Thank you for the invitation. I have lots of red marks on my paper because I realize I'm going to have to cut it down a lot.

I am going to talk about the Saskatoon Health Region lived experience of aboriginal women feeling coerced into tubal ligation. I and Dr. Yvonne Boyer were the co-studiers on that.

I won't go into the media reports. You've heard about those. We started this project—were asked to—in the fall of 2016. The Saskatoon Health Region had attempted before that to have a review, but they had an individual whom the community just wasn't going to trust, so no women came forward.

We proceeded with a community-based approach that involved pre-meetings with both the aboriginal and the health communities ahead of time, to get them to participate in the design of the study as well as to get their agreement to participate in the analysis of the data once we had it. It's a specific collective approach that I use in research.

We did literature searches, of course, looking at all the international tools, and reviewed all of the corporate documents and laws. At one point we realized we had to actually examine the child welfare law as well, because it did have an impact.

Eighteen aboriginal women called our confidential phone line. We interviewed seven of these—six in person and one by phone. Seven others made appointments, but for various reasons they were not able to attend. Some of them made a couple of tries, but they just weren't ready.

We did nine interviews with health care personnel and an interview with a couple of social workers, as well, from child welfare.

The interviews with the aboriginal women revealed that all clearly felt stressed and under much duress from being coerced, while they were in labour, into having a tubal ligation, and this added extra stress to the usual stress of childbirth. The review outlines the depth of the women's experience of being coerced. Themes arising reveal that aboriginal women were living, often, overwhelming and complex lives when this coercion was taking place. This complexity was intricately interwoven with the negative historical context of colonialism.

The overarching themes for the women were that aboriginal women felt invisible, profiled and powerless. They experienced the coercion. I don't have the time to talk about the details of that, but those are in the report. They talked about the impacts on their self-image, their relationships and their access to health care at a later time.

Such experiences as these keep aboriginal women from accessing health care. They're aware that the risk is higher to them, but they just cannot make themselves go, and that has implications for their children as well, and for the rest of their family.

Considering the distress they had and the angst they had about attending, the fact that they actually got there and told their stories to strangers was quite amazing.

The health providers were really concerned to hear that aboriginal women experienced coercion. Their overriding themes were in and around policy and team challenges. They realized there were negative attitudes toward aboriginal women and how this whole issue impacted internal and external care.

Data analysis revealed that health providers work in large, complex and ever-changing hospital systems and environments. Most felt that in recent years positive policy and practice had happened, but they did think that aboriginal women were still falling between the cracks. One thing they brought up, as did the women, was the issue of child and family services. On top of the coercion of having a tubal ligation, they were also often faced with their child being apprehended within a couple of days of birth. That was a major issue. They all came up with suggestions. You'll see them in the report and you'll see the details of the study in the report.

We came up with recommendations. In terms of the data, one thing we could not find was data on medical charts. We were able to get three medical charts, but the rest of them were destroyed at 10 years. That answers the question about litigation for some of these women. When their history goes back 20 years, there's no way to find that.

Saskatchewan, like all the provinces at that time, was in the midst of a lot of health care changes. We felt that their knee-jerk reaction to immediately stop tubal ligations post-delivery, unless you had a pre-discussion with a family doctor or an obstetrician, was going to be a real problem. The health providers and the women also thought that was going to be a real problem in the future. We suggested that the first thing they needed to do was to look at this policy. We also felt that they needed to utilize the resources they have. They have an aboriginal health council, they have a Métis and first nations health service, and they had, at the time, some sort of steering group that was working with changing their provincial policies. In these recommendations, we reminded them that there were requirements in Canadian law; that the implementation of an indigenous health engagement strategy, we felt, needed to be in place; and that there were requirements in Canadian law for consultation and accommodation.

Regarding cultural training, we recommended that they have mandatory cultural training looking at indigenous peoples and their cultures and at human rights cultures. There needs to be a clear addressing of the false stereotypes about aboriginal women being unable to look after their own children, where decisions are made for them.

In education, we recommended that there needed to be cultural competency in nursing, medical and all health professions. This is beyond cultural training. It means that there needs to be introspection by the learner to understand their own level of privilege in society. There are lots of papers on that. That can be learned.

They were talking about restructuring in Saskatchewan. We feel that the change has to be substantive, not simply an indigenization of health. That will not be enough. They need to begin extraordinary measures. It's been probably 20 or 25 years—I can't remember how long now—that we've had an Aboriginal Health and Wellness Centre in Winnipeg. Saskatoon has a large aboriginal population and they don't have that yet.

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