Enablers and barriers to assisted reproduction and fertility services for Pacific peoples in Aotearoa New Zealand: a qualitative study

The uptake of assisted reproductive technologies (ART) has increased rapidly in recent decades, and yet migrant and ethnic minority communities continue to experience barriers to accessing these services. In Aotearoa New Zealand, the Pacific diaspora have the lowest participation in ART services despite having the highest rates of infertility. The reasons for this phenomenon have yet to be fully explained. In this qualitative cross-sectional study, 13 participants (12 women, one man) self-identifying as Pacific people who had experienced infertility participated in 45-90-minute talanoa (semi-structured interviews) either in-person or online. Talanoa were audio recorded and transcribed verbatim. Transcripts were thematically analysed using a hybrid inductive-deductive approach to identify factors that acted as enablers or barriers to ART services. Three key themes were developed from transcripts. Theme one captures the importance of strong relational ties and support networks for ART service access, and the negative impacts of absent familial support. Theme two highlights the role of health literacy and service awareness in promoting self-efficacy and health-seeking behaviours, but that many participants did not feel they had this. Theme three emphasises the tension between cultural expectations and religious beliefs that influenced participants' perceptions of infertility and decisions to access ART. Altogether, these narratives bring to the forefront the challenges of navigating a sensitive health issue such as infertility in a contemporary society amidst family pressures, cultural obligations, and religious ideals. Importantly, this study also highlights the valuable role that families and churches play in supporting Pacific people to access ART, and the importance of digitally accessible health information so that people can make informed decisions about their reproductive health. This paper contains useful insights for fertility service providers and clinicians working with Pacific peoples and individuals from other communities that are culturally diverse or have high religiosity.