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CALD maternal health resource

CALD maternal health resource

What is the CALD maternal health resource?

The CALD maternal health resource is the latest resource developed by eCALD® services to support maternal health services and providers working with CALD women and their families during their pregnancy, birth and postnatal period. The resource includes culture-specific information, cultural approaches to maternal health, tools and tips, and case scenarios.

CALD refers to culturally and linguistically diverse groups who are migrants and refugees from Asian, Middle Eastern, Latin American and African (MELAA) backgrounds.

CALD maternal health resource - hardcopy and online (html)
CALD maternal health resource - hardcopy and online (html)

What are we trying to achieve?

Women from migrant and refugee backgrounds have come from different health systems. In some countries health services may be similar to those in New Zealand, but in many countries the health system and the approach to maternity services are quite different. Differing health beliefs, expectations, and language barriers can lead to miscommunication and misunderstanding between the health practitioner and women from cultural backgrounds different from their own.

Culture plays a major role in the way a woman perceives and prepares for her birthing experience. If health care providers are familiar with different cultural ideas, rituals and behavioural restrictions and are able to communicate about these, they are able to increase women’s choices for health care.

As New Zealand’s society becomes increasingly ethnically diverse, our aim is to work towards maternity services that are responsive to women from diverse cultural and religious backgrounds. Understanding traditional pregnancy, birth and postnatal practices will enable appropriate assessment, interventions and support for women and their families.

What did we find?

In the last decade, there has been a significant increase in births to Asian women in New Zealand. Currently 25% of births in the Waitemata region are to Asian women (11% nationally). As a proportion, Asian births are expected to rise to 32% by 2025 in the Waitemata region[1].

Language and unfamiliarity with the New Zealand health system means that Asian migrant women and babies are likely to experience inequalities in health outcomes. The most recent Perinatal and Maternal Mortality Review Committee report shows that:

  • Indian women, along with Māori and Pacific women, experience a higher rate of perinatal death than New Zealand European women
  • Indian women have a disproportionately high rate of stillbirth and neonatal deaths in the Auckland region
  1. Auckland DHB and Waitemata DHB Womens Health Collaboration, 2015

What have we done?

We have developed a maternal health resource to support maternal health services and providers to become more responsive to women from diverse cultural and religious backgrounds, specifically CALD women from Asian, Middle Eastern and African backgrounds.

This resource is available in hardcopy and online (HTML) and includes the following topics:

  • Cultural perspectives including traditional practices in pregnancy, birth and the postnatal period; intergenerational and interethnic marriage issues
  • Maternity services including differences between services provided in home countries and New Zealand; and tools for cultural assessment throughout the pregnancy, birth and postnatal journey
  • Antenatal care including information on appropriate cultural care during pregnancy and case studies to help readers think about how to handle similar situations in practice
  • Pregnancy and birth including advice on discussing options for birth, screening and counseling; cultural considerations when imparting bad news; and discussing the complications of pregnancy and birth
  • Female genital mutilation (FGM) including cultural considerations about how to prepare women with FGM for pregnancy, labour and birth
  • Postnatal care including case studies to illustrate the differences expectations for postnatal care
  • Perinatal mental health including information on antenatal and postnatal depression in CALD women; risk factors; diagnosis; cultural variations and issues; and includes cultural assessment tools and considerations
  • Cultural profiles including information on spiritual and traditional practices; family values; health beliefs and the various cultural understandings of pregnancy, birth, care of the baby and perinatal depression for Chinese, Indian, Korean, Filipino, Japanese, Vietnamese, Myanmarese, Muslim and Sikh women

Resource development

The main phases of our CALD Maternal Health resource development were:

  1. Review of local and international literature and consolidation of content appropriate for the New Zealand health system and our population profile
  2. Creation of written case studies and scenarios for the print, PDF and Online HTML resources
  3. Creation of video files of scenarios for the online HTML resource
  4. Creation of templates for print, PDF and online HTML resources
  5. Production of PDF, printed and online HTML resources
  6. Review of resources by health professionals working in maternal health area as well as cultural experts
  7. Modifications of resources to reflect feedback

Online version of CALD maternal health resource
Online version of CALD maternal health resource

To access this resource and other accredited online and face-to-face CALD Cultural Competency courses please visit www.eCALD.com.

Did we make a difference?

CALD maternal health resource launch
CALD maternal health resource - hardcopy and online (html)

The CALD Maternal Health resource was officially launched at the 6th International Asian and Ethnic Minority Health Conference organised by the University of Auckland’s Centre for Asian and Ethnic Minority Health Research and eCALD® Services.


The conference drew more than 200 participants from central and local government, health service providers, universities and community organisations from across the country. At the conference, over 400 copies of the resource collected by conference attendees, showing the huge demand for the resource.


Maternal health professionals reviewed this resource and provided the following feedback:

"This well researched handbook is an information packed resource covering perinatal mental health in CALD women. Descriptions of cultural beliefs and practices in various populations sit alongside case studies. A practical and engaging learning tool - highly recommended!" - Dr Margaret Mitchell-Lowe, Psychiatrist, Waitemata DHB

"I am totally impressed by this resource. It is filled with useful tools, approaches and advice on how to work with women from culturally and linguistically diverse backgrounds, I found the cultural profile sections simply excellent. It is an exceptionally high quality, research based resource and I cannot recommend it highly enough for any professional working with CALD women and their families." - Maggie O’Brien, RN, RM(Hons) FRCM, MSc - Clinical Lead Culture Change Waitemata DHB

"This is a wonderful and essential resource for any clinician working with women and their families from culturally and linguistically diverse backgrounds. It contains necessary foundational information to equip anyone to work more effectively and sensitively with this client group. Also this resource contains very useful tips and tools to enable application of the newly learnt knowledge and skills straight away. Highly recommended! - Dr Aram Kim, Consultant Psychiatrist, Maternal Mental Health, Waitemata DHB

"I think the information in the Maternity Resource is very comprehensive and I hope many people can access this." - Melissa Powell, FGM Education Programme

Where to from here?

We are currently scoping an evaluation of the CALD Maternal Health resources to assess the usefulness and the effectiveness of the resource for midwives and maternal health providers in terms of changing practice and improving engagement with CALD women during pregnancy, birth and the postnatal period.