'Issues beyond our control.'

Many pregnant woman in Nunavut suffer hardships that include stress and abuse, says a new Statistics Canada report.

"A number of the findings for Nunavut are of concern," says What Mothers say: The Canadian Maternity Experience Survey.

The 240-page survey, which interviewed women across Canada, found that, compared to pregnant women in other provinces or territories, pregnant women in Nunavut are likely to:

• Feel less happy when they learn they are pregnant;
• Receive inadequate prenatal care, that is four or fewer visits to a health clinic, start this care later in pregnancy, and rarely under an obstetrician or gynecologist;
• Skip folic acid supplements and be unaware that they should take these supplements to prevent birth defects;
• Smoke and live with smokers;
• Use street drugs before pregnancy: 26.6 per cent of pregnant women in Nunavut admitted to drug use, compared with only 5.5 per cent in Prince Edward Island.
• Use street drugs during pregnancy: about nine per cent of pregnant women in Nunavut reported using drugs while pregnant. All other jurisdictions with numbers large enough to report have proportions of less than two per cent;
• Drink more frequently;
• Be unemployed;
• Experience abuse;
• Lack support: 15 per cent say that during pregnancy they receive support "little or none of the time;"
• Feel stress: more than half say they're stressed during the 12 months before giving birth, the highest rate in Canada;
• Travel to give birth;
• Receive less support during labour from a husband or partner;
• Give birth naturally, without cesarean sections, anesthesia or stitches, and have immediate contact with their baby and breastfeed;
• Stay in the hospital briefly, but receive less follow-up care and support at home after the baby's birth;
• Display symptoms suggesting postpartum depression;
• Be unsatisfied with their health care and less likely to think their baby is in excellent health.

The survey's findings don't come as a surprise to Dr. Geraldine Osborne, the assistant director of public health in Nunavut.

But money can't resolve the problems faced by many pregnant women in Nunavut because there's a lack of capacity in the territory's communities and within her department, she said.

And some of these problems aren't even medical in nature.

"There are issues beyond our control, the social factors, the lack of employment, overcrowding, the stress and violence in homes. All these issues have a huge impact, and it's not an easy thing for health to deal with alone," she said.

"If we had a well-educated population who were fully employed and recovered from the many issues they have historically, then our job in public health would be a lot easier. "

Communities throughout Nunavut already offer the Canadian prenatal nutrition program for pregnant women, Osborne said. Soon, these programs will also provide information on the impact of smoking and drugs during pregnancy.

Vitamin supplements are already available to all pregnant women at Nunavut health clinics.

However, the real need among pregnant women in Nunavut isn't for folic acid because the enriched flour used in bannock contains folic acid, she said. Most need more iron and vitamin D, which prevent anemia and other health problems.

Osborne said Nunavut plans to start collecting more long-term information on pregnant women and their babies and train more local maternity care workers to better gauge the problems and solutions facing pregnant women in Nunavut.

The goal is to improve the health of all Nunavummiut.

"If you get it right at the start of life, if you have healthy babies and mothers, then all the problems are less likely to be severe or not even occur at all," she said.