Pijitsirniq

is an Inuit societal value that means serving and providing for family and community.

Communities, elders and family have always played an important role in the birthing process. 

Pregnant women – and 

Nunavut’s child mortality rates were the focus of much media attention this past winter after a study published in the Canadian Medical Association Journal found they were 3.6 times the national average. 

Most of the national media coverage neglected to provide the background and did little else besides reporting the statistic. However, looking at the challenges the territory is facing – and the steps it is taking to make improvements – paints a much brighter picture when it comes to maternal and newborn health. 

Inuit people living in Nunavut have experienced what Dr. Isaac Sobol, Chief 

is an Inuit societal value that means serving and providing for family and community. their babies – benefit from the care of family, community and elders. Healthy moms give birth to healthy babies – and the Nunavut is dedicated to ensuring the health of both. Medical Officer of Health for

the territory has referred to as a “cultural earthquake”: their lifestyle has changed radically over the past decades.

As with Canada’s other indigenous peoples, Inuit people were forcibly separated from their culture, language, land and traditions in all aspects of their lives – including the way women give birth.

Inuit people across the territory – community members, political leaders, health care providers, researchers and parents – have all advocated for the return of community-based birthing as an option for expecting mothers and their families.

Nunavut accounts for a

fifth of the size of Canada and

covers three time zones.Scattered across the territory are 25 communities, about half of which have a population of less than 1,000 people.

They are primarily accessible by air as there are no roads connecting communities. Many do not 

have a full-time doctor.

Four languages are spoken here – Inuktitut, English, French and Inuinnaqtun. Any one of these factors in and of

 

itself is a significant challenge

– the combination presents severe logistical challenges for health care and service delivery.Investments since the territory’s inception, a new Maternal and Newborn Health Care Strategy and funding to support its goals are improving the territory’s health care delivery when it comes to mothers and babies.

The Maternal and Newborn Health Care Strategy

 

is a five-year plan put into place in 2009 that addresses child mortality rates and puts forth a plan to make some significant improvements by

2014.These improvements include increasing in-territory care, the number of Nunavummiut who deliver maternal and newborn care, ensure care is culturally-relevant and accessible at all stages of pregnancy, and increasing family planning and improving parenting skills.

It is the Government of Nunavut’s commitment to improving health outcomes for women and children and bringing birth back to communities.

Its focus is encouraging women and families to make healthy choices and decisionsthroughout all stages of pregnancy – preconception, prenatal, perinatal, postnatal and postpartum.

The strategy confronts the reality of birth in Nunavut: that birth has been medicalized, removed from communities and moved into hospitals 

over the past decades.

The strategy has put into place concrete ways to reverse this trend, including the launch of regional birthing centres in Rankin Inlet and Cambridge Bay and a greater focus on recruiting, training and employing Inuit midwives and maternal care workers throughout the territory.

Nunavut has also introduced new legislation to support midwifery throughout the territory with the 2008 Midwifery Profession Act.

Midwives have long been a part of the health care staff providing care in the territory.

Until recently, midwives have mostly come from other parts of Canada – not Nunavut itself.

However, the Nunavut Arctic College’s Maternity Care Worker and Midwifery program is now training Inuit women in Iqaluit and Rankin Inlet and will soon be expanding to Cambridge Bay.

Inuit midwives are able to provide culturally relevant care to pregnant mothers in their native language, Inuktitut.

As of 2009, 3 Inuit midwives had graduated from the school and are now practicing throughout the territory, providing care to women in communities outside Iqaluit.

Cultural relevancy goes far beyond providing service in Inuktitut.

The inclusion of Inuit Qaujimajatuqangit (IQ), or ‘traditional knowledge’, in all aspects of program and service delivery is one of the territory’s priorities.

It is traditional knowledge that is passed on from generation to generation – and includes a range of skills from 

making a parka to midwifery practices.

The connection it provides to culture and identity help improve the health of the population – a rich cultural life is seen as one of many social determinants of health.

Traditionally, Inuit births are immediately celebrated with a number of ceremonies.

When birth happens in communities and is supported by midwives, elders are able to continue these traditions, which include an initial blessing that explains the baby’s namesake and their expectations.

The Rankin Inlet Birthing

 

Centre first started operating

in 1992 and services the whole Kivalliq region, providing low-risk pregnant women with a birthing option close to home.Since its inception, it has seen over 500 births, allowing more mothers to stay in Nunavut to deliver their babies.

An audit of the centre’s practices from its opening up to 2004 found an increase in the quality of prenatal care, no neonatal deaths, a low incidence of prenatal complications,

 

and a significant reduction

in the number of mothers and newborns who required transfer to other communities for care – from 25% to 10%.This birthing centre also operates a satellite clinic in Arviat – the community with the territory’s highest birth rate. Another birthing centre has opened this year in Cambridge Bay.

Since early 2010, Cambridge Bay has seen three births.

Eventually, women from the Kitikmeot region will be able to deliver their babies in Cambridge Bay.

The territory’s work on maternal and newborn health goes far beyond bringing 

birth back to communities: it includes programs such as Canadian Prenatal Nutrition Program, public health drop-in times for new mothers and programs to address issues of food security, housing, substance use and poverty prevalent throughout the territory.Currently, statistics

 

across the territory are difficult

to access.However, Nunavut will soon be introducing a new Pregnancy Outcome Child Health surveillance system that has been used in other jurisdictions to monitor newborn and maternal health

This will help plan continued improvements to the territory’s pregnancy programming.

Nunavummiut have a lot to be proud of culturally, socially, economically, politically. In the 11 years Nunavut has been its own territory, there has been a lot of progress – progress that will continue with time.

The territory is working to improve health indicators, but these changes take time and won’t happen overnight.

Instead of highlighting statistics that portray Nunavut negatively, the rest of Canada, researchers and the media would do well to recognize the positive things that are happening here, contextualize statistics within Nunavut and celebrate the successes throughout the territory.