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Mollons M, Levasseur-Puhach S, Kaur J, Doyle J, Giesbrecht G, Lebel CA, Woods L, Tomfohr-Madsen L, Roos L. Mixed-methods study exploring health service access and social support linkage to the mental well-being of Canadian Indigenous pregnant persons during the COVID-19 pandemic. BMJ Open 2024; 14:e078388. [PMID: 38553054 PMCID: PMC11005712 DOI: 10.1136/bmjopen-2023-078388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES This study aimed to explore how the unprecedented stressors associated with the COVID-19 pandemic may have contributed to heightened levels of depression and anxiety among pregnant Indigenous persons, and identify protective individual-level factors. DESIGN The current study used a mixed-methods design including standardised questionnaires and open-ended response questions. Using hierarchical regression models, we examined the extent to which COVID-19-related factors of service disruption (ie, changes to prenatal care, changes to birth plans and social support) were associated with mental well-being. Further, through qualitative analyses of open-ended questions, we examined the coping strategies used by pregnant Indigenous persons in response to the pandemic. SETTING Participants responded to an online questionnaire consisting of standardised measures from 2020 to 2021. PARTICIPANTS The study included 336 self-identifying Indigenous pregnant persons in Canada. RESULTS Descriptive results revealed elevated rates of clinically relevant depression (52.7%) and anxiety (62.5%) symptoms among this population. 76.8% of participants reported prenatal care service disruptions, including appointment cancellations. Thematic analyses identified coping themes of staying informed, social and/or cultural connections and activities, and internal mental well-being strategies. Disruptions to services and decreased quality of prenatal care negatively impacted mental well-being of Indigenous pregnant persons during the COVID-19 pandemic. CONCLUSIONS Given the potential for mental well-being challenges to persist and long-term effects of perinatal distress, it is important to examine the quality of care that pregnant individuals receive. Service providers should advance policies and practices that promote relationship quality and health system engagement as key factors linked to well-being during the perinatal period for Indigenous persons.
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Affiliation(s)
- Meghan Mollons
- Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Jasleen Kaur
- Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Jennifer Doyle
- Educational and Counselling Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerald Giesbrecht
- Alberta Children's Hospital Research Institute, Calgary, Province of Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Province of Alberta, Canada
| | - Catherine A Lebel
- Alberta Children's Hospital Research Institute, Calgary, Province of Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Province of Alberta, Canada
| | | | - Lianne Tomfohr-Madsen
- Educational and Counselling Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie Roos
- Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba Children's Hospital Research Institute, Winnipeg, Manitoba, Canada
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Mathias H, Foster LA, Rushton A. Programs and practices that support pregnant people who use drugs' access to sexual and reproductive health care in Canada: a scoping review. BMC Pregnancy Childbirth 2024; 24:72. [PMID: 38254076 PMCID: PMC10804510 DOI: 10.1186/s12884-023-06225-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Pregnant people who use unregulated drugs (PPWUD) are at high risk of health complications yet experience a range of barriers to sexual and reproductive health care. Given that improving maternal health and access to reproductive health care are key targets underpinning the Sustainable Development Goals (SDG), there is an urgent need to improve access to appropriate supports and services for this population. Little is known about what programs and practices exist to support PPWUD's access to sexual and reproductive health care. This scoping review aimed to identify the available literature on these programs and practices in Canada. METHODS A scoping review was conducted using JBI methodology and reported using PRISMA guidelines. Scholarly databases and grey literature sources were searched to identify literature published between 2016-2023 in English or French that discussed, defined, conceptualised, or evaluated programs and practices that support PPWUD's access to sexual and reproductive health care in Canada. Identified literature was screened using Covidence. Data were extracted from included texts, then analysed descriptively. Frequencies and key concepts were reported. RESULTS A total of 71 articles were included, most of which were grey literature. Of the total, 46 unique programs were identified, as well as several useful practices. Most programs were in urban centres in Western Canada, and most programs offered holistic 'wrap-around services.' Several programs delivered these services on-site or as 'drop-in' programs with the support of staff with lived/living experience of substance use. Most frequent program outcomes included keeping parents and children together, improving connection to other services, and reducing substance use harms. Noted helpful practices included non-judgmental care and the use of harm-reduction strategies. CONCLUSIONS Several programs and practices that support PPWUD exist in Canada, though few focus exclusively on sexual and reproductive health. There remain opportunities to improve access to programs, including expanding geographic availability and range of services. The review has clinical application by providing an overview of available programs that may support clinicians in identifying services for PPWUD. Future research should consider client perspectives and experiences of these programs. REVIEW REGISTRATION NUMBER Open Science Framework https://osf.io/5y64j .
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Affiliation(s)
- Holly Mathias
- School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada.
| | - Lesley Ann Foster
- Department of Cultural Studies, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada
| | - Ashleigh Rushton
- Faculty of Health Sciences, The University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C, V2R 0N3, Canada
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Doherty E, Wiggers J, Wolfenden L, Tully B, Lecathelinais C, Attia J, Elliott EJ, Dunlop A, Symonds I, Rissel C, Tsang TW, Kingsland M. Differential effectiveness of a practice change intervention to improve antenatal care addressing alcohol consumption during pregnancy: Exploratory subgroup analyses within a randomised stepped-wedge controlled trial. Midwifery 2023; 116:103528. [PMID: 36334528 DOI: 10.1016/j.midw.2022.103528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A practice change intervention demonstrated improvements in the provision of antenatal care addressing alcohol consumption. The aim of this study was to explore whether the effectiveness of the intervention differed between subgroups of pregnant women and types and location of maternity services. DESIGN AND SETTING Post-hoc exploratory subgroup analyses of the outcomes from a randomised stepped-wedge controlled trial conducted with all public maternity services within three sectors of a local health district in Australia. MEASUREMENTS Two outcomes (receipt of alcohol assessment and complete care) measured at two visit types (initial and subsequent) were included in analyses. Logistic regression models explored interactions between pre-post differences and subgroups of women (age, Aboriginal origin, education level, disadvantage, gravidity and alcohol consumption in pregnancy) and services (geographic remoteness, service and provider type/s) that have been reported to be associated with variation in guideline implementation. FINDINGS Surveys from 5694 women were included in the analyses. For the initial visit, no significant differential intervention effects between subgroups of women or type/location of services were found for either outcome. For subsequent visits, the intervention effect differed significantly only between Aboriginal origin subgroups (Aboriginal OR: 1.95; 95% CI: 0.99-3.85; non-Aboriginal OR: 5.34; 95% CI: 4.17-6.83; p<0.01) and women's alcohol consumption in pregnancy subgroups (consumed alcohol OR: 1.28; 95% CI: 0.59-2.78; not consumed alcohol OR: 5.22; 95% CI: 4.11-6.65; p<0.001) for assessment of alcohol consumption. KEY CONCLUSIONS These exploratory results suggest that the intervention may have had similar effects between different subgroups of women and types and location of services, with the exception of women who were non-Aboriginal and women who had not consumed alcohol, for whom the intervention was potentially more effective. IMPLICATIONS FOR PRACTICE The practice change intervention could be implemented with different maternity service and provider types to effectively support improvements in antenatal care addressing alcohol consumption. These exploratory results provide further data for hypothesis generation regarding targeted areas for the testing of additional strategies that enable Aboriginal women to benefit equally from the intervention, and to ensure those women most in need of care, those consuming alcohol during pregnancy, have their care needs met.
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Affiliation(s)
- Emma Doherty
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia.
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
| | - Belinda Tully
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia
| | - Christophe Lecathelinais
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, New South Wales 2006, Australia; Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales 2145, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales 2302, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Chris Rissel
- College of Medicine and Public Health, Flinders University, Casuarina, Northern Territory 0909, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, New South Wales 2006, Australia; Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales 2145, Australia
| | - Melanie Kingsland
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
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Toombs E, Lund J, Radford A, Drebit M, Bobinski T, Mushquash CJ. Adverse Childhood Experiences (ACEs) and Health Histories Among Clients in a First Nations-Led Treatment for Substance Use. Int J Ment Health Addict 2022:1-21. [PMID: 35937611 PMCID: PMC9341413 DOI: 10.1007/s11469-022-00883-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/11/2022] Open
Abstract
First Nations adults continue to experience significant health disparities compared to non-First Nations adults in Canada. Ongoing difficulties associated with intergenerational trauma among First Nations peoples may be examined using the adverse childhood experiences (ACEs) model, which measures various forms of abuse, neglect, and household dysfunction. We examined prevalence rates of ACEs and physical and mental health outcomes within a predominately First Nation sample of clients seeking substance use treatment from a First Nations-led treatment facility. The prevalence of ACEs was higher than national averages and previous data collected with broader Indigenous samples in Canada. Descriptive analyses of ACEs and health outcomes for those seeking First Nations-led substance use treatment showed these participants had more chronic health difficulties co-morbid with clinical levels of problematic substance use. To improve ongoing best-treatment options for those seeking substance use treatment, continued assessment and promotion of broader aspects of health and wellbeing are required, including the balance of physical, emotional, spiritual, and mental health and wellbeing across a lifespan.
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Affiliation(s)
- Elaine Toombs
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
- Dilico Anishinabek Family Care, Fort William First Nation, ON Canada
| | - Jessie Lund
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
| | - Abbey Radford
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
| | - Meagan Drebit
- Dilico Anishinabek Family Care, Fort William First Nation, ON Canada
| | - Tina Bobinski
- Dilico Anishinabek Family Care, Fort William First Nation, ON Canada
| | - Christopher J. Mushquash
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
- Dilico Anishinabek Family Care, Fort William First Nation, ON Canada
- Northern Ontario School of Medicine (NOSM), Lakehead University, Thunder Bay, ON Canada
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON Canada
- Thunder Bay Regional Health Research Institute, Thunder Bay, ON Canada
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Allen L, Wodtke L, Hayward A, Read C, Cyr M, Cidro J. Pregnant and early parenting Indigenous women who use substances in Canada: A scoping review of health and social issues, supports, and strategies. J Ethn Subst Abuse 2022; 22:827-857. [PMID: 35238726 DOI: 10.1080/15332640.2022.2043799] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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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Affiliation(s)
| | | | | | - Chris Read
- McMaster University, Hamilton, Ontario, Canada
| | - Monica Cyr
- Aboriginal Health and Wellness Centre, Winnipeg, Manitoba, Canada
| | - Jaime Cidro
- University of Winnipeg, Winnipeg, Manitoba, Canada
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6
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Ackerman M, Madampage C, Epp LJ, Gartner K, King A. An environmental scan of impacts and interventions for women with methamphetamine use in pregnancy and their children. Int J Gynaecol Obstet 2021; 155:220-238. [PMID: 34358330 PMCID: PMC9291965 DOI: 10.1002/ijgo.13851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Indigenous women are overrepresented among people who use (PWU) methamphetamine (MA) due to colonialism and intergenerational trauma. Prenatal methamphetamine exposure (PME) is increasing as the number of PWUMA of childbearing age grows. Yet impacts of MA in pregnancy and effective interventions are not yet well understood. OBJECTIVE We conducted an environmental scan of published and grey literature (2010-2020) to determine effects of MA use in pregnancy for mothers and their offspring, effective interventions and implications for Indigenous women. SEARCH STRATEGY A strategic search of Ovid Medline, Embase, ProQuest-Public Health and CINAHL databases identified academic literature, while Google and ProQuest-Public Health identified grey literature. SELECTION CRITERIA Article selection was based on titles, abstracts and keywords. The time frame captured recent MA composition and excluded literature impacted by coronavirus disease 2019. DATA COLLECTION AND ANALYSIS Data extracted from 80 articles identified 463 results related to 210 outcomes, and seven interventions. Analysis focused on six categories: maternal, neonatal/infant, cognitive, behavioral, neurological, and interventions. MAIN RESULTS Maternal outcomes were more congruent than child outcomes. The most prevalent outcomes were general neonatal/infant outcomes. CONCLUSION A lack of Indigenous-specific research on PME and interventions highlights a need for future research that incorporates relevant historical and sociocultural contexts.
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Affiliation(s)
- Melissa Ackerman
- Indigenous Wellness Research Group, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Claudia Madampage
- Indigenous Wellness Research Group, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lynette J Epp
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kali Gartner
- Department of Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alexandra King
- Indigenous Wellness Research Group, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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7
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Culturally Safe, Strengths-Based Parenting Programs Supporting Indigenous Families Impacted by Substance Use—a Scoping Review. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00237-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Menard-Kocik J, Caine V. Obstetrical Nurses' Perspectives of Pregnant Women Who Use Illicit Substances and Their Provision of Care: A Thematic Analysis. Can J Nurs Res 2019; 53:47-55. [PMID: 31529999 DOI: 10.1177/0844562119870419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The growing number of pregnant women using illicit substances presents a serious public health concern. PURPOSE The purpose of this study was to explore obstetrical nurses' perspectives toward caring for pregnant women who use illicit substances in a large inner-city hospital in Western Canada. METHODS Guided by an interpretivist and social constructivist epistemological approach, I engaged in a thematic content analysis of qualitative semistructured interviews. In total 18 registered nurses from multiple obstetrical units were recruited. RESULTS Four major themes were identified: (i) services and care were recognized through elements of caring, creating a welcoming environment, and providing client-centered care; (ii) stigma and discrimination impacted nurses preconceptions of care; (iii) coping mechanisms were necessary when struggling professionally; and (iv) recommendations of continuing specialized education were identified. CONCLUSION Obstetrical nurses highlighted a number of conflicting views about caring for pregnant women who use illicit substances. Key actions, such as establishing professional support when nurses experience ethical distress or when they are unable to provide meaningful care to patients, were suggested. Strong recommendations for ongoing professional development, as well as increased educational opportunities during prelicensure programs were made in order to support nurses in their role.
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Affiliation(s)
| | - Vera Caine
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Schultz K, Teyra C, Breiler G, Evans-Campbell T, Pearson C. "They Gave Me Life": Motherhood and Recovery in a Tribal Community. Subst Use Misuse 2018; 53:1965-1973. [PMID: 29578829 DOI: 10.1080/10826084.2018.1449861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE This study explored factors related to substance misuse and recovery among Native mothers in a Pacific Northwest tribe, focusing on motherhood as a motivating factor in seeking treatment and sustaining recovery. METHOD Using a community-based participatory research approach, we conducted a thematic analysis of 20 in-depth interviews and one focus group (N = 12) with Native women 18 years and older living on or near the reservation. RESULTS Qualitative findings highlighted challenges, motivations and strategies for seeking treatment and recovery in four major themes: (a) the close relationship between interpersonal violence and substance misuse; (b) traditional healing in recovery; (c) community-specific challenges to recovery; and (d) the motivating role of motherhood in seeking treatment and successful recovery. CONCLUSIONS A central finding of this work is that pregnancy and motherhood may be underexplored factors in Native women's substance use. Results support previous work suggesting that Native women are at high risk of interpersonal trauma and that trauma contributes to substance misuse. Findings offer several rich implications for treatment and recovery among Native mothers in tribal communities including the necessity of trauma-informed treatment, community and culturally-based interventions, more integration of treatment services with Child Protective Services, and drawing on motherhood as a motivation for seeking and succeeding in recovery.
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Affiliation(s)
- Katie Schultz
- a School of Social Work, University of Michigan , Ann Arbor , Michigan , USA
| | - Ciwang Teyra
- b Department of Social Work , National Taiwan University , Taipei , Taiwan
| | - Glenda Breiler
- c Indigenous Wellness Research Institute, School of Social Work, University of Washington , Seattle , Washington , USA
| | - Tessa Evans-Campbell
- c Indigenous Wellness Research Institute, School of Social Work, University of Washington , Seattle , Washington , USA
| | - Cynthia Pearson
- c Indigenous Wellness Research Institute, School of Social Work, University of Washington , Seattle , Washington , USA
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Cook JL, Green CR, de la Ronde S, Dell CA, Graves L, Morgan L, Ordean A, Ruiter J, Steeves M, Wong S. Screening and Management of Substance Use in Pregnancy: A Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 39:897-905. [PMID: 28935055 DOI: 10.1016/j.jogc.2017.07.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 11/28/2022]
Abstract
Substance use during pregnancy has important implications for health care providers, policy makers, and can negatively impact a woman's health and the health of her children. Understanding trends, patterns of use and outcomes are critical to prevention campaigns, building awareness, and providing effective care. This review will discuss the current therapeutic approaches and recommendations for screening and patient management for substance use in pregnancy and during the postpartum period, and it is geared towards any care providers who care for patients or those who may care for patients who may be at risk for substance use during pregnancy.
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Affiliation(s)
- Jocelynn L Cook
- The Society for Obstetricians and Gynaecologists of Canada and the Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON.
| | - Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | | | | | - Lisa Graves
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | | | - Alice Ordean
- Department of Family and Community Medicine, University of Toronto and St. Joseph's Health Centre, Toronto, ON
| | | | - Megan Steeves
- School of Public Health, University of Saskatchewan, Saskatoon, SK
| | - Suzanne Wong
- Department of Obstetrics and Gynecology and Department of Family and Community Medicine, University of Toronto, Toronto, ON
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Shahram SZ, Bottorff JL, Oelke ND, Kurtz DLM, Thomas V, Spittal PM, And For The Cedar Project Partnership. Mapping the social determinants of substance use for pregnant-involved young Aboriginal women. Int J Qual Stud Health Well-being 2017; 12:1275155. [PMID: 28140776 PMCID: PMC5328333 DOI: 10.1080/17482631.2016.1275155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
There is a dearth of knowledge about the social determinants of substance use among young pregnant-involved Indigenous women in Canada from their perspectives. As part of life history interviews, 17 young pregnant-involved Indigenous women with experiences with substances completed a participant-generated mapping activity CIRCLES (Charting Intersectional Relationships in the Context of Life). As women created their maps, they discussed how different social determinants impacted their experiences with pregnancy and substance use. The social determinants identified and used by women to explain determinants of their substance use were grouped into 10 themes: traumatic life histories; socioeconomic status; culture, identity and spirituality; shame and guilt; mental wellness; family connections; romantic and platonic relationships; strength and hope; mothering; and the intersections of determinants. We conclude that understanding the context and social determinants of substance use from a woman-informed perspective is paramount to informing effective and appropriate programs to support young Indigenous women who use substances.
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Affiliation(s)
- Sana Z Shahram
- a Faculty of Health and Social Development , University of British Columbia , Kelowna , Canada
| | - Joan L Bottorff
- b Institute for Healthy Living and Chronic Disease Prevention, and School of Nursing, Faculty of Health and Social Development , University of British Columbia , Kelowna , Canada.,c Faculty of Health Sciences , Australian Catholic University , Melbourne , Australia
| | - Nelly D Oelke
- d School of Nursing, Faculty of Health and Social Development , University of British Columbia , Kelowna , Canada
| | - Donna L M Kurtz
- d School of Nursing, Faculty of Health and Social Development , University of British Columbia , Kelowna , Canada
| | | | - Patricia M Spittal
- f School of Population and Public Health , University of British Columbia , Vancouver , Canada
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12
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Shahram SZ, Bottorff JL, Oelke ND, Dahlgren L, Thomas V, Spittal PM. The Cedar Project: Using Indigenous-specific determinants of health to predict substance use among young pregnant-involved Indigenous women in Canada. BMC Womens Health 2017; 17:84. [PMID: 28915868 PMCID: PMC5603064 DOI: 10.1186/s12905-017-0437-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/28/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Indigenous women in Canada have been hyper-visible in research, policy and intervention related to substance use during pregnancy; however, little is known about how the social determinants of health and substance use prior to, during, and after pregnancy intersect. The objectives of this study were to describe the social contexts of pregnant-involved young Indigenous women who use substances and to explore if an Indigenous-Specific Determinants of Health Model can predict substance use among this population. METHODS Using descriptive statistics and hierarchical logistic regression guided by mediation analysis, the social contexts of pregnant-involved young Indigenous women who use illicit drugs' lives were explored and the Integrated Life Course and Social Determinants Model of Aboriginal Health's ability to predict heavy versus light substance use in this group was tested (N = 291). RESULTS Important distal determinants of substance use were identified including residential school histories, as well as protective factors, such as sex abuse reporting and empirical evidence for including Indigenous-specific determinants of health as important considerations in understanding young Indigenous women's experiences with pregnancy and substance use was provided. CONCLUSIONS This analysis provided important insight into the social contexts of women who have experiences with pregnancy as well as drug and/or alcohol use and highlighted the need to include Indigenous-specific determinants of health when examining young Indigenous women's social, political and historical contexts in relation to their experiences with pregnancy and substance use.
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Affiliation(s)
- Sana Z. Shahram
- Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Present Address: Postdoctoral Research Fellow, Centre for Addictions Research of British Columbia, University of Victoria, PO Box 1700, STN CSC Victoria, Victoria, BC V8W 2Y2 Canada
- 15890 Greenhow Road, Oyama, BC V4V 2E6 Canada
| | - Joan L. Bottorff
- Institute for Healthy Living and Chronic Disease Prevention, and School of Nursing, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Nelly D. Oelke
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
| | - Leanne Dahlgren
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, 1190 Hornby Street 4th Floor, Vancouver, BC V6Z 2K5 Canada
| | | | - Patricia M. Spittal
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - For the Cedar Project Partnership
- Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Institute for Healthy Living and Chronic Disease Prevention, and School of Nursing, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, 1190 Hornby Street 4th Floor, Vancouver, BC V6Z 2K5 Canada
- Wuikinuxv Nation, The Cedar Project, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
- Present Address: Postdoctoral Research Fellow, Centre for Addictions Research of British Columbia, University of Victoria, PO Box 1700, STN CSC Victoria, Victoria, BC V8W 2Y2 Canada
- 15890 Greenhow Road, Oyama, BC V4V 2E6 Canada
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Nelson SE, Wilson K. The mental health of Indigenous peoples in Canada: A critical review of research. Soc Sci Med 2017; 176:93-112. [PMID: 28135694 DOI: 10.1016/j.socscimed.2017.01.021] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 12/06/2016] [Accepted: 01/16/2017] [Indexed: 01/18/2023]
Abstract
Many scholars assert that Indigenous peoples across the globe suffer a disproportionate burden of mental illness. Research indicates that colonialism and its associated processes are important determinants of Indigenous peoples' health internationally. In Canada, despite an abundance of health research documenting inequalities in morbidity and mortality rates for Indigenous peoples, relatively little research has focused on mental health. This paper provides a critical scoping review of the literature related to Indigenous mental health in Canada. We searched eleven databases and two Indigenous health-focused journals for research related to mental health, Indigenous peoples, and Canada, for the years 2006-2016. Over two hundred papers are included in the review and coded according to research theme, population group, and geography. Results demonstrate that the literature is overwhelmingly concerned with issues related to colonialism in mental health services and the prevalence and causes of mental illness among Indigenous peoples in Canada, but with several significant gaps. Mental health research related to Indigenous peoples in Canada overemphasizes suicide and problematic substance use; a more critical use of the concepts of colonialism and historical trauma is advised; and several population groups are underrepresented in research, including Métis peoples and urban or off-reserve Indigenous peoples. The findings are useful in an international context by providing a starting point for discussions, dialogue, and further study regarding mental health research for Indigenous peoples around the world.
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Affiliation(s)
- Sarah E Nelson
- University of Toronto Mississauga, Department of Geography, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada.
| | - Kathi Wilson
- University of Toronto Mississauga, Department of Geography, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada
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Shahram SZ, Bottorff JL, Kurtz DLM, Oelke ND, Thomas V, Spittal PM. Understanding the Life Histories of Pregnant-Involved Young Aboriginal Women With Substance Use Experiences in Three Canadian Cities. QUALITATIVE HEALTH RESEARCH 2017; 27:249-259. [PMID: 27401489 DOI: 10.1177/1049732316657812] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Despite attention paid to substance use during pregnancy, understandings of young Aboriginal women's experiences based on their perspectives have been virtually absent in the published literature. This study's objective was to understand the life experiences of pregnant-involved young Aboriginal women with alcohol and drugs. Semi-structured interviews to gather life histories were conducted with 23 young Aboriginal women who had experiences with pregnancy, and alcohol and drug use. Transcribed interviews were analyzed for themes to describe the social and historical contexts of women's experiences and their self-representations. The findings detail women's strategies for survival, inner strength, and capacities for love, healing, and resilience. Themes included the following: intersectional identities, life histories of trauma (abuse, violence, and neglect; intergenerational trauma; separations and connections), the ever-presence of alcohol and drugs, and the highs and lows of pregnancy and mothering. The findings have implications for guiding policy and interventions for supporting women and their families.
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Affiliation(s)
- Sana Z Shahram
- The University of British Columbia, Kelowna, British Columbia, Canada
- Centre for Addictions Research of BC, University of Victoria, British Columbia, Canada
| | - Joan L Bottorff
- The University of British Columbia, Kelowna, British Columbia, Canada
- Australian Catholic University, Melbourne, Australia
| | - Donna L M Kurtz
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Nelly D Oelke
- The University of British Columbia, Kelowna, British Columbia, Canada
- Department of Community Health Services, Cumming School of Medicine, University of Alberta, Alberta, Canada
| | - Victoria Thomas
- Wuikinuxv Nation, Vancouver, British Columbia, Canada
- The Cedar Project, Vancouver, British Columbia, Canada
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Abstract
Although women who use substances are often also facing severe economic and social problems, little is known about the relationship between social determinants of health and substance use among women. Furthermore, despite their increased visibility in substance use programs and policies in Canada, little is known about the social contexts of substance use among Aboriginal women. I systematically reviewed empirical research published from 1997 through March 2013 that examined the relationship between social determinants of health and substance use among Aboriginal women. Studies that were peer-reviewed, published in English, and had an abstract were included. Of an initial 261 studies, only sixteen studies met the inclusion criteria (fourteen quantitative, one qualitative, one mixed methods). The social determinants of health that were explored in these studies were socio-demographics factors, trauma, gender, social environments, colonialism, culture, and employment. The studies identified significant relationships between the social determinants of health and substance use among Aboriginal women. The almost exclusive use of quantitative methods and the prioritization of certain social determinants of health over others prevented a comprehensive and contextual understanding of substance use among Aboriginal women. Further research is needed to understand these significant relationships, particularly in relation to Aboriginal-specific determinants of health.
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Affiliation(s)
- Sana Shahram
- a Department of Interdisciplinary Graduate Studies , University of British Columbia , Kelowna , British Columbia , Canada
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Baskin C, Strike C, McPherson B. Long Time Overdue: An Examination of the Destructive Impacts of Policy and Legislation on Pregnant and Parenting Aboriginal Women and their Children. INTERNATIONAL INDIGENOUS POLICY JOURNAL 2015; 6. [PMID: 0 DOI: 10.18584/iipj.2015.6.1.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Today, in Canada, Aboriginal peoples continue to experience marginalization, over representation in the child welfare system, and a higher prevalence of poverty and substance misuse challenges. These experiences affect for Aboriginal women in particular because of the oppressive experiences of systemic racism and discrimination they face, including legislation such as the Indian Act and the Child and Family Services Act, which directly targets them. This article is based on a research project conducted in Toronto, Ontario that implemented Aboriginal research methodologies to explore ways to increase collaboration between Aboriginal families, treatment counsellors, and child welfare workers. One significant theme that emerged out of this project was the concept of time as related to policy and legislation that negatively impact Aboriginal pregnant and/or parenting women. In this analysis, we focus on the concept of time as connected to four policy areas that emerged from the findings: historical trauma caused by discriminatory legislation, the family court system, the bureaucracy of child welfare, and the need for further research and long-term solutions.
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Davey CJ, Niccols A, Henderson J, Dobbins M, Sword W, Dell C, Wylie T, Sauve E. Predictors of Research Use Among Staff in Aboriginal Addiction Treatment Programs Serving Women. J Ethn Subst Abuse 2014; 13:315-36. [DOI: 10.1080/15332640.2014.938211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | | | | | - Colleen Dell
- d University of Saskatchewan , Saskatoon , Saskatchewan
| | - Tammie Wylie
- e Tillicum Lelum Aboriginal Friendship Centre , Nanaimo , British Columbia
| | - Ernest Sauve
- f White Buffalo Treatment Centre , Saskatoon , Saskatchewan
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Lee KSK, Harrison K, Mills K, Conigrave KM. Needs of Aboriginal Australian women with comorbid mental and alcohol and other drug use disorders. Drug Alcohol Rev 2014; 33:473-81. [DOI: 10.1111/dar.12127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 02/09/2014] [Indexed: 11/30/2022]
Affiliation(s)
- KS Kylie Lee
- Discipline of Addiction Medicine; Sydney Medical School; University of Sydney; Sydney Australia
| | - Kaylie Harrison
- South Coast Medical Service Aboriginal Corporation; Nowra Australia
| | - Katherine Mills
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
- National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use; University of New South Wales; Sydney Australia
| | - Katherine M. Conigrave
- Discipline of Addiction Medicine; Sydney Medical School; University of Sydney; Sydney Australia
- Drug Health Services, Royal Prince Alfred Hospital; Sydney Australia
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Di Pietro NC, Illes J. Disparities in Canadian indigenous health research on neurodevelopmental disorders. J Dev Behav Pediatr 2014; 35:74-81. [PMID: 24356498 DOI: 10.1097/dbp.0000000000000002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To map the landscape of research on autism (ASD), cerebral palsy (CP), and fetal alcohol spectrum disorder (FASD) in Canadian Aboriginal children. METHOD The authors used a detailed search strategy to identify and access publications on ASD, CP, and FASD involving Canadian Aboriginal children, families, and communities from online databases. They analyzed these materials for the type of research, stated objectives, methodologies, and the level of engagement of Aboriginal Peoples. RESULTS The authors found a total of 52 reports published since 1981 relevant to Aboriginal children. Of these, 51 focused exclusively on FASD. They also found a near-complete failure to acknowledge community involvement in research decisions or dissemination of results in any of the publications. CONCLUSIONS The focus on FASD in Aboriginal children and the absence of research on the other 2 major childhood disorders are at odds with rates of these disorders across Canadian children. The authors argue that this trend violates fundamental principles ensuring equitable representation of all children regardless of background in research and access to benefits of research in health care and perpetuates stigma in an already marginalized population.
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Affiliation(s)
- Nina C Di Pietro
- *National Core for Neuroethics, Division of Neurology, Faculty of Medicine; and †NeuroDevNet, Inc., University of British Columbia, Vancouver, Canada
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Dell CA, Duncan CR, DesRoches A, Bendig M, Steeves M, Turner H, Quaife T, McCann C, Enns B. Back to the basics: identifying positive youth development as the theoretical framework for a youth drug prevention program in rural Saskatchewan, Canada amidst a program evaluation. Subst Abuse Treat Prev Policy 2013; 8:36. [PMID: 24148918 PMCID: PMC3874768 DOI: 10.1186/1747-597x-8-36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 10/07/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Despite endorsement by the Saskatchewan government to apply empirically-based approaches to youth drug prevention services in the province, programs are sometimes delivered prior to the establishment of evidence-informed goals and objectives. This paper shares the 'preptory' outcomes of our team's program evaluation of the Prince Albert Parkland Health Region Mental Health and Addiction Services' Outreach Worker Service (OWS) in eight rural, community schools three years following its implementation. Before our independent evaluation team could assess whether expectations of the OWS were being met, we had to assist with establishing its overarching program goals and objectives and 'at-risk' student population, alongside its alliance with an empirically-informed theoretical framework. METHODS A mixed-methods approach was applied, beginning with in-depth focus groups with the OWS staff to identify the program's goals and objectives and targeted student population. These were supplemented with OWS and school administrator interviews and focus groups with school staff. Alignment with a theoretical focus was determined though a review of the OWS's work to date and explored in focus groups between our evaluation team and the OWS staff and validated with the school staff and OWS and school administration. RESULTS With improved understanding of the OWS's goals and objectives, our evaluation team and the OWS staff aligned the program with the Positive Youth Development theoretical evidence-base, emphasizing the program's universality, systems focus, strength base, and promotion of assets. Together we also gained clarity about the OWS's definition of and engagement with its 'at-risk' student population. CONCLUSIONS It is important to draw on expert knowledge to develop youth drug prevention programming, but attention must also be paid to aligning professional health care services with a theoretically informed evidence-base for evaluation purposes. If time does not permit for the establishment of evidence-informed goals and objectives at the start-up of a program, obtaining insight and expertise from program personnel and school staff and administrators can bring the program to a point where this can still be achieved and theoretical linkages made after a program has been implemented. This is a necessary foundation for measuring an intervention's success.
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Affiliation(s)
- Colleen Anne Dell
- Department of Sociology & School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Charles Randy Duncan
- Department of Sociology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Andrea DesRoches
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Melissa Bendig
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Megan Steeves
- College of Education, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Holly Turner
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Terra Quaife
- College of Education, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Chuck McCann
- Prince Albert Parkland Health Region, Prince Albert, Saskatchewan, Canada
| | - Brett Enns
- Prince Albert Parkland Health Region, Prince Albert, Saskatchewan, Canada
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Tait CL. Resituating the ethical gaze: government morality and the local worlds of impoverished Indigenous women. Int J Circumpolar Health 2013; 72:21207. [PMID: 23986898 PMCID: PMC3754611 DOI: 10.3402/ijch.v72i0.21207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Over generations, government policies have impacted upon the lives of Indigenous peoples of Canada in unique and often devastating ways. In this context, Indigenous women who struggle with poverty, mental illness, trauma and substance abuse are among the most vulnerable, as are Indigenous children involved in child welfare systems. Objective By examining the life history of Wanda, a First Nations woman, this article examines the intergenerational role that government policies play in the lives of impoverished Indigenous women and their families. Questions of moral governance and responsibility and the need for ethical policies are raised. Design The life narrative presented in this article is part of a larger qualitative research programme that has collected over 100 life histories of Indigenous women with addictions and who have involvement with the child welfare system, as children or adults. Wanda's life story exemplifies the impact of government policies that is characteristic of vulnerable Indigenous women and draws attention to the lack of ethical standards in government policymaking in child welfare, public health and mental health/addictions. Results The path to recovery for Canadian Indigenous women in need of treatment for co-occurring mental disorders and substance addiction is too frequently characterized by an inadequate and ever shifting continuum of care. For those who feel intimidated, suspicious or have simply given up on seeking supports, a profound invisibility or forgetting of their struggle exists in areas of government policy and programming provision. Living outside the scope of mental health and addiction priorities, they become visible to the human service sector only if they become pregnant, their parenting draws the attention of child and family services (CFS), they need emergency health care, or are in trouble with the law. The intergenerational cycle of substance abuse, mental illness and poverty is commonly associated with child welfare involvement, specifically practices that place the health and well-being of Indigenous children at risk. In order to break this cycle, close attention to implementation of ethically based policies and best practice interventions is required. Conclusions From an ethical policy perspective, the focus of government policies and the practices they generate must be first and foremost to ensure that individuals, families and groups are not left worse off than prior to a government policy impacting upon their life. Furthermore, the impact of living a life determined by multiple government policies should not be a story of individual and family devastation, and government policies should not be the most significant determinant of health for any group of people.
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Affiliation(s)
- Caroline L Tait
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada.
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Dell CA, Chalmers D, Bresette N, Swain S, Rankin D, Hopkins C. A Healing Space: The Experiences of First Nations and Inuit Youth with Equine-Assisted Learning (EAL). CHILD & YOUTH CARE FORUM 2011. [DOI: 10.1007/s10566-011-9140-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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