Ma¯ori and Pasifika are ‘definitely disadvantaged’
Ma¯ori and Pacific women are disproportionately being denied the chance to have a family, with the system used to determined access to free fertility treatment labelled ‘‘unfounded and unfair’’.
The fixed body mass index (BMI), which creates a score looking at a person’s weight with respect to their height, is used to classify people underweight, normal, overweight or obese. The Ministry of Health describes the BMI as a ‘‘crude measure’’, but still uses it to determine access to care, including fertility treatment.
To get publicly funded fertility treatment, a woman must have a BMI of 32 or under. Those with a score of 30 and above are classified as obese, and at ‘‘substantially increased risk’’, the ministry said.
Because the scale has been modelled on European body types, it doesn’t account for differences in body composition seen in diverse populations. An Otago University study said BMI was ‘‘likely to be an inconsistent measure of obesity in Ma¯ori and Pacific patients’’.
Fertility New Zealand president and chair Juanita Copeland believed using BMI to determine who can access free treatment ‘‘definitely disadvantages Ma¯ori and Pacific people’’.
The organisation has called for the threshold to be raised to 35. ‘‘The BMI system is not a fair one and would certainly stop some people seeking the treatment they deserve out of fear of judgment, whakama¯ or being made to feel their infertility is their fault.
‘‘While lifestyle factors do impact fertility, we believe that the current BMI requirement is unfounded and unfair, especially to Ma¯ori and Pasifika populations and is not always the sole contributing factor to infertility,’’ Copeland said.
Ma¯ori woman Rachel Leafa, 25, of Whanga¯rei, has spent the past six years trying to get pregnant with her Samoan husband Elijah. With her BMI at 43.4, she was constantly told to lose weight.
She managed to get her BMI under 30 over seven months and recently started publicly-funded invitro fertilisation (IVF). However, the process has taken its toll, with her menstrual cycles ceasing as she battled to drop her weight.
Despite making her feel good, Leafa said she stopped exercising because adding muscle saw her BMI increase, and now followed a
restricted diet.
Leafa believed the current system doesn’t cater for anybody who sits outside of the norm. ‘‘You’re already putting a lot of blame on yourself because you can’t do what you think you’re meant to do, and then for [people] to turn around and say ‘you to lose weight’, it adds another layer of guilt.’’
Royal New Zealand College of General Practitioners medical director, Dr Bryan Betty, said a higher BMI did bring greater risks, but using it to determine fertility treatment access threw up equity issues. Betty said a system based on an individual’s risk would be more equitable.
‘‘I think BMI is problematic in the sense that different ethnicities have different make-ups in terms of muscle mass and fat deposition.’’
In the year to June, 6306 individuals accessed public fertility services. Eight per cent of couples who received their first treatment were Ma¯ori, while 5 per cent were of Pacific Island descent. In the
2018 Census, 16.5 per cent of people identified as Ma¯ori, and 8.1 per cent were Pacific peoples.
Fertility Associates’ Dr Olivia Stuart is the only Ma¯ori female fertility subspecialist in the country, and said the BMI requirement was ‘‘outdated’’.
‘‘We are seeing women with a BMI in the low to mid 30s also having a good chance of success.’’
The New Zealand Health Survey
2019/20 found around one in three Kiwis aged 15 and over were obese, with 47.9 per cent of Ma¯ori and
63.4 per cent of Pacific people sitting in this category.
Adults living in the most economically deprived areas were
1.8 times more likely to be obese than those living in the least deprived areas.