Partnership Promotes Indigenous Mothers’ Reproductive Health – Medscape

Report on Canadian Institutes of Health Research (CIHR) Initiatives to Improve Indigenous Health in Alignment with Sustainable Development Goals

Introduction

Canada’s Indigenous History Month provides an opportune moment to review the Canadian Institutes of Health Research (CIHR) efforts aimed at enhancing health outcomes for First Nations, Inuit, and Métis communities. Central to these efforts is the Indigenous Healthy Life Trajectories Initiative (I-HeLTI), which emphasizes transparent, community-led research and healthcare delivery approaches.

Focus on Sustainable Development Goals (SDGs)

The CIHR initiatives align closely with several United Nations Sustainable Development Goals, including:

• SDG 3: Good Health and Well-being
• SDG 5: Gender Equality
• SDG 10: Reduced Inequalities
• SDG 17: Partnerships for the Goals

Indigenous Healthy Life Trajectories Initiative (I-HeLTI)

Objectives and Approach

The primary goal of I-HeLTI is to identify culturally strengthening strategies to improve maternal and child health outcomes within Indigenous communities. This initiative adopts a Developmental Origins of Health and Disease framework, recognizing that social determinants such as poverty, racism, housing, and geographical location interact with genetic factors during conception, prenatal, infancy, and early childhood stages to influence long-term health outcomes.

Community-First Research Model

Historically, Indigenous health research has focused on deficits, emphasizing problems such as higher rates of diabetes or substance use without considering underlying factors like intergenerational trauma, the residential school system, and social determinants of health. I-HeLTI seeks to shift this paradigm by adopting a community-integrated and culturally respectful research model.

Community-Integrated Care: Aunties Within Reach (AWR)

Partnership and Community Engagement

AWR is a collaborative project in Alberta’s Wood Buffalo region, involving the University of Alberta’s Collaborative Applied Research for Equity in Health Policy and Systems (CARE) Lab and the Indigenous-led Ihkapaskwa Collective. This partnership exemplifies SDG 17 by fostering strong collaborations between academic institutions and Indigenous communities.

Program Features

• Delivery of reproductive health services directly within Indigenous communities.
• Engagement with health and social service providers to ensure integrated care.
• Community guidance through elders and families to ensure culturally relevant research and service delivery.

Leadership and Capacity Building

• Sheena Bradley, Cree-Métis birth worker and clinical herbalist, co-founded AWR.
• Maddie Amyotte, Cree-Métis registered Indigenous midwife.
• Support from Métis nurse practitioners and community advocates.

Addressing Maternal Health and Indigenous Birth Practices

Challenges of Maternal Evacuation

Since the 1960s, maternal evacuation policies have transferred Indigenous pregnant women from remote communities to urban hospitals. While intended to address health disparities, this practice has caused emotional, social, and cultural harm, including maternal and neonatal infections. It also disrupts traditional support systems and places women under provincial child services rather than tribal services, complicating care navigation.

Reclaiming Traditional Birth Practices

AWR and I-HeLTI promote the reclamation of Indigenous birth practices, integrating culture and ceremony into reproductive health care. Full-spectrum birth workers provide social, cultural, and outreach support, including mentorship and traditional teachings related to breastfeeding, postpartum care, mental health, and social well-being.

Implementation and Research

• CARE Lab facilitates continuous learning by identifying best practices and adapting successful programs to local contexts.
• A pregnancy cohort is being developed to support longitudinal research aligned with I-HeLTI objectives.

Impact and Future Directions

Restoring Autonomy and Rights

The initiatives contribute to repairing harms caused by historical injustices and loss of reproductive autonomy among Indigenous peoples. By restoring traditional knowledge and practices, they support SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities).

Model for Other Communities

AWR serves as a replicable model for other Indigenous communities seeking to integrate culturally safe, community-led reproductive health services. The program’s emphasis on partnership, cultural relevance, and community guidance aligns with the broader goals of sustainable development.

Conclusion

The CIHR’s Indigenous Healthy Life Trajectories Initiative, through projects like Aunties Within Reach, exemplifies a commitment to improving Indigenous health outcomes by addressing social determinants, promoting cultural safety, and fostering community leadership. These efforts contribute significantly to achieving the Sustainable Development Goals related to health, equality, and partnerships.

1. Sustainable Development Goals (SDGs) Addressed or Connected

1. SDG 3: Good Health and Well-being
   • The article focuses on improving Indigenous maternal and child health outcomes, addressing noncommunicable diseases, and enhancing healthcare delivery in Indigenous communities.
2. SDG 10: Reduced Inequalities
   • The article highlights health disparities faced by Indigenous peoples, including the impacts of intergenerational trauma, racism, and social determinants of health.
3. SDG 5: Gender Equality
   • Focus on reproductive health, maternal health services, and empowering Indigenous women through culturally relevant healthcare and birth practices.
4. SDG 17: Partnerships for the Goals
   • The article describes partnerships between Indigenous communities, research institutions, and health policy labs to co-create health solutions.

2. Specific Targets Under Those SDGs Identified

1. SDG 3: Good Health and Well-being
   • Target 3.1: Reduce the global maternal mortality ratio.
   • Target 3.4: Reduce premature mortality from noncommunicable diseases through prevention and treatment.
   • Target 3.8: Achieve universal health coverage, including access to quality essential health-care services.
2. SDG 10: Reduced Inequalities
   • Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, or other status.
3. SDG 5: Gender Equality
   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.
4. SDG 17: Partnerships for the Goals
   • Target 17.16: Enhance the global partnership for sustainable development, complemented by multi-stakeholder partnerships.

3. Indicators Mentioned or Implied to Measure Progress

1. Maternal and Child Health Indicators
   • Maternal mortality ratio (number of maternal deaths per 100,000 live births).
   • Neonatal and infant mortality rates.
   • Incidence and prevalence of noncommunicable diseases in Indigenous populations.
2. Access to Healthcare Services
   • Proportion of Indigenous women receiving culturally safe and community-integrated reproductive health services.
   • Rates of maternal evacuation from remote Indigenous communities for childbirth.
3. Social Determinants and Inequality Measures
   • Measures of social determinants such as poverty, housing, racism, and geographic accessibility.
   • Indicators of inclusion and empowerment within Indigenous communities.
4. Community Engagement and Partnership Indicators
   • Number and quality of partnerships between Indigenous communities and research or health institutions.
   • Degree of community leadership and guidance in research projects.

4. Table of SDGs, Targets, and Indicators

SDGs	Targets	Indicators
SDG 3: Good Health and Well-being	3.1: Reduce maternal mortality ratio 3.4: Reduce premature mortality from noncommunicable diseases 3.8: Achieve universal health coverage	Maternal mortality ratio Neonatal and infant mortality rates Prevalence of noncommunicable diseases Access to culturally safe reproductive health services
SDG 10: Reduced Inequalities	10.2: Promote social, economic and political inclusion	Measures of social determinants (poverty, racism, housing) Indicators of inclusion and empowerment
SDG 5: Gender Equality	5.6: Ensure universal access to sexual and reproductive health and rights	Access to reproductive health services Use of culturally relevant birth practices
SDG 17: Partnerships for the Goals	17.16: Enhance global partnerships for sustainable development	Number and quality of Indigenous-community partnerships Community leadership in research initiatives

Source: medscape.com