"I wish I'd had this when I was pregnant."
The young woman with a baby on her lap is flipping through the colourful pages of Pregnancy Stories: A Guide for Expecting Inuit Moms and Dads, pausing occasionally to admire a drawing or a traditional health tip. She and Dr. Amanda Sheppard are sitting in the cheerfully controlled chaos of a weekly mother and baby drop-in clinic run by Iqaluit Public Health. The room is packed with babies, toddlers, and their mostly young mothers, many wearing the traditional Inuit amauti. In the background, babies are weighed, parents chat, and nurses give advice on baby care and breastfeeding.
Sheppard, an applied scientist who works at AboutKidsHealth at The Hospital for Sick Children, has been working on this project for over a year; we have flown to Iqaluit to deliver the first print run to her local advisory board, and also to gauge its likely success with the target audience. So far, the verdict is positive. While many of the young mothers in the room turned to the Internet for advice during their pregnancies, none of the information they found was particularly geared to life in the North. Sheppard hopes Pregnancy Stories will help fill that gap.
Sheppard and the advisory board thought hard about the best way to present the health messages they wanted to convey without seeming either preachy or overwhelming. Eventually, taking into account the still-strong traditions of storytelling and respect for elders, they settled on an illustrated booklet that follows the stories of three different expecting couples, with an accompanying website (InuitHealthMatters.aboutkidshealth.ca). The material has been translated into Inuktitut, French, and soon Inuinnaqtun.
The booklet features week-by-week health tips and information for mothers and month-by-month information for fathers. Each page is illustrated with a central scene, and includes smaller vignettes of fetal development and an elder giving a piece of traditional advice - sometimes to be taken with a grain of salt. "'If you carry food in both hands, you will have twins'?" laughs one woman. "Oh no! I carry groceries in both hands all the time!"
"They look like Inuit people," another young mother says appreciatively.
Confronting the challenges of pregnancy in the north
Life in Nunavut poses some unique challenges to pregnant women and their families. Nunavut is at once the largest province or territory in Canada and the least populated, with 31,000 people - roughly the same population as Moose Jaw, Saskatchewan - spread over 1.9 million square kilometres. The territory averages 800 births per year; slightly more than half of those births take place in Nunavut, but the others generally take place in southern hospitals. Even the births that take place in the territory often involve a flight to Iqaluit, the territory's tiny capital. Food and even necessities like diapers are expensive. Smoking and drinking are nearly universal - roughly 80% of pregnant women smoke - and the teen pregnancy rate is 24% as opposed to Canada's overall average of 5%. Outcomes such as premature birth and infant mortality are also strikingly higher than in the rest of Canada.
Dr. Geraldine Osborne, Nunavut's Chief Medical Officer of Health, is a soft-spoken Irishwoman who is all too aware of those challenges. To get to her office at the Department of Health and Social Services, we have weaved our way past busy staff and towering stacks of health promotion materials - everything from the new Nunavut food guide to brochures promoting breastfeeding to posters and magnets proclaiming that "Tobacco Has No Place Here".
Osborne hopes that Pregnancy Stories will, in its friendly, non-preachy way, be another tool to help improve the health of Nunavut's young families. "Of course, healthy pregnancies happen in the context of healthy families and healthy communities," she says. "So I like the approach you've taken, that you've brought in the partners, and the locations, the families, I think that's really important. And that's something we're trying to do, not just single out pregnant women, but to take into account the environment in which they live."
Back in Toronto, thousands of kilometres from Iqaluit, Sheppard is happy that the results of a long year's work are finally rolling out to the people who need it. "While the Inuit Health Matters tools won't change the policies in place regarding flying expecting women out of their communities to give birth, we hope our content will empower and educate the soon-to-be-mom and those around her about healthy behaviours and attitudes about the pregnancy and baby's development," she says.
Managing Editor, AboutKidsHealth