State of knowledge of Aboriginal health: A review of Aboriginal public health in Canada

128 Pages·2012·2.01 MB·English

The STaTe of Knowledge
of aboriginal healTh
A Review of Aboriginal Public Health in Canada
NATIONAL COLLABORATING CENTRE CENTRE DE COLLABORATION NATIONALE
FOR ABORIGINAL HEALTH DE LA SANTÉ AUTOCHTONE
©2012 National Collaborating Centre Acknowledgements Suggested citation:
for Aboriginal Health (NCCAH). National Collaborating Centre for
The National Collaborating Centre for Te National Collaborating Centre Aboriginal Health (2012). Te State
Aboriginal Health supports a renewed for Aboriginal Health would like to of Knowledge of Aboriginal Health: A
public health system in Canada that is acknowledge the contributions of Review of Aboriginal Public Health in
inclusive and respectful of diverse First representatives of regional ofces of the Canada. Prince George, BC: Author.
Nations, Inuit and Métis peoples. The Public Health Agency of Canada in
NCCAH is funded through the Public providing feedback on an earlier draf of
Health Agency of Canada and hosted at the this report, and for the assistance of West
University of Northern British Columbia, Coast Editorial Associates for their copy
in Prince George, BC. Production of this editing services.
report has been made possible through a
financial contribution from the Public Tis publication is available for download
Health Agency of Canada. The views at: www.nccah.ca
expressed herein do not necessarily represent
the views of the Public Health Agency.
ConTenTS
Executive Summary 4
Te State of Knowledge of Aboriginal Health:
A Review of Aboriginal Public Health in Canada 7
Defnitions 7
How Tis Report is Organized 8
1.0 Literature Review: Key Health Issues 9
1.1 Maternal, Fetal and Infant Health 9
1.2 Child Health 12
1.3 Communicable Diseases 14
1.4 Non-Communicable Diseases 16
1.5 Mental Health and Wellness 18
1.6 Violence, Abuse, Injury and Disability 21
1.7 Environmental Health 24
1.8 Food Security and Nutrition 27
1.9 Summary 29
References 29
2.0 Social Determinants of Health 37
2.1 Perspectives on the Social Determinants
of Health 37
2.2 Current Health Realities 42
2.3 Summary 59
References 60
3.0 National Aboriginal Health Programs
and Initiatives 65
3.1 Historical Overview 65
3.2 Te Current Context 65
3.3 Federal Health Programs and Initiatives 68
3.4 Summary 80
References 80
4.0 Provincial and Territorial Aboriginal
Health Programs and Initiatives 84
4.1 British Columbia 85
4.2 Alberta 88
4.3 Saskatchewan 91
4.4 Manitoba 94
4.5 Ontario 97
4.6 Quebec 101
4.7 New Brunswick 105
4.8 Prince Edward Island 106
4.9 Nova Scotia 109
4.10 Newfoundland and Labrador 110
4.11 Yukon 112
4.12 Northwest Territories 113
4.13 Nunavut 115
4.14 Summary 118
References 119
Conclusion 126
3
exeCuTive Summary
“Tere is clearly a great need for[...] equity
in the types of health-related programs and
initiatives ofered to Aboriginal peoples
across the provinces and territories, in order
to improve health and well-being in a
culturally appropriate and respectful way.”
In recent decades, there has been a partnership with the Public Health Aboriginal populations ofered by federal,
considerable improvement in the health Agency of Canada to compile a report provincial and territorial governments.
status of Aboriginal1 people in Canada. on the current state of knowledge of (Tese summaries are based on an Internet
Nevertheless, Aboriginal people continue Aboriginal health, which is intended search conducted in 2009, and therefore
to experience a consistently lower level of to inform a Public Health Agency of may not be inclusive of all programs and
health than do non-Aboriginal peoples. Canada Aboriginal Public Health Policy initiatives currently available).
Tere are multiple reasons for these health Framework. Te goal of Te State of the
disparities, and many national Aboriginal Knowledge of Aboriginal Health, therefore, Key Health Issues Facing
organizations, as well as federal, provincial is to provide a high-level summary of what Aboriginal Peoples
and territorial governments, are working is currently known about and being done
to eliminate these disparities. to improve the health of First Nations, While Canadians, on average, enjoy
Inuit, and Métis peoples. Te report some of the world’s best health care
To further understand the prevalence includes an overview of literature and and quality of life, Aboriginal peoples
of health issues among Aboriginal data pertaining to the health issues faced generally have poorer health than the
peoples, the underlying causes of these by Aboriginal peoples, an examination of non-Aboriginal population, particularly in
health issues, and what is being done to these issues from the perspective of social terms of maternal, fetal and infant health;
address them, the National Collaborating determinants of health, and summaries of child health; certain communicable and
Centre for Aboriginal Health formed current health programs and initiatives for non-communicable diseases; mental
1 Te Aboriginal peoples of Canada are defned, by Statistics Canada, as “persons who reported identifying with at least one Aboriginal group, that is, North American
Indian, Métis or Inuit [Eskimo], and/or those who reported being a Treaty Indian or a Registered Indian as defned by the Indian Act of Canada, and/or who were
members of an Indian Band or First Nation.” For the purposes of this report, “Aboriginal peoples” refers to these three population groups: First Nations, Métis and
Inuit, which is inclusive of those who are non-status Indians but who self-identify as First Nations or Inuit.
4
health and wellness; violence, abuse and determinants and lifestyle decisions, National Aboriginal Health
injury; and environmental health. Tis but also by a host of other factors that Programs and Initiatives
disproportionate burden of ill-health can infuence physical, mental and social
be largely attributed to adverse socio- health and well-being, a more holistic At the national level, Health Canada
economic conditions and historical perspective is required to understand has been providing health programs and
circumstances which have resulted in the current health disparities between services to status (registered) Indians
a higher prevalence of the risk factors Aboriginal Canadians and the general living on-reserve and to Inuit living within
for these conditions, such as alcohol population. A social determinants of their traditional territories since 1945.
or tobacco use, overcrowded housing health framework can provide this Te nature of how these programs and
conditions and inadequate diet. Tere holistic perspective. Social determinants services are being delivered has undergone
are considerable barriers to addressing of health are those factors that focus on considerable changes since the 1980s,
these health issues, such as geographic, the economic and social conditions that however, with the federal government
educational and economic barriers, that govern peoples’ lives. moving away from direct service delivery
afect access to health services. Te health to First Nations and Inuit communities.
issues facing Aboriginal peoples, and the Te World Health Organization and Most hospital care and primary health
barriers encountered in addressing them, the Public Health Agency of Canada services are provided through provincial
are not uniform across First Nations, have identifed some common social and territorial governments for all
Inuit and Métis peoples. If they are to be determinants that have considerable Aboriginal peoples, but there has also
efective, public health interventions must infuence on the health of individuals been devolution of responsibility towards
consider the unique contexts in which and communities. Tese international community-based health services. Te
Aboriginal people live. and national perspectives on social federal government’s direct role is now
determinants are inadequate for primarily through the implementation
Efective implementation of public understanding the health inequities of limited public health and prevention
health interventions requires current faced by Aboriginal peoples in Canada. services and health promotion programs
and relevant data. However, there are Indigenous-specifc social determinants, through the First Nations and Inuit
serious limitations in the current health such as the impacts of colonialism on Health Branch of Health Canada. Most
research and data for Aboriginal peoples. Aboriginal languages, culture and identity, of the programs and initiatives have been
At present, much of the available research underlie some of the most pervasive socio- implemented to address the existing
and data consider Aboriginal peoples as a economic inequities between Aboriginal health disparities between Aboriginal
homogenous group and fail to take into and non-Aboriginal Canadians. However, peoples and other Canadians. However,
account diferences among First Nations, Aboriginal peoples do not uniformly they are also primarily limited in scope
Inuit and Métis; among urban and rural experience the same social and economic to those Aboriginal peoples which fall
populations; and among on-reserve and disparities, nor are they equally afected under the federal government’s direct
of-reserve populations, with respect by colonial policies, and these diferences responsibility as defned under the Indian
to the health issues faced, the factors must be taken into consideration in Act. Only a few programs and initiatives
underlying these issues, and the challenges the development of public health have been implemented to assist First
in addressing them. Also lacking is data interventions. Nations that are not registered or live
that is longitudinal, national in scale, of-reserve, Inuit who live outside their
and compares the same variables across While attempts can be made to examine traditional territories, and Métis. Te
the same cohort over the same time each social determinant of health in federal government also provides funding
period. Tese limitations impede a full isolation, the determinants are in fact to a number of other non-governmental
understanding of the health of First multifaceted and interactive. Tis organizations to develop, implement or
Nations, Inuit and Métis peoples and the implies that if there are to be meaningful administer health programs and initiatives.
development of strategies to address their improvements in the health and well-being
unique health concerns and challenges. of Aboriginal Canadians, not only must Several of the health issues facing
public health strategies address the socio- Aboriginal peoples are well recognized
Social Determinants of Health economic disparities between Aboriginal and addressed by the federal government
and non-Aboriginal Canadians, but they through targeted programs and initiatives.
Given that health status is determined must also adopt an integrated and multi- Most notably, the federal government
by factors that go beyond genetic sectoral approach. has implemented several programs
The State of Knowledge of Aboriginal Health: A Review of Aboriginal Public Health in Canada 5
and initiatives aimed at the healthy consistency in the types of programs need for programs and initiatives that
development of infants and children, at and initiatives that are provided for refect the lived-world realities of the
improving overall health and reducing Aboriginal peoples across the provinces population they are intended to serve,
diabetes, and at reducing substance use/ and territories. and for equity in the types of health-
abuse. Other health issues are less well related programs and initiatives ofered to
addressed by the federal government, As with federal programs and Aboriginal peoples across the provinces
including those related to cancer, injury, initiatives, some Aboriginal health and territories, in order to improve health
mental health and respiratory illness. issues are recognized and addressed and well-being in a culturally appropriate
Tere were also few federal programs and more consistently across the provinces and respectful way. As well, there is a
initiatives available for Métis and urban and territories than others. While need to enhance access to programs and
Aboriginal populations. programs and initiatives related to early initiatives for Aboriginal peoples living
child development, maternal health outside urban centres (where most health
Provincial and Territorial and healthy living (physical activity/ programs and services are located) and
Aboriginal Health Programs nutrition) programs are fairly typical for non-status First Nations and Métis
and Initiatives across the provinces and territories, peoples who are currently excluded from
programs and initiatives in the areas most programs and initiatives and whose
Te provinces and territories are of suicide prevention, substance abuse, health needs are not being adequately
responsible for providing health care violence against women, cancer and addressed.
services for First Nations people living communicable diseases are less common,
of-reserve, Métis, those not eligible for particularly in provinces with low One limitation of this report is that
registration, and Inuit people not living proportions of Aboriginal people. its focus is on federal and provincial/
within their traditional territories. Tey Programs and initiatives in the territories territorial government programs and
are also responsible for hospital care and tend to be available more commonly to initiatives. Aboriginal organizations and
most primary health care services for the general public than to Aboriginal governments have been implementing
all Aboriginal peoples, including First peoples specifcally. And, despite a fairly some innovative health programs in
Nations on-reserve and Inuit. In addition, substantial Aboriginal population, few particular places that are more culturally
provincial and territorial governments also programs and initiatives that met our appropriate and refect the specifc
implement, either directly or indirectly, search criteria were identifed in Manitoba health needs of those communities.
health programs and initiatives targeted and Saskatchewan. Some of these programs also incorporate
at addressing current health disparities Aboriginal approaches to health and
between Aboriginal peoples and other Given the diversity of Aboriginal healing and are having positive impacts
Canadians. Te implementation and peoples across the country – refected on improving health. Te success of such
administration of programs and initiatives in Aboriginal cultures, socio-economic programs draws attention to the need to
within provinces and territories refects indicators and diferences in health recognize existing Aboriginal approaches
the complexity of health care provision priorities and needs – it is not surprising to health and healing.
for Aboriginal peoples in Canada that diversity and complexity are also
generally. While provincial and territorial refected in the implementation of
governments may develop, implement health programs and initiatives to serve
and administer such health programs this population. Nevertheless, in many
and initiatives directly, ofen this involves provinces and territories, too many health
multiple levels of government working in needs of Aboriginal peoples are expected
partnership with Aboriginal governments to be satisfactorily met through programs
and organizations. In addition, most and initiatives that are available to the
programs and initiatives are not province- general public, without regard for the
wide in scope, but are more local or unique context in which these health
regional. As a result, there is a lack of issues have arisen. Tere is clearly a greater
6
The STaTe of Knowledge of
aboriginal healTh
A Review of Aboriginal Public Health in Canada
It should come as no surprise that a with the Public Health Agency of Canada groups: First Nations, Métis and Inuit,
person’s overall health and well-being are to compile a report on the current state of which is inclusive of those who are non-
afected by a multitude of factors. To have knowledge of Aboriginal health, which is status Indians but who self-identify as
optimal health, people must have adequate intended to inform a Public Health Agency First Nations or Inuit.
nutrition and housing; they must live free of Canada Aboriginal Public Health Policy
from violence and substance abuse; they Framework. Te goal of this document, Public health
must feel like they are contributing to therefore, is to provide a comprehensive, Public health can be described as “the
their family, community or environment; high-level summary of what is currently science and art of promoting health,
and they must have timely access to known and being done for the health of preventing disease, prolonging life and
health care. When people do not have Canada’s Aboriginal peoples. improving quality of life through the
access to these basics of life, they become organized eforts of society.”3 Trough
increasingly vulnerable to serious Defnitions combining sciences, skills and beliefs,
medical conditions, such as chronic public health seeks to improve the health
diseases and mental illness. Alarmingly, In undertaking a knowledge-gathering of entire communities and of society as a
this is the state of health in which many exercise like this, and to frame the scope of whole. As such, it emphasizes two areas:
Aboriginal peoples in Canada live. In fact, this report, it is important to defne three “the prevention of disease, and the health
in almost every health-related area, the key terms: Canada’s “Aboriginal peoples”, needs of the population as a whole.”4
Aboriginal peoples of Canada experience “public health” and “public health policy
a consistently lower level of health than do initiative.” Public health policy initiative
the non-Aboriginal peoples. For the purposes of this report, the
The Aboriginal peoples of Canada term “public health policy initiative”
Tere are multiple reasons for the health Broadly speaking, the Aboriginal peoples refers to those programs and activities
disparities faced by Canada’s Aboriginal of Canada are defned, by Statistics that have been formed in response to
populations. Many national Aboriginal Canada, as “persons who reported federal, provincial or territorial, regional
organizations, as well as federal, identifying with at least one Aboriginal and organizational policies directly
provincial and territorial governments, group, that is, North American Indian, related to public health. As such, these
are working to eliminate these disparities. Métis or Inuit [Eskimo]), and/or those initiatives (programs, foundations) focus
To further understand the health issues who reported being a Treaty Indian or a on community or society-wide health
facing Canada’s Aboriginal peoples, the Registered Indian as defned by the Indian benefts. More specifcally, these initiatives
underlying causes of these health issues, Act of Canada, and/or who were members are aimed at addressing and eventually
and what is being done to address them, of an Indian Band or First Nation.”2 For eliminating the health disparities faced by
the National Collaborating Centre for the purposes of this report, “Aboriginal particular populations in Canada: First
Aboriginal Health formed a partnership peoples” refers to these three population Nations, Inuit and Métis.
2 Statistics Canada (2011). Defnitions, sources and symbols. Health profle, February 2011. Ottawa, ON: Statistics Canada. Retrieved April 30, 2011 from
http://www12.statcan.ca/health-sante/82-228/help-aide/DQ-QD04.cfm?Lang=E
3 Committee of Inquiry into the Future Development of the Public Health Function, 1988, as cited in National Advisory Committee on SARS and Public Health
(2003). Learning from SARS: Renewal of public health in Canada. Ottawa, ON: Health Canada, p. 46.
4 Premier’s Advisory Council on Health, 2001, as cited in National Advisory Committee on SARS and Public Health (2003), p. 46.
The State of Knowledge of Aboriginal Health: A Review of Aboriginal Public Health in Canada 7
How This Report is Organized categories, but are instead multifaceted programs and initiatives implemented at
and interactive. Te chapter draws on the provincial/territorial level for each
Tis report contains four substantive available published and unpublished province and territory. Each profle begins
chapters. literature on social determinants, as well with some context for the implementation
as statistical data, to demonstrate the of programs and initiatives in that
Chapter 1 provides an overview of disparities between Canada’s Aboriginal province or territory. Te programs
literature and data pertaining to and non-Aboriginal population with and initiatives are then split into two
the health issues faced by Canada’s regards to social determinants of health. sections. Te frst section includes health-
Aboriginal population. It summarizes related programs and initiatives that are
current knowledge of the prevalence Chapter 3 examines the role of the federal funded and administered directly by
and incidence of diseases for Aboriginal government in providing health programs the provincial/territorial government
peoples generally, and for First Nations, and initiatives for Aboriginal peoples. It for its Aboriginal population across the
Inuit and Métis peoples, where available. begins with a brief historical overview province or territory. Te second section
It also highlights some of the current gaps of the role of the federal government presents examples of other types of health-
in knowledge of these issues. Te chapter in public health, and then outlines its related programs and initiatives that are
draws on published and unpublished current roles and responsibilities in the available in that province or territory
literature released since 1995 in the areas provision of health programs and services. for its Aboriginal population, including
of maternal, fetal and infant health; child Te chapter then summarizes the public regional programs and initiatives that are
health; communicable diseases; chronic health programs and initiatives that have ofered through regional health authorities
diseases; childhood abuse/neglect; mental been developed by the federal government or municipalities, federal initiatives
health and wellness; unintentional injuries for, or have a targeted component for, that are administered by provincial or
and disabilities; environmental health; various Aboriginal populations. Tis list territorial governments and/or Aboriginal
and food security and nutrition. begins with an overview of programs and organizations, and programs and
initiatives that provide benefts spanning initiatives that are administered directly
Chapter 2 outlines an approach to multiple health areas. It is followed by Aboriginal organizations, such as
understanding the health issues faced by by programs and initiatives aimed at Aboriginal friendship centre associations.
Canada’s Aboriginal population. Tis improving Aboriginal peoples’ health in Tese programs and initiatives were
approach is rooted in an understanding the areas of children and youth; mental identifed through an Internet search in
of health as determined not only by health, suicide and substance use; chronic early 2009. Given the challenges associated
genetics and lifestyle decisions, but also diseases; communicable diseases; physical with Internet-based searches and the
by a host of other factors that infuence activity and nutrition; and environmental diferent ways programs and initiatives are
physical, mental and social health and health. It concludes with a summary of implemented across Canada, this section is
well-being and that are commonly referred federal programs and initiatives targeted not meant to be inclusive of all programs
to as “social determinants of health.” Te specifcally at the urban Aboriginal and initiatives available.
chapter begins by providing an overview population. Tese programs and
of what is meant by social determinants initiatives were located through a search of Te conclusion summarizes what has been
of health from international, national and federal government websites and reports learned about the state of knowledge of
Indigenous perspectives. It then brings in early 2009. Aboriginal public health in Canada. It
these perspectives together to examine summarizes the fndings from each of the
the disparities between Aboriginal and Te implementation of health-related four substantive chapters and uses them
non-Aboriginal people on a range of programs and initiatives for Aboriginal to highlight the gaps in knowledge and
social determinants and the impacts these peoples in Canada is complex. Not only in programs and initiatives that currently
disparities have had on the health of is the federal government involved, but exist in the eforts to meet the health
Aboriginal people in Canada specifcally. the programs and initiatives are ofen needs of Canada’s Aboriginal population.
Tese social determinants are organized implemented directly by provincial/
in six categories: socioeconomic status, territorial governments or through In addition, an annotated bibliography
children and youth, gender, health partnerships involving multiple levels developed from the literature that was
services, the physical environment, and of government and/or Aboriginal collected for and that formed the basis of
culture and language. It is important governments and organizations. Chapter Chapter 2 of this report is available as a
to note that these are not stand-alone 4 presents profles of health-related companion to this report.

8
Chapter 1:
liTeraTure review:
Key healTh iSSueS
Tis chapter provides an overview as the Aboriginal Healing Foundation topic is relatively sparse and focuses on
of the literature and data pertaining and the National Aboriginal Health two key themes: access to health care
to health issues faced by Canada’s Organization, among others; and by services generally and more culturally
Aboriginal population. It summarizes drawing on our own collection of appropriate care specifcally.
current knowledge of the prevalence and Aboriginal health resources. Tis is not a
incidence of diseases, conditions and systematic review, nor is there an attempt In remote and rural areas where many
health-related issues among Aboriginal to critically appraise the literature. Aboriginal communities are located,
peoples in Canada generally, and where lack of access to health services can
available, among First Nations (with and We would like to acknowledge the work be problematic because of population
without status, living on- and of-reserve), of the research team afliated with the density too low to support wide-
Inuit and Métis populations specifcally. Efective Public Health Practice Project ranging health services, lack of
It also highlights some of the gaps in at McMaster University for collecting the transportation infrastructure, northern
knowledge of these health issues. data that formed the basis of this chapter. climate conditions, and difculties in
Teir annotated bibliography of relevant communicating health issues and needs as
Te literature reviewed for this chapter literature forms a companion document a result of language and cultural barriers
includes published and unpublished to this report. However, the views and (Halseth & Ryser, 2006; Tait, 2008;
literature5 released since 1995 in the areas opinions expressed in this chapter remain National Aboriginal Health Organization
of maternal, fetal and infant health; child ours alone. [NAHO], 2008). Health services in
health; communicable diseases; chronic remote and isolated communities are
diseases; childhood abuse and neglect; 1.1 Maternal, Fetal and typically characterized by health centres
mental health and wellness; unintentional Infant Health that are stafed primarily by nurses rather
injuries and disability; environmental than physicians, critical shortages of
health; and food security and nutrition. Birthing and midwifery medical specialists and personnel, high
Peer-reviewed literature was identifed Birthing and midwifery has been turnover rates for health professionals,
through the use of scientifc databases identifed in the literature as an important limited programs, and lack of medical
such as PubMed, MEDLINE and the topic among Aboriginal women, whose equipment (NAHO, 2004, 2008; Rohan,
Applied Social Sciences Index, among fertility rate is nearly twice that of non- 2003; Smith, 2003). Tis forces the
others. Non-peer-reviewed literature was Aboriginal women (2.6 compared with majority of expectant mothers to travel
identifed through a search of the websites 1.5, respectively) (Statistics Canada, to larger urban centres at 36 weeks,
of government agencies and departments 2006a). Te fertility rate is highest among away from the support of their families
such as Health Canada and the Public Inuit (3.3) and lowest among Métis and communities, in order to give
Health Agency of Canada; through (2.2) women (Statistics Canada, 2006a). birth (NAHO, 2008; Rohan, 2003). In
national Aboriginal organizations such Despite this, the literature related to this addition, a lack of culturally relevant
5 Unpublished literature is ofen referred to as grey literature. Tis literature typically includes technical reports from government agencies or scientifc research groups,
working papers from research groups or committees, white papers or preprints. Tese sources of information may be available electronically on the Internet or as
hard copies, and since their distribution is not controlled by commercial publishing companies, they may lack basic information such as author, publication date or
publishing body. (Wikipedia, “Gray literature,” http://en.wikipedia.org/wiki/Gray_literature, accessed January 13, 2011).
The State of Knowledge of Aboriginal Health: A Review of Aboriginal Public Health in Canada 9
services, supports and facilities is a barrier regulations (NAHO, 2004). Aboriginal (Epoo & Van Wagner, 2005). Wider
to quality care for Aboriginal mothers midwives play an important role in expansion of Aboriginal midwifery is
(Tait, 2008; NAHO, 2008). It has been prenatal health promotion, providing restrained by multiple factors, including
recognized by national Aboriginal primary health services within the scope increasing regulations regarding midwifery
organizations and practitioners that of their practice, assessing prenatal risk practice, difculty in recruiting and
bringing birthing back to the communities and making appropriate referrals, and retaining midwives, lack of public funding
is a means of improving access to culturally assisting with the birth of infants (NAHO, for midwifery care, and requirements for
appropriate health services for expectant 2008). In addition, they provide expectant midwives to carry professional liability
Aboriginal mothers (NAHO, 2008; mothers with a choice about where they insurance (NAHO, 2004, 2008; Skye,
SOGC, 2007; Epoo & Van Wagner, 2005; would like to give birth. 2010; Smith, 2003).
Couchie & Sanderson, 2007; Van Wagner,
Epoo, Nastapoka & Hardy, 2007). Tere have been a number of recent Breastfeeding and infant nutrition
initiatives to support Aboriginal Very limited epidemiological data on
Te birthing process for Aboriginal midwifery, including the development of breastfeeding and infant nutrition are
women is entrenched in culture and Aboriginal midwifery training models and available, and what there is tends to focus
tradition. As a result, not only must Aboriginal community-based birthing primarily on breastfeeding initiation
health services for expectant mothers centres such as the Inuulitsivik Health and sustained breastfeeding rates. Rates
include modern forms of medical care, Centre in Puvirnituq, the Rankin Inlet have been found to be generally lower
but they must also incorporate tradition Birth Centre in Nunavut, and the Tsi for Aboriginal women than for other
and cultural beliefs (Skye, 2010; NAHO, Non:we Ionnakeratstha Ona:grahsta: Canadians (Black, Godwin & Ponka,
2008). Tis includes incorporating Six Nations Maternal and Child Centre 2008). Tese rates difered among First
traditional knowledge, medicine and in southern Ontario (NAHO, 2004, Nations, Inuit and Métis women. A
practices of maternal and child health, as 2008; Skye, 2010). Tere is some limited report edited by McShane, Smylie and
well as Aboriginal conceptions of health evidence demonstrating the success Adomako (2009) used data from the 2006
and well-being (Skye, 2010). While there of these birthing centres in improving Aboriginal Peoples Survey (APS) for First
is considerable diversity among Aboriginal prenatal care and birth experiences Nations (of-reserve), Inuit and Métis
populations regarding these conceptions for Aboriginal women (Couchie & women and the 2002/03 First Nations
of health and well-being, what is shared Sanderson, 2007). Tis is refected in some Regional Health Survey (RHS) for First
is a holistic view of health, where balance evaluations that show improvements in Nations women on-reserve to highlight
must be maintained mentally, physically, perinatal mortality rates, preterm labour, diferences in breastfeeding initiation
spiritually and emotionally (Skye, 2010). infant birth weight, breastfeeding and the and sustained breastfeeding among these
Increasing the number of Aboriginal rate of interventions such as C-sections groups of women (Figure 1.1). Tey
midwives to bring birthing back to the
communities is seen as one means of
Figure 1.1: Breastfeeding initiation and sustained breastfeeding among mothers, by Aboriginal identity
improving access to culturally appropriate
health services (Smith, 2002, as cited in
100
sustained
NAHO, 2008; NAHO, 2004; Healey &
90 breastfeeding
Meadows, 2007; Smith, 2003; Couchie &
at 6 months
80
Sanderson, 2007).
breastfeeding
70
initiation
Aboriginal midwives typically receive 60
their training either through community- 50
based training programs (as in Ontario 40
and Quebec) or through the passing on
30
of traditional knowledge and skills from
20
one generation of midwives to another
10
(NAHO, 2004). Some midwives, as in the
case of Manitoba and British Columbia,
First Nations First Nations Inuit Métis Canadian
prefer to be accredited and work within (off-reserve) (on-reserve) Population
the College of Midwifery, while others
want to be exempt from midwifery Sources: ACS 2006, RHS 2002/03 and NLSCY 2000/01 (as reported in McShane, Smylie & Adomako, 2009, p. 45)
10
Percentage of mothers