Close examination of the rooted structural issues of history, racism, and social and economic frameworks that create disadvantages for Aboriginal women in Canada has led to the creation of a dominant discourse that suggests FASD is an Aboriginal issue, and that blames mothers and holds them, as individuals, responsible for maternal health and birth outcomes. These points are contested by many Canadian women authors (Badry 2012; Hunting & Browne 2012; Poole 2007; Poole & Greaves 2007; Rutman et al. 2000).
In 1997, Health Canada released It Takes a Community, a report resulting from a collaboration of FASD experts, provincial and territorial governments, national Aboriginal organisations and First Nation and Inuit community representatives. Session participants stressed the need to address FAS/FAE issues holistically to account for the social determinants of health, including ‘discrimination, poverty, domestic violence, solvent and drug abuse, and residential school
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syndrome’12. Nine years later, the Ontario Federation of Indian Friendship Centres produced a ‘FASDTool Kit for Aboriginal communities’ using a ‘medicine wheel’ to represent a holistic approach to FASD prevention recognising the inclusion of relationship, reason, movement and mobilisation and vision (Wemigwans 2005).
Square in 1997 highlighted the First Nations reserve experience and claimed that ‘1 in 10 children is the victim of alcohol teratogenesis and that ‘for every child identified … in northern Manitoba, there are probably 2 or 3 others with behavioural and learning problems’. Square reported ‘roughly 100 cases of FAS/FAE [per 1000 births] on the reserve’ and claimed this prevalence rate meant FAS qualified as an epidemic: ‘it is time for federal and provincial governments to take action’ (p. 59). FASD was officially understood at this time to be ‘a nation-wide health concern’ and non-
discriminatory ‘on the basis of race, socio-economic status, or sex’; it was still presented as ‘an alcohol and addiction issue, with ramifications in areas including women’s health, disability, family violence, mental health, employment, child welfare, education and criminal justice systems’ (Health Canada 1997).
Josephine Nanson (1997, pp. 807–808) considered binge drinking in pregnancy with a focus on identifying women at risk, targeting pregnant women who sought information from Motherisk
counselling service in Toronto. Traditional notions of mothering in identifying the stress of pregnancy as a possible reason for alcohol use were challenged, as was traditional research on pregnant women who drink. Nanson cited Square (1997), who had written about socioeconomic status, employment history and education as barriers for women at highest risk who might not contact health services. Square’s argument was that these factors had been ignored, and suggested that drinking in pregnancy might be a coping mechanism in response to life trauma, which disrupted their consideration of the risk to their unborn children. Nanson pointed out that Square had also argued for the recognition that women ‘rarely wish to harm their children’ and proposed ‘compassion and support’ replace legal solutions which were framed as treatment. Square had also proposed improving the overall health of young, poor women, which she believed should reduce the incidence of alcohol-related birth defects. Nanson claimed there is a need for ‘family centered treatment programs in which children are integrated and for multi-faceted, community based prevention programs designed for and by the community in which women at high risk live’. The growing acceptance of women as a ‘special group’
12 Residential schools were a system ‘set up by the Canadian government and administered by churches that had the nominal objective of educating Aboriginal children but also the more damaging and equally explicit objectives of indoctrinating them into Euro-Canadian and Christian ways of living and assimilating them into mainstream Canadian society’
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led to doubt about the efficacy of current therapeutic approaches to needs of women which arose from traditional gender constructs or from women’s social position in relation to men (Nanson, 1997, pp. 807–808).Halseth (2013) produced a comprehensive appraisal of the health of Canadian Aboriginal women in respect to gender and socio-economic determinants of health as barriers. Racism, violence, poverty, HIV, alienation from community and culture, single motherhood and low rates of educational attainment and employment were ‘some of the factors that intersect with gender to impact health and well-being of Aboriginal women’ (p.15). The depth of research in this document demonstrates the attention Aboriginal health has received over time; however, Halseth concludes,
The many challenges associated with health status among Aboriginal women in Canada can be largely attributed to historical precedents and the resulting socio-economic circumstances. Addressing these challenges is complex within a multijurisdictional framework of health care provision and within the diverse contexts of Aboriginal women’s lives. (2013, p. 15)
Disparities were revealed in a comprehensive comparative review of research conducted on Canadian Aboriginal children in the areas of autism, cerebral palsy and FASD. Of 52 reports published since 1981, 51 focused exclusively on FASD with little attention given to engaging the local communities. The authors concluded that the focus on FASD was not representative of the prevalence of these three conditions and violated ‘fundamental principles ensuring equitable representation of all children regardless of background in research and access to benefits of research in health care and [perpetuated] stigma in an already marginalized population’ (Di Pietro & Illes 2013, p. 81).