Suchergebnisse

AbstractWe examined the perspectives of the Red River Métis citizens in Manitoba, Canada, during the H1N1 and COVID‐19 pandemics and how they interpreted the communication of government/health authorities' risk management decisions. For Indigenous populations, pandemic response strategies play out within the context of ongoing colonial relationships with government institutions characterized by significant distrust. A crucial difference between the two pandemics was that the Métis in Manitoba were prioritized for early vaccine access during H1N1 but not for COVID‐19. Data collection involved 17 focus groups with Métis citizens following the H1N1 outbreak and 17 focus groups during the COVID‐19 pandemic. Métis prioritization during H1N1 was met with some apprehension and fear that Indigenous Peoples were vaccine‐safety test subjects before population‐wide distribution occurred. By contrast, as one of Canada's three recognized Indigenous nations, the non‐prioritization of the Métis during COVID‐19 was viewed as an egregious sign of disrespect and indifference. Our research demonstrates that both reactions were situated within claims that the government does not care about the Métis, referencing past and ongoing colonial motivations. Government and health institutions must anticipate this overarching colonial context when making and communicating risk management decisions with Indigenous Peoples. In this vein, government authorities must work toward a praxis of decolonization in these relationships, including, for example, working in partnership with Indigenous nations to engage in collaborative risk mitigation and communication that meets the unique needs of Indigenous populations and limits the potential for less benign—though understandable—interpretations.

IntroductionIn Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), a prenatal income supplement. Research has demonstrated positive outcomes associated with HBPB, but it remains unknown if Metis women and children – who are of mixed European and Aboriginal descent and one of the most marginalized populations in Canada -- benefit from the program.
Objectives and ApproachThe Manitoba Metis Federation and the Manitoba Centre for Health Policy partnered to determine the impact of HBPB on Metis newborn and early childhood outcomes. We included all Metis women giving birth in Manitoba 2003-2011 who received income assistance during pregnancy (n=4,852), adjusting for differences between those receiving (n=3,681) and not receiving (n=1,171) HBPB with propensity score weighting. We used multi-variable regressions to compare outcomes between groups: breastfeeding initiation, low birth weight, preterm birth, small- and large-for-gestational age, Apgar scores, birth hospitalization length of stay (LOS), neonatal readmissions, infant hospitalizations, vaccinations at age 1 and 2, and child development scores at kindergarten.
ResultsHBPB receipt was associated with reductions in low birth weight (adjusted Relative Risk (aRR): 0.74 (95% CI: 0.58-0.94)) and preterm births (aRR: 0.78 (0.65-0.94)), and increases large-for-gestational age births (aRR: 1.21 (1.06-1.39)) and neonatal readmissions (aRR: 1.58 (1.05-2.37)). Birth hospitalization LOS was lower for newborns whose mothers received HBPB (Mean Difference 0.29 days). HBPB was associated with increases in vaccinations for children aged 1 (aRR: 1.08 (1.00-1.15)) and 2 (aRR: 1.12 (1.05-1.18)). No significant associations were found for small-for-gestational age births, Apgar scores, breastfeeding initiation, infant hospitalizations or child development scores.
Conclusion / ImplicationsA modest unconditional prenatal income supplement to low-income Metis women was associated with improved birth outcomes and child vaccinations; however, an association with increased neonatal readmissions warrants further exploration. Lack of significant associations between HBPB and child development measures suggests more sustained support may be necessary to improve longer-term outcomes.