Reaching across difference

There are growing numbers of trans and non-binary whānau accessing perinatal healthcare in Aotearoa New Zealand (NZ). International literature shows that their perinatal healthcare needs, including their lactation and chestfeeding/breastfeeding information, care and support needs, are not well understood by perinatal healthcare providers. This leads to inequities in perinatal care provision and access, potentially jeopardizing reproductive justice for trans and non-binary whānau. My study aimed to explore the knowledge and beliefs of Lead Maternity Care (LMC) kahu pōkai about lactation and chestfeeding/breastfeeding for trans and non-binary whānau with the purpose of understanding continuing midwifery education needs in this space. A qualitative interpretive description study design, underpinned by social constructionism, facilitated the identification of potential causes of health inequity while recognising the social, cultural and historical contexts within which knowledge is constructed, and the power dynamics that influence this construction. The ability to determine what may be required to interrupt potential reasons for inequity is enhanced by this understanding. I conducted semi-structured interviews with ten LMC kahu pōkai. I analysed the data garnered from these interviews using reflexive thematic analysis and identified four themes. The first theme illustrated participants’ awareness of their lack of knowledge and explored why and how they tried to address their knowledge gaps. Theme two described participants’ perception of a system-wide lack of knowledge due to cis-normative and gender essentialist assumptions and depicted participants’ sense of responsibility to keep whānau safe within this system. Theme three explored what participants were doing to advocate for trans and non-binary whānau within their sphere of influence and identified what support is needed from the midwifery profession to generate a broader impact. And finally, the fourth theme provided participants’ perspectives for an expansive imagining of midwifery that safely serves all whānau who access perinatal healthcare. Findings demonstrate that participants are motivated to learn and desire education that prepares them to provide safe and inclusive perinatal care for trans and non-binary whānau generally before focusing on the specificity of lactation and chestfeeding/breastfeeding care. For whānau to have the best chance of experiencing reproductive justice from midwifery care in Aotearoa NZ, profession-wide education and engagement with cultural humility is required to address and unpack the restrictive cis-normative and gender essentialist assumptions that have become embedded norms within the midwifery profession in Aotearoa NZ.