Many of the health inequities suffered by Aboriginal Canadians are a result of the loss of sovereignty over their own affairs, thus a return to self-governance over health services is recognized as one of the most important solutions to resolving these inequities (Warry, 1998). Culturally appropriate health services are necessary for precipitating community revitalization through amelioration of health concerns such as substance abuse, poor nutrition, and domestic violence. Pregnancy and birth is an especially important process by which Aboriginal communities can rebuild the foundations of their Nations because traditionally birth was a powerful ceremony that strengthened connections between the mother, her newborn, their kin, and their territorial lands. Furthermore, birth is an immediate tool for decolonization; Simpson (2006) writes,

 

In order to heal our Nations, our communities, and our families, we must reclaim this ceremony...by reclaiming pregnancy and birth, we are not only physically decolonizing ourselves, but we are also providing a decolonized pathway into this world. (p. 28)

 

Attention to Aboriginal maternity care services is further warranted by the higher fertility rate, youthful age distribution, and increased infant mortality rate of Canadian Aboriginals. While federal census data does not provided a complete picture of Aboriginal demographics for reasons such as warranted mistrust of colonizers and government fabricated categories of who and how one can identify as an Aboriginal, trends in recent census data indicate the Aboriginal population is one of the youngest and fastest growing cohorts in Canada. The median age of Aboriginal Canadians is 27.7 years as compared to 40.6 years for non-Aboriginal Canadians, with the largest proportion of the Aboriginal population (28%) falling in the 14 years and younger category (Employment and Social Development Canada, 2015). Furthermore, across Canada, the Aboriginal population growth rate is 20.1%, while the non-Aboriginal growth rate was 5.2%; Aboriginal women can expect to have 2.6 children over their lifetime, whereas the average for Canadian women as a whole is 1.5 children (Stout & Harp, 2009). However, despite evacuation policies and the adoption of the Western model of health care, the rate of infant mortality among Canadian Aboriginals is dismal when compared to non-Aboriginal infants. For example, Luo et al. (2004) reported the infant mortality rate for rural and urban First Nations infants in British Columbia to be 2.3 and 2.1 times higher than for non-Aboriginal infants, respectively.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 1. Aboriginal ancestry population growth 1901-2011. Colour coded to demonstrate slow, rapid, and exploding population growth in black, green, and red, respectively. Since 1971, the Aboriginal population in Canada has increased by 487%, in part due to an amendment of the Indian Act in 1985 that allowed many Aboriginal women and their children to regain "Indian status". Retrieved from https://www.aadnc-aandc.gc.ca/eng/1370438978311/1370439050610

 

 

On October 1st, 2013, the First Nations Health Authority (FNHA) assumed responsibility for health programming for First Nations people living in British Columbia from the federal government. The FNHA is the first province-wide Aboriginal-led health authority in Canada, and was born out of several agreements between British Columbia First Nations, the Province of British Columbia, and the Government of Canada, importantly the Transformative Change Accord: First Nations Health Plan (2006). One of the action items of the health plan is a Maternity Access Project that carries the mandate of bringing birth "closer to home and back into the hands of women".

 

 

 

 

 

 

 

 

 

Figure 2. Tripartite members of the First Nations Health Plan include the  Government of Canada, the Province of British Columbia, and the First Nations Health Authority. Retrieved from http://www.newswire.ca/news-releases/successes-marked-in-new-approach-to-first-nations-healthcare-in-bc-517702601.html

 

 

Elsewhere in Canada, the restoration of the role of the community midwife has been central to achieving the return of birth back into the hands of Aboriginal women. Twelve Aboriginal midwifery practices have been established in Ontario, Quebec, Nunavat, Manitoba, and the Northwest Territories, providing some Aboriginal women with the choice to birth in their own communities (National Aboriginal Council of Midwives, 2012). Most of these Aboriginal midwifery services have been established in remote regions that do not have access to specialty physicians or surgical services; in the event of an adverse perinatal outcome, the woman and/or the newborn must be medevaced south for care.

 

In spite of the lack of emergency services, women giving birth in these communities have equivalent or better perinatal outcomes when compared to women elsewhere. For example, the Inuulitsivik midwifery service in Northern Quebec reported fewer fetal and neonatal deaths than the Canadian average and a lower Cesarean section rate (2.1%) than the other Inuit regions (10%) and the rest of Canada (25.6%) (VanWagner, Osepchook, Harney, Crosbie, & Tulugak, 2012). Previous to the implementation of the midwifery service, 91% of the region's Inuit women were evacuated south prior to their due date; today the rate of maternal transfer is 13.6%, decreasing not only health care costs, but also the financial and psychosocial burdens incurred by pregnant women and their families upon relocation for birth. VanWagner, Epoo, Nastapoka, and Harney (2007) report the establishment of the midwifery service "has been fundamental for community healing, and marks a turning point for many families who suffered from family violence in Nunavik".

 

In the video that follows, Aboriginal film maker Lorena Fontaine speaks of how mother's trauma from the residential schools negatively impacted her own confidence in becoming a mother. However, with the assistance of two Aboriginal midwives, she was able to return to her mother's traditional territory to give birth, drawing strength from the land, her ancestors, and her kin. She describes the birth of her firstborn as being "extremely political (as) she was the first child to be born in (the) community in over 50 years". By choosing to birth in a way deemed "dangerous" by settlers, Lorena sent a clear message about her and her community's authority to conduct birth to the patriarchy that has repeatedly attempted to squelch the sovereignty of Aboriginal women. She exemplifies what Simpson writes about; by returning to the lands of her people, not only was Lorena able to begin to heal from the intergenerational trauma inflicted upon her family by settlers, but she also forged a path for her daughter that leads away from the colonizing harms suffered by her ancestors.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

 

Employment and Social Development Canada. (2015, Nov 9). Canadians in context: Aboriginal population. Retrieved from http://well-being.esdc.gc.ca/misme-iowb/.3ndic.1t.4r@-eng.jsp?iid=36

First Nations Health Authority. (2006). The transformative change accord: First Nations health plan. Retrieved from http://www.fnha.ca/Documents/TCA_FNHP.pdf

Luo, Z. C., Kierans, W. J., Wilkins, R., Liston, R. M., Uh, S. H., Kramer, M. S. (2004). Infant mortality among First Nations versus non-First Nations in British Columbia: Temporal trends in rural versus urban areas, 1981-2000. International Journal of Epidemiology, 33, 1252-1259. http://ije.oxfordjournals.org/content/33/6/1252.full.pdf+html

National Aboriginal Council of Midwives. (2012). Aboriginal midwifery practise in Canada. Retrieved from http://www.aboriginalmidwives.ca/aboriginal-midwifery/practices-in-Canada

Simpson, L. (2006). Birthing an Indigenous resurgence: Decolonizing our pregnancy and birthing ceremonies. In D. M. Lavell-Harvard & J. C. Lavell (Eds.) Until our hearts are on the ground: Aboriginal mothering, oppression, resistance and rebirth (pp. 25-33). Toronto, ON: Demeter Press.

Stout, R., & Harp, R. (2009). Aboriginal mother and infant health in Canada: Review of on-reserve programming. Retrieved from http://www.pwhce.ca/pdf/AborigMaternal_programmes.pdf

Van Wagner, V., Osepchook, C., Harney, E., Crosbie, C., & Tulugak, S. F. (2012). Remote midwifery in Nunavik, Quebec, Canada: Outcomes of perinatal care for the Inuulitsivik Health Centre, 2000-2007. Birth, 39(3), 230-237. http://onlinelibrary.wiley.com/doi/10.1111/j.1523-536X.2012.00552.x/full

Warry, W. (1998). Unfinished dreams: Community healing and the reality of Aboriginal self-government. Toronto, ON: University of Toronto Press.