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Madeline Dion Stout, Gregory D. Kipling and Roberta Stout
In November 2000, the five Centres of Excellence for Women’s Health, the Canadian Women’s Health Network and the Women’s Health Bureau of Health Canada identified Aboriginal women’s health as an area for priority intervention. They asked us to capture the cumulative knowledge and experience generated through Centres of Excellence activities on Aboriginal women’s health to help establish priorities for future work.
We set out to provide an overview of key health and health-related indicators for Aboriginal women in Canada and conduct a critical review and synthesis of research and other initiatives on Aboriginal women’s health undertaken or funded by the Centres. Our Aboriginal Women’s Health Research Synthesis Project Final Report also reports on the proceedings of the National Workshop on Aboriginal Women’s Health Research held in Ottawa in March 2001, and presents recommendations for priority setting in future research.
The Research in Context
It has been long argued that policy makers and researchers show little interest in the challenges facing Aboriginal women in Canada. Doubly marginalized as both female and Aboriginal, these women have seldom benefited from sustained research attention that explores, in substantive fashion, their lives, challenges and strengths.
The situation has improved over the last 15 years, as Aboriginal women’s organizations and their allies have forced decision makers to take notice of the appalling inequities in many Aboriginal women’s lives. But much of the work being undertaken remains narrowly focused and is often tangential to the underlying causes of Aboriginal women’s marginalization and oppression.
Madeline Dion Stout, Gregory D. Kipling and Roberta Stout
In November 2000, the five Centres of Excellence for Women’s Health, the Canadian Women’s Health Network and the Women’s Health Bureau of Health Canada identified Aboriginal women’s health as an area for priority intervention. They asked us to capture the cumulative knowledge and experience generated through Centres of Excellence activities on Aboriginal women’s health to help establish priorities for future work.
We set out to provide an overview of key health and health-related indicators for Aboriginal women in Canada and conduct a critical review and synthesis of research and other initiatives on Aboriginal women’s health undertaken or funded by the Centres. Our Aboriginal Women’s Health Research Synthesis Project Final Report also reports on the proceedings of the National Workshop on Aboriginal Women’s Health Research held in Ottawa in March 2001, and presents recommendations for priority setting in future research.
The Research in Context
It has been long argued that policy makers and researchers show little interest in the challenges facing Aboriginal women in Canada. Doubly marginalized as both female and Aboriginal, these women have seldom benefited from sustained research attention that explores, in substantive fashion, their lives, challenges and strengths.
The situation has improved over the last 15 years, as Aboriginal women’s organizations and their allies have forced decision makers to take notice of the appalling inequities in many Aboriginal women’s lives. But much of the work being undertaken remains narrowly focused and is often tangential to the underlying causes of Aboriginal women’s marginalization and oppression.
Research has begun to be more critical of existing policies and structures and we cite a number of examples in the report. Attention has increasingly focused on patterns of Aboriginal women and men’s usage of the formal health care system, with particular emphasis on access barriers and means of overcoming them. There is increasing focus on emerging issues such as HIV/AIDS, diabetes and the implications of Bill C-31. A notable development is researchers and policy makers’ growing interest in health determinants, along with the importance of capitalizing on knowledge already present within Aboriginal communities.
Nonetheless, additional resources need to be channeled into Aboriginal women’s health, which remains under studied and poorly understood despite some innovative, action-oriented research work.
The Research of the Centres of Excellence in Women’s Health
In reviewing the Centres projects, we identified five principal theme areas, encompassing Aboriginal women’s health status, violence and sexual abuse, substance abuse and maternal health, health-seeking behaviour, and access to services.
While all of the initiatives undertaken or supported by the Centres probe questions of key concern to Aboriginal women, additional work is needed in a number of areas. In particular, steps must be taken to ensure that research methodologies are clearly articulated and respectful of Aboriginal women’s multiple burdens, that attention be focussed on groups of Aboriginal women whose needs and concerns have been under-represented in previous research, and that research initiatives be reflective of Aboriginal women’s linguistic and cultural diversity. Other issues include the lack of sufficient funding to pursue Aboriginal women’s health research, and the need to ensure adequate and appropriate follow-up. We also highlight the importance of giving Aboriginal women control over research that affects them and the need to enhance training and networking opportunities for Aboriginal women researchers,. We urge the fostering of partnerships and collaboration with both Aboriginal and non-Aboriginal organizations.
Indigenizing the Research Process
We have a number of recommendations to promote the indigenization of the research process. The Centres of Excellence for Women’s Health, in conjunction with Aboriginal women’s health researchers and appropriate Aboriginal organizations, should outline a strategy for just, sustainable and inclusive collaborations and partnerships. The Centres should educate researchers and research participants about health research and Aboriginal women.
Aboriginal organizations also need to be part of developing a strategy for the incorporation of Aboriginal women’s health stories, experiences and knowledge into an analytical framework that can be used as a "lens" when doing research with Aboriginal women. A dialogue is needed between academic and community researchers to address outstanding issues related to health research on Aboriginal women, particularly as these relate to identity, culture and key social categories.
Engaging Aboriginal Women in the Research Process
The Centres must recognize Aboriginal women’s multiple burdens, including poor health status, poverty, violence, substance abuse, childcare and over-surveillance. Aboriginal women’s health researchers and appropriate Aboriginal and non-Aboriginal organizations should work with Aboriginal women in communities to promote participation in research projects, share approaches to mobilize Aboriginal women, and identify means of strengthening community driven research.
The Centres, in conjunction with the Canadian Women’s Health Network, could coordinate research and develop policy that would support Aboriginal women’s groups; involve researchers deemed to be personally suitable for work with Aboriginal women; protect the rights of both researchers and Aboriginal women; build upon Aboriginal women’s strong leadership role in health-related matters at the community level; recognize the evolving capacity of Aboriginal women to conduct research; and show sensitivity to diverse audience groups.
The Centres could work with researchers to develop an analytical tool that would assist in establishing Aboriginal women’s health research so as to weigh the consequences of acting or not acting on key health issues, and also examine the pain/health/healing paradigm that informs the provision of health care services to Aboriginal women.
We hope the Centres, the Women’s Health Bureau and other relevant federal government departments will consider holding an annual meeting on Aboriginal women’s health research.
Addressing Gaps and Weaknesses in Aboriginal Women’s Health Research
We recommend that the Centres work with Aboriginal women’s health researchers and appropriate Aboriginal and non-Aboriginal organizations to determine when, how and why academic and community methodologies should override, intersect or co-exist with one another; identify and track positive health indicators; facilitate networking by Aboriginal women’s health researchers; exploit new information technologies to disseminate and share research findings; undertake analyses which compare and contrast local, regional and international trends, issues and solutions; and articulate both gender- and Aboriginal-based analyses.
The Centres should work with Aboriginal women’s health researchers to develop culturally-appropriate methodologies; identify model communities such as Alkalai Lake and Hollow Water; develop a knowledge base of key Aboriginal concepts and principles (e.g., respect) which may be relevant in the pursuit of health research; situate research in larger social, economic, political, legal and cultural contexts; undertake research which is sensitive to Aboriginal women’s diversity; understand the implications of the medicalization of Aboriginal women’s health; and carry out research which supports Aboriginal women’s programming needs.
There was a strong consensus among the participants at the National Workshop on Aboriginal Women’s Health Research that research must be both action oriented and acted upon. In the words of one woman, "… once the research has [been] done, we have to do whatever it takes to act on this research." We must seek ways of promoting change.
The full text of the Aboriginal Women’s Health Research Synthesis Project Final Report may be downloaded at www.cwhn.ca/sites/default/files/resources/synthesis/synthesis-en.pdf. Copies of the report, available in both English and French, can be ordered from the Canadian Women’s Health Network.
Madeleine Dion Stout is a Cree-speaking educator from the Kehewin First Nation. She is widely recognized for her work on women’s health issues and has published for Status of Women Canada and others. A former faculty member at Carlton University, she now resides in British Columbia. Gregory D. Kipling is a health researcher currently working on immigration and refugee issues. Roberta Stout is a Cree woman from Kehewin Alberta, currently working on Aboriginal women, health and the environment.