Co-designing culturally safe breast screening with wāhine Māori
Building trust and prioritising cultural safety in life-saving breast screening programs
The power of screening
Screening programs significantly reduce cancer mortality - breast screening by 30-45% and cervical screening by about 90%. Yet in Aotearoa New Zealand, Māori are less likely to participate than pākehā (white New Zealanders), often only engaging after symptoms appear. Historical context matters: many Māori have experienced inequitable treatment to their pākehā counterparts for generations, leading to low trust in health institutions and their ability to offer cultural safety.
In the Waikato region, particularly Kirikiriroa/Hamilton, breast and cervical screening rates for wāhine (women) fell well below the 70-75% target coverage rate. This occurred despite available public transport, a dedicated breast care centre, and several kaupapa Māori hauora (Māori wellbeing) organisations. Health New Zealand's National Screening Unit (NSU) recognised that traditional approaches weren't working and sought to develop solutions that could authentically address these disparities.
“Māori don’t trust the health service in the first place – our whānau have had horrific experiences for generations.”
Shifting power to wāhine Māori
We partnered with the NSU to build internal co-design capability and then apply this knowledge through community-led practice. The approach was transformative: giving agency to a co-design rōpū (group) of wāhine Māori to undertake the work themselves. This honored Te Tiriti principles and the Pae Ora framework by shifting power to those most affected.
The rōpū's membership remained intentionally flexible to accommodate the busy lives and changing priorities of wāhine. As members learned more about cancer prevention, they became passionate advocates, determined to share knowledge with their whānau and communities. Their lived experience, aroha (compassion), and individual strengths converged to develop solutions that would not just increase screening access but potentially transform intergenerational hauora.
A focus on wānanga (safe spaces)
Through successful testing and feedback, the co-design rōpū recognised their ideas would make tangible differences to screening rates. Their solution centred on wānanga. The word wānanga is unique to Te Reo Māori, without any true equivalent in English. Whānau, hapū and iwi have their own interpretation of wānanga; but broadly speaking, wānanga are safe spaces for open discussion, sharing of traditional knowledge and stories, and deliberation. In the context of cancer screening, wānanga can:
Connect, heal, and educate deeply
Combine appropriately with other kaupapa relevant to whānau and hauora
Restore a sense of connection and community in healthcare systems that often treats people as individual numbers.
What emerged wasn't a fixed product but a "living" idea designed to be "scaled out" rather than up. This approach invites communities to lead their own adaptations, meeting diverse, unique, and evolving needs while avoiding the kind of centralised control that gets in the way of spaces feeling safe and personalised.
The project highlights that addressing health inequities requires multiple solutions working together over time. By centering cultural concepts and community leadership, we co-created a framework that respects autonomy while providing essential health services in ways that resonate with wāhine Māori.
For more information about co-designing health services with Māori communities, contact the National Screening Unit at Health New Zealand.