Aotearoa New Zealand performs poorly with respect to child injury prevention in comparison to other high-income countries.[[1–4]] Moreover, the burden of injury is disproportionately borne by Indigenous children—tamariki Māori—who experience the highest ethnic-specific injury mortality and hospitalisation rates in Aotearoa.[[5,6]] They account for 29% of all hospitalisations due to unintentional injuries in childhood.[[3]] More broadly, intentional and unintentional injuries are leading causes of mortality and morbidity among Māori.[[5,6]]

These findings reflect broader patterns of health inequities experienced by Indigenous peoples globally[[7,8]] and in Aotearoa.[[8–10]] Such inequities illustrate breaches of key foundational documents. This includes the Universal Declaration of Human Rights (1948) and the Declaration on the Rights of Indigenous Peoples, which guarantees equity for Indigenous peoples.[[11]] It also breaches Māori rights outlined in Te Tiriti O Waitangi, the agreement with the Crown on which this nation is founded and which specifically guarantees equity for Māori in Aotearoa.[[10–12]]

To date, injury prevention messages and interventions in Aotearoa have been largely developed through a Pākehā lens. Data over time show a 25% reduction in unintentional injury hospitalisation rates among Māori tamariki (0–14 years) between 2009 and 2018.[[12]] However, significant disparities persist between outcomes for tamariki  Māori and non-Māori children.[[3,13]] This suggests interventions are more effective among tamariki Pākehā and their whānau in comparison to Māori.[[3,13]] Indeed, Reid, Cormack and Paine[[9]] highlight the role of colonisation in systematically eroding Indigenous “ways of being including languages, traditional practices and the social structures necessary for their transmission” as one of the key contributing factors underpinning health inequities observed among Māori. Researchers[[14,15]] have also emphasised the danger of adopting a “one-size-fits-all” approach in recognition that health promotion interventions may work well among some groups of people but less effectively among others.[[14,15]] Reid[[14]] asserts that, in many cases, evaluation of generic information campaigns “shows better uptake of the intervention among those people already privileged in society and best positioned to take up new ideas, information and opportunities.”

In recognition of this systematic erosion of Indigenous (Māori) culture, we argue the need to draw on and incorporate mātauranga Māori and te ao Māori perspectives within child injury prevention messaging and interventions. Internationally, Indigenous injury prevention work echoes the need for approaches to injury prevention that are based on Indigenous knowledge.[[8,16,17]] Specifically, we argue that the incorporation of mātauranga Māori and te ao Māori perspectives within child injury prevention initiatives in Aotearoa will promote Māori knowledge and expertise and ultimately the wellbeing of tamariki Māori and their whānau. In particular, the status of taonga (treasured) that Māori bestow on tamariki encourages whānau to keep tamariki safe. Similarly, many aspects of tikanga, kawa and mātāpono that underlie Māori culture contain protective elements and safety principles that can be readily applied to injury prevention messaging.

We propose a strengths-based approach to support child injury prevention and cultural autonomy for Māori. Our approach is based on work by Safekids Aotearoa. Safekids Aotearoa is located within Starship Children’s Health and are tasked with helping to reduce “the high rates of preventable injury to children.”[[18]] The approach draws on Māori child-rearing practices and kawa haumaru (safety mechanisms) that are culturally safe and responsive to Māori and thus support tamariki and whānau to flourish. It incorporates foundational elements of mātauranga Māori, tikanga, kawa and mātāpono that are inherently protective in nature. We outline these concepts and offer examples that highlight how they can be considered from an injury prevention point of view. We then detail two values-based child-rearing practices determined by mātāpono that illustrate the value of a Māori framework: tuakana and teina relationships and kotahitanga.

Mātauranga Māori

Mātauranga Māori is shaped by te ao Māori and recognises the natural order of the world and the reciprocal relationship between Māori and their environments. It encapsulates a series of connections and accompanying responsibilities between the environment and its resources.[[19]] Mātauranga Māori remains central to Māori culture by reinforcing tikanga and kawa in contemporary society.[[19]]

Importantly, mātauranga Māori can inform child safety in a dynamic and reciprocal way, as illustrated in the pūrākau (Māori narrative) of Ranginui (sky father) and Papatūānuku (Earth mother). In this pūrākau, the environment was an inhospitable one for their tamariki to fully mature in, and thus their tamariki made the decision to force the separation of their parents’ embrace. The tamariki used open discourse to determine the best course of action. Despite opposing views between tuakana and teina, Tāne-Mahuta (God of the forests and birds, and child of Ranginui and Papatūānuku) led the action to separate Ranginui and Papatūānuku.

Although this pūrākau may sound counter-intuitive to enabling a safe environment, it reflects the balance required to support child development and risk-taking in a more holistic and affirming way, and ensures children flourish in safe and enabling environments. Ticknor[[21]] describes finding the right balance to supervision by providing tamariki with both the freedom and the tools to make safe informed and conscious decisions. Tāne-Mahuta and his siblings were smothered in their parents’ safe embrace, which didn’t allow for them to develop their taha tinana (physical health), taha wairua (spiritual health), taha hinengaro (psychological health) and taha whānau (family health). Post separation, Tāne-Mahuta went on to create flora and then mankind, who, as kaitiaki (guardians), have tuakana-like dominion over the flora and responsibilities to the environment.[[22]] Thus, the tikanga and kawa drawn upon to engage tree felling or climbing ensured that the mana (authority), mauri (life force) and tapu (sacredness) of Tāne-Mahuta, his children and mankind were safeguarded from unintentional harm.

Tikanga

Tikanga underpins conduct, policies and customs of an individual or group.[[23]] The word “tika” means “to be right, or correct.” Thus tikanga focuses on the correct way of doing things.[[22,23]] This includes moral judgements about appropriate behaviours and interactions in everyday life and entails both conscious and subconscious knowledge and practices. It is deeply embedded in mātauranga Māori and te reo Māori, and it guides the relationships that co-exist between individuals, the environment and objects.[[22,23]]

There are unintentional child injury prevention practices that sit within the boundaries of tikanga. In the pūrākau of Mahuika (deity of fire) and Māui (prominent Polynesian character in Māori narratives), for example, Māui came to understand the dangers of fire when he barely escaped with his life after playing with his grandmother’s sacred flames. This pūrākau provides both a starting point for developing a kaupapa Māori approach to burns prevention and a Māori framing for a wider understanding of safety from a child-rearing perspective.

Tikanga may also encapsulate customs that are flexible and can be adapted for contemporary understanding and practices to support the promotion of child safety.[[24]] For example, although neither cars nor child restraints were part of pre-colonial Māori society, practices and mechanisms put in place before setting out on journey may be regarded as tikanga that are intended to keep whānau safe: licensing, awareness of road signage, a safe vehicle with a current warrant of fitness and registration and the correct forms of restraints for tamariki are relevant to reducing child injuries from road crashes. Promoting these understandings and practices as tikanga may work to engage Māori in a more effective and culturally relevant way. These understandings can also enhance the responsiveness of local boards, councils and transport agencies, so they implement designs and traffic-calming measures that equitably protect tamariki Māori from pedestrian injuries while they walk to school.[[25]]

Kawa

Kawa guides the practices and relationships within and between whānau, hapū (subtribe or extended families) and iwi (tribe/s or communities).[[22,24]] While tikanga and kawa are interconnected, kawa is distinguished as the actions or protocols that guide the way Māori life is ordered.[[ 22,24]] Kawa thus regulates behaviours and practices in different settings and in relation to different issues. Of note, both tikanga and kawa vary from iwi to iwi.

Mead[[23]] argues from a te ao Māori perspective that unintentional injuries among tamariki could potentially be a consequence of a breach of tikanga and/or kawa in the reciprocal interactions between tamariki, their whānau and others. Thus, tikanga and kawa provide a regulatory function and offer guidance that can protect tamariki from unintentional harm.[[23,24]] For example, kawa surrounding a car journey could incorporate the singing of a seat belt rhyme in te reo Māori, by which tamariki would remind parents of the kawa haumaru for keeping themselves and their whānau safe. Alternatively, a karakia (prayer or blessing) for safe travels would serve a similar purpose.

Mātāpono

Mātāpono are the pillars upon which tikanga and kawa are founded. Durie[[22]] describes mātāpono as “values that underpin collective social norms.” These motivate protective elements, reciprocal respect and equitable relationships with the natural, social, built and other environments. By providing a bottom-up approach to inform, adapt or create tikanga, the protective concepts incorporated in mātāpono can be pivotal to framing injury prevention messages.

• Mana: preserving, maintaining and nurturing the authority that tamariki Māori inherit at birth from tīpuna (ancestors), iwi, hapū, whānau and parents.
• Mauri: valuing and respecting the life of individuals, the collective and their interdependence with the environment.
• Tapu: valuing and respecting the sacredness of taonga to ensure these are acknowledged, preserved and maintained.

Within te ao Māori, tamariki are regarded as taonga, gifted by ngā atua (Māori celestial beings) and tīpuna[[26]] and, therefore, understood as tapu.[[23,24]] Māori child-rearing practices often acknowledge tamariki as taonga.[[26,27]] This status is explicitly incorporated in Māori child-rearing practices, which are influenced by mātāpono that seek to protect the mauri, mana and tapu of tamariki. Key child-rearing practices of particular importance when considering injury prevention in a context where child flourishing is valued include:

• Whakapuhi: cherishing and indulging tamariki; encouraging them to be inquisitive, adaptive and to explore their environments and the people within them.[[26,27]]
• Aroha: caring for tamariki and fostering taha tinana, taha hinengaro, taha wairua and taha whānau wellbeing and identity.[[27]]
• Whakamana: building and maintaining the mana of the child.[[27]]
• Tuakana-teina: encouraging reciprocal mentoring between older and younger siblings.[[ 26,29]]
• Rangatiratanga: fostering the authority that tamariki inherit to lead whānau, hapū, iwi aspirations and self-determination.[[26,27]]
• Kaitiakitanga: teaching tamariki to be protectors of tikanga, lives, land and resources.[[19,27]]
• Manaakitanga: teaching tamariki to be guardians of their own and others’ mana.[[22,24,26,27]]
• Whakatūpato: teaching tamariki to be cautious and safe in their environment and with those around them.[[22,24,27]]
• Kotahitanga: a collective approach to Māori child-rearing in which iwi, hapū and whānau are responsible for safe, supported and nurtured child-rearing.[[22,27]]

Each of these Māori child-rearing practices resonates in clear and direct ways with concepts of a child flourishing within social, physical and community contexts and environments where serious or fatal injuries and harms are prevented. Here we illustrate the implications by drawing on two of these child-rearing practices.

Tuakana-teina

Within te ao Māori and Māori child-rearing practices, a reciprocal mentoring relationship is often observed between tuakana and teina. This relationship revolves around teaching and learning exchanges[[26,27]] and fosters the development of mātāpono among tamariki,[[27]] as well as providing teina with critical guidance to safeguard and navigate tikanga and kawa.[[28]]

Consideration and incorporation of tuakana-teina relationships within a Māori framework for understanding injury prevention has clear potential to support and empower tamariki to take steps to keep themselves and each other safe. Indeed, the tuakana-teina relationship is regarded among many Māori as critical to tamariki development. However, such a relationship may be at odds with non-Indigenous injury prevention programmes, which often ascribe primary responsibility to adults/parents for teaching tamariki and keeping them safe. As a result, they often overlook the strengths and benefits of tuakana-teina relationships and focus solely on adult caregivers as supervisors and educators. There remains much debate regarding the effectiveness of Western, non-Indigenous injury prevention programmes that have sought to teach safety skills directly to tamariki. For example, studies evaluating road pedestrian safety skills have yielded mixed results.[[30,31]] Conversely, programmes based on tuakana-teina mentorship have shown improved educational outcomes for Māori.[[29]] While educational interventions in the absence of safer environments are likely to deny opportunities for more equitable outcomes, acknowledging and engaging the strengths of tuakana-teina relationships could provide opportunities for a broader net of mentoring supporting knowledge acquisition and behaviours that promote healthy development and safety consciousness.

Kotahitanga

Kotahitanga recognises the roles and contributions of the collective. Māori child-rearing is based on kotahitanga among iwi, hapū and whānau. In past times, kotahitanga required iwi members to be kaitiaki (guardians) of tamariki and the mauri, mana and tapu of tamariki.[[22,27]] Safe, supported and nurtured child-rearing was, in principle, the responsibility of all people at all levels—iwi, hapū and whānau. Specifically, kotahitanga embraces a collective and communal approach to supervising tamariki, which includes entrusting members of the wider whānau and tuakana as effective supervisors.[[26,27]] Similar to tuakana-teina relationships, child-rearing practices based on kotahitanga may be viewed as being at odds with non-Indigenous injury prevention programmes that emphasise the role of individual caregivers as effective supervisors of tamariki.[[32]]

Kotahitanga as an approach provides an opportunity to reconsider how tamariki supervision and child-rearing are understood in the context of injury prevention. Existing programmes such as Mana Ririki: Strengths-Based Māori Parenting Programme,[[27]] and parenting resources such as Whakatipu,[[33]] utilise Māori parenting techniques to improve outcomes for contemporary Māori whānau. They offer possible templates for reframing unintentional injury prevention in line with kotahitanga and, more broadly, te ao Māori perspectives. They also offer the potential to be implemented in a way that promotes the inherent strengths of Māori approaches to child-rearing.

Conclusion and recommendations

In line with other Indigenous injury prevention work,[[8,16,17]] we argue a strengths-based approach, founded on mātauranga Māori and inclusive of tikanga, kawa and mātāpono, offers an alternative to the non-Indigenous programmes that have formed the mainstay of child injury prevention in Aotearoa. We believe clear links should be established between Māori cultural values and knowledge and evidence-based injury prevention strategies. We argue that, in doing so, injury prevention approaches will better reflect the fair, just and ethical governance guaranteed to Māori in Article 1 of Te Tiriti o Waitangi.

Safekids Aotearoa has begun shifting the focus of child injury prevention messaging and interventions to be grounded in kaupapa Māori approaches informed by the critical insights offered through kawa haumaru. In 2019, Safekids Aotearoa curated video resources that centred on te ao Māori and mātauranga Māori with a panel of kaumātua (elders) and Māori injury prevention staff. These video resources share fundamental insights into tikanga, kawa and mātauranga Māori as safety mechanisms that encompass a whānau-approach to safety within the home. Safekids Aotearoa has also established a Māori expert group to contribute to advocacy, research and kaitiaki of mātauranga Māori interventions and outcomes for tamariki Māori. Further, Safekids Aotearoa are presently exploring the development of a Māori parenting and shared-experience story-telling video series that highlights Māori cultural contexts of parenting and cultural knowledge transference.

Such work is similar to the New Zealand Accident Compensation Corporation’s (ACC’s) My Home is My Marae approach, the purpose of which was to equip and empower Māori communities with the necessary knowledge to identify and reduce hazards in their own homes.[[34]]

These examples illustrate the increasing awareness of the imperative to embed Indigenous values and practices to improve unintentional injury outcomes for Māori.[[34,35]] As Reid[[36]] states: “A critical expression of fair, just and ethical governance is equity.” Evidence to date suggests that the realisation of the latter is systematically undermined by Western-centric prioritisation in approaches to service design, intervention development, research and funding.[[37]]

We recommend the following actions to assist in re-shaping injury prevention in Aotearoa and to achieve equitable outcomes for tamariki Māori:

• Develop approaches for collecting mātauranga Māori narratives and evidence that can inform kaupapa Māori tools and strategies to prevent child injury.
• Reconsider unintentional child injury prevention approaches to reflect mātauranga Māori, a communal approach to child-rearing and the role of tuakana-teina relationships.
• Access and utilise practices embedded within Māori parenting training to support Safekids Aotearoa’s unintentional child injury prevention programmes and messages and, at the same time, work with existing Māori parenting programme providers to embed injury prevention messages and practices.
• Challenge dominant, deficit-framed narratives about the reasons why tamariki Māori are at increased risk of injury that do not acknowledge the impacts of colonisation, loss of culture and identity and pervasive failures of health systems.

In summary, this viewpoint highlights key elements of mātauranga Māori, tikanga, kawa and mātāpono that we argue should be incorporated into a kaupapa Māori approach to injury prevention. We advocate that this is necessary to reduce health inequities between Māori and non-Māori and advance Māori aspirations. Kawa haumaru provides an opportunity not only to collate mātauranga Māori injury prevention and initiatives, but to revitalise Māori child-rearing and parenting practices that contribute to the holistic safety and wellbeing of whānau, hapū and iwi.

We recognise that this approach requires ongoing consultation and research to identify mātauranga Māori and local insights that can be linked to injury prevention aspirations for all New Zealanders. It also requires the development of public funding mechanisms, evaluation frameworks, dissemination processes and timeframes that reflect Māori tikanga and kawa for sharing knowledge and decision making.

Glossary

• Aotearoa: New Zealand
• atua: Māori celestial beings
• hapū: sub-tribe or extended families
• iwi: tribe/s or communities
• kaitiaki: guardians
• karakia: prayer or blessing
• kaupapa Māori: Māori perspective/s
• kaumātua: elders
• kawa: practices
• kawa haumaru: safety mechanisms
• kotahitanga: collective
• mana: authority
• Māori: Indigenous person or people in Aotearoa
• mātāpono: values
• mātauranga Māori: Māori knowledge
• mauri:  life force
• Papatūānuku: Earth mother
• pūrākau: Māori narratives
• Ranginui: Sky father
• taha hinengaro: psychological health
• taha tinana: physical health
• taha wairua: spiritual health
• taha whānau: family health
• tamariki: children
• Tāne-Mahuta: God of the forests and birds, and child of Ranginui and Papatūānuku
• taonga: treasured
• tapu: sacredness
• te ao Māori: Māori world view
• teina: younger sibling/s
• tikanga: customs
• tīpuna: ancestors/s
• tuakana: older sibling/s
• whānau: families