Bringing healthy birth back to Quw'utsun : examining determinants of an elevated rate of preterm birth in Quw'utsun (Cowichan Valley) territory, British Columbia, Canada
Bibliographic record
Abstract
Indigenous people in Canada have a higher rate of preterm birth, which is birth before 37 weeks of gestation, compared to other residents. Though research has linked health disparities between Indigenous and non-Indigenous people to colonial legislations and actions, there lacks evidence of specific determinants of preterm birth among Indigenous people. As part of the Quw'utsun Preterm Birth Study that Cowichan Tribes initiated to address the elevated rate of preterm birth in Quw'utsun territory (Cowichan Valley, British Columbia), I examined the determinants of health that are associated with preterm birth and that could be amenable to intervention among Indigenous people. The research team and I created a research framework, Nuts'a'maat shqwaluwun (one heart, one mind), to adhere to Quw'utsun standards for ethical research: (a) self-determination of Quw'utsun people in research and (b) respect for the snuw'uy'ulh, which are the “ways of life” that Elders share with younger generations to guide them through all aspects of life, including pregnancy and birth. Using this framework enabled adherence to these standards throughout this study. We interviewed Indigenous women in Quw'utsun to understand the factors that impacted the health of their pregnancies and preterm births specifically. Social and environmental challenges negatively affected health in pregnancy. In addition, the snuw'uy'ulh were viewed as foundational to the promotion of health in pregnancy. To compare preterm birth rates between First Nations and other residents, we undertook a population-based retrospective cohort study of deliveries in the Cowichan Valley (2011-2022) by using a linkage of the First Nations Client File and Perinatal Data Registry. The rate of preterm birth for First Nations (22.6%) was three times higher than for other residents (7.2%; risk ratio 1.91, 95% CI 1.65, 2.22, adjusted for maternal age, parity, and timing of first prenatal visit). Finally, we conducted knowledge-translation activities to identify the determinants that were amenable to intervention. We identified early and consistent attendance at prenatal care visits and prenatal care that supports pregnant people to follow the snuw'uy'ulh. In summary, the determinants of preterm birth among Quw'utsun people are multifactorial and require comprehensive intervention studies, informed by the findings of this study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.008 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".