New programme to reduce pregnant Māori smoking rates shows promise

Health programmes that teach Māori knowledge about pregnancy and reinstitute traditional practices could help reduce smoking during pregnancy, a new study claimed.

The study evaluated a stop smoking programme for pregnant Māori women that combined traditional tools and knowledge with innovative digital technology. Participants in the Heru and Hapū Māmā feasibility trial were given a heru, a Māori head comb to wear and Māori knowledge delivered via video and an app utilising augmented reality.

Developed by Waikato based KaiRua Ltd, the programme was originally to be delivered in-person to the women as a group, but lockdowns scuttled that. KaiRua adapted and had the speakers filmed, and the programme resources sent by contactless courier. A closed Facebook group enabled the participants support each other. KaiRua and some of the speakers also provided topics for discussion and supported the women as needed.

Despite the challenges of lockdown and remote delivery, the evaluator Toumairangi Marsh said the trial proved that the programme was feasible.

“The Heru and Hapū Māmā programme was highly attractive to pregnant Māori women who smoked and nearly all the women stayed engaged in the programme to the end, which is unusual for such programmes. Whilst, some women did stop smoking, for others it was a down, up, down experience. The extra stress of lockdown thwarted one woman’s effort to quit, whereas others said lockdown helped because there was less socialising and exposure to other people smoking.” She said.

The author recommended that “the smoking abstinence goal needs to be pragmatic, and while complete sustained abstinence is best, vaping appeared to be a popular alternative. If women cannot stop smoking completely, they should be supported to replace smoking with use of a non-combustible alternative.”

“The gift of a heru, a traditional Māori taonga (treasure), was a key behavioural change component of the programme. Wearing the heru invoked a sense of connection to past knowledge and status, and strengthened the mums’ focus and connection to the baby they were preparing to bring into the world,” said Marsh.

The study also showed that some participants met with resistance to their wearing their heru at work indicating a need for education on heru for workplaces.

“The Heru and Hapū Māmā programme could help address the concerning recent rise in sudden unexpected deaths in infancy (SUDI),” Marsh said. “Smoking during pregnancy is a risk factor for SUDI and the Heru & Hapū Māmā programme was highly attractive to Māori women who smoked, who were still in their first and second trimester. The earlier in pregnancy that we can get cessation support to pregnant women, the better for reducing that risk.” She said.

In March, the Ministry of Health announced that there had been a worrying rise in the number of SUDI deaths. In 2019, an estimated 52 babies died of SUDI, up 24 percent on the 2013 to 2017 average.

“An additional advantage of the Heru and Hapū Māmā programme was that it was attractive and engaging even when delivered remotely. I strongly recommend that Heru and Hapū Māmā be developed further and that it keeps the option for women to participate face to face, remotely or as a hybrid of both modes,” Marsh said.

The report has been published by the Centre of Research Excellence: Indigenous Sovereignty & Smoking who funded the feasibility trial of the Heru and Hapū Māmā programme and the evaluation.

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