Commentary – Why are we failing Aboriginal mothers? (Anna Podnos)
By Anna Podnos
In the last issue of the IMS Magazine we explored mood disorders and the stigma surrounding mental illness. One of the main mood disorders, major depression, occurs twice as frequently in women as it does in men and has a devastating effect on health, happiness, and productivity. Aboriginal mothers who are removed from their communities to give birth due to inadequate access to health care near their homes have high rates of post-partum depression, and this has a severe negative impact on infant health and development.
Aboriginal women in Canada are suffering from a lack of equitable access to culturally appropriate midwifery, and this is resulting in higher risks of adverse pregnancy and poorer infant health outcomes when compared to the general Canadian population.(1) Aboriginals are the fastest growing segment of the Canadian population, and almost half of them are under the age of 25. Not only are Aboriginal mothers younger than non-Aboriginal Canadian women, they are also having almost twice as many babies on average, and these babies tend to have high birth weight, which can be associated with infant birth trauma, asphyxia, and metabolic complications. Together with the major disparities in health status, housing, education, and food security and nutrition, it is clear that Aboriginal Canadians should be an important priority—not only for Canada, but also for the rest of the world, since infant mortality rate is the single most comprehensive indicator of the level of health development in a society and is recognized internationally in its inclusion in the World Health Organization’s Millennium Development Goals.(2)
Regrettably, we cannot even accurately estimate infant mortality, pre-term birth, still births, and maternal deaths during childbirth in Aboriginal Canadian communities due to the lack of data collection. Some reports indicate that still birth, infant mortality, and perinatal death rates for Aboriginal children are about double the Canadian average. Aboriginal women are at nearly twice the risk for maternal mortality compared to the overall Canadian population. There is a consistent lack of funding allocated to providing accessible care to the Aboriginal Canadians, especially remote and poverty-stricken communities. For example, Health Canada has recently eliminated funding to the Women’s Health Contribution Program, which supported on-reserve Aboriginal programming for maternal and infant health, as well as treatment for pregnant women and mothers addicted to drugs or alcohol.(3)
A majority of pregnant Aboriginal women from rural, isolated regions spend at least the last four weeks of pregnancy outside their communities, often without the baby’s father and extended families for support.(4) Given that in all Aboriginal cultures experienced midwives traditionally attend births, the removal of births from many Aboriginal communities has had profound spiritual and cultural consequences that have been linked to the loss of cultural identity. When women are separated from the support of their families and communities, there is an increase in small, premature infants, as well as maternal and newborn complications, including postpartum depression.(5) Providing women with access to culturally appropriate midwifery in their own communities could help improve the health of mothers and infants in a holistic way. An Aboriginal midwife is not only a primary health care provider who cares for pregnant women, babies, and their families throughout pregnancy and for the first weeks in the postpartum, but she also a promotes breastfeeding, nutrition, and passes on important values about health to the next generation.
Having birthing centres and trained midwives in marginalized Aboriginal communities could focus on low-risk pregnancies, with healthy mothers delivering healthy babies. Recently, a step in this direction was taken by opening the Toronto Birthing Centre in Regent Park, where women deliver babies in the care of their own midwives. Aboriginal women living in urban areas, such as Toronto, may be disconnected from their historical roots, so having a birthing centre provides a space “that speaks to them, and to their needs, and their philosophies, and their world views.”(6) Although this does not address the issue of access to culturally appropriate maternal and infant health care for people living in remote northern communities, it has the potential to inform us about practices that work best to solve indigenous health care issues. As an Ojibwa woman who gave birth at the Toronto Birthing Centre recalled in a Toronto Star interview, “Having midwives open to including First Nations’ traditions in the delivery made all the difference in feeling comfortable with giving birth.”(6)
The need for culturally appropriate midwifery in remote Canadian communities is clear—Aboriginal mothers are an especially vulnerable part of our population, and their needs should be addressed in a holistic and effective way—and it is time to speak up about this issue.
- First Nations and Inuit Health. Health Canada. 2013. Available from: www.hc-sc.gc.ca
- The Millenium Development Goals. Women and Children First. 2014. Available from: http://www.womenandchildrenfirst.org.uk/
- Health Canada’s Women’s contribution program cut. Winnipeg Free Press. 2012. Available from: http://www.winnipegfreepress.com/
- Healthier mothers and babies. Canadian Public Health Association. Available from: http://www.cpha.ca/
- Midwifery and Aboriginal Midwifery in Canada. National Aboriginal Health Organization. 2004. Available from: http://www.naho.ca/documents/naho/english/publications/DP_aboriginal_midwifery.pdf
- Aboriginal health care: Toronto’s first stand-alone birth centre geared to cultural practices. The Toronto Star. August 28, 2013. Available from: http://www.thestar.com/news/ gta/2013/08/28/aboriginal_health_care_torontos_first_standalone_birth_centre_geared_to_cultural_practices.html