Inuit stillborn rates three times those of other Canadians: report

APRIL LIM
Postmedia News

Inuit-populated areas of the country have three times the stillbirth rate of the rest of Canada, according to a new report in the prominent medical journal The Lancet.

About 2.6 million third-trimester stillbirths occur worldwide every year, according to the Lancet‘s Stillbirths Series, authored by 69 experts from more than 50 organizations in 18 countries. The series provides an assessment of global numbers, causes of stillbirths, perceptions and beliefs around the world, and offers ways to help prevent stillbirths.

“Now we have no excuse. Now we have systematic estimates, we know that there’s a big number, we know that women care about them, and we also know there are things that we can do about it,” said Dr. Joy Lawn, lead author of the series. “The good news here is that this is something that is meant to be high up on the global agenda.”

Although Canada has a relatively low stillbirth rate compared to other countries — Pakistan’s stillbirth rate is 46.7 and Nigeria’s is 41.7 — the Inuit-populated areas of the country stand out.

Canada’s recorded stillbirth rate per 1,000 births in 2009 was 3.3. Inuit communities have three times that rate.

Catherine Curry, senior program officer at the Inuit Tuttarvingat Centre — the Inuit-specific branch of the National Aboriginal Health Organization dedicated to Inuit health and wellness issues — has been studying Inuit maternal health care in northern Canada for six years.

Curry said poor access to maternity heath care may be the reason why many Inuit women face a higher risk of stillbirths.

“Stillbirths can’t be blamed on any one thing, but good prenatal care, by far, if it was delivered to every woman, would prevent that to a great degree,” Curry said.

“It’s something that families really don’t get over. Nor do they ever want to forget their child, and it’s something that, even with a physical death, the relationship still continues on. These little babies are very a part of many families’ lives,” said Dr. Christine Jonas-Simpson, assistant professor in the faculty of health at York University in Toronto.

Jonas-Simpson has been involved in research and production of educational materials on the experience of losing a child. Her own baby was stillborn in 2001.

While Curry does agree that the rates are worse in Inuit areas, she said she thinks the problem is more about child health than stillbirths. She said she would like to see better prenatal care available in every Inuit community, including more support to help deal with violence, poverty and substance abuse.

“There’s actually aren’t a lot of (stillbirths). It’s just when you compare statistics because even one stillbirth up north is big statistic,” Curry said. “Many Inuit babies are born alive and need to be healthier. Generally many public health factors and insufficient prenatal care impact infant-mortality rates. Prenatal care can mitigate a lot of those factors,” Curry said.

Certain birth defects are caused by poor nutrition, and some of them are irreversible, while other birth defects are caused by substance abuse and are preventable through extra support in the communities and counselling, experts say.

Curry said Inuit women who receive care from midwives — especially Inuit midwives — do better. However, Curry said only a handful of communities have established birthing units where midwives can practise, so most Inuit women are being taken out of their communities for to give birth even though they may have good reasons for not wanting to leave: having children at home, economic reasons, other family obligations.

“When you have to change from one provider to another throughout the prenatal experience . . . you end up seeing a whole bunch of different care providers (and they’re) telling you the same thing over and over again. You have to relate to all kinds of people from different cultures and languages and so on and so on,” Curry said.

She also added there is insufficient prenatal care in communities where women do not have access to midwives in their communities.

Curry said she thinks prenatal care by midwives is much better than the care nurses can provide. She said a midwife will spend more time with a pregnant woman than nurses, who usually tend to pregnant women in an emergency situation.

“In communities without midwives, the nurses take on whatever prenatal care they can afford to do in their busy schedules and often it’s much less than women should be getting,” Curry said.

Most Inuit want the best of modern medicine and the best of their own cultural practices and knowledge in combination, Curry said.

“It’s important to understand that Inuit women deserve the right to have options. Just like any other women anywhere else in Canada. The more remote you are, the less options you have,” Curry said.