Learning from success: An exploration of community-based stakeholders' views on improving care for pregnant and parenting Aboriginal people

The human rights abuses and resource exploitation of Aboriginal people in Canada's colonial past and neocolonial present has left a legacy of inequitable health and social conditions that contribute to increased perinatal risk factors. The complex "system" of administration, governance and health services delivery impedes program innovation and responsiveness alienating relationships between Aboriginal people, health care providers and organizations. These dynamics underlie the problems of poor access to, participation in, and outcomes of care during pregnancy among Aboriginal women and families. The study used a critical postcolonial stance and an emancipatory methodological approach to describe community-based stakeholders' perspectives on their experiences improving care for pregnant and parenting Aboriginal women and families. Phase I exploratory interviews with 16 First Nations community, policy, and health service leaders and providers identified Aboriginal 'innovator' organizations for participation in phase II. Two Aboriginal health care organizations in one region of British Columbia participated in the comparative case study. Data were collected through exploratory interviews and small group discussions with 57 people, document review and researcher field notes and were analyzed using the interpretive descriptive method. Seventy three people participated, with 60 percent self-identified as Aboriginal and 90.4 percent women. Results show that Aboriginal parents' experience, and therefore the intention of care must be situated within an understanding of colonial and neocolonial relations, especially the intergenerational impact of residential schools; safety in health care relationships and settings; and responsiveness to peoples' experiences, priorities and capacities. Care for pregnant and parenting Aboriginal people involves multiple stakeholders who may hold different views of health care roles, relationships and decision-making. While the two cases shared a similar vision of roles and relationships, differences in processes of health system change, and in the governance models impacted the Aboriginal organizations' experiences of improving care for pregnant and parenting Aboriginal people. Greater stakeholder involvement in governance of care may enhance Aboriginal organizations' capacity to achieve safe and responsive care. This can contribute to moving forward from the intergenerational impact of residential schools, toward Aboriginal peoples' vision for strong and healthy children, families and communities