Social Science & Medicine 53 (2001) 1135–1148

Infant care practices in New Zealand: a cross-cultural

qualitative study
Sally Abela,*, Julie Parkb, David Tipene-Leacha, Sitaleki Finauc, Michele Lennand
a
Department of Maori and Pacific Health, University of Auckland, Private Bag 92019, Auckland, New Zealand
b
Department of Anthropology, University of Auckland, Private Bag 92019, Auckland, New Zealand
c
Pacific Health Research Centre, Department of Maori and Pacific Health, University of Auckland, Private Bag 92019, Auckland,
New Zealand
d
142 Victoria Road, Devanport, Auckland, New Zealand

Abstract

This paper describes and compares the infant care practices and beliefs of Maori, Tongan, Samoan, Cook Islands,
Niuean and Pakeha (European) caregivers residing in Auckland, New Zealand. Focusing on four areas } sources of
support and advice; infant feeding; infant sleeping arrangements; and traditional practices and beliefs } it explores
inter-ethnic similarities and differences and intra-ethnic tensions. The international literature indicates that there can be
significant cultural variation in infant care practices and in the meanings attributed to them. There is, however, little
New Zealand literature on this topic, despite its importance for effective health service and health message delivery.
Participants were primary caregivers of infants under 12 months. An average of six focus groups were conducted within
each ethnic group, resulting in a total of 37 groups comprising 150 participants. We found similarities across all ethnic
groups in the perceived importance of breastfeeding and the difficulties experienced in establishing and maintaining this
practice. The spectrum of behaviours ranged widely with differences most pronounced between Pacific caregivers,
especially those Island-raised, and Pakeha caregivers, especially those in nuclear families. Amongst the former, norms
included: the family as central in providing support and advice; infant bedsharing; abdominal rubbing during
pregnancy; baby massage; and the importance of adhering to traditional protocols to ensure infant well-being. Amongst
the latter, norms included: strong reliance on professional advice; looser family support networks; the infant sleeping in
a cot; and adherence to Western biomedical understandings of health and illness. Maori caregivers bridged the
spectrum created by these groups and exhibited a diverse range of practices. Intra-cultural differences were present in all
groups indicating the dynamic nature of cultural practices. They were most evident between Pacific-raised and New
Zealand-raised Pacific caregivers, with the latter attempting to marry traditional with Western beliefs and
practices. # 2001 Elsevier Science Ltd. All rights reserved.

Keywords: Infant care practices; Cross-cultural; New Zealand; Maori; Pacific; Focus groups

Introduction in similar ways. Conversely, different groups’ practices

The way we humans look after our babies is invested
with moral value and cultural and personal meaning.
Infant care practices can differ in significant ways
between cultures or social groups and yet be justified
*Corresponding author.
may be similar but the meanings ascribed to them may
vary. For example, a study of Mayan and middle-class
United States (US) women showed that both groups
justified their infant sleeping arrangements with refer-
ence to norms of good parenting and the child’s present
needs and future development. Yet the Mayan mothers
(and most fathers) slept with the infant in their bed,
whereas the US mothers placed their children in separate
beds or cots, usually in a separate room (Morelli,

0277-9536/01/$ - see front matter # 2001 Elsevier Science Ltd. All rights reserved.
PII: S 0 2 7 7 - 9 5 3 6 ( 0 0 ) 0 0 4 0 8 - 1
1136 S. Abel et al. / Social Science & Medicine 53 (2001) 1135–1148
Oppenheim, Rogoff, & Goldsmith, 1992). Similarly,
while breastfeeding is almost universally considered the
ideal means of infant feeding, Van Esterik (1985)
contrasted Western biomedicine’s emphasis on breast
milk as a product with more traditional understandings
of breastfeeding as a process.
There are clearly distinct cultural differences in certain
infant care practices and beliefs. Culture, however, is not
unitary, static, and bounded but contestable, dynamic,
and historically produced (Fardon, 1990). Since culture
is historically produced through interaction with chan-
ging economic, social, and political forces, the reasons
behind and meanings assigned to particular practices
can change over time. Ethnographic work in the Pacific
on infant care (e.g. Marshall, 1985) acknowledged that
the processes of colonisation and the ingress of
biomedical understandings resulted in great variation
and historical change in infant care practices. Similarly,
a detailed study of Navajo mothers’ infant feeding
practices (Bauer & Wright, 1996) indicated a complex
interplay among cultural considerations, economics,
work issues, perceived obstacles and available solutions,
advice given and individual preferences.
Understanding cultural differences in beliefs and
practices relating to infant well-being is important for
the successful delivery of health messages and health
services to diverse populations. This is particularly so in
countries, such as in New Zealand, where indigenous
and migrant groups are minorities and where the
ideology underlying mainstream concepts of health
and illness and informing health service delivery is that
of Western biomedicine and the dominant Pakeha
culture. However, research that describes and compares
present-day infant care practices of Maori, Pacific and
Pakeha1 families in New Zealand is scarce. Most
contemporary work in this field has focussed on risk
factors for Sudden Infant Death Syndrome (e.g.
Mitchell et al., 1992; Scragg et al., 1993) or on specific
practices, such as breastfeeding (e.g. McLeod, Pullon, &
Basire, 1998) and sleeping arrangements (e.g. Tuohy &
Smale, 1998). The main descriptive accounts of Maori
infant care date back several decades or focus more on
older children (e.g. Beaglehole & Beaglehole, 1946;
Metge, 1995; Ritchie & Ritchie, 1963), as do those about
Pakeha infant care (e.g. Ritchie & Ritchie, 1970, 1997).
Pacific accounts are based in the Pacific Islands (e.g.
Marshall, 1985).
This paper aims to begin to address the gap in the
literature on infant care practices in New Zealand. It is
based on findings from a 1998 cross-cultural study that
strove to scope, describe and compare the infant care
practices of parents/caregivers from the Maori, Tongan,
Samoan, Cook Island, Niuean and Pakeha communities
1
‘Pakeha’ is a Maori word referring to New Zealand
residents of Anglo/Celtic/European backgrounds.
in Auckland, New Zealand (Abel et al., 1999). Although
it was part of a pilot study to inform a proposed sudden
infant death syndrome case control-study, the Infant
Care Practices study2 was essentially a project in its own
right with a particular emphasis on exploring infant care
norms. In this paper we focus on four selected areas of
infant care practice explored in the study: sources of
support and advice; infant feeding; infant sleeping
arrangements; and traditional practices and beliefs. We
aim to elucidate the similarities and differences in the
practices and beliefs of Maori, Pacific and Pakeha
caregivers within these selected areas. In addition, we
aim to show differences and tensions within these ethnic
groups, revealing the dynamic nature of cultural
practices.
Background
New Zealand is located in the South Pacific and, at
the time of the 1996 census, had a population of 3.6
million people, the majority of whom were Pakeha. The
indigenous Maori people comprised 15% of the national
population and approximately 12.5% of the population
of Auckland, the nation’s largest city. Pacific peoples,
who comprised 6% of the national and 12% of
Auckland population, made up the third largest
population group (Statistics New Zealand, 1997).
For Maori, the impact of 160 years of European
colonisation has had a profound impact on many areas
of life. Alongside the alienation of land, language and
culture, many traditional practices have changed or have
been marginalised and Maori have become positioned in
the lower socioeconomic strata of New Zealand society
(Walker, 1992). Over the past three decades there has
been a renewal in Maori leadership and political life, a
resurgence of Maori language and culture, some
progress in reparations by the State for past losses and
confiscations of lands and other properties and the
acknowledgement and re-emergence of some traditional
behaviours (Durie, 1998). Nowadays Maori as a group
are diverse both in socioeconomic status and in their
adherence to a ‘Maori’ way of life. They are, however,
disproportionately represented in the lower socioeco-
nomic groups and health outcomes for Maori infants
continue to be significantly poorer than those for
Pakeha infants (Ministry of Health, 1998).
The Pacific population in New Zealand consists of
peoples from a number of different countries, the four
largest groups being Samoan, Tongan, Cook Islands
and Niuean. These groups share a broad set of cultural
affinities, such as mythology and customary practices,
2
The Infant Care Practices Study was based in the Depart-
ment of Maori and Pacific Health, University of Auckland and
was funded by the Health Research Council of New Zealand.
 S. Abel et al. / Social Science & Medicine 53 (2001) 1135–1148
while also exhibiting cultural distinctions. Pacific peo-
ples have been in New Zealand for over a century but
the peak migration occurred in the 1960s and early
1970s. The four largest groups have differing histories
with their adopted country. While Cook Islanders and
Niueans have automatic rights to New Zealand citizen-
ship Samoans and Tongans do not, so the former have
moved more freely between their home country and New
Zealand. Samoans’ and Tongans’ relationships with
New Zealand differ in that Samoan migration occurred
earlier than Tongan migration and hence there are more
first- and second-generation New Zealand Samoans
(Krishnan, Schoeffel, & Warren, 1994). Pacific peoples
in New Zealand continue to have strong family and
church networks that support the continuation of many
‘traditional’ beliefs and practices. In the late 1990s,
however, there was evidence of some inter-generational
tension between Island-raised parents, who held firmly
to these beliefs and practices, and their New Zealand-
raised children, who have begun to challenge them
(Meleisea & Schoeffel, 1998; Tiatia, 1998). Pacific
peoples tend to be positioned in the lower socio-
economic groups and Pacific infants, like their Maori
counterparts, have poorer health outcomes than Pakeha
infants (Ministry of Health, 1997).
Method
The Infant Care Practices study commenced in
January 1998, following approval from the University
of Auckland Ethics Committee. Focus groups were
chosen as the method most appropriate for exploring
social norms and personal opinions, allowing partici-
pants to talk freely about their own and others’
behaviour (Murphy, Cockburn, & Murphy, 1992). A
key feature of focus groups is the use of ‘‘group
interaction to produce data and insights that would be
less accessible without the interaction found in a group’’
(Morgan, 1988, p.12).
The decision to conduct separate focus groups for
each of the four Pacific groups was based on the
understanding that, although there were some common
customary practices, the differences in language, culture
and migration history might present some distinct
Table 1
Number and composition of focus groups
Maori Tongan
Number of focus groups 7 (+ 1 i/v) 7 6
No. of women 17 17
No. of men 9 8
Total people 26 25a
a
There were in fact 43 Tongan participants but 18 did not qualify as current caregivers of infants.
1137
differences in infant care practice. The focus group
facilitators were of the same ethnicity and gender as
group participants to ensure that the groups were
conducted in a sensitive manner. The facilitators
were chosen for their strong community links and their
interest in research. Following a period of training, and
working in close conjunction with the study coordina-
tors, the facilitators took responsibility for the recruit-
ment, organisation and running of the groups and for
transcription and, where necessary, translation of the
audio tapes.
Recruitment of participants occurred largely through
the facilitators’ personal networks but churches and a
number of community health services were also used.
Participants were required to be caregivers of an infant
under 12 months old. Within each ethnic group
participants were selected to cover a range of back-
grounds in terms of age, relationship status, socio-
economic status, number of children and, in the case of
Pacific participants, the country where raised.
An average of six focus groups were conducted within
each of the six ethnic groups and these were completed
by November 1998. The groups were primarily women-
only but for each ethnic group at least one group was
men-only and another was mixed. In total 37 groups and
two one-on-one interviews (i/v) were conducted, invol-
ving 150 caregivers (see Table 1).
All but eight participants were parents of infants. The
remaining eight were Tongan, Samoan or Cook Island
grandparents who had either adopted their grandchild
or were actively involved in their care. Parents of infants
ranged in age from mid-teens to early forties. Almost all
Maori and Pakeha participants were first-time parents
but approximately half of Pacific parents had two or
more children. The lower limit of parenthood experience
was 2 months. None of the couples taking part were of
different ethnicities. While most focus groups were
relatively homogenous in terms of age, socioeconomic
background and country in which raised, a few Pacific
groups and the Maori men’s group contained partici-
pants from a range of ages and backgrounds. This had
implications for our findings that are discussed later.
The question schedule was divided into three periods:
antenatal, the birth and following birth. Questions were
open-ended and focussed around the following broad
Samoan Cook Is Niuean Pakeha Total
6 5 (+ 1 i/v) 6 37 (+2 i/v)
8 23 10 21 106
10 7 4 6 44
28 30 14 27 150
1138 S. Abel et al. / Social Science & Medicine 53 (2001) 1135–1148
areas: the practices best for baby’s health and well-
being; the barriers to attaining these; forms of support
available and barriers to getting support; the main
worries and rewards of parenting a young baby. The
primary questions in the antenatal period were: ‘‘What
do you think gives babies a good start in life?’’ and
‘‘What are the reasons some babies don’t get a good
start in life?’’ For the period following the birth the
primary questions were: ‘‘What do babies and parents
need to keep young babies safe and well?’’ and ‘‘What
are the barriers to attaining these?’’ Specific probes
covered areas such as: maternity and infant services,
advice and support, infant feeding, sleeping arrange-
ments, smoking and traditional practices. Personal and
structural constraints were explored. Participants were
asked to discuss their own experiences and observations
as well as what they perceived to be cultural norms.
Those with other children were also asked to discuss and
compare their infant care experiences with those
children.
Six Tongan, three Samoan, two Cook Islands and one
Maori focus group were conducted fully or partly in
their own language and translated into English. All
others were conducted in English. With participants’
permission all groups were audio-taped. Tapes were
transcribed and, where necessary, translated. A thematic
analysis was undertaken on the data. The English
transcriptions and translations were examined closely
for key themes, then coded and entered into NUD*IST,
a qualitative research computer software package
(Gahan & Hannibal, 1998). The data from each ethnic
group were analysed and written up separately then
compared for common and divergent patterns. In order
to mitigate the limitations of cross-cultural interpreta-
tion, a facilitator from each ethnic group was also
involved in the coding and preliminary analysis of the
data and drafts of the report were critiqued by the
facilitators and others from the particular ethnic group.
Findings
Here we review the findings in the four areas
mentioned: sources of support and advice during
pregnancy and the first months of the baby’s life; infant
feeding; infant sleeping arrangements; and traditional
practices and beliefs. These were chosen because they
were key areas relating to infant care and because they
best exemplified inter and intra-cultural differences.
The primary differences in the findings from the
Pacific participants were between Pacific-raised and
New Zealand-raised participants. By comparison, differ-
ences between the four ethnic groups were minimal. We
have, therefore, chosen to differentiate Pacific data
according to ‘where raised’ in the following sections.
This issue will be discussed further later.
Sources of support and advice
A common theme amongst participants from all
ethnic groups was that support and advice during
pregnancy and after the baby was born were very
important. Having a baby brought significant life
changes and this transition was made easier with strong
support. There were, however, some clear differences
between groups in who parents turned to for support
and advice and the extent to which this was offered.
Amongst the participants from all of the Pacific
groups strong family support for pregnant women and
new parents was assumed and readily offered. Children’s
well-being was the responsibility of the extended family.
Only in the case of unmarried pregnant women was
family support equivocal because of the stigma this
brought to the family, but this was deemed only
temporary. The husband/partner played an important
support role in the antenatal period usually providing
his wife/partner with desired foods and relieving her of
some household responsibilities. After the baby was
born, however, he took more of a background role
compared to female relatives. Female family members,
particularly mothers, mothers-in-law, sisters and aunts,
provided considerable practical, financial, and emo-
tional support in the short and longer terms and had an
important influence on infant care practices. Often new
mothers were not required to do anything in the first few
days or weeks other than rest and feed the baby.
She [mother] helped a lot. It was like I hardly had
anything to do with the baby } only at feeding time,
because I breastfed the baby. So all other times the
baby was with my mum. . . Also our families helped a
lot, especially when the baby came out of hospital.
They helped with clothes and money for the baby.
Many times they came and visited, helped look after
the baby, even brought food and money.
(Samoan-raised mother of two)
In the few cases where New Zealand-raised Pacific
participants did not have a strong family network
available or were closely involved with Western medi-
cine and values, professional services became more
important as a source of support and advice. Most
Pacific mothers, however, did not see a need to attend
antenatal classes or seek postnatal support from
professional organisations because their families met
their information and support needs. Furthermore,
some perceived these organisations to be aimed at
Pakeha mothers and babies, so not relevant to them.
The central influence and involvement of older
female relatives, who were invariably brought up with
more traditional practices, created tensions for some
New Zealand-raised Pacific parents. These parents were
sometimes criticised by older family members for being
 S. Abel et al. / Social Science & Medicine 53 (2001) 1135–1148
unduly influenced by Pakeha ways and several experi-
enced tension and difficulty at times in marrying
Western and traditional advice and practices.
Most of the time during my pregnancy I faced
challenges from my mother. She grew up in Tonga so
is therefore very traditional. . .. She did not want me
to sleep during the day. On the other hand, my
doctor told me I must rest during the day. When she
[mother] rang up from work and found that I was
sleeping, she would tell me to get up and move about
and if I didn’t it would cause ı´la fale, a Tongan word
for some serious disease where the baby is very
sleepy. . .. Although I didn’t believe what [she] told
me, I tried to comply with both ways, just in case
something happened and [she] blamed me.
(New Zealand-raised Tongan first-time mother)
For the most part, however, they negotiated these
tensions and difficulties successfully. For example, they
adopted some Western practices (such as putting the
baby to sleep in a cot), but modified them to
accommodate more traditional ways (such as having
the cot against the bed). They were respectful of their
family’s practices, appreciated the support and advice
they offered and valued their close involvement in their
infant’s life.
F: [Baby] has got a bit of eczema, so Mum will
always say, ‘‘All you need is lauti (ti leaf) and a faguu
(oil).’’ But you think, ‘‘Well the doctor said. . .’’
(pauses and laughs). But the thing is sometimes I just
let them because, I mean, they do mean well.
S: And that’s the whole point, not to miss if they
mean well. (Two New Zealand-raised Samoan
women)
Maori parents who lived with or were closely linked to
extended family received considerable support and
advice from female family members, although some of
the infant care practices of the latter (e.g. sleeping
arrangements) more closely resembled Western practices
than those of their Pacific counterparts.
My Mum, my Dad, my Aunty, they all live at home.
And the minute the baby would cry or I’d get tired
they’d be holding her. That’s what I think made it
easy for me. I had all my family around me.
(Single, first-time Maori mother, early 20s)
Like the New Zealand-raised Pacific parents, some of
these Maori parents experienced tension between valu-
ing the support and advice offered by family and yet
feeling restricted by their beliefs, expectations, and
demands. Although those closely connected to their
families received considerable support from them, many
1139
also sought support and advice from other young
mothers and professionals.
By contrast, those Maori living as nuclear families,
who tended to be older, had less involvement with their
extended families. Like Pakeha parents, they tended to
attend antenatal classes and rely on professionals, their
partner and peers for support and advice both during
pregnancy and after the baby was born.
Pakeha parents, who mostly lived in nuclear family
situations, received less advice and support from their
extended families than Pacific and most Maori parents.
Although usually the young single women were drawn
more closely into the family, a few did not have family
support and relied on friends. Most of the older (over 25
years) Pakeha mothers relied on their husband/partner
as their primary source of emotional and practical
support and on professionals and friends for advice and
other support. Antenatal classes, antenatal care, post-
natal midwifery care and well-baby services were
extremely important to these parents as sources of
advice. They were also more likely to read books and
watch videos on pregnancy and infant care. While some
would like to have had closer involvement with their
families, geographical distance or work commitments
often precluded this. These older parents were keen to
follow current ‘expert’ opinion on optimum infant care
practices and this, along with looser extended family
connections, meant that their own parents had con-
siderably less input into infant care than was the case
with Pacific and some Maori participants.
Intra-cultural differences also emerged in the Pakeha
groups. These were related to age. Younger parents
(under 25 years) tended to be more ‘intuitive’ in their
approach to infant care and went with what ‘felt right,’
while older parents were more inclined to follow expert
advice and were more anxious to ‘do it right.’ Many of
the latter expressed anxiety about their ability to parent
well and found confusing the conflicting models of
parenting, such as a structured versus an ‘on-demand’
approach to feeding and sleeping.
Infant feeding
Breastfeeding was one of the areas on which there was
most consensus among ethnic groups. Most women were
keen to breastfeed because of the perceived physical and
emotional benefits for them and their baby. These
benefits included: that it was nutritionally ideal for the
baby; it infused the baby with the mother’s love and
warmth; it was convenient and easy; and it was cheap.
There was no apparent ethnic distinction in these
perceived advantages.
All but a few mothers had attempted to breastfeed.
Many of these had been successful and had fed for
several months or were still feeding at the time of the
focus group. There was considerable agreement amongst
1140 S. Abel et al. / Social Science & Medicine 53 (2001) 1135–1148
women across all ethnic groups, however, that the
establishment of breastfeeding was not easy and could
be very painful. Many mentioned that they had
experienced cracked and sore nipples and breast
engorgement. These factors, along with the perception
of not having enough milk and feeling confused by
inadequate and conflicting advice from professionals
and in some cases from relatives, were the primary
reasons for the early cessation of breastfeeding or
complementary bottle feeding.
Complementary feeding with formula was not
uncommon and often this was because of a perception
that the woman was physiologically incapable of
providing enough milk for her baby. Many felt justified
in their decision to complement or substitute the breast
with the bottle when, following the introduction of
formula, the baby was more settled and slept more
soundly.
While there were many common themes amongst the
different ethnic groups on the topic of breastfeeding,
some distinctions occurred in discussion about solids.
These concerned the type of food and the age of first
introduction. Common early foods for all ethnic groups
were pureed fruit and vegetables and soft cereals. In
addition, Samoan women mentioned sua alaisa (a
special soup) and Cook Islands women mentioned pia
(arrowroot starch) and mokomoko (coconut milk).
Although some Samoan-raised mothers indicated that,
traditionally, caregivers premasticated their infant’s
food, none of the Pacific mothers in the study mentioned
doing this themselves. The choice of solids was an area
in which tensions were evident between New Zealand-
raised Samoan and Tongan parents and the older
generation. The latter considered fresh fruit and
vegetables optimum for the baby and did not condone
prepared foods. There were also differing views about
the age at which solids should be introduced.
My mum wanted to feed [baby] a sua alaisa (rice
soup) and I said ‘‘No not now, it’s too early.’’ And
she goes, ‘‘Se e le meaola fia palagi, oh sa outou laiti’’
(‘‘You act like a Pakeha. When you were young I
used to feed you that’’).
(New Zealand-raised Samoan first-time mother)
Although Western health professionals advise that
solids should not be introduced until the baby is at least
four months old, several Maori, Pacific and young
Pakeha women mentioned that they introduced solids at
3 months. A few Pacific caregivers began their baby on
solids as early as 6 to 8 weeks. The main reason given for
the early introduction of solids was that the baby was
not settled after feeding and not sleeping well. Once
solids were introduced this changed and it was possible
to reduce the frequency of night feeding. Some Cook
Islands participants argued that Pacific babies were
hungrier than Pakeha babies so the age limit advice did
not apply to them.
Infant sleeping arrangements
Our aim in asking parents about sleeping arrange-
ments was to arrive at a holistic appreciation of the
context of infant sleeping arrangements. Invariably
where the baby slept received considerably more
discussion than what position it slept in. This may have
been because, for the most part, caregivers from all
groups knew that placing the baby on its back was the
safest position. The main discussion on this point was
the anxiety experienced when the baby tended to roll
over into a prone position.
With few exceptions, adult–infant bedsharing was the
norm amongst caregivers from all of the Pacific ethnic
groups. This usually meant the baby slept with the
mother alone, with both parents or with the mother and
grandmother. In Pacific-raised families it was relatively
common for the husband to sleep elsewhere for the first
few weeks. A few New Zealand-raised Pacific parents
used a cot but this was usually in the parents’ room,
often next to the bed with the side down, and usually the
baby slept for some of the night in the parents’ bed.
Bedsharing was not only a strong cultural tradition
for Pacific families but it was perceived to have many
practical, psychological and spiritual benefits for the
baby. It was practical in that it enabled easy attendance
to the baby’s physical needs during the night, and it was
beneficial psychologically and spiritually in that the
baby received love, comfort and moral and spiritual
strength by sleeping with its mother.
[One] concern is with the fact that nowadays mothers
tend to let their babies sleep on their own, in their
own little cot or bed. There is a Tongan belief that
there is such a thing that we call kaliloa, when the
mother opens her arms and continuously holds the
baby close to her most of the time. We believe that
this is the best way of bringing up any child and this
is their rightful place.
(Tongan-raised grandfather)
Some Pacific-raised Tongan and Samoan caregivers
saw bedsharing as protective of sudden infant death
syndrome (SIDS) because the mother was able to easily
sense if anything was wrong with the baby. Conversely,
having the baby in a separate room was perceived to
place it at risk because it could not be observed.
The thing about having different rooms for them and
the parents, well, I believe this is the reason why some
babies are found dead in their beds. They are too
young and vulnerable. They might turn and lie on
their stomach and cover their noses for too long and
 S. Abel et al. / Social Science & Medicine 53 (2001) 1135–1148
stop breathing. And the mother cannot see it because
she is sleeping in another room.
(Samoan-raised mother of three)
Many of the Maori parents in the study, especially
those living in extended family situations, and many of
the young Pakeha women also shared their bed with
their infant, although most tended to be very flexible in
their sleeping arrangements. Commonly they adopted
differing arrangements depending on circumstances and/
or the age of the baby. For example, some parents chose
to have the baby sleep separately when very young,
because they perceived it to be vulnerable to overlaying,
then brought it into the parental bed once it was a little
older and less vulnerable. Others wanted their newborn
baby in the parental bed because they wanted it close to
them then, as it became more robust, were happy to use
a cot. Many varied their arrangement throughout the
night. Some settled the baby in their bed then
transferred it to the cot once asleep, while others put
the baby to sleep in its cot then brought it into the
parental bed for feeding during the night and kept it
there. Some parents varied their baby’s sleeping
arrangements according to changes in their living
arrangement or relationship status, for example, bring-
ing the baby into their bed in the case of a relationship
separation. Pragmatic and emotional concerns were the
main reasons for this variety and flexibility of sleeping
arrangements.
Older Pakeha parents and some Maori parents in
nuclear families put their baby to sleep in a cot, usually
in the parents’ bedroom to start with. Although some of
these parents occasionally had the baby in bed with
them, the standard practice was for the baby to sleep
separately from the start with the trend being towards
increasing autonomy, i.e. towards the baby sleeping in
its own room. Some parents put their baby to sleep in a
cot in a separate room for their own well-being, because
they found they could not sleep with it in the same room.
Others chose separate sleeping arrangements because of
perceived benefits to the baby. For example, some felt
that it encouraged the baby to become independent, a
few even suggesting that bedsharing made the baby too
dependent on the mother.
I don’t agree that they (mother and baby) should
sleep together. . ... ‘Cause in my way of thinking he
could end up relying so much on his mother. . . I
strongly recommend, as soon as they can, to stay in
their own beds.
(First-time Maori father in nuclear family)
Others were afraid of the risk of overlaying the baby if
it was in the parental bed or of increasing the risk of
SIDS. Some of these parents were aware that bedsharing
was a risk for SIDS if the adult was a smoker and a few
1141
parents who smoked made a clear decision not to
bedshare for this reason. Some non-smokers, however,
were confused about the advice about sleeping arrange-
ments and were very wary about sleeping with their
baby. In fact some experienced considerable anxiety if
they inadvertently ended up doing so by, for example,
dropping off to sleep while nursing or cuddling the baby.
I remember one night [daughter] would not go to
sleep. She screamed. . .. She was on my tummy and
she went to sleep and I thought ‘‘I’m not supposed to
lie here with her on my tummy.’’. . . I remember
feeling so guilty because [daughter] had gone to sleep
on my tummy and I was lying on the bed.
(First-time Pakeha mother, early 30s)
Traditional beliefs and practices
Amongst Pacific participants the most commonly
mentioned traditional practice during pregnancy was
attending a fofo (traditional masseur) for milimili (gentle
rubbing) of the abdomen. The main reasons for
attending a fofo were: not feeling well; to enhance
well-being; and to prepare for the labour and birth.
Milimili appeared to be popular amongst Pacific women,
although some New Zealand-raised Pacific women were
wary of or avoided the practice.
Many Pacific women from all groups acknowledged
the symbolic importance of ritual disposal of the
placenta and umbilical cord, either through burial or
disposal at sea, and some preserved them for later return
to the Islands. Traditional baby massage was popular
amongst both Pacific- and New Zealand-raised partici-
pants from all groups, except Niuean. Baby massage was
usually carried out by an older family member or a
traditional masseur and was used for both preventive
and therapeutic purposes. It was performed to generally
strengthen the baby and was believed to prevent SIDS.
It was also used to treat conditions such as rashes and
breathing problems.
Many Samoan- and Tongan-raised participants,
particularly grandparents, believed that infant poor
health or even death could be caused directly by such
behaviours as parental infidelity, violence, inattention,
and deviation from traditional practices (e.g. eating
prohibited foods in pregnancy, not providing the baby
with the protection of bedsharing, or not following
correct naming protocols). Tongan and Samoan grand-
parents also took seriously the customary practice of a
member of the father’s family, usually his sister, naming
the first child after a member of that family. They
believed, in accordance with traditional belief in
spiritual influences on health, that breaches of naming
protocol might upset dead or live relatives who could
adversely affect the baby’s health. Most other Pacific
1142 S. Abel et al. / Social Science & Medicine 53 (2001) 1135–1148
participants, however, did not ascribe such significance
to the name itself or the person naming the baby,
although many felt it was important to name the baby
after a family member.
Such beliefs were, however, points of difference for
other Pacific parents, particularly those raised in
New Zealand. Many were able to cite but did not
necessarily believe in the significance of a number of
traditional prohibitions during pregnancy, such as: not
eating certain foods; not cutting certain things; not
stretching upwards; and not wearing men’s clothing. In
addition, while a few mentioned the use of herbal
remedies and other plant infusions to treat the umbilical
stump, cure rashes, and settle a crying baby, very few
used them, preferring instead to use Western medicines.
Similarly naming protocols were not followed closely by
many younger Pacific parents, even those raised in the
Pacific Islands.
Despite their scepticism about traditional beliefs and
practices, many New Zealand-raised Pacific parents
recognised the value that their older relatives placed
on them and were tolerant of, for example, their using
traditional remedies on their child. Reflecting the
tensions involved in trying to marry two very different
belief systems, some were ambivalent in their scepticism.
They stated that they adhered to some of the practices
either because they did not want to ‘take the risk’ or they
did not want to be seen by their older relatives to be
responsible in any way for anything going wrong with
their baby.
Compared to New Zealand-raised Pacific parents,
Maori parents appeared to adopt traditional infant care
practices and beliefs less commonly, although it is
evident that these practices have not ceased to exist.
Some Maori parents in the study cited using protective
karakia (prayers/incantations), ritual disposal of the
placenta, and bestowing of a Maori name as means of
providing the baby with spiritual protection and
strength. The burial of the placenta was important to
ground the baby’s wairua (spirit) and to recognise
symbolically that the placenta and the land to which it
was returned were sources of nurturing for the baby.
Burial usually occurs at a place of significance to the
whanau (extended family) and where the link with
ancestors could be facilitated, such as a burial place.
We took his whenua (placenta) back to R [tribal
home town] and we buried it there and had a little
ceremony. . .. We buried the whenua on his adopted
grandfather’s side [of the cemetery]. His birth grand-
father is going to do a tohi ceremony } that’s a
traditional blessing } this spring.
(Maori mother of two, late 30s)
Most Maori placed significance on the name chosen
for their baby and many chose a Maori name. For some
choosing a Maori name was a deliberate move away
from the recent historical trend of using Pakeha names
and a means of ensuring their baby had a strong Maori
identity. Many named their baby after a whanau
member, such as someone close or one who had died,
or a prominent tupuna (ancestor) from past generations,
as this provided the baby with spiritual protection by
linking it to its whakapapa (genealogy) and ancestors.
The choice of name was considered important because
some names were believed to carry considerable mana
(prestige/dignity).
Amongst Pakeha participants discussions around
traditional remedies focussed on the use of complemen-
tary medicines. A few mentioned they used homeopathy
and cranial osteopathy for minor baby ailments and
colic with good result. However, most did not appear to
use remedies other than Western medicines. Compared
to Pacific and Maori participants naming carried less
cultural significance, although family names were some-
times preferred.
Discussion
The research findings revealed some interesting
cultural similarities and distinct cultural differences in
the infant care practices and beliefs of the caregivers
taking part. They also highlighted the diversity and
dynamic nature of these practices and some intra-
cultural tensions. In this section we begin by discussing
some methodological issues before going on to discuss
these cultural similarities, differences, and tensions
within the context of the literature.
Methodological issues
Although Yelland and Gifford (1995) had reserva-
tions about the use of focus groups for cross-cultural
research, we found that for the most part they worked
well. In Pacific groups, however, an adherence to
traditional speaking custom produced some situations
that may have implications for the selection of focus
group participants in these communities and for
interpretation of our findings. For example, sometimes
participants deferred to those who were older or of
higher status, suggesting focus groups where partici-
pants were of equivalent age and standing may have
been preferable for encouraging free discussion. In
addition, among Tongan men, fevaitapui } a custom
that prohibits men discussing their wife’s personal life
with her brothers or male cousins–limited talk where
men’s relationships with other male participants were
uncertain. A similar custom applies in Samoan society,
although there was no evidence that this affected talk in
the Samoan men’s group. In our view, these points do
not diminish the benefit of focus groups in these
 S. Abel et al. / Social Science & Medicine 53 (2001) 1135–1148
communities but instead are factors to bear in mind
when selecting participants. Another issue to note was
that our findings suggested that Tongan and Samoan
families adhered to traditional beliefs and practices more
than Cook Islands and Niue families did. There is some
support for this from Pacific language figures which
show that Tongans and Samoans in New Zealand are
more likely to know their original language than are
Cook Islanders and Niueans (Ministry of Pacific Island
Affairs, 1999). However, because of the differing
constituency of our Pacific focus groups, we cannot
confidently distinguish the beliefs and practices of the
particular Pacific groups from each other. The Tongan
and Samoan focus groups comprised more Pacific-raised
than New Zealand-raised participants, while the reverse
was the case for Niueans and there were equal numbers
of each for the Cook Island groups.
The use of focus groups alone had some limitations,
such as the inability to explore participants’ personal
histories and more private thoughts or to tease out intra-
group differences. In retrospect, interviews with or case
studies of individuals from each ethnic group may have
provided us with additional data to interpret the focus
group findings. The facilitators from each ethnic group,
however, provided some valuable insights into the data
from their focus groups.
The most significant distinctions in the practices of the
various Pacific participants were between those who
were raised in the Islands and those raised in New
Zealand. These differences were considerably more
obvious than differences between the different Island
groups. Some Pacific commentators (e.g. Anae, 1997;
Meleisea & Schoeffel, 1998) have challenged the
collective grouping of all Pacific peoples into a pan-
Pacific entity, arguing that this obscures the very real
and important differences between these groups. At the
same time, however, there is evidence that young New
Zealand-born Pacific peoples from different ethnic
groups share more with each other than with their
Island-born parents’ generation or with their Island-
born peers (Anae, 1997; Tiatia, 1998). In this research
the distinctions between Pacific and New Zealand-
raised participants were relatively significant and con-
sistent for each Pacific ethnic group. Although a few
differences between some of the Pacific groups were
noted, these were probably because of the methodolo-
gical issues discussed earlier and have not been
stressed.
Cultural similarities
Although the cultural distinctions in infant care
practices were in many respects more obvious and
compelling than the similarities, there were a number of
points on which there was considerable agreement. All
agreed that becoming a parent was an important life
1143
change that was made easier with sound support and
advice. In addition, those who were the main sources of
support and advice, while different for the various
groups, had an important influence on the practices
adopted over time by the primary caregiver(s). The
experience of caring for a baby brought many rewards
not least of which was fulfilling the life goal of having a
family. In addition, there was consensus that for its
healthy development it was important that the baby was
loved and wanted.
Breastfeeding
In all groups breastfeeding was considered important
for physical and emotional reasons and the bond that
this created between mother and child was highly
valued. The range of reasons offered by Pacific
participants for breastfeeding provide support for Van
Esterik’s (1985) argument that with exposure to Western
health systems the traditional Pacific emphasis on
breastfeeding as a process becomes coupled with
Western biomedicine’s emphasis on breast milk as a
product. Pakeha women also placed high emotional
value on the act of breastfeeding. This convergence may
indicate that women’s valuing of this form of infant
feeding differs from that underlying the biomedical
model. Alternatively it may indicate increased recogni-
tion by biomedicine since the mid-1980s (when Van
Esterik was writing) of the importance of mother-infant
bonding and the central place of breastfeeding in this
process (Dignam, 1998).
There was also much similarity in the reported
difficulties in establishing breastfeeding, with nipple
pain, engorgement, the perception of not enough milk,
and conflicting advice being the main issues. These
difficulties were similar to those found in a number of
international and New Zealand studies (see Holmes,
Thorpe, & Philips, 1997; McLeod, Pullon, & Basire,
1998). Two Australian studies (Holmes, Thorpe, &
Philips, 1997; McIntyre, Hiller, & Turnbull, 1999) also
identified embarrassment and inconvenience as factors
leading to the early cessation of breastfeeding. These
were not identified as issues in our research perhaps
suggesting greater community acceptance of breastfeed-
ing. Ellison-Loschmann’s (1998) study of young Maori
mothers showed most were emphatic about breastfeed-
ing in public places and, in their New Zealand
breastfeeding study involving Pakeha, Maori and Pacific
women, McLeod and colleagues (1998) found that
most women felt able to breastfeed in public places,
although they advocated more public awareness of their
needs.
Perceived milk insufficiency was one of the main
reasons given by women in our study for giving up
breastfeeding. In a New Zealand study of 100 Mana-
watu women with perceptions of insufficient milk, it was
found that this perception was based on lack of
1144 S. Abel et al. / Social Science & Medicine 53 (2001) 1135–1148
knowledge about normal breast changes and the
variations present in normal breastfeeding patterns,
coupled with a period of unsettledness in the baby
(Beasley et al., 1998). The study found that the
misinterpretations created considerable anxiety that
then exacerbated the problem. Beasley and colleagues
called for improvements in breastfeeding advice, a
recommendation reinforced by our findings.
Cultural distinctions
There were some important distinctions and diversity
in the practices and beliefs of the caregivers in the study.
The most marked distinctions were between Pacific
caregivers, particularly Pacific-raised caregivers living
closely with extended family, and Pakeha parents,
especially those living in nuclear family situations. The
continued strength of family and church networks
within New Zealand have enabled Pacific-raised care-
givers to maintain continuity of many practices and
beliefs considered norms in the Islands. These include:
breastfeeding; the central role of the family in providing
support, advice and child care; infant bedsharing; the
use of milimili during pregnancy; the use of baby
massage and belief in the need to adhere to certain
traditional protocols to ensure infant well-being. While
breastfeeding was also the ideal amongst Pakeha in
nuclear families, contrasting norms included: a strong
reliance on professional advice; looser family support
networks; the infant sleeping in a cot; and the adherence
to Western biomedical understandings of health and
illness.
Maori norms appeared to span across the Pacific and
Pakeha norms. Maori parents closely linked to whanau
were similarly placed to New Zealand-raised Pacific
participants in that family played a central role in infant
care and bedsharing was not uncommon. While some
traditional Maori infant care beliefs and practices (e.g.
bedsharing as the norm) had been modified because
of long exposure to Western models of care, some
practices, such as the ritual disposal of the placenta
and naming rituals had persisted. On the other hand,
the practices of Maori older parents living in a
nuclear family situation and with loose whanau links
were similar to those of their Pakeha counterparts.
Support and advice
Ethnic differences in sources of support and advice in
general reflect both differences in the cohesion and
importance of the extended family and the effect of
historical processes. The primary role of the extended
family in Pacific infant care and the deference to older
female family members are consistent with traditional
Pacific notions of the role of the family in health
decisions (Laing & Mitaera, 1994; Macpherson &
Macpherson, 1990). A study of New Zealand Samoan
and Cook Islanders’ perspectives on health (Laing &
Mitaera, 1994), explained that traditionally the concept
of health was bound to the notions and experiences of
being kin. The health of individual family members was
the responsibility of the family as a whole, in contrast
with the Western notion that health was an individual’s
responsibility. Nevertheless, changes in the concept of
health within the New Zealand setting as a result of
exposure to the Western medical paradigm were also
noted.
The fact that Maori parents tended to rely more on
maternity care professionals than did Pacific parents
probably reflects the longer exposure Maori have had to
Western social and health systems. Recently, in response
to the call for more culturally appropriate services for
Maori, initiatives aimed at increasing Maori maternity
care professionals and introducing Maori models of
maternal and infant care have been introduced (Te Puni
Kokiri, 1993; Rimene, Hassan, & Broughton, 1998).
Some Maori participants in our study strongly endorsed
such initiatives. Others were equally happy to have
Pakeha or Maori providers as long as they received
quality care.
For Pakeha parents the comparatively diminished role
of the extended family in providing support and advice,
the importance of professional services and the valuing
of current ‘expert’ knowledge over the knowledge of
older relatives probably results from less extended
family cohesion and proximity and the powerful
influence of Western biomedicine on maternal and
infant care (Beasley, 1998).
The ethnic group distinctions mentioned were parti-
cularly evident when examining sources of breastfeeding
advice. Most Pakeha and some Maori women sought
breastfeeding advice from professionals, sisters and
peers rather than mothers or mothers-in-law. Health
professionals, in particular, appeared to have consider-
able influence over their decisions about breastfeeding, a
point also made by Beasley (1998) in her New Zealand
study. That these women did not rely on their own
mothers for breastfeeding advice probably reflects loose
extended family ties and the fact that many of their
mothers may themselves not have breastfed. In a
Melbourne study of infant feeding influences amongst
urban Aboriginal mothers, Holmes and colleagues
(1997) also noted disruption in the inter-generational
imparting of successful breastfeeding advice. Because
the Aboriginal women’s mothers had been strongly
encouraged to bottle feed, the young mothers tended not
to seek their advice about breastfeeding. By contrast, the
mothers and mothers-in-law of the Pacific women in
our study were usually the primary source of breastfeed-
ing advice. These older women were highly likely to
have breastfed since breastfeeding rates in the Pacific
have historically been high (Bathgate et al., 1994,
p. 101).
 S. Abel et al. / Social Science & Medicine 53 (2001) 1135–1148
Infant feeding
We were not able to find literature to support the
claim by a few participants that early introduction of
solids was a Pacific tradition because Pacific babies have
different needs from Pakeha babies. In her Tongan
ethnography, Morton (1996) noted great variation in
when solids were introduced, with 6 months as the
norm. In another Tongan study, Laukau (1994) found
that wage-earning working mothers tended to introduce
solids at 3 months compared to 4 months for non-
working mothers, implying that earlier feeding may be a
function of participating in a wage economy. In our
study the early introduction of solids was mentioned by
some participants from each ethnic group and may
reflect less-than-optimum breastfeeding technique or a
pragmatic response to the demands of parenting a young
baby.
Choice of and rationale for infant sleeping arrangements
While our study methodology does not enable a
discussion about the incidence of various infant sleeping
arrangements, our findings lend support to those of
Tuohy and Smale’s (1998) New Zealand study involving
6268 Maori, Pacific and other infants, which found that,
at 3 months of age interview, 40% of Pacific, 20% of
Maori and 6% of other infants had co-slept with an
adult the previous night. In our study the great
importance placed on infant bedsharing by Pacific
families contrasted with the importance most Pakeha
participants placed on the baby sleeping in a cot. There
were also some important ethnic differences in the
meanings ascribed to these practices. Most Pacific
caregivers considered bedsharing safest and best for
the baby because it allowed the mother to easily notice
any untoward signs in the baby’s well-being and because
the close physical contact enabled the baby to receive the
love and warmth needed for healthy physical, moral,
and spiritual development. By contrast, most Pakeha
and some Maori caregivers believed that putting the
baby to sleep in a cot was the safest and best option
because it prevented the risk of overlaying and
encouraged the baby to be independent.
Such differences in view go to the core of cultural
understandings of health and well-being (Morelli et al.,
1992) and illustrate contrasting cultural conceptions of
requirements for healthy personal development in early
life. The Pakeha ideal of increasing separation over time
of the infant’s place of sleep from that of its parents is
consistent with Western notions of healthy personal
development that are predicated on the move toward
increasing individuation and autonomy. By contrast, the
Pacific belief in the importance of infant–adult bed-
sharing for infant well-being is consistent with the
Pacific notion that the healthy development of person-
hood occurs within and is marked by interconnectedness
with family and knowing one’s place in relation to
1145
others (Mageo, 1998; Mavoa, Park, & Pryce, 1997;
Morton, 1996). Morton (1996, p. 12) warns against
simplistically dichotomising notions of the egocentric
Western self and the sociocentric Pacific self and argues
that some Pacific analyses over-stress the relational,
communal basis of the self and minimise expressions of
individualism. Nevertheless, her own and others’ work
with Pacific peoples (e.g. Mageo, 1998; Mavoa, Park, &
Pryce, 1997) do reveal contrasting Pacific and Western
values implicit in notions of healthy infant development
and these appear to concur with the explanations given
by caregivers in our study for their differing practices.
Traditional practices
Cultural distinctions were particularly evident in the
area of traditional beliefs and practices. The importance
for Pacific-raised participants of such practices as
milimili, pregnancy prohibitions and naming protocols
and the perceived direct causal link between parents’
behaviours and the baby’s health were all indicative of
Pacific notions of health and illness. Understandings of
health and illness within traditional Pacific paradigms
are based on ‘supernatural’ interventions that are
mediated by traditional practices and medicines (Finau,
1994). In the case of Samoa, Macpherson & Macpher-
son (1990, pp. 56–57) explain that adherence to customs
that support a Samoan world view are central to
Samoan notions of health and, conversely, non-com-
pliance to these practices and beliefs are believed to
result in ill health. Thus, transgression of what are
culturally valued practices can have adverse health
implications. The importance of adhering to certain
traditional protocols (such as naming, prayers/incanta-
tions and placenta burial) to ensure healthy outcomes
was also evident amongst Maori participants. These
understandings contrast with those within the Western
medicine paradigm in which notions of health and illness
are understood in terms of biochemical and physio-
logical balances and imbalances.
In New Zealand the dominance of the Western
biomedicine paradigm, through its powerful influence
over the construction of ‘legitimate’ health knowledge,
has resulted in the marginalisation and misunderstand-
ing of some Pacific and Maori health beliefs and
practices. For example, there has been strong disap-
proval from Western health professionals of the popular
Pacific practice of milimili during pregnancy. This
practice was seen to be the cause of the high incidence
of stillbirth due to intra-cranial haemorrhage amongst
Pacific women in New Zealand in the 1980s. The later
decline in such stillbirths was considered due to
antenatal education about the dangers of the practice
(Becroft & Gunn, 1989). However, Laing and Mitaera
(1994) dispute these claims arguing that there was no
sound research evidence to support them and that,
1146 S. Abel et al. / Social Science & Medicine 53 (2001) 1135–1148
although a Samoan medical practitioner drew attention
to the confusion between milimili and traditional
abortion techniques (Ma’ia’i, 1985), no effort was made
to differentiate between these two practices. Laing and
Mitaera argue that the validity given to the claims was
due to the dominance of Western medicine over the
construction of health knowledge. Such challenges to
traditional practices become key influences in cultural
practice change and probably explain the wariness of
New Zealand-raised women in our study about the
practice of milimili.
Intra-cultural variation and tensions
As illustrated by this last example, cultural differences
in practice and belief are not static but rather are
constantly being negotiated within changing social,
political and economic circumstances. Infant care
practices are no exception. One of the striking features
of this study was the variation and fluidity of practices
and the variety of reasons and meanings behind them.
Amongst New Zealand-raised Pacific, Maori and young
Pakeha parents, in particular, there was evidence of
significant variation in certain practices, and the reasons
behind these were as much pragmatic and responsive to
current trends and daily situations as adherence to
cultural ideals.
Of particular interest were the tensions between
New Zealand- and Pacific-raised Pacific participants
and between the former and their parents, who were
almost invariably raised in the Islands. These tensions
may reflect status differentials between those raised in
New Zealand and those from the Pacific as well as
changing cultural mores. Many New Zealand-raised
participants had adopted Western biomedical under-
standings of health and illness and, while some were
ambivalent, most did not believe in some of the
traditional notions of causality linking certain practices
(such as food proscriptions or prescriptions) with infant
well-being or ill health. Schoeffel and Meleisea (1996)
describe how many Pacific-raised Polynesian parents
disapprove of Pakeha child-raising practices, since they
are perceived to result in children being disobedient and
disrespectful toward their parents, behaviours that
transgress highly prized Pacific values of obedience,
reciprocity and respect for parents and elders. In our
study New Zealand-raised parents managed to negotiate
these challenges and differences reasonably easily.
Since in most cases the disparities were mainly at the
level of belief rather than practice and parents’ ways
were accommodated and appreciated, these tensions
appeared minimal. Where New Zealand-raised
parents had moved away from traditional practices
or introduced Western practices, such as putting
the baby to sleep in a cot, the tensions were more
apparent.
Some Pacific commentators (e.g. Tiatia, 1998; Schoef-
fel & Meleisea, 1996) have thoroughly discussed the
tensions between Pacific parents and their New Zealand-
raised children who have been raised within a Western
education system. In particular, they describe the
conflict experienced by young people to meet both
cultural expectations of reciprocity and communal living
and the requirements for success or survival within the
Western system. The inter-generational tensions seen in
our study were not as marked as those described in this
literature and this may be because caring for an infant
lies at the very heart of the notion of family and, because
of the demands of parenthood, family support is greatly
valued.
The diversity of infant care practices amongst Maori
were more pronounced than for the other groups and
this is, perhaps, to be expected of a culture with a long
history of colonisation. Maori are not a homogenous
group and at the dawn of the 21st century are diverse
and complex. While many are closely linked to tradi-
tional social structures of whanau, hapu (sub-tribe) and
iwi (tribe), others are alienated from these, are highly
mobile and/or have adopted Pakeha values (Durie,
1995). In addition, traditional practices, and in some
cases their reclamation, occur within a social and
political context of pluralism so that the reasons for
adopting them or the meanings given to them can differ
in significant ways. This diversity and complexity was
apparent in our study.
Intra-cultural differences amongst Pakeha partici-
pants were related to age. The more spontaneous and
intuitive approach to parenting of young mothers,
compared to their older counterparts who were often
very anxious about ‘doing it right’ and being a ‘good
mother’, may have been because the former were more
involved with their families because of their youth.
Alternatively, it is possible that youth and the demands
of being a young parent inspire a less reflective and more
pragmatic approach to parenting.
In brief, the significant intra-cultural differences were
related to the country in which raised for Pacific
participants, the closeness to extended family amongst
Maori and to age amongst Pakeha participants. By
comparison, intra-cultural differences based on socio-
economic status appeared to be of minimal significance.
Conclusion
This research revealed some key areas of similarity
and some distinct cultural differences in the infant care
practices and beliefs of the caregivers taking part.
Cultural differences in both belief and practice have
implications for the effective delivery of maternal and
infant health services and public health messages. The
central involvement of Pacific and Maori female
 S. Abel et al. / Social Science & Medicine 53 (2001) 1135–1148
relatives in infant care practices, for example, points to
the need for Western health service providers to
acknowledge and support their expertise and to be more
inclusive of extended family in maternity care and infant
care advice. Further, the cultural differences in meaning
assigned to bedsharing are of significance for public
health messages affecting infant sleeping arrangements.
For example, given the cultural significance of bed-
sharing for Pacific and Maori families, it is not
surprising that the 1991 New Zealand cot death
prevention campaign’s blanket warning against bed-
sharing was unpopular in these communities and
possibly had implications for the uptake of other aspects
of the prevention message, which then needed to be
addressed more appropriately (Tipene-Leach, Everard,
& Haretuku, 1999).
The research also illustrated the richness, diversity
and dynamic nature of infant care beliefs and practices
both across and within ethnic groups. For the partici-
pants the care of infants was a series of negotiations
between, for example, traditional Maori and Pacific
ways and Western notions of care, between the advice of
older family members and younger relatives and friends,
between the latter and a range of experts, and between
‘going with your feelings’ and ‘doing it by the book’. At
the same time the economic, physical and social realities
of everyday life set up tensions about how parents would
like to look after their infants and what actually
happened. Individual parents, couples, and extended
families negotiated their ways through these tensions
and what resulted was a wide range of practices and of
beliefs associated with these practices.
Acknowledgements
We would like to thank the participants and
facilitators for their important contribution to this
research, the Health Research Council of New Zealand
for the provision of funding and Carol Everard and
Dr. Jennifer Hand for their helpful comments on early
drafts. We are also grateful to three anonymous
reviewers for their useful comments.
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