Indigenous mothers expressed their frustration with the hidden costs and discrimination of the health care system of Hamilton, Ontario in a recent interview-based U of T-affiliated study. In this pioneering study, researchers learned about how some Indigenous mothers, despite their sobriety, are judged for past substance use disorders, or how their spiritual beliefs caused difficulties in accessing health care.

“For many women, [substance use disorder] offers a means of coping with trauma, such as childhood abuse, partner violence, and, for Aboriginal women, the intergenerational effects of colonization,” explains a 2010 Canadian Institutes of Health Research paper.

The co-authors of the U of T-affiliated study partnered with the Hamilton Regional Indian Centre, where they conducted 90-minute interviews with 19 Indigenous women.

Though small in scale, the co-authors noted that it was the “first qualitative study in an urban centre in Canada to ask Indigenous mothers how they select and use primary care” to address the health needs of their infants.

The study’s inspiration

In an interview with The Varsity, co-author Dr. Amy Wright, an assistant professor at U of T’s Bloomberg Faculty of Nursing, said that her previous work in Saskatchewan as a neonatal nurse practitioner, which is a specialist in newborn infant care, informed her research. Her job exposed her to many pregnant Indigenous women who had to travel from northern communities to urban areas in order to access hospitals where they could safely deliver their infants. Upon her review of the literature, she found that Indigenous infants continued to have higher mortality rates than their non-Indigenous counterparts.

“It was very apparent [that] the inequities around health care access [vary] depending on where you live,” she said.

Racial discrimination and unmet spiritual needs

The discrimination and racism that mothers often encounter hindered the building of trust with their health care team and their ability to receive reassurance and validation of their concerns. According to the co-authors, some caregivers saw previous substance use disorder or involvement with child protection services as “directly linked to being Indigenous,” despite the mothers’ efforts to improve their and their children’s lives.

Indigenous children are disproportionately represented in Canada’s child welfare system. When many Indigenous mothers are pregnant, they are flagged as “high risk,” which remains on their charts regardless of the efforts they make to better themselves and to improve their children’s quality of life. The Missing and Murdered Indigenous Women (MMIW) report details the unfair targeting of Indigenous mothers and its contribution to the phenomenon of MMIW.

Building trust was further impeded when caregivers were thought to be condescending or dismissive of the spiritual needs of mothers and their infants. Many Indigenous mothers sought holistic care and desired that their care providers be able to meet not only physical needs, but also the mental, emotional, and spiritual needs of their infants. Recognizing the importance of spiritual health needs, having an Indigenous elder available to speak to the mothers, or directing mothers to rooms that could accommodate ceremonies would have improved the care provided to the Indigenous mothers interviewed.

Geographic inequality in access to pediatric care

Wright noted that the mothers she interviewed did not live in areas with easy access to pediatric emergency services, since many of them experience poverty as well as food and housing insecurity. She attributed this to the inherently discriminatory and racist system, which was a theme that was highlighted in her findings.

The qualitative study revealed that pediatric care — from specialized emergency departments or primary care givers — was preferable to walk-in clinics. Specialized equipment and treatments, as well as child-friendly waiting areas, were among the reasons mothers specifically sought pediatric care for their infants and children. However, these services are not equitably accessible.

“In Hamilton, McMaster Children’s Hospital is in a more affluent area of Hamilton — by the university,” Wright said. “Even just that inherent inequity that they experience… meant that they were at a disadvantage to accessing that care because they were so far from it.”

Many mothers described that the cost of travel from one region to another to seek acute health services was a burden. And while walk-in clinics were the most accessible, some mothers reported that their primary care providers required them to pay a fee ranging from $40–$50 for using walk-in clinics due to provincial penalties based on the providers’ funding models.

The need for further study

The Indigenous community is understudied, underserviced, and has been historically neglected in terms of health care. Wright said that representatives at the Indigenous Friendship Centre in Hamilton were surprised that a researcher was interested in studying Indigenous mothers and their infants.

Vicky Miller, the Six Nations social worker at the Hamilton Regional Indian Centre whose clients were interviewed by Wright’s team, also noted in an interview with The Varsity that the only previously conducted studies were surveys by students interested in statistical data. No previous qualitative research has extensively explored infant health and maternal experiences.

Despite this, Miller remains optimistic. “In the last four years that I’ve worked, there has been improvement [for] families,” she said. She noted a rise in case files closed with child welfare services due to families working closely with that centre’s staff, which lets children come home to their families.