Okawimaw Kanosimowin: Mother's Bundle; A peer-driven approach to improve Indigenous maternal and birth outcomes in Saskatchewan

Abstract

Drs. JoLee Sasakamoose and Mamata Pandey lead Okawimaw Kanosimowin (Cree for "Mother’s Bundle"), an innovative initiative designed to restore the sacredness of childbirth through the revival of traditional Indigenous birthing practices. The program enhances maternal health outcomes for Indigenous women in Saskatchewan by integrating these practices into contemporary care. Central to this initiative is the Mama Pod program, which provides culturally safe, trauma-informed support to mothers. A key component is the Mother’s Bundle, a culturally significant gift containing traditional items, such as a baby star blanket, moccasins, healing medicines, and essential Western supplies. This approach bridges traditional Indigenous knowledge with modern healthcare needs, fostering cultural connections and honoring birth as a sacred process. The success of the Indigenous Birth Support Worker (IBSW) pilot in Saskatoon, as evaluated by Pandey and Sasakamoose, validates the effectiveness of a culturally responsive model in improving maternal outcomes and reaffirming Indigenous cultural identity, even amidst the challenges of systemic racism and healthcare inequities. This study disseminates vital findings, highlighting the critical role of cultural support in advancing health equity for Indigenous women.

Introduction

Dr. JoLee Sasakamoose, CIHR Research Chair in Applied Public Health for Indigenous Wellness and Health Equity at the University of Regina, leads a multidisciplinary team that harmonizes Indigenous healing traditions with Western medical practices. Collaborating with Dr. Mamata Pandey, a Research Scientist with the Saskatchewan Health Authority, their collective aim is to address the stark maternal and child health disparities experienced by Indigenous women. Their team emphasizes culturally relevant healthcare solutions that balance traditional knowledge with cost-effective, evidence-based care. They include experts from healthcare, policy, patient-partners and research sectors, ensuring a holistic, community-centred approach to maternal healthcare that prioritizes Indigenous knowledge and practices.

Target Population and Rationale

This study focuses on the health and well-being of Indigenous women in Saskatchewan, particularly those in urban areas such as Regina and remote communities. Indigenous peoples—comprising First Nations, Métis, and Inuit—represent approximately 16.3% of Saskatchewan’s population (Statistics Canada, 2021). Despite this significant presence, Indigenous women face disproportionate health challenges, especially during pregnancy and childbirth. They experience higher rates of maternal and infant health complications, compounded by socio-economic hardships such as poverty, lower educational attainment, and limited access to healthcare services. These systemic inequities, rooted in colonial legacies and systemic racism, perpetuate cycles of poor health outcomes for Indigenous mothers and their children.

A pressing concern is the lack of culturally appropriate maternal healthcare services. Indigenous women often encounter barriers such as geographic isolation, language differences, and racism within healthcare institutions, which exacerbate health inequities. Addressing these issues requires maternal care that respects and integrates Indigenous cultural practices, ensuring that prenatal, birthing, and postnatal care are accessible and culturally safe.

Despite Canada's high-income status, many Indigenous communities, particularly in rural and remote areas, experience conditions resembling those in low- and middle-income countries—marked by inadequate healthcare infrastructure, economic hardships, and limited access to essential services. These challenges necessitate culturally responsive interventions tailored to Indigenous women’s unique healthcare needs.

Research Objectives

Health equity for Indigenous women can be achieved by developing and implementing healthcare interventions that are culturally grounded and responsive. Guided by international frameworks such as the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) and the Sustainable Development Goal 3 (SDG 3), as well as Canada’s Truth and Reconciliation Commission (TRC) Calls to Action, the project focuses on dismantling barriers to maternal healthcare. The goal is to improve health outcomes for Indigenous women and their families, narrowing the gap between Indigenous and non-Indigenous populations in Saskatchewan.

This focus emerged from extensive community engagement, comprehensive analysis of health disparities, and consultations with Indigenous leaders and healthcare providers. The well-documented healthcare inequities and the expressed needs of Indigenous women reinforce the importance of this research. By incorporating the principles of the Cultural Responsiveness Framework (CRF) theorized by Sasakamoose et al. (2017), this project ensures that healthcare interventions are both culturally respectful and relevant, addressing the specific needs of Indigenous women.

Community Engagement

Community engagement is at the heart of this initiative. Partnerships with organizations such as the Federation of Sovereign Indigenous Nations (FSIN) and the Western Region III Métis Nation-Saskatchewan have shaped the research and its implementation. The Knowledge Keepers Council, composed of Knowledge Keepers and traditional healers, plays a vital role in ensuring the community’s values and cultural practices are central to the project. Through consultations, workshops, and virtual meetings, Indigenous women have been directly involved in guiding the research process, ensuring that the program reflects their needs and priorities.

This engagement has been critical to the success of the Okawimaw Kanosimowin program, which offers culturally safe maternal support to Indigenous women. The positive outcomes of the pilot have informed the program’s expansion and set the direction for future developments.

Research and Findings

This study is part of the broader Indigenous Wellness Research Corridor, aimed at addressing the maternal care needs of Indigenous women through the promotion of cultural safety and trauma-informed care. The healthcare solutions are practical and culturally respectful by prioritizing integrating traditional Indigenous knowledge with Western medical practices. This approach is essential for Indigenous women, who often face systemic barriers that undermine their access to equitable maternal healthcare.

One of the critical interventions in this research has been the development of programs such as Mama Pod, which emphasizes community-based, culturally informed maternal support. This program, along with other culturally responsive initiatives, focuses on fostering trust within healthcare systems that have historically marginalized Indigenous communities. These interventions help bridge the gap between modern healthcare and Indigenous cultural practices, ultimately improving maternal outcomes.

The research highlights the critical need to challenge and dismantle long-standing biases within the healthcare system, particularly the devaluation of Indigenous cultural identity in maternal care. By demonstrating the positive impacts of culturally tailored approaches, this study contributes to a growing body of evidence supporting the importance of integrating traditional knowledge into healthcare practices. The findings underscore that culturally safe care is not an optional addition but a fundamental requirement for advancing maternal health outcomes for Indigenous women in Saskatchewan.

Conclusion

Drs. Sasakamoose and Pandey’s Okawimaw Kanosimowin initiative exemplifies a transformative model of Indigenous maternal care, blending traditional knowledge with contemporary healthcare practices. Through a strong focus on cultural safety, community engagement, and trauma-informed care, the program serves as a vital framework for reducing health disparities among Indigenous women in Saskatchewan. By honouring Indigenous cultural practices, this initiative creates a healing environment that addresses the physical and cultural needs of Indigenous mothers, improving maternal and birth outcomes. This work is a pivotal example of how healthcare systems can evolve to genuinely meet the needs of Indigenous communities, paving the way for lasting health equity.