No First Birthday Cake: Infant Mortality Rates in Canada
An examination
by Chris Hibbard
No first birthday cake: Infant Mortality Rates in Canada
The Royal Commission on Aboriginal Peoples (1996) states that: “Children hold a special place in Aboriginal cultures. According to tradition, they are gifts from the spirit world and have to be treated very gently lest they become disillusioned with this world and return to a more congenial place. They must be protected from harm because there are spirits that would wish to entice them back to that other realm.” This statement is sadly ironic, in that more Aboriginal children never make it past the age of one than do other Canadian babies.
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Infant mortality rate is one of the key indicators of a nation’s health status. This rate, the IMR, is the number of deaths of infants under one year of age per 1,000 live births in any given population. When the rate increases, the factors that precipitated this change need be, and usually are, assessed and scrutinized.
In North America, the leading causes of infant mortality and neonatal mortality (death by age six weeks) are as follows: 20.2 per cent of deaths are attributed to congenital malformations, deformations and chromosomal abnormalities. 16.4 per cent of deaths are related to short gestation and low birth weight. Sudden infant death syndrome (SIDS) is the third leading cause of infant death.
Many babies also die because their mothers get poor health care, poor nutrition, and little prenatal education. They die because of unclean air and water. They die because they have been exposed to disease or pollutants before or after they are born. All of these things are included in a nation’s IMR – a measure of the degree to which a society has mastered the basics of life and health and made them available to its most vulnerable members.
While all countries need to deal with infant mortality, some are less affected than others. Canada tends to sit somewhere around an average of six babies per 1,000 that never make it to age one. (Canada’s IMR was 6.3 in 1999, 5.2 in 2000, and 5.5 in 2005.) While these averages may not seem like much, when we multiply these percentages by 333,000 (the amount of babies thought to be born in Canada each year), this adds up to nearly 20,000 babies born each year that never get to see their first birthday cake.
These statistics, and my extrapolation from them, is not intended to be overly dramatic or sensational. In order to personalize this issue, and bring it home so to speak, I choose to put these percentages in easier terms for us to understand. To make it even easier, if we think globally, and examine both ends of the IMR spectrum, it puts things in perspective.
Finland, for example is the world’s leader in lowest IMR. In Finland, the IMR is only 3.5. That means 996.5 out of 1000 infants born reached age one. If one looks to China, a fairly poor country that produces over 20 million babies a year, their IMR of 31 is amazingly low. But at the other end of the spectrum is Sierra Leone in West Africa. Sierra Leone’s IMR is a staggering 195. In Sierra Leone, one in every five babies do not see age one. The point can be made that the very measures that bring down infant mortality rates also bring down birth rates – since Sierra Leone, with its IMR of 195, averages 6.5 births per woman, while Finland only averages 1.7 births per woman, thus the more babies one woman has, the higher the chances one of them may not survive. Nonetheless, compared to Sierra Leone and China, Canada’s IMR is quite low.
When we narrow our focus to Canada and its people, one finds that the rates jump considerably when looking at our First Nations peoples.
In 1996, there were 117,355 children between birth and age 5 for whom Aboriginal identity was reported. In the year 2000 in Canada, the First Nations birth rate was 23.4 births per 1,000 – in itself more than twice the Canadian rate. One in five (20 per cent) of these births involved teenaged mothers compared to only 5.6 per cent among Canadian teen women. This may or may not have something to do with the fact that IM rates are two to three times higher in First Nations and Inuit communities. Canada’s 5.5 IMR in 2005 can be compared to IMRs of 6-12 for Aboriginal peoples nationwide (8-12 from 1999 – 2001; 6.8 in 2004), and to 25.5 in Nunavik and 24 in Nunavut in 2001.
(These last figures include the non-Inuit people in those regions, of which there are notably less.)
UNICEF (United Nation’s Children’s Fund) says that Indigenous children in North America rarely enjoy the same standard of health or have the same access to health care services as their non-Indigenous peers. They associate this with a lack of neonatal and post-neonatal care. In the United States, 40 million Americans do not have health insurance. Here in Canada, the likely culprits are still often related to socioeconomic status, but also to other factors.
Canadian First Nations people are approximately 80 per cent less likely to possess a university degree, and twice as likely to be unemployed, as other Canadians. Add to this that in 1996, about 28 per cent of young Aboriginal children often live in single-parent families. In urban areas, this same proportion exceeded 40 per cent. Also in 1996, approximately 12 per cent of Aboriginal children from birth to age five were living with relatives other than their birth parents. This all adds up to the fact that the majority of young Aboriginal children in Canada live in low-income families, with an average total annual income of $16,000. Keep in mind that seventy percent of Aboriginal single mothers identified government transfer payments as their major source of income.
Then there are diabetes and SIDS, allergies, bronchitis and asthma – all of these disabilities have higher rates on reserves than for those living off, and are more than twice as high as the rate for non-Aboriginal children. Increased infant health risks are also associated with both very low and very high birth weights. First Nations infants were more likely to be born pre-term, but have heavier birth weights, than non-First Nations infants, according to a recent study of infant mortality in British Columbia. This was the case in both rural and urban areas of the province.
Nationally, the proportion of low birth weight babies in the First Nations population is 5.3 per cent, only slightly lower than the rate of 6 per cent found in the general population. However, a significant proportion, 21 per cent, of mothers in the First Nations population had high birth weight babies, as compared to 13 per cent in the general population. Although mean birth weights for all infants in developed countries have been increasing (fast food nation?), the differences between the proportions of babies over 4000 grams in the First Nations population and the general population remains significant.
We should consider as well the distance between many reserves and well-equipped medical facilities. The drive-time from reserve to emergency room can in many cases take between 30 minutes to two hours. Questions of water quality, diet, and living conditions should also be taken into account. And then lest we forget, there is of course the devil on our backs – substance abuse. In particular, the use of alcohol by pregnant mothers is believed to pose a significant challenge in some Aboriginal communities.
The incidence of fetal alcohol syndrome and effects (FAS/FAE) is known to be much higher among Aboriginal children than among non-Aboriginal children, with or without any recent definitive statistics to prove it. (The Aboriginal Peoples Survey was conducted in 1991, with a second one being conducted ten years later). There are few statistics to be found at this time about the use of methamphetamines, cocaine, and solvents and how they relate to unborn children, but it would certainly not be surprising to learn officially that there are negative and or lethal side-effects.
With all of these facts and figures and statistics bouncing around in my head (and now yours I presume), rest assured that there is positivity ahead.
The IMR in Canada among First Nations (excluding still births) has been steadily decreasing since 1979, when it peaked at 27.6. Since then infant mortality rates have declined by 64 per cent for First Nations living in rural areas, and 47 per cent for urban-dwelling Indians. In comparison, the IMR of 6.8 in the year 2004 is much closer to the complete national average. Despite the steady decline, the infant mortality rate for First Nations people still remains higher than that found in the general population, and is now consistent with the rate found among the other lowest income groups in urban Canada. So this is something that we need to continue trying to change, and trying to improve on – trying to bring the IMR of our entire country, Indian and white, down to a level more like Finland, under which more children can blow out their birthday candles.
Sources
Statistics Canada, Age and Sex (Aboriginal Data 1991), Ottawa, 1993 and Statistics Canada Nation Series, 1996 Census, Table 25-003.
Norris, M.J., Kerr, D. and Nault, F. (September 1996). Royal Commission on Aboriginal Peoples, Projections of the Population with Aboriginal Identity, Canada, 1991–2016; Summary Report.
Indian and Northern Affairs Canada (December 2001), Aboriginal Women: A Profile from the 1996 Census. Ottawa: Government of Canada.
Statistics Canada, Nation Series, 1996 Census, “Aboriginal Population in Private Households by Age and Sex, Showing Census Family Status for Canada, the Provinces, Territories and Census Metropolitan Areas, 1996 Census.”
Hull, Jeremy (June 7, 2001) Aboriginal Single Mothers in Canada, 1996. Ottawa: Indian and Northern Affairs Canada, Research and Analysis Directorate.
Government of Canada (2002) Healthy Canadians – A Federal Report on Comparable Health Indicators 2002. Ottawa: Health Canada.
Canadian Institute of Child Health. (2000). The Health of Canada’s Children – Third Edition. Ottawa: Canadian Institute of Child Health.
MacMillan, H. et al. “Chapter 1 – Children’s Health.” First Nations and Inuit Regional Health Survey: National Report. Ottawa: Health Canada.
Online Sources
Statistical Profile on the Health of First Nations in Canada
http://www.hc-sc.gc.ca/fnih-spni/pubs/gen/stats_profil_e.html
First Nations Comparable Health Indicators – Health Canada – January 2005 –
http://www.hc-sc.gc.ca/fnih-spni/pubs/gen/2005-01_health- sante_indicat/ index_e.htmlHealth Canada, 1996, Trends in First Nations Mortality, 1979 to 1993, Catalogue no. 34-79/1993E; Health Canada, First Nations and Inuit Health Branch in-house statistics.
Chapter 5: Young First Nations Children in Canada – http://www.socialunion.ca/ecd/2003/report2_e/c5e.html
First Nations and Inuit Fetal and Infant Mortality Study – Public Health Agency of Canada (PHAC) & Canadian Perinatal Surveillance System – http://www.phac-aspc.gc.ca/rhs-ssg/cpss9798/cpssl_e.html
Study: Infant mortality among First Nations and non-First Nations people in British Columbia – 1981 to 2000 – http:www.ncbi.nlm.nih.gov/entrez
“The High Aboriginal Infant Mortality Rate is a Call to Action! – The pressing need to reach out to Aboriginal communities to help improve sexual and reproductive health of Aboriginal women.” – Turtle Island Native Network – http://www.turtleisland.org/discussion/viewtopic.php?p=7145&sid=4de1f0e4296aaff78864556f0c1b1682
Canada’s Performance Report 2005 – Annex 3 – Indicators and Additional Information
http://www.tbs-sct.gc.ca/report/govrev/05/ann304_e.asp
Recent trends in Canadian infant mortality rates: effect of changes in registration of live newborns weighing less than 500 g – KS Joseph, Michael S Kramer, Can Med Assoc J 1996;155(8):1047-52
The State of the World As Seen By Its Babies – http://www.pcdf.org/Meadows/imr.html
Donella Meadows’ “The Global Citizen”, February 4, 1999
