Te hāpai i te mana wāhine, te takahi i te mana wāhine: Māori women's experiences of empowerment and disempowerment in sexual and reproductive healthcare.

Introduction Māori have poorer sexual and reproductive health (SRH) outcomes compared to non-Māori New Zealanders. Patient experiences of SRH services affect how they access, utilise, and benefit from services. Learning about how wāhine Māori (Māori women) experience care related to SRH could inform improvements in how services provide care for wāhine. Aim This study aimed to explore the experiences wāhine have when accessing SRH services. Methods This qualitative study utilised semi-structured interviews to explore the lived experiences of wāhine when accessing sexual healthcare. Inductive thematic analysis was performed to generate themes from the data. Results Twelve wāhine were interviewed. An overarching theme, Te Hāpai i te mana wāhine, te takahi i te mana wāhine (empowering women, disempowering women), was identified. This theme had four subthemes: creating comfortable spaces; manaakitanga (kindness and respect) overcomes barriers to care; patients are people, not numbers; and the importance of mana-enhancing care. The data showed that wāhine benefit from services and care that make them feel comfortable and respected and that dehumanising care can impact further engagement with services. Discussion Wāhine have variable experiences when accessing sexual healthcare, and although some of those experiences showed how positive interactions with healthcare staff facilitated effective care, many experiences demonstrated how dehumanising clinical care can sometimes be. Such care risks perpetuating health inequities indirectly by eroding the trust wāhine have in healthcare services, and directly by limiting the effectiveness of healthcare encounters. Recommendations are made to improve care provided to wāhine in sexual health settings.