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This study reviews and synthesizes the literature on Indigenous women who are pregnant/early parenting and using substances in Canada to understand the scope and state of knowledge to inform research with the Aboriginal Health and Wellness Centre of Winnipeg in Manitoba and the development of a pilot Indigenous doula program. A scoping review was performed searching ten relevant databases, including one for gray literature. We analyzed 56 articles/documents. Themes include: (1) cyclical repercussions of state removal of Indigenous children from their families; (2) compounding barriers and inequities; (3) prevalence and different types of substance use; and (4) intervention strategies. Recommendations for future research are identified and discussed.
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Acessibilidade aos Serviços de Saúde , Serviços de Saúde do Indígena , Disparidades em Assistência à Saúde , Canadenses Indígenas , Poder Familiar , Transtornos Relacionados ao Uso de Substâncias , Criança , Feminino , Humanos , Gravidez , Canadá/epidemiologia , Serviços de Saúde do Indígena/estatística & dados numéricos , Manitoba/epidemiologia , Poder Familiar/etnologia , Canadenses Indígenas/etnologia , Canadenses Indígenas/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricosRESUMO
BACKGROUND: In Canada, Indigenous doulas, or birth workers, who provide continuous, culturally appropriate perinatal support to Indigenous families, build on a long history of Indigenous birth work to provide accessible care to their underserviced communities, but there is little research on how these doulas organize and administer their services. METHODS: Semi-structured interviews were conducted in 2020 with five participants who each represented an Indigenous doula collective in Canada. One interview was conducted in person while the remaining four were conducted over Zoom due to COVID-19. Participants were selected through Internet searches and purposive sampling. Interview transcripts were approved by participants and subsequently coded by the entire research team to identify key themes. RESULTS: One of the five emergent themes in these responses is the issue of fair compensation, which includes two sub-themes: the need for fair payment models and the high cost of affective labour in the context of cultural responsibility and racial discrimination. DISCUSSION: Specifically, participants discuss the challenges and limitations of providing high quality care to families with complex needs and who cannot afford to pay for their services while ensuring that they are fairly compensated for their labour. An additional tension arises from these doulas' sense of cultural responsibility to support their kinship networks during one of the most sacred and vulnerable times in their lives within a colonial context of racism and a Western capitalist economy that financializes and medicalizes birth. CONCLUSION: These Indigenous birth workers regularly expend more affective labour than mainstream non-racialized counterparts yet are often paid less than a living wage. Though there are community-based doula models across the United States, the United Kingdom, and Sweden that serve underrepresented communities, further research needs to be conducted in the Canadian context to determine an equitable, sustainable pay model for community-based Indigenous doulas that is accessible for all Indigenous families.
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COVID-19 , Doulas , Trabalho de Parto , Gravidez , Feminino , Humanos , Estados Unidos , Canadá , Doulas/psicologia , Pesquisa Qualitativa , Trabalho de Parto/psicologiaRESUMO
OBJECTIVES: To interview representatives from Indigenous doulas across Canada in order to document how they manage the logistics of providing community-based doula care and understand their challenges. These objectives inform the development of an Indigenous doula pilot programme as part of the project, 'She Walks With Me: Supporting Urban Indigenous Expectant Mothers Through Culturally Based Doulas'. METHODS: In 2020, semi-structured interviews were conducted with members of five Indigenous doula collectives across Canada. Interview transcripts were approved by participants and subsequently coded by the entire research team to identify key themes. RESULTS: Our article explores one of the main themes that emerged from these interviews: sustainable funding for Indigenous doula services. Within this theme we identified two sub-themes: (1) limitations on and regulations for available funding and (2) negative impacts of limited funding on doula service. CONCLUSION: A major challenge to providing Indigenous community-based doula services is sustainable funding. Current models of funding for this work often do not provide livable wages and are bound by limited durations and regulations that are unsustainable and can be culturally inappropriate. Due to this lack of sustainable funding, Indigenous doula service in Canada faces challenges that include high staff turnover and burnout and lack of time and resources to provide culturally safe care, pursue professional development and additional training, and keep their services affordable for the families who need them. Future research is needed to ascertain potential programmes and funding streams for sustainable Indigenous doula support in Canada, including possible integration of doula care into the universal public health care system despite the jurisdictional challenges in providing health care for Indigenous peoples.
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Doulas , Canadá , Atenção à Saúde , Feminino , HumanosRESUMO
BACKGROUND: In Canada, there has been a significant increase in the training of Indigenous doulas, who provide continuous, culturally appropriate support to Indigenous birthing people during pregnancy, birth, and the postpartum period. The purpose of our project was to interview Indigenous doulas across Canada in order to document how they worked through the logistics of providing doula care and to discern their main challenges and innovations. POPULATION/SETTING: Our paper analyzes interviews conducted with members of five Indigenous doula collectives across Canada, from the provinces of British Columbia, Manitoba, Ontario, Quebec and Nova Scotia. METHODS: Semi-structured interviews were conducted with members of the five Indigenous doula collectives across Canada in 2020 as part of the project, "She Walks With Me: Supporting Urban Indigenous Expectant Mothers Through Culturally Based Doulas." Interview transcripts were approved by participants and subsequently coded by the entire research team to identify key themes. RESULTS: Our paper examines two themes that emerged in interviews: the main challenges Indigenous doulas describe confronting when working within western systems, and how they navigate and overcome these obstacles. Specifically, interview participants described tensions with the biomedical approach to maternal healthcare and conflicts with the practice of Indigenous infant apprehension. In response to these challenges, Indigenous doulas are working to develop Indigenous-specific doula training curricula, engaging in collective problem-solving, and advocating for the reformation of a grant program in order to fund more Indigenous doulas. CONCLUSIONS: Both the biomedical model of maternal healthcare and the crisis of Indigenous infant apprehension renders Canadian hospitals unsafe and uncomfortable spaces for many Indigenous birthing people and their families. Indigenous doulas are continually navigating these challenges and creatively and concertedly working towards the revitalization of Indigenous birthing care. Indigenous doula care is critical to counter systemic, colonial barriers and issues that disproportionately impact Indigenous families, as well as recentering birth as the foundation of Indigenous sovereignty and community health.
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Assistência à Saúde Culturalmente Competente/etnologia , Doulas , Canadenses Indígenas , Serviços de Saúde Materna/normas , Parto/etnologia , Canadá/etnologia , Feminino , Humanos , Gravidez , Pesquisa QualitativaRESUMO
Though qualitative methods are often an appropriate Indigenous methodology and have dominated the literature on Indigenous research methods, they are not the only methods available for health research. There is a need for decolonizing and Indigenizing quantitative research methods, particularly in the discipline of epidemiology, to better address the public health needs of Indigenous populations who continue to face health inequities because of colonial systems, as well as inaccurate and incomplete data collection about themselves. For the last two decades, researchers in colonized countries have been calling for a specifically Indigenous approach to epidemiology that recognizes the limits of Western epidemiological methods, incorporates more Indigenous research methodologies and community-based participatory research methods, builds capacity by training more Indigenous epidemiologists, and supports Indigenous self-determination. Indigenous epidemiology can include a variety of approaches, including: shifting standards, such as age standardization, according to Indigenous populations to give appropriate weight to their experiences; carefully setting recruitment targets and using appropriate recruitment methods to fulfill statistical standards for stratification; acting as a bridge between Indigenous and Western technoscientific perspectives; developing culturally appropriate data collection tools; and developing distinct epidemiological methods based on Indigenous knowledge systems. This paper explores how decolonization and Indigenization of epidemiology has been operationalized in recent Canadian studies and projects, including the First Nations Regional Longitudinal Health Survey and how this decolonization and Indigenization might be augmented with the capacity-building of the future Our Health Counts Applied Indigenous Epidemiology, Health Information, and Health Services and Program Evaluation Training and Mentorship Program in Canada.
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OBJECTIVE: In the past few years, increasing numbers of Indigenous doula collectives have been forming across Canada. Indigenous doulas provide continuous, culturally appropriate support to Indigenous women during pregnancy, birth, and the post-partum period. This support is critical to counter systemic medical racism and socioeconomic barriers that Indigenous families disproportionately face. This paper analyzes interviews with members of five Indigenous doula collectives to demonstrate their shared challenges, strategies, and missions. METHODS: Qualitative interviews were conducted with members of five Indigenous doula collectives across Canada in 2020. Interviews were transcribed and returned to participants for their approval. Approved transcripts were then coded by all members of the research team to ascertain the dominant themes emerging across the interviews. RESULTS: Two prominent themes emerged in the interviews. The first theme is "Indigenous doulas responding to community needs." Participants indicated that responding to community needs involves harm reduction and trauma-informed care, supporting cultural aspects of birthing and family, and helping clients navigate socioeconomic barriers. The second theme is "Indigenous doulas building connections with mothers." Participants' comments on providing care to mothers emphasize the importance of advocacy in healthcare systems, boosting their clients' confidence and skills, and being the "right" doula for their clients. These two inter-related themes stem from Indigenous doulas' efforts to counter dynamics in healthcare and social services that can be harmful to Indigenous families, while also integrating cultural teachings and practices. CONCLUSION: This paper illustrates that Indigenous doula care responds to a wide range of issues that affect Indigenous women's experiences of pregnancy, birth, and the post-partum period. Through building strong, trusting, and non-judgemental connections with mothers and responding to community needs, Indigenous doulas play a critical role in countering medical racism in hospital settings and advancing the resurgence of Indigenous birthing sovereignty.
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Serviços de Saúde Comunitária , Doulas , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde do Indígena , Serviços de Saúde Comunitária/organização & administração , Doulas/psicologia , Feminino , Serviços de Saúde do Indígena/organização & administração , Humanos , Mães/psicologia , Mães/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa , EspiritualidadeRESUMO
Birthing can be an empowering experience for women. Within many Indigenous cultures around the world, birth is a ceremony to celebrate new life, acknowledging the passing from the spiritual world into the physical world. While initiatives to "indigenize" health care have been made, this paper argues that the United Nations Declaration on the Rights of Indigenous Peoples and the United Nations Sustainable Development Goals contain frameworks for Indigenous rights that include the right to incorporate Indigenous childbirth ceremonies into clinical practice. Examining the importance of birthplace, this paper details a current movement in Manitoba, Canada, to "bring birth home," which recognizes that the determinants of health experienced in the early stages of a child's development can have health implications for an individual's future.
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Direitos Humanos , Parto , Feminino , Humanos , Povos Indígenas , Grupos Populacionais , Gravidez , Nações UnidasRESUMO
The purpose of this review is to summarise past Inuit health and wellness studies in Manitoba and the Kivalliq region of Nunavut to provide a snapshot of the types of studies available and identify the gaps in knowledge. Research to date has largely been disease-based and often provides comparisons between Indigenous and non-Indigenous people. Distinct Inuit experiences are rarely written about from an Inuit perspective. However, Inuit Tapiriit Kanatami, the national organisation of Inuit in Canada, and Pauktuutit Inuit Women of Canada have been leaders in strengths-based community research and publications that address priorities determined by the Inuit, including the 2018 Inuit Tapiriit Kanatami document National Inuit Strategy on Research (132).