26 GladTidings

The infant mortality rate

among the Inuit is four times higher

than for the general Canadian

population.

M AT E R N A L a n d C H I L D H E A LT H A M O N G C A N A D A’ S

A B O R I G I N A L P E O P L E S

This is the fourth, and final study on maternal health.

Study1

Maternal and Child Health July/August 2013

Study2

Maternal Health in Afghanistan September/October 2013

Study 3

b y L i n d a P a t t o n - C o w i e

Maternal and Child Health in Malawi January/February 2014

Opening PrayerLeader: Creator God, you have given us the gift of life,All: you create no life in vain.Leader: You have created us to be in relationship with you and

with each other;All: we are fearfully and wonderfully made.Leader: Your works are beyond our understanding.All: You command us to love one

another as you love us;Leader: guide us now as we open our

hearts and minds to learn about the situation of our Aboriginal sisters and children.

All: Send your Spirit to be among us to inspire us, so that we may walk with all of our sisters and work together to raise healthy children in each community from coast to coast to coast. Amen.

Introduction“Health” can mean different things to different people. When we talk about maternal and child health among the Aboriginal peoples of Canada, it’s important to recognize what we mean. A Health Council of Canada report from 2011, says, “Aboriginal

11%of the total Aborigial Peoples population

in Canada is 0–6 years-old.

Statistics Canada, 2008

Smylie, J., & Adomako, P. (2009).

Indigenous children’s health report: Health assessment in action

27May/June2014

communities have always believed that health requires a focus on the bigger picture. A healthy life is seen as a balance between the physical, spiritual, emotional, and mental parts of ourselves.”1 As well, the community is a central focus when describing Aboriginal health; health “includes physical well-being but also the social, emotional, spiritual, and cultural well-being of the whole community. Each individual is able to achieve their full potential as a human being, thereby contributing to the entire well-being of the community. It is a whole life view and includes the cyclical concepts of life and death”.

It can help to visualize this using the Medicine Wheel, a central and important concept among Aboriginal people.2

Introduction to Aboriginal Groups in CanadaIn Canada, there are three Indigenous/Aboriginal groups recognized by the Constitution Act of 1982—First Nations, Inuit, and Métis. There are 633 First Nations groups with a population approaching one million. According to Statistics Canada, in 2011, the Métis people number over 400 000 and Inuit about 60 000. The Aboriginal people of Canada represent about four percent of the total population. First Nations and Inuit receive a range of services from Indian and Northern Affairs Canada and from First Nations and Inuit Health (Health Canada). Métis people are not eligible for similar support.

For Native Americans and Canadian First Nations, the international border crosses between traditional tribal territories (Iroquois, Ojibway, Blackfoot, and

Medicine Wheel3

Spiritual

Emotional

Mental

Physical

Dignity, Values, Connection, Reflection

Relationship, Empowerment, Cooperation,

Struggle

Action, Skills, Sustainability

Understanding,Awareness, Perspective,

Leadership

28 GladTidings

Salish peoples), and although linguistically and culturally diverse across North America, there are many commonalities on both sides. Most of the Indigenous cultural diversity in North America is seen west of the Rocky Mountains. Many Native Americans and Canadian First Nations view North America as one unit—Turtle Island.

The Inuit of Canada’s arctic regions are closely related to the Inuit of Greenland and Alaska. In Canada, there are four Inuit regions: Nunavut Territory (80 percent Inuit), and Inuvialuit, Nunavik, and Nunatsiavut. Greenland (Inuut Nunaat), part of Denmark, is mostly Inuit.

The Métis, descendants of European men and First Nations women in western Canada, are a unique Indigenous group with their own language and culture.4

The Importance of Maternal and Child Health among Canada’s Aboriginal Peoples

As Christians, we realize that when one of God’s children suffers, we are all diminished. It’s important to focus our attention on maternal and child health among our own Aboriginal peoples because, as the Health Council of Canada acknowledges, “while there is diversity among First Nations, Inuit, and Metis populations, there are significant overall health and economic disparities

29May/June2014

between the Aboriginal and non-Aboriginal Canadian population.”5 Here are just some of the differences:

• “Aboriginal people are much more likely to live in poor health and die prematurely.

• Aboriginal people have a higher burden of chronic conditions and of infectious disease.

• Aboriginal children are more likely to die in the first year of life.• Aboriginal people are more likely to live in poverty, which has a domino

effect on other aspects of their lives. They are more likely to go hungry, to suffer from poor nutrition and obesity, and to live in overcrowded, substandard housing.

• Aboriginal people are less likely to graduate from high school and more likely to be unemployed”. 6

The Lingering Effect of Residential SchoolsMany Canadians are not aware of the history of residential schools, or how the effects of these schools continue to impact current generations and, in fact, the entire Aboriginal culture. For many generations, children were removed from their homes, taken to distant residential schools, and separated from their families, their communities, their culture, and their language. Because the children were no longer exposed to positive parenting role models, parenting skills weren’t developed, and family connections disintegrated. “The fallout of this can be seen today in the form of low self-esteem, abuse, family violence, addictions, poor relationship and conflict resolution skills, high rates of single motherhood and teen pregnancy, mental health issues, lack of cultural knowledge, and a plethora of chronic health conditions.”7 Clearly, residential schools are still affecting current generations of Aboriginal peoples.

This is an area of specific concern to The Presbyterian Church in Canada. The Presbyterian Church in Canada operated eleven residential schools, two following Church Union in 1925 (Birtle School in Manitoba, and Cecilia Jeffrey School in Kenora, ON). In 1994, The 120th General Assembly adopted a confession that acknowledges our involvement in residential schools and asks for forgiveness.

30 GladTidings

Specific Areas of Health Concerns for Aboriginal Mothers and Children

Distance: Distance to birthing services from local communities is a specific area of concern for Aboriginal peoples. Many pregnant Aboriginal women live in northern and remote communities that are not served by a midwife or other appropriate health professional, and so they must leave their homes and families, often for several weeks during their last trimester, to travel to an area with more health services. At such a critical time in their lives, these women and their new babies are separated from their partners and support systems. When they do return home, their communities often lack post-natal services, such as support for breastfeeding and programs that educate and support new parents.

Limited Health Care: Aboriginal women and children have limited access to health care as a result of many factors: geography, transportation costs, lack of primary health care providers, language barriers, difficulty in coordinating services, and scarcity of specialized services such as support for children with special needs.

Fetal Alcohol Spectrum Disorder (FASD): Fetal Alcohol Spectrum Disorder has been identified as a concern in Canada’s Aborginal population.8 One of the challenges in this discussion, is that there is no definitive statistics on the incidence of FASD among our First Nation’s peoples. It is complex to diagnose, requiring a multi-disciplinary team. However, we know that alcohol abuse, including binge drinking, is common among Aboriginal women, and this does not stop when these women becomes pregnant. In the past, programs have focused almost exclusively on reducing the risk to the fetus, which is essential, but to focus treatment only during the pregnancy, does not help the mother or her child long-term.9

Those with FASD are known to suffer from life-long mental, physical, and developmental disabilities. In children this can show up in learning disabilities, poor memory, short attention spans, and poor judgment choices.10

Mental Health Issues: First Nations people are 35 percent more likely to suffer from mental health issues including suicide or self-inflicted injuries, which is 11 times higher than the national average.11 It’s imperative that culturally sensitive

31May/June2014

and traditional treatment protocols are developed and that more Aboriginal health workers are trained to deliver these services. About 16 percent of Aboriginal adults have faced severe depression, which is double the national average.12

Aboriginal women are especially susceptible to mental health issues because of high rates of sexual abuse towards Aboriginal women and a lack of support from their partners. This affects their self esteem, their physical and emotional health, and has a negative effect on her children.13

Among Aboriginal youth, we also see higher rates of psychiatric problems than that of non-Aboriginal youth. Some of the causes of this may be confused ethnic identity, and higher rates of abuse (especially among girls).14 Depression, or feelings of sadness, is seen more often in girls than boys.15 As well, suicide rates are much higher among Aboriginal youth, five to six times higher, than among non-Aboriginal youth.16

Discussion1. What does “good health” mean to you? Create your own

‘medicine wheel’ to show your ideas.2. Have you or anyone you known well experienced any of the

same health concerns that are over-represented among our Aboriginal peoples?

3. If you were faced with the choice of giving birth in a remote location with little trained support, or travelling and giving birth without your family and community support nearby,

what would you choose? Should any woman in Canada be forced to make such a decision?

32 GladTidings

Biblical Reflection1 Corinthians 12:12–26John 10:10Galatians 3:28

In small groups of 2–3, read the above passages. Read them individually, and then out loud slowly. 1. How do these texts pertain to the issues at hand? 2. What is God trying to tell us about maternal and child health and

how we should respond to the needs that have been identified in Canada today?

3. What does the Corinthians passage teach us about how we ought to live as communities of God’s children?

Closing PrayerCreator God,We thank you for the gift of life, and for the opportunity to learn more about our Aboriginal sisters and the issues they face as they seek to bear and raise healthy children. We thank you for health and social service professionals who make an effort to provide services that are relevant and culturally sensitive.

In our own lives, O God, help us to be more compassionate and understanding as we hear of the challenges faced by others. Inspire our holy imaginations so that we can work together to bring about real change that will benefit Aboriginal maternal and child health in Canada.

We pray this in the name of your precious Son, Jesus Christ. Amen.

Rev. Linda Patton-Cowie serves God among the people of St. Mark’s, in Orillia, ON. She is a member of the Healing and Reconciliation Committee of the PCC, and hopes that we will all—First Nations and Settlers alike—learn to live in right relations with each other.

For just as the body

is one and has many members, and all the members

of the body, though many, are one body, so it is with

Christ.1 Corinthians

12:12

33May/June2014

Aboriginal people in Canada:698,025 First Nations people389,785 Métis50,485 Inuit

2006 Census (Statistics Canada, 2008)

The infant mortality rate among the Inuit is four times higher than for the general Canadian population.

Smylie, J., & Adomako, P. (2009). Indigenous children’s health report:

Health assessment in action

“First Nations children born to teenagers has remained high since 1986, at about 100 births per 1,000 women—a rate seven times higher than that for other Canadian teenagers.”

Guimond, E., and N. Robitaille (2008). When Teenage Girls Have Children:

Trends and Consequences

1HealthCouncilofCanada.Understanding and Improving Aboriginal Maternal and Child Health in Canada; Conversations about Promising Practices across Canada.2011.p.5

2AboriginalHealthStrategy2010–2015.Strengthening the Circle: Partnering for Improved Health for Aboriginal People. Strengthening the Circle Partnership.2010.

3Katz,Jennifer,FNMI,AboriginalEducation&UDL.www.threeblockmodel.com.

4ProfMalcolmKingPhD,AlexandraSmithMD,ProfMichaelGraceyMD.Indigenous health part 2: the underlying causes of the health gap.TheLancet,Volume374,Issue9683,July2009.p.76–85.

5HealthCouncilofCanada,p.4.6Ibid.p.4.7Ibid.p.20.8Tait,Caroline.FetalAlcoholSyndromeAmongAboriginalPeopleinCanada:ReviewandAnalysisoftheIntergenerationalLinkstoResidentialSchoolsAboriginalHealingFoundation,Canada,2003.

9Ibid.p.xxi10Aboriginal Health Strategy 2010–2015.p.25.11HealthCouncilofCanada,p.4.12www.heretohelp.bc.ca/factsheet/aboriginal-mental-health-and-substance-use

13Ibid14Ibid.15NationalAboriginalHealthOrganization.RegionalHealthSurvey2002/03AdultSurveyHighlights.www.naho.ca/firstnations/english/regionalhealth.

16AboriginalHealingFoundation.Suicide among Aboriginal People in Canada; The Aboriginal Healing Foundation Research Series.AboriginalHealingFoundation,Ottawa,2007.

34 GladTidings

I heard God speak in the washroom, at Walmart of all places. It was a Friday afternoon, after a long day and a long week at school. I was tired and discouraged. As the pretend teacher, the substitute, I was having second thoughts about whether I was up to the task of teaching. I thought my school days were over. I thought wrong. Yes, I had been to the school concerts, school basketball games, and after-school pickups of family members, but I had not been in a classroom for 27 years. Over two decades earlier I had known the call to

youth ministry, the kind that happens outside a classroom, and so I had placed the chalk on the ledge, erased the board, and left the school to embrace the educational life of the church. Now, 27 years later, I was back. And I was not so sure that I wanted to be, or that I was meant to be.

It was with mixed feelings that I placed my name on the list for substitute teachers in my area. I was grateful for the professional education I had and how my time and education in youth ministry was valued by those who renewed my teaching licence. I was grateful for the hope of some work that allowed me to stay in my beloved homeland of the Maritimes. But, good heavens, I did not even know what the teacher dress code was now. Did I remember enough of my grammar and mathematical lessons to even have a chance in a classroom? But I needed a job!

My first day of teaching came the first week of school. Surprisingly, within an hour, all seemed familiar. Kids are kids wherever you find them. I survived. And better yet, so did the students! One day of teaching led to another and another, and by the end of September I had gotten past the unfamiliarity of the classroom, but not the idea of me being in the school and being a teacher. I still felt like a visitor and a pretend teacher. Then I went to Walmart. Coming out of the

by Audrey CameronOur Profession