Moving beyond the historical quagmire of measuring infant mortality for the First Nations population in Canada

Abstract

Infant mortality is a metric influenced by societal, political and medical advances. The way vital events are collected and reported are not always uniform. A lack of uniformity has disadvantaged some groups in society. In Canada, a multi-jurisdictional vital statistics system has truncated our ability to produce infant mortality rates for the Indigenous population. To understand how this evolved, this paper outlines the history of infant mortality, generally and internationally, and then documents the efforts to harmonize the collection and reporting of vital statistics (births and deaths) in Canada. Following this analysis is a historical review of vital event reporting for Canada's Indigenous population. A major finding of this paper is that racism, reframing, and jurisdictional posturing has limited our ability to accurately estimate live births and infant deaths for the Indigenous population. To improve Indigenous infant mortality estimation, Canada's governments need to transcend multijurisdictional challenges and fulfill international reporting obligations to Indigenous communities.

One little, too little: Counting Canada's indigenous people for improved health reporting

“…In a previous paper, we documented historically the way provincial governments inconsistently collected and reported on the vital statistics of Canada's Indigenous population, and how anti-racism legislation ended the collection of ethnicity/race fields on birth and death registrations (Elias, 2014). For the federal government to administratively account for the status Indian population, they developed an Indian Registry System (IRS).…”

“…To inform how best to link a federal IRS database to a provincial health registry system, we conducted a historical legal review into the way Canada's Indigenous population, specifically Indians, were identified by Canada's pre-and post-Confederation systems. In a previous paper (Elias, 2014), we reported some of the legislation pertaining to Indians. In this paper, we expanded our legislative review and included court cases that challenged how Indians were defined and subsequently shifted the definition of Indians in Canada.…”

“…The federal government repealed involuntary enfranchisement, prohibitions on traditional ceremonies, and litigation funding restrictions and gave Bands more financial and other administrative controls over their communities. Allowances were also made for status Indians to receive national pension benefits and other health and welfare benefits (Elias, 2014). The provinces also gained a greater role in matters related to Indians.…”

“…The newly-established office of the Indian Registrar was delegated the sole authority to determine which names would be added, deleted or omitted from the Register. The Registrar could require an individual claiming status to prove descent from persons with whom the Canadian government recognized as members of an Indian banddnot an easy feat when births were not always formally recorded or treaty census records were incomplete (Elias, 2014). And now, in addition to status loss through enfranchisement, problems establishing lineage or band membership, marriage to a non-status man, or having a non-status father, status could also be lost through operation of the "double mother" clause.…”

“…The way governments count Indigenous peoples has contributed to inconsistent reporting of Indigenous health statistics in Australia, New Zealand, United States and Canada (Elias, 2014;Freemantle et al, 2014). While vital statistics and other data collections may have high population ascertainment in these countries, the same cannot be said for key grouping fields, such as race/ ethnicity particularly for Indigenous populations.…”