Submission ID 131914
| Issue/Objective | Maternal health disparities between Indigenous and non-Indigenous women in Canada persist despite a publicly funded healthcare system. Indigenous women experience higher rates of adverse maternal and infant outcomes, reduced access to prenatal care, and greater exposure to structural and social risk factors. These inequities are shaped by colonization, systemic racism, and intergenerational trauma, which influence healthcare interactions and behaviours. Experiences of discrimination, culturally unsafe care, and geographic barriers, including the need to travel for childbirth, further reduce healthcare utilization and continuity of care. Although these disparities are well documented, the mechanisms linking trauma to healthcare engagement and outcomes remain unclear. This study proposes healthcare system trust as a key mediating factor. |
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| Methodology/Approach | An evidence-informed intervention model will be developed through synthesis of literature on maternal health inequities, intergenerational trauma, and culturally safe care in Canada. A quasi-experimental design is proposed, comparing an intervention group receiving structured, culturally safe, trauma-informed care incorporating continuity of care, culturally grounded communication, and trust-building clinical practices, with a control group receiving standard care. Participants will include pregnant Indigenous and non-Indigenous women. Healthcare system trust will be operationalized using validated multidimensional measures capturing perceived safety, respect, and institutional trust. Engagement will be assessed through prenatal care utilization and adherence, while maternal outcomes will include clinical indicators such as complications and birth outcomes. Structural variables, including geographic access, will be incorporated as covariates. |
| Results | It is anticipated that participants receiving the intervention will report higher levels of healthcare system trust and demonstrate increased engagement in prenatal care compared to controls. Increased engagement is expected to be associated with improved maternal and neonatal outcomes. Healthcare system trust is hypothesized to mediate the relationship between intergenerational trauma and healthcare engagement. |
| Discussion/Conclusion | This model advances a causal understanding of maternal health disparities by identifying healthcare system trust as a modifiable pathway linking trauma, engagement, and outcomes. By explicitly targeting trust within care delivery, the framework offers a scalable, equity-focused approach to improving maternal health and addressing systemic inequities. These findings support a shift toward trust-centered, culturally safe care and inform system-level reforms aligned with global health equity priorities. |
| Presenters and Affiliations | Lylah Khan University of Ottawa Hana Khan University of Ottawa Lylah Khan University of Ottawa Hana Khan University of Ottawa |
