Young & PregnantDelivering antenatal education to young pregnant & Maori mums

ProblemDespite providing specialist

antenatal classes for Young Mums & Maori mums in Marlborough, New Zealand attendance at these classes are poor.

This led to examining the reasons why and what measures could be implemented to reach a vulnerable pregnant population with antenatal education

Marlborough

Pregnancy RatesOverall teenage pregnancy rates

for Marlborough are not availableNZ numbers there were 7639

New Zealand teenagers who had children in 2009

39 teenagers were under the age of 15

Pregnancy Rates - Maori Maori women less likely to have an

abortion (Dickson et al, 2000)teenage pregnancy is more common

among Maori women. In1998 the fertility rate for Maori females

aged 13-17 years was 26.2 per 1,000, more than five times that of non-Maori (4.9 per 1,000).

A study by Fenwick and Purdie 2000 showed that Maori students were nearly 3 times as likely as European students to be sexually active.

Reasons for non attendance in Young MumsFeeling judged, by older mums &

Health ProfessionalsFeeling boredFeeling labelledSounded just like schoolTransport difficultiesNot given same service as other

mums so why should antenatal class be different

Reasons why Maori Mums don’t attendNot culturally appropriateThe word ‘ante’ sounded negativeWhanau (family) excluded from classesAll support for pregnancy gained from

Whanau (family) so antenatal class not valued

Again not given same service as white middle class women so why should classes be any different?

Shy of attending large groups

Culture-So what?

“An individuals cultural background will impact how one best learns and integrates new information” (Berman, 2006)

Issues to considerParents to be from Maori

background dislike being put on the spot with group activities

Maori like to take information back to the Whanau (family) then come back with questions

Can be very, very quiet and shyMaori children are brought up not

to ask questions or challenge teachers

Factors during antenatal care which affect class attendanceOften they describe Health

Professionals “do stuff to them”They are not given informed

choiceThey feel they get a substandard

serviceMidwives & Obstetricians seem

to be trying to ‘parent’ them through the system

Learning Needs“Prenatal Programs are often

designed and infused with content from the viewpoint of the health professional. Yet providers and receivers are vastly different in their views” (Berman, 2006)

Health BoardThe health board decides what is

to be covered during the classesThis goes against New Zealand’s

founding document ignoring the promises of, Protection, Partnership & Participation for Maori

My changesTo work in partnership with Maori

and young mums Identify strategies to deliver

antenatal education

New strategies/blended learningYoung couples prefer to attend

classes in traditional format

“Classes are of limited reach” (Renkert & Nutbeam, 2001)

So alternate channels for delivery should be explored and tested

Alternate ChannelsDrop in sessionsText messagingEmailYouTube videoDeveloping sessions from early

pregnancyFacebookBlogging

Drop in SessionsWeekly 2hr session informal

session group discussion See what subjects arise in the

sessionYoung mums in total controlAs an educator I just facilitateI do not controlAllow young mums an

empowerment opportunity

Factors for drop inSafe environment Informal settingCouches, coffee & soft drinksThey problem shareWork together for solutionsOral sharing of information (culturally

more appropriate for Maori)I sit in background only interject when

silence or questions cannot be answered amongst themselves

Text messagingNegotiated a deal with local text

messaging service providerDelivery of compact educational

messages in 160 characters

Examples of text messagesHealthy eating messagesSafe exercise messagesSigns of labour messagesDanger signs during pregnancySafe baby sleeping message,“Face up, Face clear and Hands

Free”

EmailCould be specifically designed

and targeted to each individual member

Could be made culturally specific for Maori without excluding European participants.

Turanga Kaupapa – the cultural guidelines for Maori pregnancy

Te Whare Tangata

The wahine (woman) is acknowledged, protected,

nurtured and respected as Te Whare Tangata (the house of the

people)

Added advantagesMaori and young mums often

used extended families computers to gain access to computers which meant others received same information and were able to ask questions

YouTube videoI made educational YouTube

video’sAccessed easilyFrom own homeInformation without intimidationStop at any timeWatch over and over againCan be accessed by young mums

in rural areas

FacebookDevelopment of facebook groupMore youngsters use facebook to

connectWider network of supportCountry wideDiscussion and ability to monitor

and facilitate correct information sharing

BloggingAll information accessed on one

easy pageAllows for participation through

leaving of commentsAllows partnership when they

suggest topics or can even contribute their own stories

Allows for protection by giving correct information

Difficulties for facilitatorNeeds creative thinkingOrganised with who is using what

method and where information sharing is up to

Time consuming making videosSteep learning curve with video

editing softwareDependent on young mum’s access

to internet, download speeds & data allowance

DifficultiesNeed to develop knowledge of

web 2.0 e.g YouTube & Blip TVMobile phone sharing common

for young Maori mums so who is getting the text messages?

Inaccuracy of mobile phone numbers – Young people often change phones during pregnancy

Trusting drop in sessionsMust have ability to allow control

of these sessions to rest with Young mums themselves

Be prepared and confident in own ability to present on any subject as and when they decide it needs to be covered

Using Social MediaRemember not confidentialNot appropriate for personal

discussion of problemsGain consent from all members

for publishing photographs & video

Monitoring of comments at all times on the page

FeedbackStill collecting feedback and

collecting dataPositive for facilitator and

participants sad when facilitator left New Zealand

Final Fact

“Studies show that teenage pregnancy significantly drops off after the age of 25”

(Colorado Springs Local newspaper, 1999)