Toiora – Healthy lifestyles
Toiora is the healthy lifestyles outcome in Te Pae Mahutonga (Māori wellness model). Toiora includes the fostering of healthy child development as well as the development of mental health. While some lifestyle factors can be major risks for child maltreatment it is widely acknowledged that these factors are so closely intertwined with deculturalisation and poverty that macro solutions are equally, if not more, important than micro, individually targeted interventions (National Screening Unit, 2004).
This section looks at the lifestyle issues faced by many vulnerable whānau that prevent them from achieving Toiora. These include (Higgins, 2010, p. 3):
- parental problems (mental health, substance abuse, poor parenting skills or family/domestic violence)
- challenging child characteristics (low birth weight, disability or other special needs)
- family characteristics (poor relationships, large number of children, single parenthood or early parenthood), and
- previous experiences of abuse/neglect (of either parents or children).
For example, compared to white families, the caregivers in American Indian and Alaskan Native American families where children were removed by welfare services had greater drug, alcohol and mental health problems (Carter, 2010). Asian and Pacific Islander families in Washington State who were referred to child protective services were more likely to be experiencing higher levels of social and economic stress (Pelczarski & Kemp, 2006). Compared to non-Aboriginal families, Aboriginal families in Canada investigated for child maltreatment had worse socio-economic conditions and reported higher rates of substance abuse (Blackstock et al, 2004).
These risk factors are not separate things that may or may not culminate in child maltreatment; rather, they are intertwined and associated factors that often fall into place along a chain of causality. For example, parenting skills are undermined by substance abuse and mental health problems. Substance abuse has been linked to experiences of childhood sexual abuse that have, in turn, been linked to social welfare policies that were not responsive to indigenous cultural practices and often resulted in the loss of children from indigenous families and communities. This interweaving of ‘risk factors’ within and across the levels explored in this paper is also acknowledged in other indigenous communities and can lead to “hurtful parenting practices and insensitivity to children’s needs by some … parents” (Dionne, Davis, Sheeber, & Madrigal, 2009, p. 912).
In this section, some of these risks to whānau are examined, and particular attention is paid to describing the nature of the risk to the safety and wellbeing of children within whānau. However, we acknowledge that there is no comprehensive epidemiological study of Māori child maltreatment, so the picture being painted here is piecemeal, at best.
Many of the personal risk factors for child maltreatment explored below are well established within non-indigenous populations. This section specifically examines the evidence for a relationship between them and child maltreatment within Māori and other indigenous populations. The incidence of these risk factors for Māori is also reported where these data are available.
Mental health issues
The 2006/07 New Zealand Health Survey found that “Māori adults were nearly twice as likely as non-Māori adults to report they had a high or very high probability of anxiety or depressive disorder” (11.2 percent versus 6 percent) (Ministry of Health, 2010, p. 46). Baxter (2007, p. 121) summarises mental health statistics for Māori, including:
- Just over half of Māori had experienced a mental disorder during their lifetime.
- The most common lifetime disorders for Māori were anxiety (31.3 percent), substance (26.5 percent) and mood (24.3 percent) disorders.
- Mental disorders for Māori were more common in those aged 16 to 24 and 25 to 45 years, those living in low-income households and those living in areas of high deprivation.
Mental health issues are linked to child maltreatment and other complex risk factors. Depression, for example, is linked to substance abuse, lack of social support, low socio-economic status, domestic violence, being married and being female. Maternal depression has been linked to child maltreatment (Ta, Juon, Gielen, Steinwachs, McFarlane, & Duggan, 2009). Mental health issues have also been found to be more prevalent in indigenous women who were abused as children (Duran et al, 2004).
An Hawaiian longitudinal study revealed that, among mothers considered to be at risk for child maltreatment, Asian and Native Hawaiian/other Pacific Islander women were significantly more likely to suffer from depressive symptoms than white women (Ta et al, 2009).
Poor parenting skills
The importance of parenting outcomes is two-fold: first, parenting plays a special role in the intergenerational transmission of health and health risks at the biological, psychological and environmental levels … and, second, parenting plays a role in the intergenerational transmission of childhood abuse. (Libby, Orton, Beals, Buchwald, & Manson, 2008, p. 196)
Rokx (1998, p. 1) writes that while Māori parents desire the best for their children, a “lack of knowledge and understanding of Māori child development, and shortcomings in effective parenting methods which maintain and are based on Māori values and ideals, prevent the positive progression of many Māori whānau”.
There is a multitude of reasons for why Māori parents have found themselves in this situation. Generally, parents who maltreat their children may have unrealistic expectations about child development, be less affectionate, responsive and playful, and be controlling (World Health Organisation, 2002). In noting the link between maternal depression and child maltreatment (also see above), Ta et al (2009, p. 43) explain that “depressed mothers are more likely to be hostile, irritable, and coercive towards their children, and, therefore, have negative parent-child relationships”.
Parenting skills for Māori parents have been identified as a priority in consultations about child abuse (Ministry of Health, 1996).
The abuse of alcohol and other substances is important as “Relationships with family and whānau are often troubled because the relationship with alcohol and other drugs becomes more important than intimate relationships” (Kina Families and Addictions Trust, 2005, p. 4). The findings of the 2007/08 New Zealand Alcohol and Drug Use Survey were that (Ministry of Health, 2010, p. 21):
- Māori and non-Māori adults were equally as likely to have consumed alcohol in the past year (86.1 percent versus 85.2 percent).
- Māori adults were less likely to have consumed alcohol on a daily basis (3.9 percent versus 7.1 percent).
- Of those who had drunk in the past year, Māori were more than twice as likely as non-Māori to have consumed a large amount of alcohol at least weekly.
- Māori adults were more than twice as likely as non-Māori adults to have consumed cannabis in the past year (27.9 percent versus 12.9 percent).
Women with substance abuse issues “may have challenging life circumstances, including severe economic and social problems … and may have difficulties providing stable, nurturing environments for their children” (Kelley, 1998, cited in Niccols, Dell, & Clarke, 2010, p. 324).
Binge drinking has been linked to childhood sexual abuse among Kanak women aged 18 to 54 years in New Caledonia. This independent association was evident among a sample of 441 women, when social and demographic factors were controlled (Hamelin et al, 2009). This should not be surprising, as “substance abuse has been identified as a means for women to cope with distressing situations in their lives, including emotional pain, distress, violence and trauma” (Niccols, Dell et al, 2010, p. 322).
Parents with substance abuse problems may not parent poorly, but their substance abuse places them at risk for parenting problems (Mayes & Truman, 2002). Although drinking behaviour can have a deleterious impact on parenting, Fischler (1985, p. 101) maintains that “even if parental drinking behaviour cannot be modified, the adverse effects upon children can be mitigated”. This might include, for example, school holiday residential programmes for children that offer children nurturing while giving parents respite from childrearing.
In writing about programmes to support Aboriginal women with substance abuse problems Niccols, Dell et al (2010, p. 326) state that:
Within an Aboriginal worldview, substance abuse is understood within a framework of mental health … conceptualised as the wellbeing of individuals and their communities, in which understanding an individual apart from her community is not possible. An individual’s wellbeing is understood to be inter-reliant with the wellbeing of the collective (children, family, community, land) and its relation to self identity.
This approach to understanding substance abuse and approaches to supporting the recovery of Aboriginal women is compatible with Māori approaches to health and wellbeing, such as those expressed in the current Whānau Ora initiative (see below). This is also stressed by calls for Māori cultural factors, including the role of whānau, hapū and iwi, to be included in alcohol treatment services for Māori (Ebbett & Clarke, 2010).
Intimate partner violence
Violence in the home is strongly related to child abuse across a wide range of countries and differing cultural environments (World Health Organisation, 2002). In the 2004–06 period, Māori adults were more likely than non-Māori adults to be hospitalised (218.8 versus 61 per 100,000), and to die as a result of intimate partner violence (4.3 versus 1 per 100,000). Māori children are also more likely to be exposed to domestic violence (Ministry of Health, 2010).
In the US, American Indian and Alaskan Native American women are more at risk of intimate partner violence than women from other ethnic groups (Jones, 2008). Research in the US has emphasised the role of alcohol and drugs in intimate partner violence (Jones, 2008); however, this has been disputed as an oversimplification that diverts attention away from issues of subjugation and colonisation (Duran, Duran, Woodis, & Woodis, 2008). Jones (2008, p. 114) writes that:
The reasons for the disproportional occurrence of DV in the American Indian community are historical (the legacy of colonialism, subjugation, oppression, and subsequent trauma) and current (high poverty rates, encounters with racism, high rates of abuse of alcohol and drugs, and isolation particularly in rural areas).
Challenging child characteristics
The presence of babies and children with special needs may be part of the mix of childcare challenges for whānau. Special needs may be due to, for example, babies being pre-term, having Foetal Alcohol Spectrum Disorder (FASD) or children having disabilities.
The prevalence of low-birthweight babies is only slightly higher for Māori than for non-Māori (7.18 versus 60.9 per 1,000 live births) (Ministry of Health, 2010). Low birthweight has been associated with unintended pregnancies (World Health Organisation, 2002) and also alcohol consumption during pregnancy (A. Chudley, 2010, personal communication).
Māori children aged 0–14 years are more likely than non-Māori children to have a disability (14 percent versus 9 percent). “The most common disability type experienced by Māori children was special education needs and chronic conditions” (Ministry of Health, 2010, p. 27). The unequal distribution of social and economic resources within our society means that whānau may have fewer options for coping with and raising a baby or child who has special needs (Taskforce on Whānau-Centred Initiatives, 2010). Pre-term infants and disabled children are also at increased risk for child maltreatment because parental attachment may be more difficult (World Health Organisation, 2002).
The term ‘FASD’ covers a range of disorders caused by women drinking alcohol during pregnancy. In Canada the overrepresentation of Aboriginal children in the child welfare system is even greater for children with FASD. The characteristics of the disorder include intellectual and developmental delay, and often behavioural and cognitive difficulties. FASD also brings with it financial costs for the families of these children, as well as the social, health and educational systems that support them (Fuchs, Burnside, Murchenski, & Mudry, 2010). In addition to alcohol during pregnancy, socio-economic status, stress, age of mother (over 30 years) and parity are also contributing factors for FASD (Stuart, 2009). However, Stuart (2009, p. 42) also notes “that many mothers of children with FASD have few or none of these interacting factors”.
The concern in Aotearoa New Zealand is the links between alcohol abuse, FASD and child removal. There are currently no data on the prevalence of FASD in New Zealand (Stuart, 2009). The Ministry of Health 2004 Health Behaviour Survey found that 82.4 percent of pregnant Māori women reported they had stopped drinking (Ministry of Health, 2007a).
As well as being poor, unemployed and less well educated (see above), “physically abusive parents are more likely to be young [and] single” (World Health Organisation, 2002, p. 67). For Māori, the proportion of children in single-parent households may mean that the responsibility of raising children is falling disproportionately to Māori women who may not have extended whānau support. However, rather than looking at these as individual risk factors, Hill (2006, p. 26) considers them to be determinants of community social organisation. This includes the “concentration of female-headed households, excessive numbers of children per adult residents, household and age-structure, population turnover, and geographic proximity to other poverty areas”. Community social organisation mediates the mechanisms through which family characteristics are associated with child maltreatment.
Previous experiences of abuse/neglect
In American Indian communities, children who were removed during intensive colonisation and assimilation and placed in boarding schools and non-indigenous foster or adoptive homes often experienced poor parenting or, at its worst, maltreatment at the hands of their caregivers (Fischler, 1985). This created what Fischler (1985, p. 100) describes as “a generation of unparented parents”. The trauma of being separated from their birth family in early childhood, the stress of being raised by a non-indigenous family or in an institution and the abuse that many of these removed or ‘stolen’ indigenous children experienced has had a profound, but perhaps not surprising, impact upon their adult lives. “Individuals exposed to chronic trauma in early childhood, experience in adulthood higher rates of mental illness and substance abuse problems, and lower levels of social, emotional and cognitive functioning” (Morgan, 2010, p. 57).
Māori women are more likely than non-Māori women to report an experience of childhood sexual abuse. Women who have experienced child sexual abuse were also found to be more vulnerable as adults to intimate partner violence and other violence (Fanslow, Robinson, Crengle, & Perese, 2007). Childhood sexual abuse has also been found to be associated with mental health problems later in life (Fergusson, Horwood, & Woodward, 2000).
Risk factors for child maltreatment include characteristics of parents, children and families. These can be linked in multiple and varied ways. For example, poor parenting skills can be because parents were not well parented themselves. Parents may have experienced childhood maltreatment with this, in turn, linked to adult mental health problems. Family characteristics may lock families into cycles of poverty and segregation in communities that experience the excessive vigilance of child welfare services, which break down personal and community identity.
This section does not insinuate that all whānau who find themselves in difficult circumstances, or experience mental health issues or the challenges of raising a child with disabilities, are potential or actual child abusers. Rather, this section has examined how Māori are more likely to experience complex circumstances which make them more vulnerable, as these circumstances add to socio-economic deprivation and societal racism. It should not be surprising that this layering of societal context, socio-economic disadvantage and difficult personal circumstances might undermine good parenting.
- Measurement of family risk for child abuse includes these areas; for example, the measure used by Duggan et al (1999, p. 67) included: “parents not married; unemployed partner; inadequate income; unstable housing; lack of telephone; less than high school education; inadequate emergency contacts; marital or family problems; history of abortions; abortion unsuccessfully sought or attempted; adoption sought; history of substance abuse; history of psychiatric care; history of depression; and inadequate prenatal care”. [Return to reference]
- Rokx’s comment is also pertinent with respect to interventions and solutions: they must be founded upon a belief that Māori parents want the best for their families and children (rather than some deficit-based notion that Māori parents are fundamentally deficient, bad people who deliberately harm their children). [Return to reference]