibility of ongoing health problems related to childbearing, such as a prolapsed uterus, urinary incontinence and varicose veins.
Maternity care in the 1920s moved from home to hospital birth, and from midwife- to doctor-led care. Neither shift was primarily responsible for the drop in maternal deaths – that owed more to the drop in the number of children born (from the 1890s), the rigorous application of antiseptic measures (1920s and 1930s), and the introduction of antibiotics (1940s).
Most women worked in the home, and the outstanding source of danger was fire (relied on for heating, cooking and washing clothes). Burns and scalds were the only kind of accident that afflicted women to a similar degree to men. Other kinds of accidents – drowning was a notable one – killed far more men than women.
Women spent most of their time at home, and conditions there varied according to socio-economic status. In Dunedin’s southern suburbs a poorer woman might find herself living on Anderson’s Bay Road, breathing the fumes of the nearby gasworks, or in the area known as ‘the Swamp’, where drains were not installed until 1909. Better-off women were more likely to enjoy a light sea breeze in St Clair.
Women’s work was less dangerous than that of men, and the pattern of women leaving employment on marriage meant that their exposure to industrial or workplace disease was further reduced.
For those women who were in paid employment, conditions were often bad. Hours of work were sometimes long – up to 15-hour days and six-day weeks for some shop or clothing workers, while many live-in domestic servants had only one afternoon off a week. Shop workers who stood all day were more likely to endure painful feet and varicose veins. Tailoresses and seamstresses engaged in ‘close work’ sometimes had sight problems, those sitting at machines were likely to suffer from ‘menstrual troubles’.
Although Māori women faced particular health challenges, the entire community’s continuing battle with epidemics took precedence in terms of health campaigns. Within general campaigns, the responsibility Māori women had as ‘mothers of the race’ was sometimes focused on. Improving the health of whānau (families) and hapū (sub-tribes) through improving that of women was one of the results aimed for.
The Young Maori Party, the Women’s Christian Temperance Union (WCTU), and Kīngitanga (Māori King movement) leader Te Puea Hērangi all worked to improve the health of Māori. Infectious diseases, housing, clean water and hygienic waste disposal were the focus of campaigns.
Behind the government’s appointment of the first Māori health officer, in 1901, was a programme developed by a group who had attended Te Aute College. From 1889 the group, which became known as the Young Maori Party, began to push for improvements in housing, water supply and sewage disposal. An important element was acknowledging traditional beliefs while introducing the concepts of hygiene and bacterial transfer that were becoming understood by science.
The government picked up this programme. The essential, basic improvements that resulted benefited everyone in a community, but its effectiveness was undermined by miserly government support.
Māori women within the WCTU in the 1890s and early 20th century fought against use of alcohol, signing personal pledges not to drink, encouraging sobriety, and resisting the infiltration of alcohol into Māori communities. The dangers they identified were strongly health-related, but also concerned loss of Māori land, which some argued was sold by men while drunk or in order to pay for drink.
Te Puea Hērangi was deeply concerned to improve Māori health. Despite her own illness, she cared for others in her community in the 1918 influenza epidemic, afterward adopting many children orphaned during it. She also worked to reduce high mortality rates from typhoid and tuberculosis. Te Puea banned alcohol from marae because of its negative effects. In the early 1940s she opened a medical clinic at Tūrangawaewae House (the Department of Health had prevented her earlier attempt to open a hospital for Māori).
Women and men, as individuals and in groups, pushed for improvements in women’s health from the 19th century. Those involved included political activists, unionists, clergy, journalists, society women, and medical and lay people. Occupational health, hospital facilities, hygiene, food, dress, sexually transmitted diseases, exercise, maternity, abortion and contraception were all focused on. Campaigns took place in the 1870s and 1880s, with a concerted burst in the 1890s.
The ‘laws of health’ were ‘so simple and plain,’ wrote E. Miller, Women’s Christian Temperance Union superintendent of hygiene and food reform, in an 1889 report.1 In addition to pushing for more women doctors and women in hospital management, the WCTU believed that women should not wear corsets, and instead should build up ‘nature’s corset’ (abdominal muscles), eat a vegetarian diet, exercise, and know their own body and the health issues that might affect it.
Hospitals had been set up from the mid-19th century, and at times conditions within them provoked action. When conditions for female patients at Dunedin Hospital caused concern in the late 19th century, women from the local elite formed the Women’s Ward Committee. Their remarkably successful fundraising resulted in the building of a new women’s ward and the introduction of trained female nursing staff (at that time hospital nursing was generally men’s work).
Activist campaigning slowed in the 20th century. In its place were strong pushes to improve home hygiene (to cut the rate of disease), reduce maternal mortality, and prevent abortion. Maternal mortality and abortion were both focused on by government and doctors; but neither were willing to make women’s very limited access to contraception easier. Activists – mainly women and non-medical people – responded to this need from the mid-1930s.
Many women desperately wanted reliable contraception. They were dependent on doctors to fit cervical caps and rubber diaphragms, or on their husbands to use condoms. Disapproval of contraception was so widespread among doctors that even married women with children were sometimes refused help.
The Family Planning Association (FPA) started in 1936 as the Sex Hygiene and Birth Society. Most of its members were women, but the group included men and a few doctors. At first the society only provided contraceptive advice, but even that was a radical move. Although disapproved of by many, the assistance was seen as a lifeline by those who contacted the society.
Women’s health altered dramatically in the second half of the 20th century. Maternal mortality was no longer a major concern, and contraception and safe abortion became available. Cancer became a major cause of death; at times its treatment was the subject of controversy. Violence and sexual abuse surfaced, and their immediate and on-going effects were identified as a women’s health issue.
Some things didn’t change. The health of New Zealand women remained high by international standards. Many of the issues women faced in the 2000s were also faced by men of similar ethnic and socio-economic status. The most advantaged were generally in very good health, while the most deprived continued to suffer high rates of preventable disease and disability, and die at relatively early ages.
Many women enjoyed good or reasonable health, but wellness was not usually studied or recorded. A focus on mortality and its causes has also meant that rates of ill health not directly related to death were not gathered until the 1990s.
The major causes of death among women in the 2000s were:
Cancer mortality rates were highest for breast (16.2%), colorectal (17.2%) and lung cancer (16.8%) in 2007. Different cancers tend to kill women at different ages. Most women who die of breast cancer, for example, are under the age of 64.
Heart disease (which causes angina, heart attacks and heart failure), resulted in more deaths among New Zealand women than any other single cause. In the 2000s the rate of heart disease among New Zealand women was higher than that among women in Australia, the United States, and Canada.
Respiratory diseases that irreversibly decrease air flow to the lungs were collectively known as chronic obstructive pulmonary disease (COPD). In the 2000s women were more likely to have COPD than men. Those living in the most deprived areas were affected at three times the rate of those living in the least deprived. Most of those affected were aged over 50.
Use of tobacco, hazardous drinking, obesity, lack of physical activity, and low fruit and vegetable consumption all increased likelihood of disease. In 2008 fewer women smoked than men – 22% compared to 26% – and they drank less alcohol. Women were more likely to be of normal weight or extremely obese than men (more of whom were overweight or obese). Women under 35 and over 65 were significantly less likely than men to be physically active. They were more likely to eat recommended levels of fruit and vegetables.
Pacific Island women, who began to arrive in New Zealand in substantial numbers in the 1950s, had a health profile similar to that of Māori.
Heart disease and stroke, diabetes, cancer and chronic lung disease were the most common causes of death among Pacific Island women. They were affected at greater rates than that for all New Zealand women (but at lower rates than Pacific Island men).
Strokes, for example, killed nearly twice as many Pacific Island women over the age of 45 as all New Zealand women (812 per 100,000 compared with 486) in 1996–2000. Pacific Island women suffer particularly high rates of diabetes – three times the rate of the general population. Pacific Island women were more likely than all New Zealand women to die from breast cancer (85 compared with 63 per 100,000), and cervical cancer (14 compared with 8 per 100,000).
Within the Pacific Island population 28% of women smoked, compared with 35% of men, and also had a lower drinking rate. Although Pacific Island women drank more than women generally, they were less likely to drink in a hazardous way. Increasing numbers of Pacific Island women were obese, with a rate of 48% in 2002–3.
The link between poor health and low socio-economic status was clear among Pacific Island New Zealanders, more than 50% of whom live in deprived areas. Poor and overcrowded housing contributed to high rates of infectious disease (such as tuberculosis) and relatively high infant mortality. These problems continued to affect the Pacific Island community in the 2000s.
Pacific Island women had a higher rate of avoidable death (where effective prevention or treatment is available) than that of all New Zealand women: 471 per 100,000 compared with 318 per 100,000 between 1996 and 2000. (Though it is not as high as the rate for Pacific Island men, at 771 per 100,000.)
Extended family played an important role in the Pacific Islands, providing advice, and emotional and practical support. Coming to New Zealand often meant losing that network. Pacific women sometimes found themselves isolated at critical moments – including during pregnancy, birth and while children were young. Despite this stress, rates of post-natal depression (PND) varied greatly. Samoan women were particularly resistant to PND, with one study finding 7.6% suffered from it, while the rate among Tongan women was 30.9% (the average for Pākehā women was 16%).
The Samoan Catholic Women’s Group and the Presbyterian Women’s Group called the first cervical education meeting for Christchurch’s Pacific Island community. Gwenivere Newport, who arrived in New Zealand from Samoa in the 1950s, remembers that ‘it was a subject that wasn’t discussed publicly in those days … so for it to be piloted by these women was great’.1
Use of medical services among the Pacific Island community has not been high. Pacific Island women’s first contact with free midwifery services, for example, tended to be late in pregnancy, with a resulting increase in complications during birth. Language difficulties, a lack of understanding of the services available and a scarcity of Pacific Island medical staff all contributed to the low use of services.
Responding to these difficulties, Pacific Island health professionals began setting up programmes and centres from the 1980s. The centres had medical staff fluent in Pacific Island languages. Some had family-sized consultation rooms, did home visits, and undertook their own staff training to increase the pool of Pacific Island medical workers.
Women’s health was the focus of quiet activism in the 1950s and 1960s, when access to contraception and less medicalised birth were both sought. More vigorous campaigning and controversy became frequent from the 1970s on. Some issues – abortion, cervical cancer, contraception, violence against women – became highly politicised.
Authoritarian medical management of childbirth had become standard in New Zealand. In 1952 a group of Wellington parents (most of them women) started the first Parents Centre. Parents Centres were set up nationally, and focused on the birth experience and the bonding of mother and child after birth.
Some Parents Centre innovations became standard, notably hospital ‘rooming in’ – baby staying in the same room as mother, rather than in a nursery – and allowing fathers to be present during a baby’s birth.
Women’s health activism flourished in the 1970s and 1980s. Close attention was paid to a range of issues, including women’s interactions with doctors, contraception, abortion, birth, violence, and breast and cervical cancer. Fundamental to this activism was the belief that women needed to understand their bodies and control their own health.
Pointing out that most medical research was done on men (or male animals), feminist health activists argued that the result was a lack of knowledge of the effects of hormonal fluctuations, pregnancy, breastfeeding and menopause on disease or drug effectiveness. Differences in the way a disease might show itself in men and women were not well known. Some conditions specific to women, including endometriosis and pelvic inflammatory disease, were not understood.
Women’s health centres and groups were set up around New Zealand. Many were at first met with hostility, and did not last long. Others remained active in the 2000s, notably the Women’s Health Action Trust and the Auckland Women’s Health Council.
The first Wellington women’s health centre had been open for two days when the city council evicted it from rooms in a community centre. Medical groups had complained and support previously promised was withdrawn without discussion or notice. The women were dismayed and angry, but had no choice except to leave.
Cervical cancer became the best-known of the feminist health campaigns. Health campaigners Phillida Bunkle and Sandra Coney discovered that more than 80 women with abnormal cervical smears had been part of an experimental study at National Women’s Hospital in Auckland.
The study involved the repeated checking of women for signs of carcinoma in situ (cancerous cells). If found, treatment was withheld while regular checks were continued. Some of these women went on to develop cervical cancer, and some died as a result.
The experiment became the focus of a commission of inquiry, known as the Cartwright Inquiry, which reported in 1988. In response to the inquiry’s findings, the government set up the position of Health and Disability Commissioner, ethical procedures became an integral part of setting up medical studies throughout New Zealand, and a cervical-screening programme began in 1989.
Activism also prompted government health agencies to pay closer attention to women’s health issues. This interest in women’s health did not survive the 1990s, when women’s health again became absorbed into family and reproductive health. The good health of socio-economically advantaged women meant that women’s health became less of a focus.
In the decades after the Second World War many Māori moved to the city. By 1971 over half the population was urban; by the 2001, 84% were. Housing and employment for many urban Māori became like that of working-class Pākehā.
Better housing, combined with increased immunity to infectious disease, helped the health transition that occurred for Pākehā in the late 19th and early 20th century take place for Māori. Rates of infectious disease (such as tuberculosis and influenza) and premature death fell, and life expectancy increased. The negative side of the transition – an increase in degenerative diseases, including cancer and heart disease – also occurred.
Māori women were not left behind in this shift, but their health remained worse than that of Pākehā women and, in some areas, worse than that of men – both Pākehā and Māori.
The leading causes of death – cardiovascular diseases, cancer, respiratory diseases and diabetes – all hit Māori women hard. Rates are higher than for Pākehā women, with greater numbers dying, and doing so at an earlier age. Although rates of death dropped between 1981 and 2004, that drop was lower among Māori women (at 22%) than any other group.
A significant proportion of deaths among Māori women were avoidable, which is defined as those who were under 75 years of age and for whom effective prevention, treatment options and health-care technologies were available.
The link between smoking, stress and lack of money was spelt out by Māori women talking to Māori researchers. One of them said: ‘Well I never drank beer. I never gambled. When you’re stressed out and haven’t got any money you can’t go out for a social life. So what do you do? Have a smoke.’1
Circulatory diseases – coronary heart disease, hypertension, and angina – have been particularly high for Māori women since at least the 1970s. At 4.2 times that of Pākehā women, the risk of death from cardiovascular disease for Māori women remained high in the 1990s.
Māori women got cancer more often and were more likely to die from it than Pākehā women. In 2002–6 for every 100,000 Māori women, 228.3 got cancer, and 107.3 died of it. This mortality rate was 90% higher than that of non-Māori women. Lung, breast, colorectal and stomach cancer were the most frequent causes of death.
In 2006–7 Māori women suffered higher rates of asthma, bronchitis and emphysema than the general population. They were also more likely to suffer and die from chronic obstructive pulmonary disease (usually caused by bronchitis and emphysema).
Diabetes was unknown in the Pacific before the Second World War, and in the 2000s the rate among Māori could only be estimated. Professor Chris Cunningham of Massey University’s Research Centre for Māori Health suspected that ‘well over’ half of those with the disease didn’t know it.
Diabetes reached epidemic level in some Māori communities in the 2000s. In 2005 Māori women were 10 times more likely to die from diabetes than the general population (at 6.5 times that of the general population, the rate for Māori men was also very high).
Smoking, hazardous drinking, obesity, limited physical activity and low fruit and vegetable intake all increase the likelihood of health problems. Unemployment increases risky behaviour, and Māori were hit particularly hard during recessions and state restructuring from the 1970s on.
Access to health care is limited by cost, availability of doctors, and attitudes of medical personnel. Health problems are strongly concentrated among poorer women – for example, 50% of Māori women with cancer come from the bottom two deprivation deciles. For these women the cost of visiting a doctor and the money required to get there and back has sometimes been beyond their means.
Medical personnel have sometimes provided a lesser quality of care to Māori. Evidence that the care of women during childbirth has been affected by the mother being Māori is particularly strong.
Although rates of infectious disease fell in the decades after the Second World War, Māori continued to suffer them at a much higher rate than Pākehā. Rheumatic fever, for example, was common in the mid-1970s. Rheumatic heart disease, caused by rheumatic fever, killed Māori women aged 44–65 at 7.8 times the rate it killed Pākehā women, and at 1.7 times the rate for Māori men. In the 2000s rates of rheumatic fever climbed again, as overcrowded housing increased.
Māori women have organised to improve their health status and, as part of that, have challenged understandings of what health means. Māori health activism has been shaped by a concern that colonisation, population loss and a resulting cultural breakdown has undermined health. Building communities and extending the protective effect of strong whānau bonds has been an important outcome of initiatives such as kōhanga reo (preschool language ‘nests’).
Development of Māori-centred models of health began in the 1970s, as part of the challenge from Māori to mainstream health providers. These models included emotional, physical, whānau and spiritual wellbeing. Alongside that theoretical framework, Māori set up their own health providers.
The Maori Women’s Welfare League, Tipu Ora and kōhanga reo were all set up to improve the wellbeing of Māori communities and Māori women.
Standard measures of health actually measure illness and death. The Maori Women’s Welfare League’s 1984 Rapuora report measured wellbeing, including physical health, peace of mind, family, lifestyle and paid work. Using this measure, a comprehensive profile of Māori women in good health was developed.
The Maori Women’s Welfare League was set up in 1951. Health was a major concern of the league. In the 1950s and 1960s members worked with public health nurses and Māori mothers, assisted with immunisation, and discussed family planning, obesity and tuberculosis. In the 1970s the league included domestic violence as a health issue; in the 1980s it set up the Healthy Lifestyles programme and released a report, Rapuora: health and Maori women. In 1993 the league, with the National Maori Congress and the New Zealand Maori Council, set up Te Waka Hauora, a national Māori health authority. At a regional level the league also became involved in the provision of health and wellbeing services to families in the 1990s and 2000s.
The first kōhanga reo was set up in 1982 and others swiftly followed; a decade later there were 630 kōhanga. The aim was survival of the Māori language (and, along with that, Māori culture). The method used – care for and teaching of pre-school children, usually by women – strengthened whānau and hapū relationships, sometimes helping build communities in urban centres. Strong whānau bonds are well-understood as a protective element in maintaining physical and emotional health.
Concerned at worsening Māori health, Tipu Ora, a health organisation, was set up in 1989 by the Te Arawa-based Women’s Health League. It has been strongly family-focused, working with new mothers and teenage parents, and setting up midwifery services.
During the 1970s and 1980s there was an expansion of Māori women organising around health issues. They identified a number of problems, including monocultural training of health-care workers, a lack of consultation and engagement with Māori communities, and an unwillingness to share resources. Many health projects were started by women.
Knowing that delivery of health services was often ineffective, Māori began setting up their own health-provider organisations. Many of these new organisations took on government contracts.
Government attention to Māori health issues grew in the 1990s, and included active development of Māori health providers. In 2000 a directorate of Māori health was set up within the Ministry of Health, and by 2004 Māori health teams began work on mental health, disabilities, cervical screening and public health.
Bryder, Linda, ed. A healthy country: essays on the social history of medicine in New Zealand. Wellington: Bridget Williams Books, 1991.
Lee, Mary Isabella. The not so poor: an autobiography. Auckland: Auckland University Press, 1992.
Manning, Joanna, ed. The Cartwright papers: essays on the cervical cancer inquiry, 1987–88. Wellington: Bridget Williams Books, 2009.