The findings show that while rural māmā often face barriers such as long travel distances, limited access to diagnostics, and workforce shortages, rural systems also foster strong, relationship-based models of care. In the most remote communities, integrated and collaborative approaches—often involving primary care, midwives, and iwi providers—support more connected and responsive care for whānau.

Primary birthing units emerged as critical community assets, enabling care closer to home, supporting whānau involvement, and promoting lower-intervention births. At the same time, the sustainability of these services is under pressure, highlighting the need for ongoing investment and support.

The research also identifies important equity gaps, particularly for Māori and Pacific women, including later engagement with maternity care and ongoing disparities in key health indicators. These findings reinforce the importance of culturally grounded, accessible, and well-integrated services.

Overall, this project demonstrates that rurality is not simply a barrier—it is also a source of innovation and strength. By building on what is already working in rural communities, there is an opportunity to design maternity care that is more equitable, connected, and responsive across Aotearoa.