Infertility struggles becoming increasing issue for Pacific communities

The fertility struggles for Pacific families in Aotearoa New Zealand will come under the microscope after a $1.2m study was awarded last month to a pair of young Tongan academic researchers.

When PMN spoke with them, Dr Edmond Fehoko from Otago University and Dr Zaramasina Clark from Te Herenga Waka, Victoria University were excited about receiving such a substantial grant from the Health Research Council and also hopeful their research would address negative stereotypes of Pacific people as prolific breeders.

In the early 2000s, demographers speculated that Pacific communities' tendency to have larger families could result in them having greater influence in society.

But Fehoko said a modern western lifestyle in New Zealand has swept in a new reality.

“It used to be that our people had 10 or even 11, 12 children but now we’re seeing Pasifika families with only one or two kids.”

Clark said by far the biggest factor affecting fertility was ageing. Where Pacific people once started having families before embarking on careers, this was no longer the case.

“The biggest issue is female ageing and what’s really interesting is that it’s not as old as you think.”

Meaning women in their mid 30s were now showing up at fertility clinics after struggling to conceive.

“As we push back having children [later], it’s going to become more and more of an issue.”

Clark will undertake the first stage, collecting data to assess the numbers presenting at fertility clinics by ethnicity.

Both she and Fehoko said for Pacific couples experiencing difficulties, the process itself was made even more problematic given the controversial Body Mass Index (BMI) is used as a criteria for publicly funded infertility treatment.

“It’s very demoralising to walk into a room and even before you can get started, to be told you’re too fat,” said Fehoko.

Clark wants the research to assess whether BMI data in New Zealand correlates to the outcomes of the treatment.

“Sometimes it's negative, sometimes there’s no impact, the justification is so loose … people come in and are higher than the [BMI] number, referring to Pacific patients who were told to come back after they had lost weight.

“The longer you wait, that’s time that people who come into the clinic don’t have,”

The subject of infertility isn’t a topic freely discussed in Pacific communities.

“We don’t talk about it enough, there are a lot of reasons we don’t understand,” Fehoko said, pointing to what they hoped the second stage of talanoa within Pacific communities would reveal.

He emphasised the importance of having a family in Pacific cultures, to pass on land and titles, that this created even more pressure, as well as the debate around science versus faith compounding matters.

“At the end of the day if science is man-made, god made man, anything under that is a blessing. I’ll be looking at stories, attitudes, not just infertility but also seeing what their experiences have been through the clinics, drawing out key themes with data, to policies, to church groups.”

Samoan general practitioner Dr Aniva Lawrence and academic co-ordinator at the University of Auckland (Northland Clinical site) said low health literacy was another major factor. It required regular and on-going access to primary health care.

However low-income areas such as South Auckland tended to have fewer GP practices, with currently just two percent of practitioners from Pacific backgrounds. Lawrence said universities were undertaking a huge effort to train more Māori and Pacific doctors.

“These are personal issues, you’re not going to bring this up on the first consultation to a practitioner you don’t know,” she said, highlighting the value of the GP-to-patient relationship.

She said colleagues were seeing higher rates of Polycystic ovary syndrome, Endometriosis as well as women of younger ages presenting with Endometrial cancer from Pacific communities.

“Unfortunately not experiencing periods is seen by some as a positive thing, you’re not having to pay for products and the inconvenience. But having a period is a positive thing,” she said, as it indicates good health in relation to fertility.

Secondary fertility issues were another phenomena, she said, explaining couples were sometimes able to produce one child but failed to get pregnant afterwards for a range of factors. These included trauma, stress that might stem from visa and residency issues, as well as poverty impacting on women’s health. Weight gain too would result in the issuing of a green prescription.

But Lawrence said without access or resources to visit a nutritionist or dietician the issues persisted.

Sara (not her real name) said she suffered several miscarriages before having a second child.

“My grandmother had her last child in her early 40s so I didn’t think it would be such a big deal getting pregnant at 35, but it was. The hardest thing was discovering nobody in my family or even our friends really wanted to talk about these things.”

Fehoko and Clark’s three year study will culminate in a symposium and they’re also hoping to have Master’s students and PhD candidates support the research.