Aboriginal women's experiences of accessing healthcare when state apprehension of children is being threatened

Background: Canadian Aboriginal children continue to be apprehended at a higher rate than non-Aboriginal children. Aboriginal mothers, who face significant social, political and economic disadvantage, are often under considerable scrutiny in relation to their parenting. Little is known about how the threat of child apprehension impacts the experiences of Aboriginal women accessing healthcare services. Therefore a study was undertaken to examine women’s perspectives on accessing health care when child apprehension is threatened. Methods: The study was guided by post-colonial feminist perspectives and followed the principles of exploratory, qualitative research design. Data collection and data analysis were carried out in two phases. Phase One involved a secondary analysis, using narrative interview data collected from a larger study (n=7). Phase One findings were used primarily to modify the interview guides developed for Phase Two. In Phase Two primary, face-to-face interviews were conducted with (i) Aboriginal women (N=9) and (ii) health care providers (n=8). Data was analyzed following the principles of thematic analysis and interpretive description. Findings: The findings indicated that women involved in the child protection system often experience complex socio-political and economic life challenges. The threat or fear of child apprehension did not impact the women’s decisions to seek medical services for their children; however the threat and fear impacted the women’s experiences with mainstream healthcare in a number of ways. Racism, prejudice, and discrimination within mainstream healthcare agencies along with the fear of child apprehension influenced the women’s decisions to access healthcare for themselves and impacted the women’s interactions with mainstream health care providers. In particular, women avoided engaging with health care providers when their children were hospitalized in part to protect themselves from judgment and discrimination. Discussion: Ongoing racism, judgment and discrimination toward Aboriginal mothers in mainstream healthcare agencies must be addressed. Health care providers working with Aboriginal people require education around culturally safe approaches to care and the history of colonialism and its effects on the health and well-being of Aboriginal people. Structural inequities such as poverty and discrimination must also be addressed through policy initiatives that attend to the social determinants of health.

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