Young Aboriginal Women’s Reproductive Health Study

Young Aboriginal Women’s Reproductive Health Study Lisa Murdock, M.A. Principal Researcher Prairie Women’s Health Centre of Excellence

Background • In 2006, there were an estimated 354,617 registered births across Canada. • This figure represents an annual increase of 3.6%. • This was the highest annual increase in the number of births since 1989. • The annual increase in 1989 was 4.2%.

Background Total Fertility Rate Canada 1.59 Manitoba 1.87 Saskatchewan 1.92

Background Age-Specific Fertility Rate (per 1,000 women, 15–19 years) Canada 13.7 Manitoba 30.8 Saskatchewan 34.1

Background Second/Subsequent Births Rate (women, 15–19 years) Canada 2.6 Manitoba 6.8 Saskatchewan 6.3

Background

Risks to Teen Mothers: Emotional distress Iron deficiency anemia Pregnancy-induced hypertention Maternal toxemia Renal disease Eclampsia Depressive disorders Death Low high school completion rate Low income level Reliance on social assistance More pregnancies over a short time Limited support from fathers of baby Risks to Children of Teen Mothers: Premature birth Low birth weight Infant mortality Early childhood injury Acute illness Poor cognitive & social development Behavioural problems Involvement with child protection agencies Incarceration as a youth Become teen parents themselves Background

Purpose The intent of the study was three-fold: • To possibly identify the key reasons for the high rate of teen pregnancy among Aboriginal women; • To determine the supports and/or lack of supports available to assist young Aboriginal women who become pregnant during adolescence; and • To inform policies, programs and practices with which to better respond to the needs of young Aboriginal mothers.

Methods and Procedures • Individual interviews, focus group discussions and a self-administered questionnaire. • Strict guidelines for consent, confidentiality and accountability. • Carried out in collaboration with members from the Aboriginal community in Winnipeg. • Ethics approval granted in September 2008. • Data was collected throughout October 2008.

Methods and Procedures • 28 individual interviews and 3 focus group discussions were conducted with Aboriginal women who had personally experienced giving birth to a child during adolescence. • The topic of discussion included knowledge, experience and thoughts on sex, safe-sex practices, pregnancy, child birth, parenting and support systems. • 20 completed questionnaires were received. • Questionnaires focused on Aboriginal women’s safe-sex practices and their utilization of community resources and supports.

Methods and Procedures • Interviews and group discussions were audio-tape recorded for accuracy. • Audio-tapes are transcribed into written format. • Data collected was analyzed both manually and with the assistance of ATLAS.ti.

Participant Recruitment • Key informant and snowball sampling strategies used to recruit participants. • Research criteria: • Aboriginal woman • Between 15 and 25 years • Had personally experienced giving birth to a child as the result of a teen pregnancy.

Study Participants • Twenty-eight women were selected to participate in the research. • Seven women identified as Métis and 21 women identified as First Nations. • Participant ages: • Two women under 18 years • 22 women between 18 and 27 years • Four women between 37 and 43 years.

Perceptions on Sex, Protection and Pregnancy The meaning of sex: “I don’t know. I honestly don’t know much about what you’re saying.” “I’m not really too sure. I never got asked that question before. This is kind of the first time, I don’t know.” “I think it’s got different meanings. It depends on who it’s with. So you could have just sex with anyone, and then it didn’t mean anything. If it’s someone that you care about and you can get real intimate and close with them, maybe it’ll have meaning. I don’t know. I don’t really think there’s a meaning for it. It’s just, I don’t know, the way you do it, and how you do it, and if you pay for it. Like, I don’t know. That’s a stupid question.”

Perceptions on Sex, Protection and Pregnancy The meaning of sex: “These are the questions I’m probably going to have a hard time with; sorry. I don’t know. Sex is something special between two people. That’s probably what it means to me. (If I was to ask you what intimacy means to you, do you think that there’s a difference?) Yeah. My answer would probably change. If you’re just asking me what sex is, it’s something physical that happens between two people. It does not have to special. Intimacy makes it special. That’s what I would say. (What do you mean by ‘special’?) Something you do with a partner that you love, and enjoy it, and its better that way. I guess that’s what I mean.”

Perceptions on Sex, Protection and Pregnancy The meaning of sexual activity: “It would probably just mean, to me, that she’s not a virgin, I guess.” “That would be when you first lost your virginity and became sexually active. Just having sex altogether, I guess.” “I don’t know, having sex, I guess, with your boyfriend or your partner.” “To be sexually active means you’re obviously having sex with somebody … You know, when you touch each other … To me, sexually active is touchy and have sex, I guess.” “It’s getting out there and having sex, turning, when you’re working.” “Having sex with a whole bunch of partners, one after another pretty much. Yeah, multiple partners.”

Perceptions on Sex, Protection and Pregnancy Acceptable sexual activity: “I'd say, like, 17 or 18. I kind of wish I waited longer. (Why is that?) 'Cause I got pregnant at 13 and had my baby at 14.” “Now, I’d say eighteen or over. Just because I know better.” “I’d say around sixteen, seventeen … just make sure they’re in a relationship. That’s still is kind of young too, though, now that I think of it. Like, if my daughter was sixteen, I’d say no.” “I think they should be properly educated about sex, like what are the consequences and what comes with sex, I guess.” “I kind of regret having sex at a young age. I would have waited until I was eighteen. At the least.”

Perceptions on Sex, Protection and Pregnancy Regarding protection: “(How would you describe protected sex?) When you’re on birth control or using condoms, stuff like that. (Do you think that there’s any form of protection that’s safer than other forms?) No. I think they’re equal. (Is there any form that’s one hundred percent safe?) No. (So how did you first learn about using protection when you’re having sex?) I don’t know. (So the first time you had sex, when you were thirteen, did you know about using condoms or birth control or anything like that at the time?) No. (So when did you learn about birth control?) Afterwards. When I finally told my birth sister I had sex. And she said, ‘Well, you gotta use condoms, and you know you have to be careful what you’re doing.’”

Perceptions on Sex, Protection and Pregnancy Thoughts on pregnancy: “Before I thought, anytime you can get pregnant, but now I know, I guess, I think, but I don’t know, two weeks after you have your period.” “At first I thought you couldn’t get pregnant during your periods. And like, you can get pregnant, you know, after. And then after, I found out you could get pregnant even during your period. That’s when the nurse told me.” “The easiest time to get pregnant is right after or before your period. (Is there any time when she can't get pregnant?) On her period. The blood pushes the eggs out so she can't get pregnant.” “I knew what babies were, but I didn’t really know exactly where they came from. My mom didn’t explain to me where babies come from and why I wondered when I was small, ‘Why is your belly so big?’ And then all of a sudden, her belly’s small again. And there was a baby in the house. ‘Where’d you get that mom?’”

Perceptions on Sex, Protection and Pregnancy Thoughts on pregnancy: “Well, I didn’t think I was. I just noticed that I was getting big, but I thought that that was just from me eating lots ‘cause I used to smoke a lot of weed … I was with my sisters on the bus. We were going to the Red River Ex. And before, there was always milk coming out from my breasts. And I didn’t know what that was … I was holding a drink and I was drinking some, and I thought I spilled some … It was always getting wet. And they said, ‘You’re pregnant.’ And I said, ‘No. I’m not.’ … Well, I did stay for the Red River Ex and all that. I’m like, ‘Whatever.’ I wasn’t too concerned because I just thought my sisters were just lying and whatever, just trying to scare me. And then, like my sister took me up to the Children’s Hospital … I was fourteen … I was almost six months.”

Perceptions on Sex, Protection and Pregnancy Sex education: “My mom, I never really ever talked to her when we were younger. I know she’d freak out to go talk to her, so I’d talk to my friends or my friend’s auntie … I kept thinking she’d get all mad at me. (What about when you had your period? Did you talk to your mother about that?) Yeah. She never really talked to me about that. (Do you talk now, today, with your mother?) Not really. Well, kind of. Like, about relationship stuff, but not really about sex; like, sex-sex. I just don’t feel comfortable talking with her about it. Probably because we haven’t talked about it before, when I was young. But I learned from that. Like, I’m going to be talking to my daughter about it when she’s young ‘cause I want her to know … I wish she wouldn’t have come and talked to me. She’ll yell at me.”

Personal Experiences with Sex First sexual experiences: “I think that I always thought that maybe he would stay with me or if what would happen after this … I never seen the guy after that.” “He was cheating on me lots and girls would always go over to his house. Like, he had his own place … He would kiss me and grope me and stuff. I didn’t really like it, but I did it just because, I don’t know, pressure. Pressure from him and from other people ... And then his sister would be like, ‘Well, you don’t do anything for him. You know? Like what do you do? My brother cheats on you because you don’t sleep with him.’ (Do you think that that’s why you slept with him?) Yeah.”

Personal Experiences with Sex First sexual experiences: “I pursued him. Him and his wife weren’t getting along, and he went with me for a year. (When you were young?) Yeah, thirteen. He was forty-two.” “He was thirty-three at the time when I was 15 years old. It took me a long time to realize that it wasn’t like, obviously it was my fault for going with him and whatever, but that’s just wrong. That’s disgusting. A thirty-three year old man and a fifteen year old girl. That’s not right.”

Personal Experiences with Sex Unsafe sex practices: “I always thought that, you know, if you went to the bathroom right after, you’d let go of everything. Like, everything would come out … I ended up getting pregnant a second time. I said, ‘I can’t do this anymore.’ It’s like, ‘We have to do something.’ So then I told him, I said, ‘Either you gotta wear a condom all the time.’” “I was worried about pregnancy. And before my ex, I was worried about STDs because I got one when I was about fifteen years old, and I was just scared. I was like, ‘What’s going on?’ I went to the doctor’s … I guess for a pregnancy test or whatever … then they asked me to do an STD check and I said, ‘Yeah.’ They sent me with a note for my mom. And that was it.”

Personal Experiences with Teen Pregnancy Planned pregnancy: “When I was younger, when I used to take care of my sister when she was pregnant, when I seen her, even when the baby came, I wanted a baby so bad ‘cause it was so cute and the baby, my nephew, was so attached to me.” “I flirted around ‘cause I wanted to get pregnant.” “I guess I thought that I loved him … I met him when I was fifteen and he was like twenty-one. And then, for some stupid reason, I wanted to have a kid with him. (What do you think that a child would have done?) Kept us together … We just broke up last year.”

Personal Experiences with Teen Pregnancy Parental expectations: “You can’t just haul along your baby all over. But mind you, I still go out. Like after, me and my daughter’s father, we split up probably about, when she was about five months. We split up for about a month. Then he, like we were young. So he did a crime. And he was back in jail for five years. So, I raised his girl by myself. I wasn’t looking for a partner or anything like that. I like it, just me and my daughter. I’d even, like, we had a bike. I’d double her all over the place; go visiting like that. I remember doing that when she was about 18 months.”

Parenting as a Teen Parental challenges: “I wish I could go out any time I feel like it. I wish I could walk out the door when I want to go. I could always just leave whenever I please, but I can’t now. And if I wanna leave, I gotta find a babysitter, and I couldn’t find somebody who wants to babysit. You know?” “You know how you get the time, how you like to go out by yourself? And you can’t because you have a baby now or once your friends call you to go out, you can’t because you have a baby now? Stuff like that. But that stuff don’t bother me.” “I sometimes maybe wished I would have waited because all my friends are out and about and having fun and I’m at home watching kids. That’s about the only thing. But otherwise, all is good.” “It’s just hard sometimes. Like when I’m alone with them, they stress me out. That’s about it. (What stresses you out?) Just always being alone with them. And they’re always asking me for things. Like, when I sit down and try and relax, they always want something again, and when they get into things. If my mom or their dad, like if I had some support that could take them out for just an hour or something, so I could just relax, I guess.”

Identifying the Needs of Young Aboriginal Mothers Addressing the needs: “Just have more support workers or something or have more places where they could live on their own and be taught stuff. Like, they have support workers, like people who know or have been through it. People to talk to them, like speakers. You know, like mentors or something like that. And then have places where they could live on their own, but they’re not on their own. Like, there’s still an office in the building, but a bunch of apartments. Help them. Have more resources or something if they need to go shopping. Have somebody that could take them or go with them or watch their baby for them while they go shopping, so they don’t feel so overwhelmed doing it. It’s hard to be a parent, but they’re teenagers.”

Discussion • What do you think about the age differences between the women in comparison to their first sexual partners? • When is it appropriate to introduce sex education into the school curriculum? What should the education include? How long should the education classes run? • What can we do to open the lines of communication and discussion around sex-related issues in the home? • What can we do to get our youth to take safe-sex practice more seriously? • What do you think about social expectations to have sex by a certain age? • Many girls who need assistance are afraid to turn to CFS out of fear that they will be deemed bad mothers because they are asking for help. There are detrimental consequences to keeping the need for help a secret, both to the health and safety of the woman and her child. What can we do about this? Is there some type of follow-up in place, after these women are out on their own? • What do you think about some of the areas suggested by the women as needing attention? • Girls need to be taught that there is much more to dating men than simply having sex. How can we send this message?

For More Information: Prairie Women’s Health Centre of Excellence 56 The Promenade Winnipeg, MB R3B 3H9 p: (204) 982-6630 f: (204) 982-6637 e: pwhce@uwinnipeg.ca w: www.pwhce.ca

Young Aboriginal Women’s Reproductive Health Study