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Many factors influence the health of a woman during her pregnancy.  A healthy start for mother and child requires access to care, social support, healthy food, a safe environment, and the reduced use or elimination of tobacco, illegal drugs and alcohol (Ministry of Health, 2005).  Generally, women who live in poverty are at greater risk of having less healthy birth outcomes. This is of particular note because of the lower socioeconomic status experienced by many Aboriginal people.

The ActNow BC Healthy Choices in Pregnancy program is geared to the general population, and focuses on prenatal alcohol use during pregnancy. Alcohol consumption can lead to a higher risk of having a child affected by Fetal Alcohol Spectrum Disorder (FASD).  The program aims to achieve:

• a 50 percent increase in the number of women receiving counselling on the use of alcohol during pregnancy, and
  
  
• the development of Fetal Alcohol Spectrum Disorder prevention strategies in all B.C. Health Authorities.
  
  

Aboriginal ActNow  has conducted its own research to support Aboriginal-specific approaches to healthy choices in pregnancy. This research looked at programs, services and initiatives in prenatal care in BC, including FASD prevention.  We also reviewed the academic and non-academic literature on healthy pregnancies, focusing on alcohol use during pregnancy and FASD prevention. Highlights of our findings follow.  For a fact sheet on Healthy Choices in Pregnancy, click here. 

Cultural Context

Research indicates, for instance, that there are cultural gaps between doctors and Aboriginal women, and that bridging the gap can help promote more effective FASD interventions. Beliefs about pregnancy and childbirth can also influence attitudes to health care.  For some First Nations women, pregnancy is viewed in a spiritual context and as a healthy, natural process requiring no intervention. In some cases, women's beliefs about pregnancy conflict with those of health-care providers.

In addition, health issues cannot be addressed in isolation from an understanding of the Aboriginal experience of such issues as colonization, residential schools, or child removals. 

The residential school system in particular has had a significant impact on Aboriginal families, culture and parenting skills.  Residential schools were designed to assimilate Aboriginal peoples into European society and to separate children from their cultural influences, including families and communities.  As evidence incidates, the removal of children was devastating to the family systems of Aboriginal groups. 

The experience of residential schools has been linked to risk factors such as substance abuse and alcohol abuse.  Researchers have also found that the impact of residential schools can be linked to risk factors for poor pregnancy outcomes among women who abuse alcohol. These include poor overall health, poor education, and chronic poverty.

Our research findings indicate that an Aboriginal-specific approach to encouraging Healthy Choices in Pregnancy must:

• be non-judgmental and respecful
  
  
• take into account the determinants that contribute to poorer health and addiction
  
  
• provide services that centre on women
  
  
• offer appropriate treatment services
  
  
• be culturally apprpriate and build on cultural and community strengths
  
  
• provide coordinated care
  
  
• address rural and remote needs
  
  
• address the need for health care providers.
  
  

Health Issues

Alcohol and pregnancy don’t mix. The range of harms caused by alcohol use during pregnancy is called FASD and includes brain damage, vision and hearing problems, slow growth and birth defects.

There is limited data on both the incidence and distribution of FASD in BC or Canada for Aboriginal and non-Aboriginal populations. Research suggests that tobacco use, family planning, nutrition, psychological distress and environmental factors such as chronic poverty and geographical location are important factors leading to alcohol abuse and negative birth outcomes. 

Aboriginal women experience numerous barriers and gaps in service that prevent them from accessing prenatal and addiction treatment services including lack of culturally appropriate services, consistency of service delivery, social stigma associated with substance issues, and geographic isolation among others.

Links

Numerous organizations provide prenatal health and FASD prevention programs in British Columbia. These are offered at the national, provincial and local levels, by both governmental and non-governmental organizations.  Many programs are Aboriginal-specific. 

• The Aboriginal Healing Foundation (AHF) promotes healing and healthy parenting, along with healthy lifestyles and well-being.  There are 19 projects receiving funding in BC.  One project, the Positive Indian Parenting Program, is delivered through the Nenqay Deni Yajelhtig Law Centre Society in Wiliiams Lake.  It seeks to address the intergenerational impacts of residential schools on FASD.  The Aboriginal Healing Foundation has produced a report on FASD and the intergenrational links to residential schools. Click here to access the AHF index of publications
• The National Indian and Inuit Community Health Represetnatives Organization (NIICHRO) publishes a magazine called "In Touch" which highlights health topics, including prenatal health and FASD issues.  It has also produced training kits, including one directed at Fetal Alcohol Syndrome and Fetal Alcohol Effect issues.  Click here to view the NIICHRO resources catalogue.
• BC Association of Pregnancy Outreach Programs  - There are more than 45 Pregnancy Outreach Programs in B.C.  These reach populations who normally do not access prenatal services and are considered "at-risk" for poor birth outcomes.   More than 30 per cent of program participants are Aboriginal.  POP seeks to improve nutrition and promote healthy growth and development of infants.  The programs are delivered at the community level but are funded by the province and/or the Canada Prenatal Nutrition Program.
• BC Women’s Hospital and Health Centre - A variety of Aboriginal and maternity services are provided at the centre, including workshops and information for Aboriginal women. Services are provided on-site and through outreach programs.  The "Aunties in Action" project, involving trained volunteers, helps improve the hospital experience for Aboriginal patients and their families.  Services are also available to substance-using women and their babies.
• Healthy Choices in Pregnancy: Provincial Education and Resource Development - BC Women’s Hospital & Health Centre, the BC Centre of Excellence for Women’s Health and the British Columbia Reproductive Care Program are working in collaboration to support the achievement of this provincial initiative. HCIP has just released four new resources, including a booklet on Women and Alcohol, and another on alcohol interventions during pregnancy.  Click here for more information.
• Northern Family Health Society -  The Northern Family Health Society (NFHS), located in Prince George, is well known for providing effective outreach services to at-risk pregnant women and families. Direct service delivery programs and activities include Pregnancy Outreach Program (Healthiest Babies Possible), and the Public Health Agency of Canada's Community Action Program for Children (CAPC) and the Canadian Pre-natal Nutrition Program (CPNP).

Resources  

Aboriginal ActNow: Healthy Choices in Pregnancy for Aboriginal Peoples in BC: An Analysis and Recommendations (2007), Jennifer Clinesmith.

See also: The Hospital for Sick Children: JFAS Int. 2003: e17 October 2003: Urban FASD internvetions: Bridigng the Cultural Gap between Aboriginal Women and Primary Care Physicians, by Paul Masotti, Ph.D., et al.

Canadian Journal of Nursing Research, Vol. 27, No. 1: Canadian First Nations Women's beliefs About Pregnancy and Prenatal Care, by Elizabeth Sokoloski.