FormalPara Key Points

  • Mana Wāhine (Empowered Women) is funded to increase breast and cervical cancer screening among Māori, Pacific, Asian, under-screened, and never-screened peoples in Aotearoa New Zealand.

  • We work in partnership with the woman and her family to ensure spiritual and cultural needs are acknowledged and that women are prepared, informed, and supported to access screening.

  • Mana Wāhine brings together old knowledge and new knowledge, with a focus on relationships and culturally appropriate services. We normalize women’s health and make it OK for women to talk about cervical and breast screening.

Mana Wāhine (Empowered Women) is a collective of five Indigenous health providers working across health districts in the greater Wellington region of Aotearoa New Zealand. All five providers are either Iwi (Tribal peoples), mana whenua (Tribal peoples who have the right to manage a particular area of land), or belong to a whānau ora collective (a culturally based, family-centered approach to wellbeing, focused on family groups).

Mana Wāhine is an independent service provider that held a direct contract with the National Screening Unit (NSU) Ministry of Health from 1990 to 2022. In 2023, the contract was transferred to Te Aka Whai Ora, the Māori Health Authority (TAW), following recent health reforms in Aotearoa New Zealand. We are funded to provide support to Māori, Pacific, Asian, under-screened, and never-screened peoples to participate in cancer screening programs.

Collectively, we have over 60 years’ experience in providing culturally appropriate and accessible breast and cervical screening support services, alongside education and health promotion. All of our services are free, including our own cervical screening undertaken by five Māori nurses based across our collective organizations. All our collective organizations provide a range of other health and social services.

The most important and effective partnership focus is with the woman and her family. We meet women at their home, at the marae (Tribal meeting house), and at other community venues. The Kapu Tī Kōrero (a chat over a cup of tea) with the kaimahi (community health worker) at the beginning is an important pathway that leads to the clinician at the end. When the women are prepared, informed, and supported to access screening, their spiritual and cultural needs are acknowledged as well as their family. This makes a difference.

Waireti Walters, a pioneering Māori community health worker, was a powerful advocate for breast and cervical screening for Māori women. She was committed to wāhine ora (healthy women) and was a key driver and a supporter of our Mana Wāhine collective from the beginning. Waireti was famous for her quote “know my face before you know my cervix.” Once relationships are established, the woman and her family may then be linked into multiple health and social services. We believe that any door is the right door.

In 2018, we launched a new kaupapa (Māori customary practice or principle) of Mana Wāhine called Te Mauri (Life Essence). Te Mauri supports families with cancer and is a significant community service, unique in Aotearoa New Zealand. Te Mauri is funded by our own collective, by local partnerships with a primary healthcare network Te Awakairangi and the Cancer Society (Wellington), and by the goodwill of others.

Mana Wāhine leadership is about strong Māori women in a network of Māori providers, including traditional healing of mirimiri (traditional massage), rongoā (traditional medicine), and karakia (traditional prayer). It brings together the old knowledge and the new knowledge. The focus is not on what we provide, but how we provide the service. This whānau ora (healthy holistic family) approach goes way beyond statistics and counting. Mana Wāhine normalizes women’s health and makes it OK to talk about cervical and breast screening. As one of the old kuia (respected elderly women) said 30 years ago, “Do you realize you are sitting on a gold mine? You must look after it.”

The overall vision and essence of Mana Wāhine is:

Mā te hauora o ngā whaea, ka piki te ora o te whānau o te hapū, me te iwi. (Healthy mothers ensure healthy families.)

This is presented beautifully in our logo, created by Tracey Kane in 1996 (Fig. 2.1).

Fig. 2.1
The logo of Mana Wahine consists of He Wahine, He Paua, and Nga Tamariki along with the text of the definitions of He Wahine, He Paua, and Nga Tamariki.

Mana Wāhine logo and interpretation

Full size image

The partnerships we build are at multiple levels and focus on a collective approach of working together to achieve better outcomes for our wāhine Māori.

Part of the role of the current manager for Mana Wāhine is to continue to grow and develop these partnerships for the betterment of the wellbeing of all women. Membership on Hei Āhuru Mōwai (Māori Cancer Leadership Aotearoa) and Māori Monitoring Equity Group NSU ensures the community voice is heard at the table. The Mana Wāhine manager chairs the National Cervical Screening Programme Advisory and Action Group that oversees, through an equity lens, the human papillomavirus primary screening and self-testing project implemented from late September 2023. Mana Wāhine has significant partnerships with public health regional screening and sexual health services dedicated to health promotion and prevention.

Key challenges for Mana Wāhine have continued from the beginning. This includes short-term contracting and inadequate funding and the subsequent risk to staff retention of valuable clinical and nonclinical staff who can secure improved job security and higher wages elsewhere. The continuous restructuring of health services, and screening services in particular, results in staff turnover, a loss of organizational knowledge, and considerable time spent rebuilding relationships. When pilots and innovations are funded and succeed, there is no guarantee of them continuing in the future. The focus of the funder is on numbers and Māori providers sometimes have to compete with each other to be awarded a contract to deliver a service. There is still lip service paid to equity and the COVID-19 pandemic has seen significant delays identified for Māori women accessing screening. The inequity has increased.

The future direction for Mana Wāhine is co-designing the service with whānau at the center. Māori health providers need to stay strong and stay together.