In 2011, data from the National Household Survey (NHS) showed that 1.4 million people self-identify as Aboriginal, representing 4.3% of the total Canadian population (StatCan 2012). Of the 1.4 million, more than half of Canada’s Aboriginal population live in urban centres, and two-thirds of Canada’s urban Aboriginal population lives in Western Canada. An estimated 28,000 Aboriginal people reside in the city of Vancouver, representing 7 percent of the city’s population, with 70% of Vancouver’s total Aboriginal population living in the city’s poorest neighbourhood, the Downtown Eastside (Benoit, Carroll, & Chaudhry, 2003). Aboriginal peoples in Canada experience disproportionate levels of unemployment, violence, incarceration, poverty, physical and mental illness as a result of inadequate access to the social determinants of health including employment, housing, fair legal counsel and health services (Van Herk, Smith, & Andrew 2010). 

      

When considering issues of health and access among Aboriginal peoples, Aboriginal women stand at a far greater disadvantage than Aboriginal men; illustrating clearly the historical legacy of sexist and racist policies in creating systemic burdens of illness. Aboriginal women are disproportionately afflicted with health problems such as diabetes, HIV/AIDS, addiction and related issues as compared to Aboriginal men or non-Aboriginal women. Additionally, poor access to care negatively impacts Aboriginal families on the whole, as Aboriginal women play such a predominant care-taking role within their communities (van Herk, Smith, & Andrew, 2010). For example, in urban centres across Canada, 80% to 90% of Aboriginal female-led households were found to exist below the poverty line, resulting largely from dependence on meagre levels of social assistance (Browne & Fiske,  2001).

 

It is important to emphasize that these inequities in health and social indicators are not due to lifestyle, behavioural, or cultural issues, rather, they are indicators of a complex interplay of social, political and economic determinants that influence health status and access to health services (Browne & Fiske, 2001). Thus, in studying maternal health care access and Aboriginal women's interactions with mainstream health services,  it is significant to understand how an intersection of disparities such as gender, class, and race along with the strains of domestic and paid labour have resulted in an unfair health burden borne in Aboriginal women in Canada. Social factors are more salient overall than health behaviours in determining health status, so health must be considered within the context of gender roles, access to social and economic capital, the geopolitical environment, cultural values and the impact of racism and sexism (Spitzer, 2005). Furthermore, neoliberal policies have reduced federal spending on social and health services, which has had the result of magnifying these inequities due to an increased burden on the individual to advocate for their own health, while at the same time making assumptions about who is privileged enough to access particular spaces and resources (Moore, 2008). 

 

In highlighting particular aspects of the social determinants of health for Aboriginal women in Canada, I am not intending to generalize the experiences of a large and diverse group of women. Rather, I've made reference to contemporary literature on barriers to access with the hope of providing a foundation for understanding how individual Aboriginal women's experiences with mainstream maternal health care practice reflect historical processes and systematic structures. With this understanding, I will use a feminist, intersectional perspective as the theoretical orientation to highlight some common themes that have arisen from the narratives of Aboriginal women's experiences accessing maternity care. 

 

 

References

 

Benoit,C., Carroll, D., & Chaudhry, M. (2003). In search of a healing place: Aboriginal women in vancouver's downtown eastside. Social Science & Medicine, 56(4), 821-833. 

Browne, A. J., & Fiske, J. (2001). First nations women's encounters with mainstream health care services. Western Journal of Nursing Research, 23(2), 126-147. 

Moore, S. E. H. (2010). Is the healthy body gendered? toward a feminist critique of the new paradigm of health. Body & Society, 16(2), 95-118. 

Spitzer, D. L. (2005). Engendering health disparities. Canadian Journal of Public Health/ Revue Canadienne De Sante's Publique, 96, s78-s96. 

van Herk, K. A, Smith, D., & Andrew, C. (2010). Identity matters: Aboriginal mothers' experiences of accessing health care. Contemporary Nurse: A Journal for the Australian Nursing Profession, 37(1), 57-68.