Epistemic injustice and Body Mass Index: Examining Māori and Pacific women’s access to fertility treatment in Aotearoa New Zealand

ABSTRACT The availability and uptake of assisted reproductive technologies is increasing across the globe yet delays and disparities continue to exist for many Indigenous and minority ethnic groups in terms of outcomes and access to fertility treatment and reproductive services. In this article, we examine the fertility stories of nine Māori (Indigenous people of Aotearoa) and Pacific cisgender women living in Aotearoa who were interviewed as part of a large qualitative study conducted with participants seeking access to assisted reproduction for the purposes of family building. The focus of the article is on the experiences of Māori and Pacific women for whom clinical criteria, which include a Body Mass Index cutoff of 32 kg/m2, present a key barrier blocking access to publicly funded fertility services. We draw on the conceptual tool of epistemic injustice, described by the philosopher Miranda Fricker, as a lens through which to examine the challenges Māori and Pacific women face accessing fertility treatment. The study findings indicate that most participants, at some point throughout the course of their reproductive journeys, encountered epistemic injustice when seeking fertility treatment. To redress this bias, we believe revision of Body Mass Index criteria guidelines, which were implemented as part of a nationwide Clinical Priority Criteria Assessment strategy more than 20 years old, are warranted.