Highly fertile: the unique infertility stigma faced by Māori and Pasifika

Aree Altments, of Ngāti Porou and Te Āti Haunui-a-Pāpārangi descent, has seven half-siblings and about 30 cousins on her mother's side of the family. Fertility was everywhere, so she never questioned her own ability to conceive without medical help, even after trying to have a baby for five years with her husband.

"It takes a village to raise a baby, and then sometimes you're like, well, I don't have a baby, but I have the village. So where's my baby?" says Altments.

It wasn't until she was booked to act in a commercial for one of the few fertility treatment providers in New Zealand that she started talking to the company's marketing manager about infertility, IVF and the government funding options to pay for the otherwise costly treatments.

“I was literally just scared and it stopped me from reaching out because no one was talking about [infertility] either,” she says of her whānau and friends.

“...I was looking for someone who looks like me that was going through the same thing as me, that was like, you know, ashamed a little bit or thinking ‘There’s something wrong with me. I’m Māori. We have lots of kids all the time.’”

The chance connection with the commercial sent Altments on a four-year journey with IVF. She decided to share the experience with only a few people, unless the outcome was positive.

Research shows that Māori and Pasifika are often perceived by themselves and others as highly fertile. It’s a stigma that brushes over infertility in Māori and Pasifika that either matches or surpasses that of the general population, where one in four New Zealanders will face fertility challenges.

Seeking fertility treatment can come with a sense of failure for most cultures. However, because of the hyper fertile image attached to Māori and Pasifika people, using fertility treatments can carry additional whakamā, or shame. For this reason - and many others - Māori and Pasifika are under-represented in those who access treatments such as IVF.

“I've had Māori patients who come through and create their family, and they are too embarrassed to tell their parents and their friends,” says Dr Olivia Stuart, who is of Ngāpuhi and Ngāti Kahungunu descent obstetrician and gynaecologist with Fertility Associates.

“Nobody knows in their world how they've created their babies because they find accessing fertility treatment and fertility care really, really embarrassing.”

She has also had Māori and Pasifika patients come to appointments with their whole whānau for support.

“It is quite diverse. It can be a spectrum.”

Fertility treatments like IVF are gruelling and are best done with a wide support network, says Angela Rennie, a counsellor specialising in fertility issues. The processes often involve invasive tests and procedures, and copious amounts of self-injected drugs at specific times.

“...I do find with the Pacific and Māori clients and other cultures that they often are more likely to hide their journey from people close to them, which also reduces support and increases feelings of loneliness in that journey, because of the judgment that they perceive they might get.”

Qiane Matata-Sipu, 39, who is of Te Waiohua, Waikato, Ngāpuhi, Ngāti Pikiao and Cook Islands descent, comes from a line of women who struggled with infertility. Yet, with her Tongan husband being one of 11 boys, she always anticipated having kids.

“Being with someone who came from a big family, we just automatically assumed we would have children, they would all be boys, and that was that.”

After years of trying and focusing on her health, she was turned down for government-funded fertility treatment because her BMI was over 32.

According to research from the University of Otago, BMI is likely to be an inconsistent and inaccurate measure of obesity in Māori and Pacific patients. While obesity can impact ovulation, Fertility Associates’ data shows there is no difference between IVF success above or below a BMI of 32, according to Stuart. She also argues that a BMI cutoff can unfairly limit access to Māori and Pasifika. They typically have a higher muscle mass, which can inflate their BMI, she says.

Matata-Sipu opted to pay out of pocket for IUI - intrauterine insemination, where sperm is injected into the uterus at an optimal time during ovulation, which is determined by daily blood tests. It is cheaper but less successful than IVF.

“We didn’t tell a lot of people for various reasons. Part of it was that we just didn’t have the energy to go through the conversation it takes when you start talking about fertility treatment...”

“It’s also when you have people around you who are on their fifth or sixth child, and it is just really easy for them, it is actually hard to talk about.”

After three rounds that cost $10,000, Matata-Sipu did not get pregnant. However, through tests, she discovered she likely had Polycystic Ovary Syndrome (PCOS), a hormonal disorder that can impact fertility and weight gain.

“...That's when I started to think, ‘Hang on. Is this a hereditary thing, you know? Is this something that we've never thought about, to talk about as a family, and what does this actually mean for me and my ability to have children?”

It was an unfinished story that Matata-Sipu, a public speaker and journalist, shared in a magazine article she wrote in 2016. She planned to start IVF a few months later, but she conceived a baby.

“I'm pretty sure that if anyone had looked at me, they would have thought I was on drugs because I was hyperventilating and crying and laughing and smiling and crying,” she says, of when a pregnancy test in a public bathroom delivered the news. Five months ago, she gave birth to her second child.

Shame surrounding treatment is only one reason Māori and Pasifika are underrepresented in fertility treatment data, says Dr Guy Gudex, the executive director of Repromed, an Auckland-based fertility treatment provider. About 12 percent of Auckland's population is Māori. Yet, Māori make up only two to three percent of Repromed patients, says Gudex.

“It could range from they're not aware of the services to not presenting or not feeling comfortable to present to health providers with medical problems, particularly something like fertility, which is a very sensitive thing.”

Māori or Pasifika people who need an egg or sperm donation also have a greater difficulty because clinics have very few donors of that ethnicity, says Gudex.

“...generally speaking, if you’re Māori or Pasifika and you need a donor, we kind of encourage people to find their own donor from within the family if that is possible.”

There also might be a growing need for Māori and Pasifika to access fertility treatment. Historically, Māori and Pasifika have started their families much earlier than the general population. That gap is shrinking, especially for Māori women in urban Auckland having their first baby at an older age, according to Gudex. The fertility of women typically decreases as they age, dropping rapidly in their late 30s.

Stuart, from Fertility Associates, says services are increasing outreach to Māori and Pasifika with a focus on rural areas. Staff receive cultural training and there is one Māori doctor at or connected to each Fertility Associates location. While many unused embryos are destroyed, patients who request to have theirs returned - and many Māori and Pasifika patients do - receive the embryos in a kete, a woven bag.

The staff at Repromed say karakia, created in consultation with kaumātua, before destroying unused embryos.

“It just adds a spiritual element to what's otherwise a rather cold process of just ‘These embryos are not needed anymore and we're going to dispose of them,’” says Gudex.

Altments had her first consultation for IVF in January of 2020. She was 39, a few months shy of the 40-year-old age limit to receive government funding.

She began documenting it to potentially share later on social media. Following an egg retrieval procedure and lab fertilisation, Altments ended up with three viable embryos. In 2023, the first embryo was transferred.

“That went well. It was successful, and I have my little boy.”

She has since posted her journey on TikTok so other Māori with infertility issues will see someone who looks like them talking openly about a subject cloaked in whakamā.

“...I have followers from my TikTok who have sent me photos of their baby because they saw my TikTok and they had the courage to go in and try again, or get help...

“It’s brought a tear to my eyes because I’m like, I knew that this was all going to be for a good reason.”