Epistemic injustice and Body Mass Index: Examining Māori and Pacific women’s access to fertility treatment in Aotearoa New Zealand

ABSTRACT

The availability and uptake of assisted reproductive technologies is increasing across the globe yet delays and disparities continue to exist for many Indigenous and minority ethnic groups in terms of outcomes and access to fertility treatment and reproductive services. In this article, we examine the fertility stories of nine Māori (Indigenous people of Aotearoa) and Pacific cisgender women living in Aotearoa who were interviewed as part of a large qualitative study conducted with participants seeking access to assisted reproduction for the purposes of family building. The focus of the article is on the experiences of Māori and Pacific women for whom clinical criteria, which include a Body Mass Index cutoff of 32 kg/m2, present a key barrier blocking access to publicly funded fertility services. We draw on the conceptual tool of epistemic injustice, described by the philosopher Miranda Fricker, as a lens through which to examine the challenges Māori and Pacific women face accessing fertility treatment. The study findings indicate that most participants, at some point throughout the course of their reproductive journeys, encountered epistemic injustice when seeking fertility treatment. To redress this bias, we believe revision of Body Mass Index criteria guidelines, which were implemented as part of a nationwide Clinical Priority Criteria Assessment strategy more than 20 years old, are warranted.

KEYWORDS:

• Aotearoa New Zealand
• Body Mass Index
• Fertility treatment
• Māori and Pacific women

Acknowledgments

Many thanks to Danielle Webb (Ngāpuhi) for assisting with this study and to the participants who shared their stories.

Ethics approval

Victoria University of Wellington (000027702) and Auckland University of Technology (19/2,662,019).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Royal Society New Zealand Marsden Fund [MFP-18-AUT-002].

Notes on contributors

Rhonda M. Shaw

Rhonda M. Shaw is Associate Professor of Sociology in the School of Social and Cultural Studies at Te Herenga Waka–Victoria University of Wellington, New Zealand. Her research interests include the sociology of morality and ethics, empirical research on the donation and provision of human biological materials and services, and family life and intimate relationships. Rhonda is a Principal Investigator on the Royal Society (NZ) Marsden Fund (2019 – 2022) project, Accessing Assisted Reproduction: Social Infertility and Family Formation.

Edmond Fehoko

Edmond Fehoko is a Health Research Council of New Zealand Pacific Postdoctoral Fellow based at the School of Māori and Pacific Studies, University of Auckland. Edmond holds a BA in Social Science and Criminology, MA in Social Science, and a PhD in Public Health from the Auckland University of Technology. His research expertise includes cultural spaces and practices, cultural identity, mental health and addiction, education, and assisted reproductive technologies. In 2019, Edmond received the 2019 Sunpix Pacific Peoples Award for services to Pacific research and education.