Scoping Review: Inuit Perinatal Wellness

Complicated by the disruption of gender roles through settler colonialism, Inuit communities in Nunavut face substantial challenges and barriers to maternal and post-natal health, terms here used interchangeably with perinatal wellness. Specifically, medical evacuation/displacement from traditional lands, ill-informed healthcare practises, and invasive Western medical procedures often will compromise the cultural practises and overall mental and physical wellbeing of Indigenous women. The role of gender within Inuit perinatal wellness has also been overlooked within much of the traditional approaches to health research in Canada. To date, little is known about needed supports for Inuit in this area and few Inuit-designed and directed programs aimed at perinatal wellness have been put in place. A scoping review will be conducted to assess the current state of Canadian Inuit perinatal wellness, its services and policies in practise, in order to draw inferences on the social, physical and mental wellbeing of the mothers and their newborns. This review is part of a three-year community based research project (2022 to 2025) seeks to collaboratively build new knowledge through a co-designed pilot program of perinatal support for Inuit women and families, especially for the Arviat community in Nunavut. BACKGROUND: The community of Arviat, Nunavut, has a population of just under 3,000 people. Over 95% of the residents in Arviat are Inuit, and the vast majority of residents speak Inuktitut as their first language (96.8%). With a birthrate of nearly twice the national average (22.6 per 1000 live births as opposed to 10.1 for the rest of Canada), and little to no perinatal support or services, Arviat is a particularly relevant community for research concerning perinatal wellness. Similar to Inuit women in other parts of the Arctic, women in Arviat are typically required to leave their communities one month prior to their due dates (up to two months prior for those considered high risk) to give birth in Winnipeg, Manitoba. The large number of babies born to mothers in Arviat, the absence of local maternity care services, and a fly-out model of childbirth makes Arviat an ideal community to explore perinatal wellness and Arviarmuit (Inuktitut word meaning “a resident of Arviat”) women’s, their partners’, and community members’ perinatal wellness perspectives. Arviat is also a community that has consistently advocated for improved perinatal supports, services, and the creation of a community birthing centre since 1981. The Aqqiumavvik Wellness Society, part of the Nunavut Network Environment for Indigenous Health Research (NEIHR) hub, is committed to improving perinatal health and has historically provided maternal support to women in the community when funding was available. Aqqiumavvik’s established presence in the community makes it a natural local partner for our proposed community-based research project. The perinatal period – or the time leading up to and following childbirth – can be fraught with worry and strong emotions, a range of new and increased individual and family needs, complex and difficult decision making, and contexts which can negatively impact maternal wellness. The perinatal experience can impact those of different genders as well. Inuit culture, values and understandings, many of which have been impacted by colonialism, interact with a range of gender norms and roles within families at this time. Complicating this, Inuit autonomy for decision making concerning wellness and childbirth has been vastly marginalized by colonial policies and authoritative health practitioner relations, hospital politics, and limited resources (e.g., where, when, and with who women may give birth etc.). Inuit communities in Nunavut face a range of other issues and challenges that can further impact families’ perinatal wellness as well. Limited or no prenatal services and supports, lack of language-appropriate information, and inadequate infrastructure have gone unaddressed and have consequently, compromised maternal and infant health for generations. Inuit believe research outcomes must be actionable and aimed at improving conditions for the common good, therefore, program and/or policy changes must be designed, directed by, and result from, fully engaged consultation with Inuit to result in outcomes that will improve these conditions. Existing research indicates Indigenous women typically receive limited prenatal education and support, and often experience feelings of stress and/or isolation when they are required to leave their communities to give birth.Consultation and discussion with Arviarmiut women, as part of the project consultation (Phase II of the Indigenous Gender and Wellness Team Grant), strongly reaffirms these findings. Perinatal literature concerning Indigenous communities in Canada identifies many other areas of concern as well. For example, a knowledge gap exists concerning the importance of country food use in pregnancy and early childhood development. There is also limited knowledge about how overcrowded housing, low levels of education, food insecurity, and a lack of language appropriate services and resources affect Inuit perinatal wellness. Stereotypes, miscommunication, racism and time constraints placed on health-service interactions also serve to strain relationships between Inuit families and medical providers. The relationships with health providers can be further complicated by transitory employment, and within these relationships Indigenous women are known to face racism and a lack of cultural understanding and cultural safety. Additionally, the use of and support for breastfeeding, and the role fathers and community members can play in it, is another area where information is lacking. Establishing breastfeeding immediately after birth can be disrupted by both hospital policies and racist perceptions. Research in these areas is vital and relevant as Inuit communities today tend to have lower rates of breastfeeding than the national average, despite having the highest rates of breastfeeding in the country only 70 years ago. Further, trauma, both historical and ongoing, experienced by Inuit families from the residential school system, the forced relocation of communities, and the removal of Inuit to southern TB sanitoriums, among many other things, can all play a significant role in discussions concerning Inuit perinatal wellness as well. Although Inuit communities have faced, and continue to face, these complex issues, which can impact their well-being substantially, few Inuit-designed and Inuit-led programs or policies aimed at perinatal wellness have been put in place. Where programs in southern Canada serving Indigenous communities, such as holistic perinatal frameworks that encompass fathers or other partners, do exist (e.g., via Brighter Futures Programs currently incorporated within some First Nations communities etc.), most Inuit communities, especially those in northern and remote regions, have not had the opportunity to explore these options. Such approaches may have potential to increase perinatal wellness, but all programs or policies must be designed by Inuit or adapted substantially, such that they are underpinned by a foundation of Inuit values and understandings. Inuit Qaujimajatuqangit (referred to as IQ or Traditional Knowledge) is essential for personal and collective wellness and balance. Built on a framework described as maligait or laws, which inform specific principles/societal systems, IQ is inclusive of all aspects of Inuit culture, values, and life -- as the “past, present and future experience, knowledge and values of Nunavut society”. It is this critical link between wellness and Inuit culture that must guide all work concerning perinatal wellness and gender. Applying a gender lens to the topic of perinatal wellness, highlights the opportunity to engage mothers, but also fathers or partners, families and community members within these discussions. Inuit support for women during pregnancy, breastfeeding, early childcare, and parenting are community and shared responsibilities, which enable Inuit to create capable and contributing human beings through a process called inunnguiniq.

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