Project Summary
The team aims to strengthen Native Hawaiian and Pacific Islander (NHPI) birthing sovereignty by examining cultural agency as a protective factor for pregnant NHPI women navigating Western medical systems. The team will document how participants, families, and pale keiki (Native Hawaiian Birthing Attendants) from Ka Lāhui O Ka Pō, Kōkua Kalihi Valley’s Native Hawaiian birthing classes, and their birth ecosystems (clinicians, traditional healers, community members, midwives, and other healthcare partners) can assert agency in contexts often hostile to culturally-affirming choices, and how this agency can improve psychological dimensions of care and contribute to improved maternity and birthing-related health outcomes.
Research Questions/Aims
- How do NHPI communities define cultural agency in the context of birthing?
- What culturally safe and equitable practices and policies can protect and uplift cultural agency in birthing for NHPI communities?
Actionability
- To guide participating midwives, pale keiki (Native Hawaiian Birth attendants), researchers, providers, insurers, and other healthcare stakeholders in adopting concrete practices that increase cultural safety, reduce birth trauma, and strengthen family and cultural agency during pregnancy and birth.
Meeting the Moment
In the current sociopolitical landscape, there are more restrictions on Indigenous reproductive autonomy and their rights, and a declining investment in family planning, which has heightened risks for Indigenous communities. This project responds directly to Hawai’i’s ongoing legal restrictions on midwifery regulations and reproductive rights. It takes concrete local action to address threats to reproductive rights, which are being rolled back nationwide.
Outcomes
Health Outcomes: NHPI maternity and birthing people’s mental wellbeing and physical health Other: Best-practices “blueprint” that guides institutions toward culturally safe decision-making and informs the place of NHPI culturally grounded maternity and birthing practices within contemporary health environments; “Cultural Agency in Birth Readiness Scale” to gauge and guide institutions’ continuous improvement in policies and practices that impact NHPI maternity and birthing experiences.
Kōkua Kalihi Valley Comprehensive Family Services
Ho‘oulu ‘Āina’ (100-acre forest reserve/cultural healing program)