New Insights from University of Otago and Victoria University Research

A groundbreaking qualitative study conducted by researchers from the University of Otago and Victoria University of Wellington has shed light on the complex enablers and barriers faced by Pacific peoples in Aotearoa New Zealand when accessing assisted reproduction services. Published ahead of print in Human Fertility in April 2026, the research highlights significant disparities in fertility care, despite Pacific communities experiencing some of the highest infertility rates in the country.

Pacific peoples, who make up around 9% of New Zealand's population, traditionally have higher total fertility rates compared to European groups. However, studies show they face elevated risks of infertility, with relative risks up to 1.76 for women and 2.37 for men compared to Europeans. Despite this, their participation in assisted reproductive technology (ART)—treatments like in vitro fertilisation (IVF), intrauterine insemination (IUI), and egg freezing—remains the lowest. This paradox underscores the need for targeted research from New Zealand's academic institutions to address health inequities.

Understanding Pacific Peoples in Aotearoa

Pacific peoples in Aotearoa encompass diverse ethnic groups from Samoa, Tonga, Fiji, Cook Islands, Niue, Tokelau, and others, forming a vibrant diaspora community. Many migrated for work or family, contributing significantly to New Zealand's economy and culture. Health disparities persist, including higher rates of obesity, diabetes, and now infertility challenges, often linked to socioeconomic factors, lifestyle transitions, and limited access to culturally appropriate healthcare.

Infertility, defined as the inability to conceive after 12 months of unprotected intercourse or 6 months if over 36 years old, affects Pacific individuals disproportionately. A 2021 baseline survey confirmed higher infertility burdens among Pacific groups, yet ART uptake lags, prompting university-led investigations into systemic issues.

The New Qualitative Study: Methodology and Approach

Led by Cameron D. Young from the University of Otago's Department of Anatomy, with collaborators Rebekah G. Kennedy and Rhonda M. Shaw from Victoria University of Wellington's School of Social and Cultural Studies, and Janet L. Pitman from Otago's Faculty of Medicine, this cross-sectional qualitative study involved semi-structured interviews with 13 self-identified Pacific participants (12 women, 1 man) who had experienced infertility.

Recruited via community networks and fertility clinics, participants shared talanoa-style narratives—Pacific conversational methods emphasizing relational storytelling. Data underwent reflexive thematic analysis, identifying four overarching themes. This approach, rooted in Pacific methodologies, ensures cultural relevance and participant voices drive the findings, exemplifying ethical research practices at New Zealand universities.

Navigating Culturally Unsafe Services

A dominant barrier was the lack of cultural safety in healthcare settings. Participants reported racism, tokenistic engagement, and poor communication. One woman described feeling 'judged' and 'not listened to,' highlighting how Western medical models overlook Pacific holistic views of health, whānau (family), and spirituality.

Cultural safety, a framework developed in New Zealand nursing emphasizing provider awareness of power imbalances, is crucial yet often absent in fertility clinics. Clinics are concentrated in urban areas like Auckland and Wellington, distant from many Pacific communities in South Auckland or regional hubs, exacerbating access issues.

Financial Toxicity: The Cost Imperative

ART costs in New Zealand range from NZ$10,000–15,000 per IVF cycle privately, with public funding tightly rationed. Eligibility requires BMI under 32 for women and 40 for men, no smoking, and age limits, criteria disproportionately excluding Pacific peoples who have higher average BMIs due to genetic, dietary, and socioeconomic factors.

Participants called the expense 'financial toxicity,' draining savings and straining whānau resources. Public funded cycles number only ~2,500 annually nationwide, with long waits. University researchers advocate revising BMI thresholds, noting evidence that higher BMIs do not preclude successful outcomes with multidisciplinary support.

Photo by Rubaitul Azad on Unsplash

Religious Beliefs and Stigma: Personal and Communal Hurdles

Religion, central to Pacific identity (over 90% Christian), both enables and barriers access. Some faiths view ART as 'playing God,' causing internal conflict, while others offer support. Stigma around infertility as a 'curse' or failure leads to silence, isolation, and delayed help-seeking.

One participant shared, 'In our culture, children are everything... infertility feels like shame on the family.' This echoes prior scoping reviews on minority groups' ART barriers.

Family and Community Support: Key Enablers

Conversely, whānau and church networks provided emotional, practical, and financial aid. 'My family rallied, paid for one cycle,' noted a mother. Community talanoa normalized experiences, reducing stigma. Researchers emphasize integrating Pacific support systems into services for better outcomes.

Broader Context: NZ Fertility Services Landscape

New Zealand's ART is regulated by the Assisted Reproductive Technology Order 2004, with ~15,000 cycles yearly. Public funding, via District Health Boards, covers ~20%, prioritized by clinical need. Pacific underutilization persists despite Health Research Council-funded projects like this study, signaling need for equity-focused reforms.

Fertility NZ's 2024 commissioned research by University of Auckland reinforces BMI and cultural barriers for Māori and Pacific. Fertility NZ report.

Implications for Policy and Practice

The study calls for culturally safe clinics with Pacific staff, revised funding criteria (e.g., BMI flexibility, subsidies), community education, and faith-inclusive counseling. Universities like Otago and Victoria are pivotal, training health professionals in Pacific epistemologies.

• Increase Pacific representation in fertility workforce
• Fund talanoa-based support groups
• Expand telehealth for rural access
• Research holistic Pacific fertility models

NZ Universities' Role in Addressing Health Disparities

This research exemplifies New Zealand universities' commitment to Pasifika health. University of Otago's Ōtākou Whakaihu Waka and Victoria's social science expertise drive equity-focused studies. Similar projects, like HRC-funded $1.2m Tongan-led infertility research, highlight growing academic investment.

Such work informs national strategies, positioning unis as leaders in reproductive justice.

Photo by Markus Winkler on Unsplash

Future Outlook and Calls to Action

Ongoing projects promise deeper insights. Policymakers must act: revise CPAC criteria, boost funding, mandate cultural competency training. For Pacific whānau, awareness campaigns can destigmatize infertility. NZ universities continue championing inclusive health research, fostering healthier Aotearoa.

Explore opportunities in NZ higher ed health research via NZ university jobs.