A new study in Canada has looked at the experiences of Nehiyaw (Cree) fathers in Canadian maternal health services. The study provides a unique insight into how the western model of individualised, health-led maternity care encounters the values of a particular community with a strong familial tradition, called “peyakohewamak” in the Nehiyaw language. The Nehiyaw community in Canada has suffered long-term colonisation, a key feature of which is the undermining of traditional family systems and of the role of men in families.
The qualitative study, involving six fathers, is part of a wider programme to improve maternal healthcare for the Nehiyaw community. A community based design process prior to the study, organised with the Maskwacis community in Alberta, highlighted the importance of engaging fathers in the process. Community Elders insisted on this and mothers highlighted the importance of it.
Nehiyaw fathers face particular challenges in their roles and identities. The policy of residential schools in these communities meant that children were forcibly removed from their families and denied their traditional language and culture. Many were abused. Shame and a lack of confidence around parenting has been found to be a problem for fathers in other communities, for example, Indigenous men in Australia.
The researchers decided to focus on fathers actively involved in pregnancy and supporting their partners. This approach also contrasts with many studies designed in a top-down manner, which tend to frame fathers as problems to be fixed.
Each father was interviewed for between 30 and 60 minutes. Afterwards they were invited to submit photographs that tell stories about their lives. These were discussed with them at a second interview.
A number of themes emerged.
Love, support, responsibility
All the fathers talked about love, care, support and respect for their partner. They described doing more around the house and their feeling of responsibility for staying patient and calm. Some regarded it as particularly important to attend antenatal appointments and inform themselves thoroughly about pregnancy, childbirth and caring for children.
But they did not describe this approach as easy. They talked about being stressed, scared, intimidated, nervous, emotional and worried. Many linked this to the process of colonisation, which has undermined the role of fathers in families. Residential schools only taught that men should earn.
Most fathers saw the pregnancy and new fatherhood as an opportunity to develop new roles and identities as Nehiyaw men.
Families as support for fathers
The fathers acknowledged the important influence on them of growing up within stable and supportive families. Others referred to the support of the Nehiyaw culture, which provides knowledge and guidance about family life. Community events and rites of passage are supportive of strong family roles.
Western designed maternal health systems are not supportive
All the fathers described varying degrees of exclusion by the maternal health service. Prenatal courses are not geared to Indigenous men, lack reference to culture and tradition and lack relevance to men generally. Instead, prenatal education is based on health facts in line with the western model.
Some of the fathers were reluctant to travel to a neighbouring town for maternal healthcare because of tensions between the Indigenous and non-Indigenous communities.
Some fathers described receiving excellent support and care from health professionals, despite the deficits in the overall model of the maternal health service.
Recommendations: community based peer support
Some of the fathers suggested integrating Elders and Indigenous peer supports within health services. The researchers suggest community-based peer support groups for fathers.
Relevance to global healthcare
The model of maternal healthcare described in Canada is the model that is being exported globally, into communities everywhere that have strong familial values. This study sheds a strong light on this global challenge. The linking of maternal care for Indigenous people in Canada with colonialism raises challenging questions for maternal healthcare globally.
Oster RT, Bruno G, Mayan MJ, Toth EL, Bell RC & the ENRICH First Nations Community Advisory Committee (2018), Peyakohewamak – Needs of involved Nehiyaw (Cree) fathers supporting their partners during pregnancy: Findings from the ENRICH study, Qualitative Health Research 1-12
Photo: aaron gilson. Creative Commons.