The research team, led by Amio Matenga-Ikihele of Moana Connect and the University of Auckland, conducted eight focus groups with 31 mothers and grandmothers living in Auckland between February and October 2022. What sets this study apart methodologically is its commitment to Pacific research paradigms. The investigators used the Kakala framework, a Pacific methodology that structures research like the weaving of a garland, from gathering and making to presenting and reflecting, combined with Talanoa, a conversational approach rooted in open, respectful dialogue across the Pacific. This meant participants were not treated as data points but as knowledge holders whose lived experience carries analytical weight equal to any clinical guideline.

The technical findings are striking in their nuance. Using a general inductive approach to analysis, the researchers identified three overarching themes: knowledge and awareness of SUDI, infant sleep practices, and the sources of information and influence that shape family decisions. Crucially, the first theme dismantles any assumption that the problem is a simple knowledge deficit. Participants demonstrated solid awareness of SUDI and its established prevention measures, including the importance of a clear cot, avoiding exposure to tobacco smoke, and positioning babies safely for sleep. These women knew what the health system recommends, and many could articulate it clearly.

Yet knowledge alone did not translate into practice, and here lies the study’s most consequential insight. Despite understanding official advice, many mothers reported choosing to follow the guidance of family members, particularly grandmothers, over that of healthcare professionals, especially around bedsharing. In Pacific cultural worldviews, the grandmother is not a peripheral figure but a central conduit of infant care knowledge, an authority whose experience spans generations and whose involvement reflects values of collective child-rearing, kinship obligation, and intergenerational wisdom. When a grandmother says the baby should sleep beside her, that instruction carries a weight that no pamphlet or clinic consultation can easily displace.

This dynamic creates what public health researchers call a translation gap, but framing it as a simple failure of communication would be a mistake. Bedsharing sits at the intersection of culture, practicality, and love. For many families, sharing a sleeping surface facilitates breastfeeding, enables close monitoring of the infant, and reflects norms of physical closeness that are central to Pacific parenting. International evidence indicates that bedsharing can elevate risk under certain conditions, particularly when combined with maternal smoking, alcohol or drug consumption, sofa-sharing, or soft bedding, while the risk profile under other circumstances remains debated. Blanket discouragement, the study’s authors argue, simply pushes the practice out of clinical view, leaving families without the harm-reduction information that could genuinely save lives.

The implications for health services are profound. The researchers conclude that SUDI prevention strategies must be co-designed with Pacific communities, integrating risk minimisation approaches with Pacific cultural worldviews rather than imposing generic messages that families quietly set aside. They specifically call for grandmothers to be recognised and engaged as key conduits of infant care knowledge, effectively turning the most influential voices in the household into partners rather than obstacles. This represents a shift from a deficit model, in which Pacific families are seen as needing correction, to a strengths-based model in which existing family structures become the delivery mechanism for safer sleep practices.

The study also carries a pointed message for clinicians. Health professionals, the authors argue, should be supported to engage in open, non-judgmental conversations about safer bedsharing rather than issuing blanket prohibitions. In practical terms, this means a midwife or Well Child nurse might ask not whether a family bedshares, but how, and then provide specific, actionable advice: keeping the baby face-up, ensuring the sleep surface is firm, keeping bedding away from the infant’s head, avoiding sofa-sharing, and never bedsharing after drinking alcohol or smoking. Such conversations require time, cultural humility, and trust, resources that are often scarce in pressured primary care settings but which the evidence suggests are decisive.

Context matters for understanding the urgency. Pacific peoples make up a significant and youthful share of New Zealand’s population, and SUDI rates in Pacific infants have historically exceeded those of the general population, a disparity shaped by socioeconomic factors, housing conditions, smoking prevalence, and access to culturally responsive care. Previous national interventions, including the distribution of wahakura, the flax woven portable sleep spaces pioneered in Aotearoa, have shown that culturally embedded solutions can work when they respect rather than override Māori and Pacific practices. The new study extends that logic by identifying precisely who within Pacific families holds the authority to normalise such solutions.

Methodologically, the study offers a template for health research with indigenous and migrant communities. The Kakala framework and Talanoa methodology are not merely stylistic choices; they alter what data becomes visible. In a talanoa, participants can raise topics a structured interview would never surface, and the relational warmth of the format encourages honesty about practices, like bedsharing, that families might otherwise conceal from researchers they fear will judge them. Ethics approval was granted by New Zealand’s Southern Health and Disability Ethics Committee in November 2021, and all participants gave written informed consent. The work was funded by the Health Research Council of New Zealand’s Pacific Project Grant, with the funders having no role in the design, analysis, or decision to publish.

The broader lesson reaches well beyond Auckland. Around the world, public health campaigns fail when they treat households as collections of individuals receiving messages, rather than as social systems in which advice flows through relationships of trust and obligation. This study demonstrates that in Pacific families in Aotearoa, the shortest path to a safer sleeping baby may run through the grandmother’s hands. If health systems learn to equip and honour those hands with accurate, non-judgmental information, the gap between what families know and what families do may finally begin to close, and fewer Pacific whānau will have to endure the unthinkable loss that SUDI represents.

Subject of Research: SUDI prevention knowledge and infant sleep practices among Pacific mothers and grandmothers in New Zealand

Article Title: Exploring SUDI knowledge and practices among Samoan, Tongan, Cook Island Māori, and Niue mothers and grandmothers in Aotearoa New Zealand: a qualitative study

Article References: Matenga-Ikihele, A., Pole, K., Langridge, F., Fa’aui, A., Heather, M., Percival, T., Paynter, J., & Nosa, V. (2026). Exploring SUDI knowledge and practices among Samoan, Tongan, Cook Island Māori, and Niue mothers and grandmothers in Aotearoa New Zealand: a qualitative study. BMC Public Health. https://doi.org/10.1186/s12889-026-29886-6

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29886-6

Keywords: SUDI, sudden unexpected death in infants, infant sleep practices, bedsharing, Pacific health, Talanoa methodology, Kakala framework, grandmothers, Aotearoa New Zealand, qualitative research, health equity, co-designed interventions

The study, led by Sharyn Graham Davies of Monash University together with Nelly Martin-Anatias of Massey University and Carina Truyts of Deakin University, was conducted between 2020 and 2023 and funded by a New Zealand Royal Society Marsden Fund grant. Rather than treating each marginalized group in isolation, as most previous research has done, the team set out to map where barriers overlapped, where they took different forms, and where they were especially punishing. The design reflects a growing critique in reproductive health scholarship: that siloed studies of LGBTQ+ exclusion, migrant exclusion, or religious exclusion can each reveal important injustices while obscuring the shared architecture of the system that produces them all.

The evidence base is substantial. The researchers carried out 52 in-depth interviews with 73 individuals and ran four focus groups involving 40 participants, for a total of 113 people. Participants spanned heterosexual, gay, lesbian, older, single, coupled, Muslim, migrant, Māori and Pacific communities, and were recruited through fertility clinics, community organisations and social networks. All data were analysed using reflexive thematic analysis, a qualitative method in which researchers iteratively code interview material and refine themes while explicitly reflecting on how their own positions shape interpretation. Crucially, the team then subjected those themes to a structured comparison across participant groups, asking systematically where barriers converged, where they differed in form, where they were most pronounced, and where they were not clearly evidenced at all.

What emerged were six recurring barriers to accessing assisted reproductive technology. The first was exclusionary clinical design, meaning that clinics and their administrative processes were built around a narrow model of who a fertility patient is. The second was the privileging of the heterosexual nuclear family, an assumption embedded in eligibility criteria, referral pathways and everyday clinical interactions. The third involved cultural and religious tensions around kinship and permissible reproduction, particularly acute for Muslim participants for whom third-party gametes raise serious religious questions. The fourth was the emotional labour demanded of patients, together with judgments about parental deservingness that participants felt were imposed on them. The fifth concerned the scarcity and governance of gametes and surrogacy. The sixth was economic: the sheer cost of treatment, compounded by funding rules that determine who receives public support and who pays out of pocket.

The analytical heart of the paper lies in showing that these six barriers did not operate uniformly. Donor scarcity, for example, hit different groups through entirely different mechanisms. Single women and lesbian participants faced it as long waitlists and limited donor availability, a straightforward supply problem. Muslim participants encountered it as a religious constraint, because restrictions on third-party gametes meant that donor programs could be theologically off-limits regardless of supply. Gay men faced a compounded version of the problem, since building a family through surrogacy requires both egg donation and a surrogate, multiplying the scarcity they must navigate. The same underlying shortage, in other words, was refracted through religion, sexuality and family structure into three distinct experiences of exclusion.

Funding rules emerged as especially consequential, particularly where they intersected with age, residency status, body mass index and pathway-specific costs. New Zealand’s public fertility funding, like that of many countries, attaches conditions to eligibility, and the study shows how those conditions land differently depending on a person’s social location. Migration trajectories interact with residency requirements, so that a migrant may become ineligible precisely during the years when treatment would be most effective. Singlehood and sexuality determine which clinical pathways are even offered, and later-life family formation collides with age thresholds. A rule that appears neutral on paper, the authors suggest, becomes a mechanism of inequity once it passes through the realities of migration status, relationship recognition and the biological clock.

Central to the study’s framing is the concept of social infertility, a term the researchers use to describe situations where societal conditions, rather than biological dysfunction, constrain a person’s reproductive possibilities. A lesbian couple with no medical fertility problem is infertile only in the sense that the system is not built for them; the same applies to a single woman, a gay couple, or someone whose religion forbids the only treatments on offer. Biological infertility has been studied exhaustively, the authors note, but social infertility remains comparatively underexplored. By placing social infertility at the centre of a comparative design, the study reframes what looks like a series of private misfortunes as a public, structural problem, one that is produced by formal funding rules, clinic and administrative design, donor-market conditions, legal regulation and informal cultural exclusion.

The researchers are careful about what their comparison does and does not show. Finding cross-group convergence, they stress, does not mean that different social locations are interchangeable. A Muslim woman navigating religious prohibitions on donor gametes faces a qualitatively different challenge from a gay man negotiating international surrogacy law, and a migrant on a temporary visa faces constraints neither of them will ever encounter. The value of the comparative approach is precisely that it distinguishes the shared institutional scaffolding from the group-specific mechanisms that operate within it. That distinction matters because it changes what policy can realistically fix: a barrier produced by a funding rule requires a legislative answer, while one produced by clinical culture requires changes in how clinics are designed and how staff are trained.

Those policy implications form the study’s practical core. The authors call for mechanism-specific responses rather than blanket statements of inclusivity. Equitable eligibility and funding rules would address the formal gatekeeping that disadvantages migrants, older prospective parents and those on non-heteronormative pathways. Inclusive administrative and clinical design would tackle the everyday friction of forms, intake systems and assumptions that signal to patients who belongs. Culturally and religiously responsive care would acknowledge that for some communities, permissible reproduction is a live theological question that clinics must engage with rather than ignore. Clearer information pathways would reduce the burden of emotional labour that currently falls on patients to decode the system themselves. And reforms addressing donor and surrogacy scarcity would attack the supply-side bottleneck that constrains single women, lesbian couples and gay men in particular.

The study arrives at a moment when assisted reproduction is expanding globally, with clinics marketing their services to an ever-broader clientele even as access remains rationed by cost, law and culture. Its findings suggest that the inequities embedded in fertility care are not incidental frictions but features of how the system was designed, and that they will persist until the mechanisms producing them are addressed one by one. For the 113 New Zealanders who shared their experiences, the message of the research is that their struggles were not separate stories of bad luck or individual circumstance, but chapters of a single structural account. For policymakers, the message is sharper still: making fertility care genuinely equitable will require looking past the categories that divide patients and fixing the machinery that excludes them all.

Subject of Research: Social infertility and intersecting barriers to assisted reproductive technology access in Aotearoa New Zealand

Article Title: Shared struggles: Muslim, migrant, lesbian, gay, single and older experiences of accessing assisted reproductive technology

Article References: Davies, S. G., Martin-Anatias, N., & Truyts, C. (2026). Shared struggles: Muslim, migrant, lesbian, gay, single and older experiences of accessing assisted reproductive technology. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03050-3

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03050-3

Keywords: assisted reproductive technology, social infertility, reproductive equity, LGBTQ+ family building, migrant health, Muslim perspectives, donor scarcity, surrogacy, fertility funding, heteronormativity, Aotearoa New Zealand, qualitative research

The study’s starting point is a theoretical one. Disaster and emergency management, the authors contend, behaves as a complex adaptive system: a network of interdependent actors—central and local government agencies, emergency services, Indigenous partners, civil society organizations, and private sector entities—whose roles and relationships shift as hazard conditions evolve. Three properties of such systems matter most for DEM. Self-organization allows actors to reconfigure coordination autonomously, as observed during the 2011 Tōhoku disaster in Japan, where local actors improvised networks after formal command structures collapsed. Nonlinearity means disruptions can propagate in ways that produce consequences disproportionate to their initial cause, a dynamic famously analyzed by Charles Perrow in his work on normal accidents. Emergent behavior, meanwhile, means system performance arises from interactions among actors rather than from prescribed plans, and therefore cannot be fully anticipated or controlled in advance.

These characteristics expose a structural mismatch. Leadership scholarship has evolved from trait-based theories toward relational, situational, and transformational models, yet it has remained anchored within the organizational unit rather than the interorganizational system. Even systems-oriented approaches such as meta-leadership and complexity leadership theory retain a largely leader-centric orientation, privileging the individual actor as the primary locus of control. The limitations of that orientation are visible in disaster history: post-event analyses of Hurricane Katrina identified failures of individual leadership alongside structural fragmentation, unclear cross-agency mandates, and inadequate mechanisms for aligning distributed actors toward shared objectives. The 2010 Haiti earthquake similarly showed how leadership capacity interacted with pre-existing institutional weakness and fragmented international coordination.

To fill this gap, the researchers turned to stewardship theory, which emerged as a counterpoint to agency theory’s assumption that actors are self-interested and require monitoring and incentives to perform. Stewardship instead conceptualizes actors as fundamentally motivated to pursue collective goals when organizational identification and value alignment are strong. Extended to the system level, stewardship becomes a form of meta-governance—concerned with shaping a system’s goals, rules, feedback, and response—rather than with directing operational activity. The concept has been applied in natural resource governance, public health system management, and complexity-informed public policy, but had not been systematically examined within DEM, despite the field’s combination of distributed authority, multi-agency interdependence, and nonlinear hazard environments.

The empirical work employed constructivist networked grounded theory, a methodology combining Charmaz’s constructivist grounded theory with social network analysis to examine both the relational structure of the DEM system and practitioners’ experiences within it. Data were collected between August 2024 and June 2025 from participants recruited across national forums, professional networks, emergency services, territorial authorities, civil society organizations, and private sector actors. Interviews ranged from 43 to 96 minutes, with a mean of approximately 60 minutes, and analysis proceeded through iterative coding, constant comparison, and progressive category refinement until theoretical saturation was reached. Notably, stewardship was not a predetermined analytical construct; it emerged inductively as the integrative category explaining how participants understood coherence, legitimacy, learning, and adaptive coordination to be sustained across organizational boundaries.

Four interdependent themes emerged from the analysis. The first concerned governing a distributed system. Participants described uncertainty about who holds overarching responsibility for the system as a whole, with national oversight perceived as bounded to particular hazards rather than extending across the full breadth of interagency coordination. Recurrent misalignment between nationally designed arrangements and local operational realities was a persistent friction, sharpened by the fact that national guidance, absent legislative force, cannot be required to be followed. Participants also described ambiguity about which actors were recognized as legitimate contributors to the system, with the operational network extending well beyond formally prescribed structures.

The second theme centered on trust and inclusive participation as the relational infrastructure of coordination. Participants emphasized that the quality of pre-existing relationships was a more reliable predictor of coordination effectiveness than formal arrangements or statutory roles—one practitioner quipped that you need to build a relationship over eight cups of coffee before you can start asking for something. Civil society organizations were described as providing relational networks and community intelligence that are substantial but underrecognized within formal system definitions. Indigenous partnership emerged as a distinct dimension: under Te Tiriti o Waitangi, signed in 1840, Māori hold an enduring basis for partnership in governance, and participants described how the quality of that engagement directly shaped both the legitimacy and operational reach of the system, though Treaty-based partnership quality varied significantly across regions.

The third theme addressed information sharing and learning. The aspiration of a common operating picture was widely referenced but characterized as aspirational rather than operational—one participant observed that the only common thing about it is the word common. Incompatible information systems, platform fragmentation, and institutional protectiveness over data combined to produce what the authors call a feedback deficit: a system theoretically capable of shared sensemaking but operationally fragmented along institutional boundaries. Compounding this, insights gained through events and exercises were described as fading as urgency declined and personnel changed, leaving institutional memory residing in individuals rather than organizational systems and rendering learning sporadic rather than cumulative.

The fourth theme concerned sustaining capability and legitimacy over the long term. Resourcing was described as unevenly distributed, with reliance on locally generated ratepayer revenue producing what participants called a postcode lottery of capability, where organizational capacity reflects local financial circumstances rather than hazard exposure or statutory obligation. Workforce sustainability emerged as a significant concern, with 31 of 40 participants describing burnout, illness, recruitment delays, inconsistent professional standards, and the absence of any centralized repository for qualifications or competency requirements. Accountability, meanwhile, was described as diffuse, operating primarily through post-event inquiry rather than ongoing assurance of preparedness and coordination quality.

From these findings, the authors distill a three-pillar framework of system stewardship. Relational stewardship encompasses the trust, boundary-spanning networks, and inclusive participation through which coordination becomes possible, including sustained investment in Treaty-based partnerships with iwi and the formalization of relationships into organizational arrangements rather than individual positions. Informational stewardship covers shared situational awareness, data transparency, and feedback-informed learning, requiring both technical investment in compatible information management and cultural change that treats learning as a shared system function. Institutional stewardship concerns equitable resourcing, workforce capability, and accountability mechanisms that sustain capability and legitimacy over time. Crucially, the three pillars are interdependent: weakness in one degrades the others, while alignment across all three creates the conditions for sustained adaptive performance. Trust facilitates information sharing; shared understanding strengthens institutional confidence; equitable resourcing enables the sustained engagement through which relationships are built.

The practical implications are considerable. For national agencies, stewardship implies a reorientation of the governance function—from setting requirements to cultivating conditions, from assuring compliance to strengthening capability. For policymakers, the framework makes visible the structural interdependencies between funding, professional standards, and accountability mechanisms, demonstrating that reforms to any single dimension in isolation are unlikely to produce durable improvement. The authors caution that the conditions underpinning system stewardship should not be assumed to persist indefinitely; trust, shared learning, institutional legitimacy, and collaborative relationships require continual investment and renewal, and may be eroded by organizational change, resource constraints, and competing priorities. The study’s limitations are acknowledged: findings derive from a single national context, reflect participant interpretations rather than direct observation, and capture a single point in time, though the framework forms part of a cumulative research program. Ultimately, the study argues that strengthening disaster and emergency management requires moving beyond episodic leadership during events toward the deliberate, continuous stewardship of the relational, informational, and institutional conditions through which adaptive coordination, collective learning, and long-term system coherence are cultivated and sustained.

Subject of Research: System stewardship as a complex adaptive system governance framework for disaster and emergency management in Aotearoa New Zealand

Article Title: Stewardship for Disaster and Emergency Management: A Complex Adaptative System Governance Framework

Article References: Miller, T., Le De, L., & Hore, K. (2026). Stewardship for Disaster and Emergency Management: A Complex Adaptative System Governance Framework. International Journal of Disaster Risk Science, 17(4), 725-738. https://doi.org/10.1007/s13753-026-00762-6

Image Credits: AI Generated

DOI: 10.1007/s13753-026-00762-6

Keywords: disaster and emergency management, system stewardship, complex adaptive systems, meta-governance, governance framework, adaptive coordination, Aotearoa New Zealand, trust and collaboration, institutional memory, emergency management workforce, Māori partnership, disaster risk science