Why are Indigenous babies being hospitalized more often?

Striking new stats from a Quebec study illuminate just how challenging it can be for some Indigenous parents to raise healthy children. According to researchers at the University of Montreal and major First Nations community health services in Quebec, Indigenous babies are twice as likely to be hospitalized as their non-Indigenous counterparts.

The study, which was published May 29 in the Canadian Medical Association Journal, looked at 19,770 First Nations, 3,930 Inuit and 225,380 non-Indigenous babies born between 1996 and 2010 in Quebec. Respiratory diseases and infections were the most common causes of hospitalization in infants. When comparing First Nations and Inuit versus non-Indigenous infants, researchers found there were 70 to 80 more hospitalizations per 1,000 infants for respiratory diseases, and 30 to 40 more hospitalizations per 1,000 infants for infections. Indigenous babies were about twice as likely to develop bronchiolitis and about seven times as likely to develop pneumonia.

This comes after a 2016 report from the Canadian Centre for Policy Alternatives that found Indigenous children are also more than twice as likely to live in poverty than non-Indigenous children, and after a ruling from the Canadian Human Rights Tribunal last week that found Ottawa was discriminating against Aboriginal kids by failing to comply with orders to provide them with adequate care.

“The excess risks of these diseases may be related to infant immunizations and the quality of the living environment, and thus may be largely preventable,” write the authors of the Quebec study. The researchers suggest that improving infant immunization programs, promoting breastfeeding, discouraging smoking at home and improving living conditions in Indigenous communities could benefit infant health.

The Quebec study also found that Indigenous mothers were more likely to live alone, and have lower education levels compared with non-Indigenous mothers. They also had higher rates of chronic diseases such as pre-existing diabetes, high blood pressure and kidney disease. Pregnancy complications like gestational diabetes, gestational hypertension and preeclampsia were also more likely to be present.

The report says the factors behind the increased risk are not yet understood, but tobacco and alcohol use, poor housing conditions, financial and food insecurity, and stress may play a role. A 2016 British Columbia study also found that Indigenous women received poor quality obstetric care. There are programs in various First Nations communities across the country to help address some of those factors when it comes to the health of Indigenous babies, but many barriers to adequate health care for families still exist.

Gail Anishinabie, program coordinator at Healthy Babies Healthy Children in Sandy Lake First Nation, Ont., works with mothers in the remote, fly-in community, which is located 600 kilometres northwest of Thunder Bay. The program, which is available in communities across Ontario, encourages healthy pregnancies and helps prepare participants for motherhood, with prenatal classes, home visits for new moms and community kitchens to help promote healthy diets.

Anishinabie says the cost of living is high in Sandy Lake. While fresh produce is available, it is often unaffordable to expecting mothers. When a bag of apples or oranges costs $11, processed foods with few nutrients can seem more attractive, she explains.

Access to health care is also a major barrier for many Indigenous parents. Anishinabie says Indigenous parents in her community often require help applying for Indian status cards and health cards for their children. Without one, it can cost the family or band council $3,000 to $4,000 to pay for a medical evacuation (medevac) for a child over the age of one.

Anishinabie also says it’s often difficult to get a timely appointment at the community clinic when illness occurs, with many patients having to wait a week. The Quebec study reports that illnesses being left untreated for too long is one possible cause for the high levels of infant hospitalizations in Indigenous communities.

Donna Rae has dealt with some of these struggles first-hand. A mother of six, she lives in the remote fly-in community of North Spirit Lake First Nation, 500 kilometres north of Thunder Bay, and she and her children often have to leave home to seek medical care. Rae’s son, Luke, had to travel with his father to the nearby town of Red Lake to access medical care when he was two with H1N1. The toddler spent a week away from his home.

Now 22 weeks into a high-risk pregnancy, Rae has to travel 274 kilometres each month to visit a doctor in Sioux Lookout, Ont.—a trek not everyone could make. She is currently dealing with ovarian cysts, an umbilical hernia and the risk of gestational diabetes. Rae explains that sometimes she feels the medical staff in her community is dismissive. While seeking treatment for her conditions that put her pregnancy at risk, her family doctor questioned why she needed to leave the community each month, stating that there was nothing wrong with her. Luckily, the doctor in Sioux Lookout advocated for her pregnancy as high-risk and requiring treatment outside of the community.

Rae says that the difficulties of seeking care for herself and her family while leaving her children at home is stressful. “It puts a strain on me,” says Rae, who worries about the effects that the stress may have on her unborn baby.

The Quebec report states that there is a need for studies in other provinces to better understand Indigenous health risks nation-wide. In the meantime, the study authors write: “There is an urgent need for interventions to reduce Indigenous versus non-Indigenous infant health inequalities."

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