It Takes a Village – Birth Outcomes Disparities.

Birth outcome disparities in NHPI communities in Utah.

Around October of last year my wife signed us up for a health workshop being run by a Native Hawaiian Pacific Islander (NHPI) organization here in Utah. The workshop, aptly named It Takes a Village, addressed birth outcomes disparities in Utah’s Native Hawaiian/Pacific Islander communities. Although this workshop was specifically for NHPI in Utah, I felt that this issue was bigger than just this state and so I wanted to share it here.

I loved that the workshop was designed specifically for Pasifika with cultural concepts and methods utilized in the sessions. During the first workshop, project participants became members of a village council and in turn, the workshops became village council meetings or fono. Each workshop or fono became an opportunity for the participants or village council to learn about birth outcomes disparities in the context of their culture. The fono had videos, presentations, discussions, activities, and assignments.

The final product of these efforts was the It Takes a Village: Giving our babies the best chance project. Grounded in Pacific Islander cultural beliefs and practices, the project we did was a small presentation at our local chapel to raise awareness and educate about maternal and infant health – I thought I’d share the presentation here. The birth disparities I learnt during the workshop was appalling, to say the least.

Here are the facts:

Pacific Islanders have the highest infant mortality rate in Utah, along with Black/African American populations.
That is double the rate of other Utah communities.
For every 1,000 pregnancies, we lose 11 babies and 20 mothers.

I also wanted to include some Pasifika concepts that were used in the workshop and how it was used as teaching tools.

Tauhi Vā / Vā

Throughout our different island cultures, you will find a strong practice of maintaining and nurturing relationships, especially with members from ones’ kin, church, school, and villages. This is the pan-Pacific concept of vā. Vā literally means space. It is the space in which we relate and it’s how we interact with each other. It touches every aspect of Pacific Islander life through our relationships with our families and community and is carried on from one generation to the next. Vā is often strongest with kin members and people with genealogical ties.

Tauhi ‛a e vā (Tongan) or tausi le vā (Samoan) is the act of nurturing and developing the vā. When we tauhi vā or tausi vā, we purposefully build, strengthen, and maintain the relationships that connect us to one another.

This concept was used to remind us that nurturing and maintaining our physical health needs to be a family priority. It literally takes a village to ensure that our mothers and babies have the best possible chance of survival.

Fonua / Fanua

Land is a central part of Pacific Islander identity. When we care for the land and environment, that care comes back to the people. “The purpose of this relationship and exchange between the environment and [its people] is to maintain harmony in life in sustainable ways.” (Tu‘itah, 2007). Fonua (Tongan) or fanua (Samoan) means all nourishing environments, including the land, physical environment, ecosystem, etc. This includes the mother’s womb and baby’s placenta.

Fonua or fanua is also the word for the baby’s placenta. The placenta is an organ formed during pregnancy, which connects the mother and baby. Through the placenta, the mother provides oxygen and nutrients to the baby.

“In the world of the womb, the baby is sustained by her fonua [fanua], the placenta. The baby is later born into the [land], where she experiences life and builds relationships with the fonua [fanua]: the entire ecology, including its human inhabitants. As part of the birth process, the remains of the [placenta] that sustained the baby are returned by burial to the [physical land] … Upon her death, she is returned to her fonualoto [tu‛ugamau] (land within the land), or her grave.”
Tu’itah

Kaliloa / ‘Aliloa

Our ancestors, grandparents, parents, and elders practiced and valued passing on cultural knowledge and wisdom to their descendants. Parents fostered close relationships by spending quality time with their children talking. This began right after birth, where on the mother’s forearm, knowledge, teachings, and cultural wisdom was passed on to the child through storytelling. This practice was the child’s first introduction to education.

In the Pacific, wooden headrests called kali (Tongan) or ‘ali (Samoan) are used as pillows. Long headrests are called kaliloa (Tongan) or ‘aliloa (Samoan).

kaliloa or ‘aliloa is also the word for the mother’s forearm or the headrest for infants, which is long because it continues to support the child throughout the child’s life. In the Pacific, when children were strong culturally, physically, and mentally, mothers were praised for preserving the culture and sharing wisdom through the kaliloa or ‘aliloa.

Tāno‛a / Tānoa

In our Pacific culture, the tradition of drinking kava or ‘ava was practiced in the islands and has also followed Pacific Islanders in their migrations abroad.

Traditionally, the kava or ‘ava bowl was referred to as the tāno‛a (Tongan) or tānoa (Samoan). The tāno‛a or tānoa (kava or ‘ava bowl) was used as a space for learning and discussing social, political, and cultural issues. Many important family and community conversations took place around the tāno‛a or tānoa. The tāno‛a or tānoa symbolizes communal learning, continual learning outside of the home, learning from elders (informed individuals) about best practices, and learning about culture.

The tāno‛a or tānoa was traditionally the father’s area for educating. This complemented the education received in the home or mother’s domain through the kaliloa or ‘aliloa. Both were nurturing spaces for children, the future of the clan.

I truly pray that our Pasifika leaders and people prioritize health above all else. A takeaway I got from a session was that every time an infant passes away, we lose a piece of our future and our culture becomes that more endemic. Our children are our hope — for our families, our culture, our way of life — and we need to give them the best chance to live because it takes a village.

Alfred Tora