Abstract
BackgroundDespite clear evidence regarding how social determinants of health and structural inequities shape health, Aboriginal women’s birth outcomes are not adequately understood as arising from the historical, economic and social circumstances of their lives. The purpose of this study was to understand rural Aboriginal women’s experiences of maternity care and factors shaping those experiences.MethodsAboriginal women from the Nuxalk, Haida and 'Namgis First Nations and academics from the University of British Columbia in nursing, medicine and counselling psychology used ethnographic methods within a participatory action research framework. We interviewed over 100 women, and involved additional community members through interviews and community meetings. Data were analyzed within each community and across communities.ResultsMost participants described distressing experiences during pregnancy and birthing as they grappled with diminishing local maternity care choices, racism and challenging economic circumstances. Rural Aboriginal women’s birthing experiences are shaped by the intersections among rural circumstances, the effects of historical and ongoing colonization, and concurrent efforts toward self-determination and more vibrant cultures and communities.ConclusionWomen’s experiences and birth outcomes could be significantly improved if health care providers learned about and accounted for Aboriginal people’s varied encounters with historical and ongoing colonization that unequivocally shapes health and health care. Practitioners who better understand Aboriginal women’s birth outcomes in context can better care in every interaction, particularly by enhancing women’s power, choice, and control over their experiences. Efforts to improve maternity care that account for the social and historical production of health inequities are crucial.
Highlights
Despite clear evidence regarding how social determinants of health and structural inequities shape health, Aboriginal women’s birth outcomes are not adequately understood as arising from the historical, economic and social circumstances of their lives
Despite clear evidence indicating that social determinants of health and structural inequities shape health, Aboriginala women’s birth outcomes may be presented without accounting for historical and current economic and social circumstances
Beyond modifying individual lifestyle behaviours, actions are required to diminish stressors arising from racism, poverty, and the organization, funding, and delivery of rural care
Summary
Despite clear evidence regarding how social determinants of health and structural inequities shape health, Aboriginal women’s birth outcomes are not adequately understood as arising from the historical, economic and social circumstances of their lives. Despite clear evidence indicating that social determinants of health and structural inequities shape health, Aboriginala women’s birth outcomes may be presented without accounting for historical and current economic and social circumstances. Recent research stresses the mechanisms preceding and underlying these differences. After controlling for income, smoking, and cervicovaginal infection, differences between Aboriginal and non Aboriginal women in low birth weight, prematurity, or macrosomia were statistically non-significant [3]. Poverty, stress, and low self esteem influenced the relatively high numbers of Aboriginal women who received inadequate prenatal care [5]. Kendall [1] recently argued that:
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