Autonomy, Tradition, and Childbirth: The Medical Evacuation of Pregnant Women By: Sequoia ‘Mitzy’ Lehman

About the author: Sequoia ‘Mitzy’ Lehman is a third-year student doing a BA in History and Art History. She says that “we live in a country preoccupied with sending help to other countries at the expense of people who have been living on this land for thousands of years.” She is passionate about human rights issues happening within this land. She wrote this paper for HIST*3390 “The Government in Indigenous Spaces.” In the future of her academic career, she aims to focus on language used in historical narratives, and the impact terminology and vocabulary have on the interpretation and dissemination. She believes the limitations and implications of language are an integral part of our understanding of history.

111 In the wake of the Second World War (1939-1945), the Canadian government, ostensibly under the eye of foreign governmental bodies, was being pressured to demonstrate its responsibility in caring for the wards of the state. The paternalistic foundations of Canadian government traditionally viewed Indigenous people as incapable and requiring governmental agency. Westernized patriarchal governments such as Canada’s were accustomed to exerting control through institutions under the guise of standardized practice in “welfare.” The medicalization of childbirth, which had begun overseas with the scientific revolution and the Enlightenment, combined with the monitoring of infant mortality rates, produced alarming statistics for Inuit and northern mothers and their babies. In 1958, data collected from northern territories found that mortality rates in the north were higher than anywhere else in the country, and the Inuit had the highest infant mortality rate than any other Indigenous group in Canada.1 The paternalistic federal government perceived this as failing to care for its wards,2 and began instituting the standardized medical policies already being practiced for European and settler women. Medical evacuation of pregnant Inuit women informed policymaking regarding public health care and obstetric accessibility for northern communities, which actively undermined traditional birthing practices. This interfered with the transmission of insular midwifery knowledge, the autonomy of Inuit women, and the mental health of entire communities.3 Medical evacuation for pregnant mothers has its roots in earlier sociological medical history of both North American colonies, and overseas Europe. To understand why childbirth is both so medical and so political, it is necessary to understand what it is that childbirth represents. Fundamentally, it will inevitably mean something different to every culture, however in colonial contexts childbirth represents the very nature of the woman who is giving birth. During colonization, women from ‘savage lands’ were believed to be very different on the most basic level from European women.4 This is typified from the two very different ways European women and Inuit women gave birth. Inuit women gave birth while kneeling, often holding a horizontal bar for support, and sometimes even gave birth alone.5 Their birthing practices were active, engaged, and ultimately in control of both their own bodies, and their babies’. Traditional Inuit birthing practices extolled the necessity of

1 Patricia Jasen,“Race, Culture, and the Colonization of Childbirth in Northern Canada” Social History of Medicine 10. 3 (December 1997: 395 2 Ibid., 397. 3 Janet Mancini Millson and Kyra Mancini, Inuit Women: Their Powerful Spirit (Maryland: Rowman & Littlefield Publishers, Inc., 2007), 147. 4 Jasen, “Colonization of Childbirth,” 384. 5 Naqi Ekho and Uqsuralik Ottokie, Interviewing Inuit Elders, Childrearing Practices, ed. Jeans Briggs. (Iqaluit: Nunavut Arctic College 2000), 32.

112 keeping the spine straight, and attributed sitting down too much during birth and pregnancy to poor development of the baby.6 European women, on the other hand, gave birth lying down, surrounded by helpers. Their birthing process, demonstrated by the position they took to birth, was inherently more passive, and much of their control was relinquished to those helping them. European women were both seen and treated as more delicate and refined, than the ‘savage women’ of North America’s First Nations. Indigenous women served as a stark opposite to their European counterparts, and the stereotype assigned to them by the White settlers was animalistic and grotesque.7 Holding European women up as model women informed the settler understanding of Inuit childbirth. With global modernization came an acute interest in the scientific process, leading missionaries and explorers to lean on any quantifiable measure they could to insinuate moral inferiority in Inuit women, from the size of the baby and length of labour to the harshness of their lives. These were used to highlight a perceived need for conversion, and thereby modernization. However, with the increase of data accumulation came an understanding within the scientific community that infant and mother mortality rates during birth among ‘civilized’ communities were shockingly high. This statistical danger made many European women reluctant to give birth, inciting fright from indisputably White supremacist governments regarding the long-term survival of the European race. As this stood in opposition to the supposed benefits of civilization, theories started to develop regarding ‘over-civilization’, or the over refinement of ‘good breeding’ that had led European women to lose whatever animalistic traits that they had once shared with ‘natural women,’ losing along with them the ability to safely give birth on their own. This is what led to the justification of full reliance on male gynaecologists by European women, informing the precedent set for birthing standards held by European settlers in North America.8 As medical science continued to evolve, and the philosophy of rationality began to be prioritized over the religious, the need for pain during birth for the sake of original sin was ultimately discarded in favour of more scientific approaches and the use of anaesthetic. Anaesthetic placed birth firmly within medicine, and was henceforth medicalized. In the late 1960s and 1970s common law regarding Indigenous rights and issues began to reform. Prior to this period, Inuit peoples had been regarded separately from the rest of constitutional ‘Indians.’ Hudson’s

6 Ekho and Ottokie, Interviewing Inuit Elders, 39. 7 Jasen, “Colonization of Childbirth,” 386. 8 Jasen, “Colonization of Childbirth,” 391.

113 Bay Company employee Nicol Finlayson documented his stay in Ungava and European relations with both northern Indigenous and Inuit communities. In one of his journals, Finlayson described a winter in 1833. “Two families of Esquimeaux wintered alongside of us last season; they often visited the Indians while in our neighbourhood.”9 European settlers distinguished between the Inuit and other Indigenous groups, which led to the Inuit not being recognized as Indians under the Indian act until 1975. This constitutional reform had begun with Québequois unrest regarding the protection and guarantee of stability for minorities. Crucially, during this time the Arctic was left within a holding category on the Canadian map, which removed a number of its existing barriers to political change. Finally, in 1975 modern treaties were adjusted to include Inuit common-law rights.10 In Québec, the department of Indian and Northern Affairs reached an agreement regarding treaty rights of Inuit communities living around James Bay and Northern Québec. Within the hundreds of pages of this document, there is a section regarding healthcare practices and the transition to provincial responsibility in the delivery of health and medical services to the Inuit living in this region. The few subsections applying to healthcare provisions are a minimal implementation of governmental responsibility, and underlines the continued valuing of Western medical practices over traditional Indigenous medicine. Of these few subsections, only one statement directly applies to pregnancy and childbirth: “Maternal and child health to improve maternal and child health by reducing maternal morbidity and mortality in the pen-natal period as well as infant morbidity and mortality. To promote and improve the physical and mental state of health of preschoolers”11

The implementation of these intentions are expanded upon in the following statements: “For the purposes of the present Agreement, the first line health and social services shall include: - the daily services of a clinical or public health nurse, who shall not necessarily be hired on a full time basis or be expected to take up permanent residence; - the regular

9 Nicol Finlayson, letter to Erland Erlandson, Fort Chimo 31 March 1834. In Northern Quebec and Labrador Journals and Correspondence, 1819-35. (Glasgow: Hudson’s Bay Record Society Limited,1963), 227. 10 Mary Simon, “Where We Have Been and Where We Are Going,” International Journal 66.4 (2011): 881. 11 109. Indian and Northern Affairs Canada, Agreement Respecting the Implementation of the James Bay and Northern Quebec Agreement Between Her Majesty the Queen in Right of Canada and , Minister of Indian and Northern Affairs J. Hugh Faulkner (Québec: Indian and Northern Affairs Canada, 1975) Schedule 2.1. 10-9.

114 first line services of a social service agent, to be provided locally, but not necessarily on a full-time basis; - whenever necessary, the services of a general practitioner.”12

This section clearly indicates the value of clinical medicine, but also quite ominously provides the foundation for maternal medical evacuation when it states avoidance of hiring full time nurses or service agents within the provided healthcare clinics. Furthermore, the next section applying to the schedule of these provisions states: “Québec undertakes to expeditiously review health and social services staff, facilities and equipment at Kuudjuak (Fort Chimo) with the intention of upgrading the capabilities of the existing establishment to fulfill the sectoral responsibilities envisaged by this Section, and similarly for the community of Povungnituk, including plans for the earliest feasible construction of a hospital centre for general care”13

While this appears to be positive action towards better healthcare, these statements make no mention of the nature of accessibility or the specific services offered by these facilities and staff. A critical phrase in the third statement reveals the bureaucratic dissonance practiced by both the federal and provincial governments. ‘Fulfilling sectoral responsibilities’ refers to meeting a certain number of regional services, and speaks from the position of paternalistic providers to their wards, not from the position of the needs of real people.14 In a study done on birth outcomes for both Inuit and non-Indigenous women that compared outcomes from northern communities to southern communities, results demonstrated a predictable increased risk to northern Inuit mothers and their babies. However, results from the southern areas showed that Indigenous women in these regions equally experienced elevated levels of risk and complication in childbirth as non-Indigenous mothers.15 The implications of these results suggest that complications in Indigenous childbirths are not informed by lack of proximity to clinical healthcare services; if this were the case Indigenous women in southern regions would, in theory, experience the same level of risk as non-Indigenous women. What

12 109. Indian and Northern Affairs Canada, James Bay and Northern Quebec Agreement 1975, Section 10-10. 13 109. Indian and Northern Affairs Canada, James Bay and Northern Quebec Agreement 1975, 15(5), 265. 14 Peter Aspinall, “Language Matters: the Vocabulary of Racism in Health Care,” Journal of Health Services Research & Policy 10. no. 1 (2005): 58. 15 Zhong-Cheng Luo et.al, “Birth Outcomes and Infant Mortality Among First Nations Inuit, and Non-Indigenous Women by Northern versus Southern Residence, Quebec,” Journal of Epidemiology and Community Health 66. no. 4 (2012): 33.

115 this implies instead is that the marginalization and discriminatory policies governing Indigenous populations is contributing to an overall decrease in health and welfare.16 Even given access to maternal healthcare, Indigenous mothers have consistently experienced marginalization through systematic racism endemic in medical environments.17 While there are medical facilities set up to cater specifically to women from remote communities being evacuated for the latter days of their pregnancies and the delivery of their children, these facilities do not provide any access to traditional birthing methods, and very few of them have midwives on staff. The women who attend these facilities have expressed just as much disconnect and isolation from their traditions and families as women sent to other hospitals.18 This disconnect between living experience and practical medicine is aided through healthcare falling formally under the jurisdiction of provincial governments, not the Canadian federal government. As such, there is variation in healthcare practices across provinces. Candace Johnson has researched the relationship between pregnant women and their relationships to childbirth as defined through healthcare, cultural diversity, and dialogue conventions. “Negotiating Maternal Identity,” Johnson explains that there is, and has historically existed, a disconnect between how mothers experience childbirth and how it is treated by their doctors “because the institution of childbirth is defined and reproduced by patriarchy, women’s experiences are diminished.”19 The vast majority of marginalized and minority women will not even consider alternative birthing methods because of the concern for safety, which Canadian governments have assigned to conventional medical practice.20 However, there are a growing number of upper class Canadian women who idealize what they call “natural” birth, and have expressed a discomfort surrounding the focus of obstetricians. Their concern is that medical practitioners are focussed on the health of the baby, resulting in a clinical coldness and isolation of the mother.21 None of the discourse surrounding Canadian settler women’s birthing practice emphasizes the focus or role of the mother, denoting the lack

16 Karen M. Lawford, Audrey R. Giles, and Ivy L. Bourgeault, “Canada’s Evacuation Policy for Pregnant First Nations Women: Resignation, Resilience, and Resistanc,” Women and Birth 31. no 6 (2018): 484 17 Robert Gagnon et. al., “Interactions Between Indigenous Women Awaiting Childbirth Away from Home and Their Southern, Non-Indigenous Health Care Providers,” Quantitative Health Research 28 (2018: 1860 18 Terry O’Driscoll, Lauren Payne, Natalie St. Pierre-Hansen, Helen Cromarty, Bryanne Minty, and Barb Linkewich. “Delivering Away From Home: The Perinatal Experiences of First Nations Women in Northwestern Ontario,” Canadian Journal of Rural Medicine 16., no. 4 (2011): 129. 19 Candace Johnson, Maternal Transitions: A North-South Politics of Pregnancy and Childbirth (New York: Routledge, 2014), 88 20 Johnson, Maternal Transition, 117. 21 Johnson, Maternal Transition, 122.

116 of evolution in maternal rights throughout colonial history. This stagnation of maternal medical practice has supported the Western approach to birth that emphasizes the passive role of the mother. The medicalization of childbirth affected both European and Indigenous women, as it set the standard for what colonial have come to view as acceptable birthing practices and safe procedures. Before 1958 when statistics flagged a critical need for Northern birthing support, a precedent for medical evacuation had already been set by the governmental relocation and evacuation response to tuberculosis epidemics. As statistics were interpreted as dependant on the location of birth, when there was a perceived need for medical intervention in Northern communities, the government followed its existing infrastructure.22 Controlling the reproductive lives of Inuit women has isolated these women, their children, and the act of childbirth, putting mother and child further at risk. Health is not merely determined by physical wellbeing, but emotional and spiritual wellbeing. If maternal and infant mortality rates are decreased, but youth and adult suicide rates are increased, this is not an improvement in community health.23 For Inuit women, removal from home communities disconnected them from traditional birthing practices, which do not consider the act of birthing as the sole aspect of this experience. The role of those present, the spiritual and literal roles and implications of those present, the anticipation and preparation for birth, and the overall learning taken from birthing towards a woman’s life experience are all traditionally integral to Inuit birth.24 Even within institutes geared directly at Indigenous women delivering away from their homes, a serious disconnect from cultural practices and traditions created a clinical isolation resulting in an alien and separated experience of childbirth.25 The language used in the dialogue surrounding childbirth has been equally impactful on the identity of mothers and the relationships between Indigenous mothers and their healthcare providers.26 Non-Indigenous Canadian mothers have played a significant role in forming public, governmental, and medical opinion on traditional births. As mentioned above, non-Indigenous Canadian women tend to use the term ‘natural’ in reference to alternative birthing practices, which encompasses traditional births. The problem with this terminology is that it is vague, and idealizes the experience of Indigenous

22 Jasen, “Colonization of Childbirth,” 396. 23 Lawford, et. al., “Canada’s Evacuations Policy for Pregnant First Nations Women,” 483. 24 Pertice M. Moffit, “Colonialization: A Health Determinant for Pregnant Dogrib Women,” Journal of Transcultural Nursing 15.4 (2004): 327. 25 Driscol et. al., “Delivering Away From Home: the Perinatal Experience of First Nations Women in Northwestern Ontario,” 128. 26 Aspinall, “Language Matters,” 57.

117 women who are marginalized in obstetric medicine27 and often unable to choose their traditional birthing practices.28 The problem in conflating ‘natural’ and ‘traditional’ is twofold: first of all, the latter involves cultural practice and has room for the inclusion of some elements of Western medicine and safety procedures29 while ‘natural’ is a departure from medicine altogether. Second, with this confusion of nature and tradition there comes the misconception of traditional births as coming with higher risk and less safety.30 Inuit mothers and their newborns have experienced enormous disruption in their community lives and family connections as a result of being removed from their homes during moments in their lives of critical traditional importance and immense personal stress. Maternal medical evacuation has had consequences psychologically and economically for Inuit mothers, their children, and their families. Traditional values and practices, not only in childbirth have been interrupted and undermined by removing the privacy of childbirth and placing into the public sphere.31 It was common into the mid nineteenth century for pregnant Inuit women to be very private and shy about their pregnancies32 and mothers were very involved in the development and birth of their babies. Beyond the position they took to deliver, Inuit women were very active throughout their pregnancies.33 Transmission and preservation of cultural identity is linked to reproductive capacity and child-rearing, so by directly interfering in the reproductive lives of Inuit women, so too have medical and governmental institutions interfered with the valuing of Inuit communities’ identities and traditions.34 In an interview published in 2000, an elder named Uqsuralik Ottokie comments on the change in communal birthing practices and expectations for mothers within her lifetime. “For a pregnant woman, the rules were different than today’s rules.”35 Canada’s policy of evacuating pregnant Inuit mothers for the purpose of giving birth in medical health centers is not only demonstrative of a patriarchal government exerting its control over subjugated populations and controlling women’s bodies, but is also indicative of the its attitudes towards Indigenous populations. Treaties and land-claim agreements created in the 1970s have structured policies the Canadian federal and provincial governments

27 Lawford, et. al., “Canada’s Evacuation Policy for Pregnant First Nations Women,” 480. 28 Johnson, Maternal Transition, 124-25. 29 Johnson, Maternal Transition, 118. 30 Driscol et. al., “Delivering Away From Home,” 129. 31 Laurie B. Green, John Mckiernan-Gonzàlez, and Martin Summers, Precarious Prescriptions: Contested Histories of Race and Health in North America (Minneapolis: University of Minnesota Press, 2014), 122. 32 Ekho and Ottokie, Interviewing Inuit Elders, 32. 33 Ekho and Ottokie, Interviewing Inuit Elders, 39. 34 Green et. al, Precarious Prescriptions, 121-122. 35 Ekho and Ottokie, Interviewing Inuit Elders, 33.

118 employ in the treatment of Indigenous Nations. The question of pregnancy medicalization is a universal feminist issue,36 and the impacts on the lives of mothers and their babies are even more substantial in Inuit communities. The Canadian government and healthcare institutions have marginalized and isolated Inuit women from their communities, families, and traditions.37 Western medical authorities have prioritized clinical childbirth, continuing a colonial custom of patronizing and controlling women, as well as furthering colonial misrepresentations of Inuit women as savage and uncivilized. This has led to a significant decline in mental well-being of mothers and babies, and undermined and eroded cultural Inuit practices and identities.38 The dissolution of traditional Inuit birthing practices reflects the intentions of the Canadian federal and provincial governments in the formation of Treaties with Inuit and the other Indigenous peoples living in what is now Canada.

36 Jessica C. A. Shaw, “The Medicalization of Birth and Midwifery as Resistance,” Health Care for Women International 34 (2013) 523. 37 Lawford, et. al., “Canada’s Evacuation Policy for Pregnant First Nations Women,” 481. 38 Pertice M. Moffitt, and Ardene Robinson Vollman, “At What Cost to Health? Tilcho Women’s Medical Travel for Childbirth,” Contemporary Nurse 22. no. 2 (2006): 2.

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