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Abstract

Indigenous people in Canada have a higher rate of preterm birth, which is birth before 37 weeks of gestation, compared to other residents. Though research has linked health disparities between Indigenous and non-Indigenous people to colonial legislations and actions, there lacks evidence of specific determinants of preterm birth among Indigenous people. As part of the Quw'utsun Preterm Birth Study that Cowichan Tribes initiated to address the elevated rate of preterm birth in Quw'utsun territory (Cowichan Valley, British Columbia), I examined the determinants of health that are associated with preterm birth and that could be amenable to intervention among Indigenous people. The research team and I created a research framework, Nuts'a'maat shqwaluwun (one heart, one mind), to adhere to Quw'utsun standards for ethical research: (a) self-determination of Quw'utsun people in research and (b) respect for the snuw'uy'ulh, which are the “ways of life” that Elders share with younger generations to guide them through all aspects of life, including pregnancy and birth. Using this framework enabled adherence to these standards throughout this study. We interviewed Indigenous women in Quw'utsun to understand the factors that impacted the health of their pregnancies and preterm births specifically. Social and environmental challenges negatively affected health in pregnancy. In addition, the snuw'uy'ulh were viewed as foundational to the promotion of health in pregnancy. To compare preterm birth rates between First Nations and other residents, we undertook a population-based retrospective cohort study of deliveries in the Cowichan Valley (2011-2022) by using a linkage of the First Nations Client File and Perinatal Data Registry. The rate of preterm birth for First Nations (22.6%) was three times higher than for other residents (7.2%; risk ratio 1.91, 95% CI 1.65, 2.22, adjusted for maternal age, parity, and timing of first prenatal visit). Finally, we conducted knowledge-translation activities to identify the determinants that were amenable to intervention. We identified early and consistent attendance at prenatal care visits and prenatal care that supports pregnant people to follow the snuw'uy'ulh. In summary, the determinants of preterm birth among Quw'utsun people are multifactorial and require comprehensive intervention studies, informed by the findings of this study.