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In Conversation: Katherine Arnup on Death, Dying and Dignity During COVID-19

Gaby Novoa

August 4, 2020

In May 2018, the Vanier Institute published Family Perspectives: Death and Dying in Canada1 by Katherine Arnup, PhD, which examined the evolution of death and dying across generations, the desires and realities of families surrounding death and dying, the role of families in end-of-life care and its impact on family well-being.

With the current conversation surrounding COVID-19 and post-pandemic context, we joined in conversation with Dr. Arnup to hear her reflections on some of the themes explored in the 2018 report, and on the impact of the pandemic on conversations surrounding death and dying in Canada.


Tell us about how you feel COVID-19 has impacted the conversation and attitudes on death and dying among families and policymakers in Canada.

Death is in many ways in the public eye more now than it was prior to COVID-19, and has been from the get-go, once the virus became a presence in the world, because a number of countries experienced a large number of deaths before it really hit here. People were very aware that something major was happening in terms of death.

In Canada, we’ve had daily deaths, casualties and case counts being reported, much like in wartime. There’s been war imagery accompanying this in many ways, but certainly in my lifetime, I’ve never seen anything like this – it’s almost unavoidable. If you visit the CBC website, the first thing you see is the current counts, which makes you very aware of how many people have died. You can’t really get away from it, with these constant reminders. There’s a sense that we’re “at war” with a virus. Especially at the beginning, there was a sense that it could be anywhere, people nearby could be carrying it, and you could get it and it could kill you. A lot of fear – fear of the virus and a fear of dying.

One of the themes in Family Perspectives: Death and Dying in Canada is that people’s fear of death and dying deters families from having important conversations about it. Do you think the pandemic has forced people to think about death in a more in-depth way, or have anxieties and fears caused more avoidance of the conversation on death and dying?

I think it’s the latter. In my report, I was talking about a kind of acceptance of death and planning for death. But since there are many unknowns around COVID, which has struck so many people throughout the world, it’s different from anything any of us have experienced.

I think one of the biggest ways that COVID-19 and death have been front and centre throughout the pandemic is around seniors and their families. It’s quite true that the virus poses a greater risk for seniors than for anyone else, although certainly other factors make people vulnerable as well. However, seniors, and particularly people in their 80s and 90s and people with comorbidities, are likely to have a bad result and perhaps die as a result of contracting the coronavirus.

That’s especially been the case in long-term care facilities. In Ontario, the long-term care facility in Bobcaygeon was one of the first ones that the public really became aware of, where they had many deaths in a short period of time. Overall in Canada, the most recent data on this showed that 81% of the deaths in Canada were in long-term care, compared with the average of 42% in developed countries in the OECD.2 The numbers are much higher in Canada, so dramatic that the military was called in for assistance in Ontario and Quebec, which also fits with the military and war metaphors. They reported incredibly appalling conditions in those long-term care homes.3

I think a lot about long-term care homes now in a way that I didn’t before. I believe that I was just like most Canadians in that I didn’t think about them, beyond saying “I hope I never end up there,” and I think that’s very typical of Canadians. Maybe true for people in other countries, but I can say it for Canadians and that fits in with some of the things I’ve written about in the 2018 report and elsewhere: we want to live forever, but we want to be healthy, strong and independent – those are huge values for us.

Living in long-term care is something we really don’t want to think about, so most of us haven’t looked at the conditions there – many of which existed before the pandemic. That is, often four people to a room, staff working at several homes, understaffing, staff being very busy rushing from patient to patient and then going to another home. A lot of those things were happening already, and they created the conditions for the pandemic to grab hold and decimate long-term care populations.

I think those who have family in long-term care homes have had a huge wake-up call. They probably knew something about the conditions, and some of them were active caregivers in those homes – that is, going and caring for their loved ones – while some people virtually never visited. My aunt was in a long-term care home in a small town not that far from Bobcaygeon. I visited her when she was dying, and was actually really impressed with that home. She had her own room and you could tell that the staff cared for their patients, for their residents. I don’t think everything negative that we’ve seen is the case for all long term-care by any means. But we mostly just haven’t thought about it.

Pat Armstrong, a major scholar of health care in Canada, has been involved in a 10-year study of long-term care homes.4 She and her team remind people that though we don’t want to think about them, any of us could end up in long-term care almost in the blink of an eye: a major accident or a stroke, a fall that means we can’t care for ourselves, a diagnosis of dementia. Any of those things could mean that I end up in a long-term care home. I don’t want to, like most people, but we always think it’s going to be somebody else and not us. I think that the crisis has made us aware that it can be anyone – our mothers, our fathers, our sisters, ourselves. With change – and only one changed circumstance has to happen – we could be there as well. It’s a reminder that we all need to be fighting to change those institutions and how people die.

I was looking at the list of desires and assumptions discussed in the report, two of which stood out as I read the military report: we want to die at home and we want to die with dignity. It’s very clear that there was no dignity in the way that people were dying in long-term care homes. Indeed, there was no dignity in how they were being cared for, because of the conditions there. It’s also clear that people are there in those facilities because families can’t take care of them. It’s not that families don’t care. It’s that their own lives and the demands of their lives, and the lack of home care, means that they can’t care long-term for a family member who’s got dementia and maybe is acting out, or a family member who really needs 24/7 care.

Many Canadians also assume that they can get all the home care they and their families need. The pandemic has meant that many people had to cancel the home care that was coming in, especially at the beginning, because they were afraid to get COVID from their home care provider. Home care providers, by their very nature, are usually working in several homes. So, they’re potentially carrying the virus to many homes. It’s meant that not only is there not enough home care generally, but in the case of COVID, people were also hesitant to have those carers coming into their homes.

Like the pre-existing challenges in many long-term care homes, we’ve seen certain vulnerabilities and inequities amplified within the pandemic. Do you find any hope in how the conditions of long-term care are now being brought to greater public awareness?  

With long-term care homes, I feel a need to speak out about it, and to press governments to make changes that could have a huge impact, such as federal standards, or for senior care to be included in the Canada Health Act so that it becomes a shared responsibility across governments.

I think families have really mobilized and have seen the shortcomings and some of the reasons why the conditions are so bad. This is partly due to the for-profit homes, which have higher deaths, but also a lack of inspections and of enforcement of what exists in the law. In bringing it to the public attention as it has, in being such a tragedy, I think that there is hope for improvement, and I hope that many more people are now aware that it could be them, that it could be their families.

People who have children with severe disabilities who are living in congregate care are also facing similar issues of not being able to have family with them, as they still aren’t able to go into those homes. I do see a lot more discussion now around families as caregivers, having them recognized as caregivers and not just as visitors, as they’re being talked about. It’s an issue that the Vanier Institute has raised, I’ve done work with the Change Foundation, and there are other organizations that have made progress on that. So, I feel positive and see hope there for a recognition of the role of caregivers and their importance in the health and well-being of those who are cared for.

There has been increased opportunity to talk about advanced care directives. Even if people aren’t necessarily having those conversations, I think that if they’re faced with a family member getting COVID, it will spur the realization that we don’t always know what our family member wants. Even though the conversation around death hasn’t come on to the table in the best way, I think it provides openings for those of us who have been promoting the importance of advanced care. It provides an avenue for discussion, to be able to say to people that this is a realistic concern. We just never know when something will happen, and something will happen. We need to know what each other wants. Our children need to know what we want – I think the pandemic opens the door to that.

I’m writing and have been making videos, and I will be encouraging people in one of my next ones to talk to their family members (if they haven’t already) about what they want and about making advanced care directives, because it’s really important. Family members having to say “I just don’t know what Mom would want” is a mistake that doesn’t have to happen.

I feel optimistic about these things, and optimism in the face of a pandemic is in short supply. I’m optimistic around that sense that we’re all in this together, which we began this pandemic with. Our Prime Minister stressed this idea every day in his talks, and other people did as well. I think there has been significant pulling together around a sense of community and caring for one another. I’ve experienced this in my own neighbourhood – people who never normally talked to one another are checking in. When you go for a walk, people ask how you are doing and it’s genuine. I think that’s a strangely positive thing that is a result of the pandemic. I hope that it lasts, that people are doing things for elderly neighbours and that they’re more aware of who might be in need of help on their street. Anything that increases a sense of community I think is a great thing.

You touch on this point in your video “Expanding Our ‘Bubbles,’”5 on feeling reassured in many ways by this sentiment that we’re all in this together, though you also note that it has become increasingly apparent that we’re not all in the same boat. We might all be in it together, but the way we’re experiencing it varies greatly, whether it’s higher risk among seniors and other groups.6 Could you elaborate?

When you look at the breakdown of the areas that are still COVID hotspots, it’s where there are people living in poverty, people of colour, people who are working high-risk jobs in health care and in the service sector, and people living in large numbers together because they might not be able to afford anything else. Significant outbreaks among migrant workers employed in agricultural work and workers in food processing plants also demonstrate the impact of inequalities in our society on people’s vulnerability in the pandemic.

Another important way in which people haven’t been in it all together has been in families’ inability to have funerals, wakes, services or celebrations of life during the pandemic. I think this is having a huge impact on those who aren’t able to mark the death of a loved one with friends and family. There have been many families who couldn’t have a service of any kind, who couldn’t hug, who couldn’t get together beyond small groups. I just wonder what happens to that grief.

Many of those people who died, died alone. People in long-term care facilities and in hospitals have died alone. None of us wants that to happen. None of us wants it to happen to the people we love, and we don’t want to have it happen to us. It is an important tenet of hospice palliative care: let no one die alone. That this has been happening on a huge scale for the families left behind, it means enormous grief and guilt, feeling that “I couldn’t be there for Mom” or “I couldn’t be there with Mom when she was dying.” That’s heartbreaking. I don’t know what people do with that; you kind of have to push it down. I think about how all the obituaries say, “When it’s possible, we’ll have a service.” It’s hard for me to imagine all those services and where they’ll happen and whether that will provide the closure and support that people need. I certainly haven’t seen anything like that in my lifetime.

What gives you hope going forward? 

I think about these questions: What do we want when we die? But also, what do we want as we grow older? What do we need to support us in that? How are we dealing, in general, with aging and dementia? What do we hope for? How can we create places that are very different from long-term care homes? How can we make that happen?

Katherine Arnup, PhD, is a writer, speaker and life coach specializing in transitions, and a retired Carleton University professor. Author of Family Perspectives: Death and Dying in Canada (and several books, including “I Don’t Have Time for This!”: A Compassionate Guide to Caring for Your Parents and Yourself and Education for Motherhood, she has pioneered studies on family experiences and provided unique insights into family life throughout her career.

Gaby Novoa is responsible for Communications at the Vanier Institute of the Family.

This interview has been edited for length, flow and clarity. 


Notes

  1. Katherine Arnup, PhD, Family Perspectives: Death and Dying in Canada, The Vanier Institute of the Family (May 2018).
  2. Canadian Institute for Health Information, “Pandemic Experience in the Long-Term Care Sector: How Does Canada Compare with Other Countries?” CIHI (June 25, 2020). Link: https://bit.ly/3hGl4bc.
  3. Canadian Armed Forces, “Op LASER – JTFC Observations in Long Term Care Facilities in Ontario,” CAF (May 20, 2020). Link: .
  4. Pat Armstrong is a Distinguished Research Professor in Sociology at York University and a Fellow of the Royal Society of Canada. Link: .
  5. Katherine Arnup, “Expanding Our ‘Bubbles,’” (YouTube). Link:.
  6. In Family Perspectives: Death and Dying in Canada, Arnup writes that experiences of death and dying are affected by factors of gender, race, class, ethnicity, geography, marginalized status, ability, sexual and gender identity, marital status and Indigenous, First Nation, Inuit and Métis status.

Getting Out, Getting Active and Family Well‑Being

Gaby Novoa and Nathan Battams

June 22, 2020

Summer 2020 will be a unique one for families, as communities across Canada cautiously continue to relax public health measures and restrictions and families manage major transitions at home, at work and in their communities.

Many parents are working from home for the first time, which can present some challenges but also opportunities to spend more time with their children and to foster healthy physical activity behaviours, which, after months of being in physical isolation, will likely be a welcome pursuit for many.

Families are shifting summer plans to manage uncertainties

People typically make family decisions based on choice and circumstance, and the coronavirus pandemic and public health measures have had an impact on both. Responding to a variety of factors related to the pandemic – including financial insecurity, a need or desire to remain close to manage work and family, some continued mobility restrictions and uncertainty whether restrictions will return – it’s not surprising that nearly 6 in 10 (59%) parents surveyed in late April reported that they have changed their vacation plans due to the pandemic, and 72% say that it’s unlikely that they will take a holiday this year.

Children and youth will also be adapting their plans and activities, as many summer camps and organized sports or activities will either be postponed or not taking place. While some organizations are set or pending announcements to open, the impact of the pandemic on family finances may deter some parents from registration in order to carefully manage expenses. Others may avoid sending their kids anywhere due to health concerns or anxiety, particularly if their children live with any immunodeficiency.

With more families spending time at home this summer and plans being changed and adapted, there are growing opportunities for many families to get outdoors and be active together.

Family support critical to children’s levels of physical activity

The newly released Family Influence: The 2020 ParticipACTION Report Card on Physical Activity for Children and Youth reports that less than 1 in 5 children and youth in Canada meet national guidelines for physical activity, sedentary and sleep behaviours.1 The report underlines the role of families in promoting healthy habits in its guiding Consensus Statement, which was developed through a national multidisciplinary expert panel:

Families can support children and youth in achieving healthy physical activity, sedentary and sleep behaviours by encouraging, facilitating, modelling, setting expectations and engaging in healthy movement behaviours with them. Other sources of influence are important (e.g., child care, school, health care, community, governments) and can support families in these pursuits.2

As the report states, youth’s physical activity levels, is greatly influenced by family social support – particularly during early childhood. This support is shown to be most effective when taking self-regulatory approaches and when grounded in specific actions, such as setting goals together. Studies assert that parents who make clearly defined plans – how, when, where – to encourage their child’s healthy movement behaviours are more likely to follow through. As role models, parents can have a significant impact: every additional 20 minutes of physical activity by a parent can mean an additional 5 minutes in their child’s daily physical activity.3

Outdoor play and location linked to well-being

A growing body of research demonstrates the link between well-being and access to parks and green spaces. In 2017, the majority of households in Canada (87%) reported having a park within 10 minutes of their home. Of these households, almost all (85%) reported that they had visited the park within the previous 12 months. Among households that reported that they did not have nearby access (13%), 39% nevertheless reported visiting a park or green space in the previous 12 months.4

Research has shown that a neighbourhood’s built environment can have an impact on the time children spend outdoors, with lower traffic volumes, access to a yard and neighbourhood greenness all associated with more time spent by children playing outdoors in one study.5

Research from Statistics Canada has found a strong association between time spent outdoors and levels of physical activity among children, as well as a positive impact on psychosocial health and lower likelihood of experiencing peer relationship problems.6 More than one-third (36%) of surveyed parents with children aged 5–17 said that they play active games with their kids.7 Since the start of the pandemic, nearly two-thirds (62%) of youth in Canada cited exercising outdoors.8

Outdoor play can foster “freedom, fun, creativity, and skill- and confidence-building.”9 Whether it’s walking through a park, playing a game in the front yard or going for a jog, getting outdoors and practising healthy behaviours with family can play an important role in supporting physical activity and wellness at any time, but are particularly important as families continue to navigate the COVID‑19 pandemic and new and/or adapted ways of coming together.

Gaby Novoa is responsible for Communications at the Vanier Institute of the Family.

Nathan Battams is Communications Manager at the Vanier Institute of the Family.


Notes

  1. ParticipACTION, Family Influence: The 2020 ParticipACTION Report Card on Physical Activity for Children and Youth (June 17, 2020). Link: https://bit.ly/2Zser6r.
  2. Ibid.
  3. Ibid.
  4. Gordon Dewis, “Access and Use of Parks and Green Spaces: The Potential Impact of COVID‑19 on Canadian Households,” COVID‑19: A Data Perspective (June 9, 2020). Link: .
  5. Amalie Lambert et al., “What Is the Relationship Between the Neighbourhood Built Environment and Time Spent in Outdoor Play? A Systematic Review,” International Journal of Environmental Research and Public Health (October 11, 2019). Link: https://bit.ly/2N8nan1.
  6. Richard Larouche et al., “Outdoor Time, Physical Activity, Sedentary Time, and Health Indicators at Ages 7 to 14: 2012/2013 Canadian Health Measures Survey,” Health Reports, Statistics Canada catalogue no. 82-003-X (September 21, 2016). Link: .
  7. ParticipACTION, The Brain + Body Equation: Canadian Kids Need Active Bodies to Build Their Best Brains. The 2018 ParticipACTION Report Card on Physical Activity for Children and Youth (2018). Link: .
  8. Rubab Arim, Leanne Findlay and Dafna Kohen, “The Health and Behavioural Impacts of COVID‑19 on Youth: Results from the Canadian Perspectives Survey Series 1,” COVID‑19: A Data Perspective (May 15, 2020). Link: .
  9. Lambert et al.

Family Finances and Mental Health During the COVID‑19 Pandemic

Ana Fostik, PhD, and Jennifer Kaddatz

May 26, 2020

In March 2020, the coronavirus pandemic suddenly brought social and economic activities to a halt across Canada, with data showing serious impacts on labour market activity. Recent estimates from Statistics Canada show that 1 million fewer Canadians were employed in March than in February, and the usual labour market activity of 3.1 million Canadians was affected (i.e. worked fewer hours or lost their job).1

According to survey data for April 10–12, 2020 from the Vanier Institute of the Family, the Association for Canadian Studies (ACS) and Leger,2 38% of men and 34% of women aged 18 and older said that they lost their job temporarily or permanently, or experienced pay or income losses, due to the COVID-19 pandemic. Consequently, 27% of men and 25% of women reported a negative financial impact (i.e. ability to pay mortgage or rent and/or their bills).

Not surprisingly, Statistics Canada recently found that adults who suffered a major or moderate impact of the pandemic were much more likely to report fair or poor mental health than those who were less impacted (25% and 13%, respectively).3

Data collected in mid-April by the Vanier Institute of the Family, the Association for Canadian Studies and Leger show that younger adults have been particularly affected: more than half (52%) of those aged 18–34 reported a negative impact on their labour market activity (job or pay/income losses), compared with 39% of those aged 35–54 and 21% of those aged 55 and older. This is reflected in the shares of adults experiencing immediate negative financial outcomes, which were reported by 33% of adults under 55 and 15% of those over 55.

Adults in financial difficulty are more likely to report mental health issues

Among the core working age population (aged 18–54), just over half reported feeling anxious or nervous (53%), irritable (49%) or sad (48%) often or very often during the COVID-19 pandemic, according to the Vanier Institute/ACS/Leger survey. Four in 10 reported difficulty sleeping (40%) and having mood swings (40%) often or very often.

Among those who experienced immediate negative outcomes, such as not being able to pay rent or mortgage and/or their bills, about 6 in 10 reported anxiety or nervousness (63%), irritability (60%) or sadness (57%) often or very often, whereas half said they have had difficulty sleeping (50%) or experience mood swings (52%) often or very often (fig. 1).

Women in financial difficulty suffer from mental health issues in higher shares than men

According to the 2018 Canadian Community Health Survey, women were slightly less likely than men to report excellent/good mental health (66% and 71%, respectively).4 During the coronavirus pandemic, however, Statistics Canada found a much larger difference, at 49% of women and 60% of men.5

Vanier Institute/ACS/Leger survey data show women aged 18–54 reporting specific mental health issues often or very often in much larger shares than men of the same age. About 6 in 10 women reported experiencing anxiety or nervousness, irritability or sadness often or very often, compared with 4 in 10 men. Similarly, about half women experienced difficulty sleeping or mood swings often or very often, compared with 3 in 10 men (fig. 1).

This difference by gender in reporting mental health issues is maintained even when examining the proportions of men and women who suffered immediate negative financial outcomes and those who did not. For instance, three-quarters of women (76%), compared with half of men (51%), who had difficulty paying mortgage or rent and/or their bills reported feeling nervous or anxious often or very often. Almost 7 in 10 women in financial difficulty experience irritability (67%) or sadness (67%), compared with about half of men in the same situation (53% and 48%, respectively) (fig. 1).

About 6 in 10 of women in financial difficulty (55% and 62%) suffered difficulty sleeping and had mood swings often or very often, compared with 4 in 10 men in the same situation (45% and 42%, respectively) (fig. 1).

Adults with financial difficulties report similar mental health issues, whether living with young children or not

If women are significantly less likely than men to report positive mental health during the pandemic, even when financial outcomes are controlled for, what factors might be at play in creating these gender differences? Could these mental health challenges be related to family responsibilities?

An analysis of the April 10–12, 2020 data indicates that heightened symptoms of poor mental health do not appear to be linked to the presence of children in the home. Women who live with children aged 12 and younger in the household report experiencing anxiety (69%), irritability (60%), sadness (59%), difficulty sleeping (51%) and mood swings (51%) often and very often in similar proportions as women who do not live with children (63%, 57%, 60%, 47% and 48%, respectively). Men who live with young children also report these problems in similar proportions as those who do not (fig. 2).

Among women in financial difficulty, there is little difference in the share reporting any of these mental health problems whether they have young children living in the household or not. This is also true among women who did not experience immediate negative financial outcomes: living with children aged 12 and under in the household does not appear to make a difference (fig. 2).

Analysis of self-reported mental health status shows that some of the differences by gender persist when controlling for province of residence, age, financial difficulty, job/pay loss, presence of children aged 12 and under, household income, marital status and educational attainment. Controlling by these variables and compared with men who are in financial difficulty, women in financial difficulty are about twice as likely to suffer from anxiety, sadness or mood swings. Among adults who have not suffered financial negative outcomes, there are no significant differences between men and women in mental health outcomes once controlling for these factors.

While this analysis could not pinpoint potential reasons why women are more likely than men to report poor mental health symptoms, future research may seek to focus on psychological differences between women and men in crisis situations in order to determine whether or not women and men react differently in crisis situations or when there is an immediate threat to personal or family health and well-being. More research on the impact of gendered aspects of household work and caregiving, including the mental burden associated with these types of unpaid work, might also shed light on these differences.

Ana Fostik, PhD, Vanier Institute on secondment from Statistics Canada

Jennifer Kaddatz, Vanier Institute on secondment from Statistics Canada


Notes

  1. Statistics Canada, “The Impact of COVID-19 on the Canadian Labour Market,” Infographics (April 9, 2020). Link: .
  2. A survey by the Vanier Institute of the Family, the Association for Canadian Studies and Leger, conducted March 10–13, March 27–29, April 3–5, April 10–12, April 17–19 and April 24–26, included approximately 1,500 individuals aged 18 and older, interviewed using computer-assisted web-interviewing technology in a web-based survey. All samples, except for the March 10–13 and April 24–26 samples, also included booster samples of approximately 500 immigrants. Using data from the 2016 Census, results were weighted according to gender, age, mother tongue, region, education level and presence of children in the household in order to ensure a representative sample of the population. No margin of error can be associated with a non-probability sample (web panel in this case). However, for comparative purposes, a probability sample of 1,512 respondents would have a margin of error of ±2.52%, 19 times out of 20.
  3. Statistics Canada, “Canadian Perspectives Survey Series 1: Impacts of COVID-19 on Job Security and Personal Finances, 2020,” The Daily (April 20, 2020). Link: .
  4. Leanne Findlay and Rubab Arim, “Canadians Report Lower Self-Perceived Mental Health During the COVID-19 Pandemic,” STATCAN COVID-19: Data to Insights for a Better Canada, Statistics Canada catalogue no. 45280001 (April 24, 2020). Link: .
  5. Ibid.

 

Families in Canada Express “Major Concern” for Senior Health and Well-being During COVID-19

Nadine Badets and Ana Fostik, PhD

April 30, 2020

The Public Health Agency of Canada identifies older adults as being particularly vulnerable to COVID-19 and at high risk for severe illness and death.1 In 2019, 9.1 million people in Canada were aged 60 and older, representing about one-quarter of the total population.2

As of April 27, 2020, about 37% of confirmed COVID-19 cases in Canada were diagnosed in adults aged 60 and older, and this age group accounted for more than half (56%) of all coronavirus cases with pneumonia. Adults aged 60 and older had the highest proportions of severe outcomes with 66% of reported COVID-19 hospitalizations, 63% of Intensive Care Unit (ICU) admissions and 95% of deaths.3

The higher susceptibility of older adults to the virus has created heightened levels of stress for seniors and their families and caregivers as they navigate the COVID-19 pandemic.

Key facts and statistics

  • Approximately 37% of confirmed COVID-19 cases in Canada were diagnosed in adults aged 60 and over (April 27, 2020).
  • Adults aged 60 and over have accounted for 66% of reported COVID-19 hospitalizations, 63% of Intensive Care Unit (ICU) admissions and 95% of deaths (April 27, 2020).
  • 70% of adults aged 18 and older indicated that they are somewhat/very afraid that a member of their immediate family will contract COVID-19 (April 27, 2020).
  • 15% indicated that some senior relatives are currently living in nursing homes or long-term care facilities, 85% of whom expressed concern about the health of these family members (April 27, 2020).
  • Nearly 8 in 10 (79%) of coronavirus deaths in Canada occurred in nursing and long-term care homes (April 28, 2020).

Families with senior relatives in nursing homes are most concerned

In a survey conducted on April 17–19, 2020 by the Vanier Institute of the Family, the Association for Canadian Studies and Leger, close to 70% of adults aged 18 and older indicated that they are somewhat or very afraid that a member of their immediate family will contract COVID-19.4 For context, in 2018 Statistics Canada found that about 7.8 million adults aged 15 and older provided care to a family member or friend,5 and almost 4 in 10 care recipients in Canada 2018 were aged 65 and older.6

During the COVID-19 pandemic, 11% of adults reported that at least one senior relative was living with them.7 Close to 47% indicated that the seniors in their family live in their own separate homes, and 15% indicated that some senior relatives are currently living in nursing homes or long-term care facilities.

Most adults (85%) whose senior family members live in care facilities expressed concern about the health of these family members, while a slightly lower share of adults who live with seniors (77%), or whose senior family members live in separate homes (72%), expressed concerned for their health.

Seniors in long-term care facilities are struggling to cope with pandemic restrictions

A large part of the devastation caused by the coronavirus pandemic has been occurring in nursing homes and long-term care facilities. Dr. Theresa Tam, Canada’s Chief Public Health Officer, announced in mid-April 2020 that about half of COVID-19 deaths in Canada have been linked to outbreaks in long-term care homes for seniors,8 and, as of April 28, 2020, nearly 8 in 10 (79%) of coronavirus deaths in Canada occurred in nursing and long-term care homes.9

Almost 61% of relatives reported that they are somewhat or very worried about the quality of care seniors are receiving in nursing homes and long-term care facilities. Furthermore, close to two-thirds (63%) of adults whose senior relatives live in long-term care homes think these family members are having a somewhat or very difficult time coping with COVID-19 restrictions, such as staying in their rooms and no contact/visits from others. About 12% aren’t sure how their relatives are coping with the restrictions.

Nadine Badets, Vanier Institute on secondment from Statistics Canada

Ana Fostik, PhD, Vanier Institute on secondment from Statistics Canada

 


Notes

  1. Public Health Agency of Canada, People Who Are at High Risk for Severe Illness from COVID-19 (April 20, 2020). Link: .
  2. Statistics Canada. Population Estimates on July 1, by Age and Sex (Table 17-10-0005-01). Link: .
  3. Public Health Agency of Canada, Coronavirus Disease 2019 (COVID-19): Epidemiology Update (April 29, 2020). Link:.
  4. A survey by the Vanier Institute of the Family, the Association for Canadian Studies and Leger, conducted March 10–13, March 27–29, April 3–5, April 10–12 and April 17–19, 2020, included approximately 1,500 individuals aged 18 and older, interviewed using computer-assisted web-interviewing technology in a web-based survey. All samples except for the March 10–13 sample also included booster samples of approximately 500 immigrants. Using data from the 2016 Census, results were weighted according to gender, age, mother tongue, region, education level and presence of children in the household in order to ensure a representative sample of the population. No margin of error can be associated with a non-probability sample (web panel in this case). However, for comparative purposes, a probability sample of 1,512 respondents would have a margin of error of ±2.52%, 19 times out of 20.
  5. Statistics Canada, “Caregivers in Canada, 2018,” The Daily (January 8, 2020). Link:.
  6. Statistics Canada, “Care Counts: Care Receivers in Canada, 2018,” Infographics, Statistics Canada catalogue no. 11-627-M (January 22, 2020). Link:.
  7. April 17–19 survey by the Vanier Institute of the Family, the Association for Canadian Studies and Leger (see note 4).
  8. Olivia Bowden, “Long-Term Care Homes with the Most Coronavirus Deaths in Canada,” Global News (April 17, 2020). Link:.
  9. Beatrice Britneff and Amanda Connolly, “Coronavirus Spread Slowing in Canada; Death Rate Rises Due to Long-Term Care Fatalities,” Global News (April 28, 2020). Link: .

 

Health Habits During the COVID-19 Pandemic

Jennifer Kaddatz and Nadine Badets

April 27, 2020

Canada’s lockdown for the COVID-19 pandemic has placed heavy restrictions on individuals and businesses, which have altered many commonplace activities, from preparing and consuming foods to shopping, exercising and spending time outdoors. The health of adults in Canada is changing, and not just because of the virus, but also because of pre-existing and newly emerging health habits.

Throughout this period of social isolation, adults are spending more time preparing meals and drinking alcohol at home, but spending less time exercising and going outside, according to four weeks of recent survey data from the Vanier Institute of the Family, the Association for Canadian Studies and Leger1 and other pandemic data sources.

These patterns will be important to watch throughout the duration of the pandemic, given the potential impacts on both physical and mental health among families across the country.

About 4 in 10 adults spend more time preparing meals at home

Healthy eating is fundamental to good health, is a key element in healthy human development and is important in reducing the risk of many chronic diseases. Preparing and cooking food at home can reduce the amount of sodium, sugar and saturated fat in meals while at the same time increasing the intake of vegetables, fruit, whole grains and plant-based proteins. On the other hand, eating out or ordering in can negatively impact a person’s health because of the potential for the meals to be more highly processed, with lower quantities of vegetables, fruits and whole grain foods.2

Not surprisingly, during COVID-19 isolation more people in Canada are eating home-cooked meals. In fact, 41% of adults say that they are spending more time preparing meals now than they were before the pandemic, according to April 9–12 data (fig. 1). Women, in particular, seem to be spending more time in the kitchen, with 44% saying they are preparing meals “more often” as compared with 38% of men. In fact, nearly half (48%) of women aged 35–54 are spending more time preparing meals, as are 44% of men in that age group.

In contrast, a lower share of women (18%) than men (24%) picked up take-out food from a restaurant in the week before the April 9–12 survey, although women are about equally as likely (18% vs. 16%) to get food delivered to their home or business (figs. 2 and 3). Young men, aged 18–34, are most likely to pick up take-out food (24%) in the past week, whereas young women aged 18–34 are the gender/age group most likely to order in (27%).

One in 5 adults are drinking more alcohol at home

Alcohol can have significant consequences for physical and mental health if consumed in large quantities, by exacerbating pre-existing mental health issues, increasing the short-term risk of injury or acute illness, and increasing the long-term risk of serious diseases like liver disease and some cancers.3 Accordingly, if alcohol consumption goes up during the coronavirus crisis, there could be significant post-pandemic impacts on individual and family health and on the health care system in Canada.

A survey by Statistics Canada carried out March 29–April 3 found that 20% of Canadians aged 15–49 are drinking more at home during the COVID-19 pandemic than they were before it started.4 Similarly, a March 30–April 2 poll by Nanos/Canadian Centre on Substance Use and Addiction found that 21% of adults aged 18–34 and 25% of those aged 35–54 have started drinking more at home since the start of the COVID-19 crisis.5

Respondents to the Nanos poll who report staying home more and consuming more alcohol say that their drinking has increased most often because of the lack of a regular schedule (51%), boredom (49%), stress (44%) and/or loneliness (19%).

According to data collected April 9–12 by the Vanier Institute of the Family, the Association for Canadian Studies and Leger, 14% of adults had gone to a liquor store in the previous week, with more men (18%) having done so than women (11%).

Nearly 4 in 10 are exercising less often

Although being confined to home may have increased the amount that adults are drinking, it does not seem to have increased the amount that they are exercising.

On the contrary, nearly 4 in 10 women (38%) and 33% of men say as of April 9–12 that they are exercising “less often” now than they were before pandemic. People living in Quebec (42%) most commonly report a decrease in their frequency of exercise as compared with those in the other provinces.

Notably, it appears that younger families may be spending more time exercising. A greater share of adults who live with children (23%) report they are exercising more often since the pandemic began compared with those who were not living with children (18%) (fig. 4). Additionally, nearly 3 in 10 adults aged 18–34 (28%) say that they were exercising more often since the start of the crisis compared with 14% of adults 55 years and older.

Increased COVID-19 anxiety and decreased exercise may be linked

According to the Canadian Psychological Association, regular physical activity can reduce day-to-day stress, can prevent depression and anxiety disorders, and may be as effective as psychological and pharmaceutical treatments for depression and anxiety.6 At the same time, however, mental health challenges, such as anxiety and depression, can also make it difficult to adopt or continue with an exercise program, particularly during unusual times.

In fact, April 9–12 data reveal that people who “very often” report anxiety or nervousness during the COVID-19 crisis are more likely to say they are exercising “less often” (20%) now than they were before the pandemic, whereas 13% say they are exercising “equally as often” as before the COVID-19 crisis started.

In comparison, adults who say that they have felt anxious or nervous “not often at all” since the beginning of the pandemic are more likely to say that the frequency with which they exercise has not changed since the start of the pandemic (24%) than to say that they are exercising more often (17%) or less often (17%) now.

Almost half of adults are going outside less often

Spending time outdoors in nature has a significant impact on mental health and wellness.7 Furthermore, in 2016, Statistics Canada’s General Social Survey found that 7 in 10 Canadians participated in one or more outdoor activities, showing that spending time outdoors is an important part of Canadian lifestyles.8

Nevertheless, during the COVID-19 pandemic, almost half of women (46%) and men (45%) say that they are going outside less often now than they were before the crisis. The shares of those saying they are going outside less often vary by province, from a low of 39% in Quebec and Manitoba/Saskatchewan to a high of 49% in Ontario.

What is of particular interest, however, is the variation in the share of people going outside less often by urban or rural area of residence. More than half (54%) of urban dwellers indicate that they are going outside less often now than before the pandemic, compared with 45% of suburban adults and 29% of people living in rural areas.

At the other end of the spectrum, when it came to those who say they are going outside more often, a higher proportion of women (25%) than men (15%) report a positive change.

It will be interesting to see, as spring changes to summer, whether the shares of people in Canada who are going outside, and who are exercising more often, increase with the warmer temperatures.

Jennifer Kaddatz, Vanier Institute on secondment from Statistics Canada

Nadine Badets, Vanier Institute on secondment from Statistics Canada


Notes

  1. The survey, conducted March 10–13, March 27–29, April 3–5 and April 9–12, 2020, included approximately 1,500 individuals aged 18 and older, interviewed using computer-assisted web-interviewing technology in a web-based survey. The March 27–29, April 3–5 and April 9–12 samples also included booster samples of approximately 500 immigrants. Using data from the 2016 Census, results were weighted according to gender, age, mother tongue, region, education level and presence of children in the household in order to ensure a representative sample of the population. No margin of error can be associated with a non-probability sample (web panel in this case). However for comparative purposes, a probability sample of 1,512 respondents would have a margin of error of ±2.52%, 19 times out of 20.
  2. Health Canada, Canada’s Food Guide. Link: .
  3. Peter Butt, Doug Beirness, Louis Gliksman, Catherine Paradis and Tim Stockwell, Alcohol and Health in Canada: A Summary of Evidence and Guidelines for Low Risk Drinking. Ottawa, ON: Canadian Centre on Substance Abuse (November 25, 2011). Link:  (PDF).
  4. Statistics Canada, “How Are Canadians Coping with the COVID-19 Situation?” Infographics (April 8, 2020). Link: https://bit.ly/2wVzkuL.
  5. Nanos conducted an RDD dual frame (land- and cell-lines) hybrid telephone and online random survey of 1,036 Canadians, 18 years of age or older, between March 30 to April 2, 2020 as part of an omnibus survey. Participants were randomly recruited by telephone using live agents and administered a survey online. The margin of error for this survey is ±3.1 percentage points, 19 times out of 20. The research was commissioned by the Canadian Centre on Substance Use and Addiction and was conducted by Nanos Research. Link: (PDF).
  6. Canadian Psychological Association, “Psychology Works” Fact Sheet: Physical Activity, Mental Health, and Motivation (November 2016). Link: (PDF).
  7. Canadian Parks Council, Connecting Canadians with Nature: An Investment in the Well-Being of Our Citizens (2014). Link: .
  8. Statistics Canada, Canadians and the Outdoors (March 26, 2018). Link: .

Facts and Stats: Maternal Mental Health in Canada

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Maternal health and well-being is an important public health issue, of which mental health is a key component. Data shows that while most new and expectant mothers report good mental health and high life satisfaction, experiences of postpartum depression (PPD) and anxiety are common in Canada.

Research shows that PPD and poor mental health are detrimental to the well-being of mothers and can, if left untreated, adversely affect infant development (e.g. low birth weight, preterm birth, increased risk of mental health problems in the child later in life), as well as leave partners and other family members (including fathers, who are at an elevated risk for depression or anxiety) feeling overwhelmed.

Fortunately, multiple effective and well-researched treatment options are available to help women recover, and research shows that social and emotional support from partners and other family members throughout the perinatal period can reduce the likelihood of PPD and emotional distress for both mothers and newborns.

This edition of Facts and Stats explores the mental health of new and expectant mothers in Canada, with a focus on family well-being.

Highlights include:

  • In 2018–2019, most (60%) mothers who recently gave birth rated their mental health as excellent or very good, while nearly one-quarter (23%) reported feelings consistent with PPD or an anxiety disorder.
  • In 2018–2019, 30% of mothers who recently gave birth under the age of 25 reported feelings consistent with PPD or an anxiety disorder, compared with 23% among those 25 or older.
  • In 2018–2019, nearly one-third (32%) of recent mothers who reported feelings consistent with PPD or an anxiety disorder said they have received treatment for their emotions or mental health since the birth of their child.
  • Maternal mental health is affected by socio-economic status, with research showing higher rates of PPD and depressive symptoms among mothers from marginalized groups, including people living with disabilities; recent migrant mothers, asylum-seekers and refugees; and mothers self-identifying as Black or First Nations.
  • Mothers with adverse life experiences are also at a higher risk of developing mental disorders, such as those living in food-insecure households or in emergency or conflict situations, and those who have experienced violence (domestic, sexual or gender-based) or natural disasters.

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This resource will continue to be updated as new research and data emerges (previous versions will be continually available on our fact sheets page).

Source information available on the PDF version of this resource.

The Impact of Post-Traumatic Stress on Canadian Armed Forces, First Responders and Their Families

Supporting Families of Serving and Retired Members of the Canadian Armed Forces and First Responders Living with Post-Traumatic Stress is a report based on a roundtable convened by Medavie between Wounded Warriors Canada, the Mental Health Commission of Canada and the Vanier Institute of the Family that took place in February 2019. The report explores the challenges faced by families impacted by post-traumatic stress (PTS) experienced by first responders and serving or retired members of the Canadian Armed Forces (CAF). Though there is a growing awareness of the risk of PTS and the potential of developing post-traumatic stress disorder (PTSD), families often lack the support they need to both help their loved one and address the impact on their own health and their daily lives.

While PTSD is most often used in public discussion, categorizing it as a disorder means it is a clinically diagnosed condition. During the roundtable, and subsequently throughout this report, the concept of PTS is the focus, as it includes those who experience symptoms but may not have a formal diagnosis.

Families are often the first source of support an individual living with PTS will turn to and they can play a key role in ensuring their loved one receives care. Family members who may feel the impact of PTS on their lives include adult children, parents, siblings and spouses. They may need to adjust, adapt and respond to expanding and/or evolving roles at home and/or changing behaviours, moods and attitudes exhibited by their loved one. Individuals and families need tools to help them communicate their experiences, emotions and feelings with each other to address the impact that PTS is having on their lives.

Access to resources for mental health support across military and first responder communities varies, with more funding for programs aimed solely at the individual experiencing PTS. CAF has been developing nationally accessible programs for serving and retired members and, to an increasing degree, their families.

Download the report Supporting Families of Serving and Retired Members of the Canadian Armed Forces and First Responders Living with Post-Traumatic Stress

Download the media release

 


Published on August 27, 2019

A Snapshot of Grandparents in Canada (May 2019 Update)

Canada’s grandparents are a diverse group. Many of them contribute greatly to family functioning and well-being in their roles as mentors, nurturers, caregivers, child care providers, historians, spiritual guides and “holders of the family narrative.”

As Canada’s population ages and life expectancy continues to rise, their presence in the lives of many families may also increase accordingly in the years to come. With the number of older Canadians in the workforce steadily increasing, they are playing a greater role in the paid labour market – a shift felt by families who rely on grandparents to help provide care to their grandchildren or other family members. All the while, the living arrangements of grandparents continue to evolve, with a growing number living with younger generations and contributing to family households.

Using newly released data from the 2017 General Social Survey, we’ve updated our popular resource A Snapshot of Grandparents in Canada, which provides a statistical portrait of grandparents, their family relationships and some of the social and economic trends at the heart of this evolution.

Highlights:

  • In 2017, 47% of Canadians aged 45 and older were grandparents, down from 57% in 1995.1
  • In 2017, the average age of grandparents was 68 (up from 65 in 1995), while the average age of first-time grandparents was 51 for women and 54 for men in 2017.2, 3
  • In 2017, nearly 8% of grandparents were aged 85 and older, up from 3% in 1995.4
  • In 2017, 5% of grandparents in Canada lived in the same household as their grandchildren, up slightly from 4% in 1995.5
  • In 2017, grandparents who were born outside Canada were more than twice as likely as Canadian-born grandparents to live with grandchildren (9% and 4%, respectively), the result of a complex interplay of choice, culture and circumstance.6

Published on May 28, 2019

1 Statistics Canada, “Family Matters: Grandparents in Canada,” The Daily (February 7, 2019). Link: .
2 Ibid.
3 No comparator provided because this is the first time the question has been asked in the General Social Survey.
4 Ibid.
5 Statistics Canada, “Family Matters: Grandparents in Canada.”
6 Ibid.

Family Perspectives: Death and Dying in Canada

Death is a natural part of life, but many Canadians are hesitant to have essential conversations about the end of their lives. The Vanier Institute of the Family seeks to change this with the publication of, a conversation catalyst intended to spark dialogue in households, workplaces and communities across the country by exploring death and dying through a family lens.

Family Perspectives: Death and Dying in Canada examines the evolution of death and dying in Canada across generations, the desires and realities of families surrounding death and dying, the role of families in end-of-life care and its impact on well-being. Through current data and trend analysis, interviews with caregivers and families, and reflections on hospice volunteering from author Dr. Katherine Arnup, this study discusses death and dying within the current and emerging social, cultural and policy landscapes.

Highlights:

– Hospice palliative care can play an important role in helping dying people and their families, yet most Canadians don’t receive any.

  • Palliative care benefits up to 85% of dying people at the end of their lives.
  • An estimated 16% to 30% of Canadians receive some form of palliative care, depending upon where they live.
  • Three-quarters (74%) of surveyed Canadians report having thought about end-of-life care, but only one-third (34%) have actually had a conversation with a family member. 

– Medical assistance in dying (MAID) is having an impact on the conversation on death and dying in Canada. 

  • Since June 2016, more than 2,600 people across Canada have obtained medical assistance in dying.
  • More than one in eight seniors in Canada (12%) say they or a family member have talked to a health care provider about access to MAID.

– Death is becoming less taboo in Canada, thanks to care providers and community initiatives. 

  • Hospice staff and volunteers, death doulas and other end-of-life practitioners are providing diverse forms of support to many families in Canada, including facilitating advance care planning and discussions about end-of-life care, coordinating care and providing grief support.
  • “Death Cafés” are helping people across Canada to gather and discuss their thoughts about death and dying.

“While many people are hesitant to talk about death and dying with their families and health care providers, some of the silence surrounding death and dying in Canada has been broken – a step in the right direction,” says Dr. Arnup. “Talking about death with family, planning for what we hope for and supporting others can help us to see that death is a natural part of life that is not inherently undignified, and to appreciate the present, thereby enriching our lives.”

“Birth and death are among the few universal family experiences,” says Vanier Institute CEO Nora Spinks. “Many Canadians and their families are hesitant to discuss death despite the importance of these conversations in providing and arranging for the care of loved ones at the end of life. It is our hope that Family Perspectives: Death and Dying in Canada helps to move the conversation forward as we recognize and celebrate National Hospice Palliative Care Week.”

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Published on May 7, 2018

 

Facts and Stats: Families and Mental Health in Canada

At some point, most families find themselves affected by mental illness, whether it’s because a family member (or multiple family members) personally experiences a mental health condition or because they’re providing care to someone else – or both. With appropriate treatment and support, however, most people who experience a mental illness will recover,1 and families often play an important role in providing, arranging or helping pay for care.

Our new fact sheet provides an overview of families and mental health in Canada, including rates of mental health conditions within families, factors that contribute to mental illnesses and the roles family members can play in mental health treatment.

.

Notes


  1. Centre for Addiction and Mental Health, Mental Illness and Addiction: Facts and Statistics (n.d.), accessed September 20, 2017. Link: .

Health Care Experiences of Military Families of Children with Autism


Heidi Cramm, Ph.D.

Military families in Canada are highly mobile, relocating three to four times more often than their civilian counterparts.1 This mobility has been found to complicate access to health care for these families, most of whom live off-base (85%, compared with only 20% in the mid-1990s) and rely on provincial and territorial civilian health care systems. This has an acute impact on the 8.2% of military families who have children with special needs, including those living with Autism Spectrum Disorder (ASD).2

Autism Spectrum Disorder (ASD) is a common neurodevelopmental disorder with an estimated prevalence of 1 in 68 children. While this condition primarily affects social communication, often making it difficult for people living with ASD to share enjoyment or emotional experiences with others, it has a range of symptoms and associated behaviours:

  • Approximately 25% of people living with ASD are non-verbal, unable to use or respond to non-verbal communication (or are otherwise delayed in its use), such as pointing, gesturing and so forth, especially to indicate something of interest.
  • People with ASD often have difficulties understanding abstract language/communication such as metaphors, sarcasm, colloquialisms and jokes.
  • Repetitive behaviours, such as rocking, hand-flapping, finger movements and so forth, are common among people with ASD.
  • People living with ASD are often highly sensitive to change, and they are “creatures of habit.”
  • Most people with ASD have a range of sensory dysfunctions that vary widely (e.g., extreme sensitivities to noise, touch, smells, tastes, etc.) while many also exhibit a high pain threshold.
  • Some children with ASD have exceptional abilities in music, visual and academic skills.
  • In addition, up to 90% of children with ASD will have a co-existing medical and/or psycho-behavioural disorder, such as ADHD, anxiety, sleep disorders, feeding disorders, seizures, intellectual disability and gastro-intestinal disorders.

Early Intervention Supports Treatment for Children with ASD

Research suggests that early intervention is most impactful to the prognosis of ASD,3 and it can enhance the development of learning, communication and social skills for people living with the condition. Autism is typically diagnosed in early childhood, even as early as 18 to 24 months of age.

In many provinces, families experience long waiting times when seeking early diagnosis and/or intervention due to a “bottlenecking” of access to appropriate diagnostic centres – delays that can sometimes exceed two years.

Between 21% and 27% of military families do not have a family doctor, compared with 15% among the general population.4 Since many health services and treatments are accessed through family doctors, this discrepancy means that military families can have a harder time accessing services for children with special needs, including those with ASD. With each move, families who are moving toward the top of wait-lists for services find themselves back at the bottom.

Since many health services and treatments are accessed through family doctors, this discrepancy means that military families can have a harder time accessing services for children with special needs.

Exploring the Experiences of Military Families of Children with ASD

In a recent qualitative study, military families who have a child with ASD were interviewed to explore and describe their experiences navigating health care systems on behalf of their children.5

Many of these families reported that they had a hard time getting their child’s condition noticed, validated and medically diagnosed. Families generally found it difficult to get the assessment for ASD, and this delay in assessment and subsequent diagnosis meant that, for many, their access to intervention services was held up significantly.

One parent explained that their family experienced delays in accessing care for their son after moving because many of the programs available in their new community were for people living with autism who have a diagnosis. Since the family didn’t realize that they would need to have the diagnosis in hand when they sought care in their new neighbourhood, they went ahead and moved without having one, only to find that their son couldn’t access these programs as a result. Access to care for their child was delayed by months.

Difficulties accessing care can have an impact on family finances. Frustrated with wait-lists and the implications of delayed services for their child’s long-term development, many families opted instead to pay directly for private assessment services. One participant described making the decision to seek out private assessment and intervention because the wait-lists would exceed their posting tenure: “We paid privately… because the wait-list was too long. Once we had that diagnosis, [a community organization] put us on a wait-list for [Applied Behaviour Analysis] therapy. That wait-list is two years long. So we were never going to see the end of that wait-list either. So… we started paying privately for him.”

Frustrated with wait-lists and the implications of delayed services for their child’s long-term development, many families opted instead to pay directly for private assessment services.

At times, families waiting for care said they wound up moving again before their child’s name made it to the top of the local wait-list. For some families, service access was within sight, and then another posting forced them to move and start all over again. One participant shared that after waiting for some time for their child to get into a program, they finally received confirmation from their intervention team that the child would be able to start in September – which was of little help to them at that point, since they were going to be moving again in July.

With services varying widely from province to province (along with the corresponding eligibility and funding), some families reported consternation over losing services that they had previously had access to but were simply not available in their new location. One participant described this experience, “We realized the school [in the current province] didn’t offer the same things that they do in [the previous province]… there was nothing they could do…”

These variations also exist from region to region within the same province. For example, another participant described having to remove her child from a highly beneficial education program because they were moving, but then found they were unable to place him in a similar program in the new city because the program didn’t exist there (even though they were in the same province). Families in several other provinces described similar circumstances when moving interprovincially or intraprovincially.

Ongoing Pursuit of Health Care Affects Family Well-Being

While military families are highly resilient, difficulty accessing health care services for their children with ASD can have an impact on their own and their family’s well-being. Participants in the study commonly described frustration and confusion over the daunting tasks of sorting out how to get their children whatever services were possible. One participant described “bursting into tears” after finally getting to the top of a wait-list for intervention only to find the service did not meet expectations.

Some participants described having to draw on support from extended family to help care for their children. One participant said her parents retired and moved to the family’s current posting to assist because “they knew [our son] needed more help and we needed a break.” Others lamented the fact that extended family were too far away to really provide any assistance and were “just not able to be there.” Participants’ experiences with Military Family Resource Centres (MFRCs) were diverse, as the available services varied from base to base.

Parents often experienced strain on their relationships with their spouse or partner as their efforts to find caregiver supports and develop local networks can be complicated by training exercises, deployments and postings. As a result, hard choices are sometimes made related to whether or not a new posting, which comes with career opportunity, is feasible given the health care implications for the child with ASD.

Parents often experienced strain on their relationships with their spouse or partner as their efforts to find caregiver supports and develop local networks can be complicated by training exercises, deployments and postings.

Some participants described the Canadian Armed Forces (CAF) member making career decisions such as changing trades or requesting a specific posting for the benefit of the child, even though it could have an impact on their career trajectory and, by extension, the family as a whole. One participant said their family would consider living apart (i.e., imposed restriction) if it meant the child would receive the services needed, even though this would create a protracted separation that could have a significantly negative impact on the family as a whole.

In some military families, a civilian spouse may need to limit their involvement in the paid labour force to offset the caregiving requirements of the child. Such “trade-offs” are common in military families, with more than half (51%) of surveyed CAF spouses reporting that they have made some career sacrifices because of their partner’s military service, according to a 2009 study from the Director General Military Personnel Research and Analysis (DGMPRA). This limited workforce involvement can further constrain family finances that may be needed to pay for private services for their children. This can have a greater impact on dual-service families (families with two serving CAF members).

Military Families Express Desire for Navigation Support

Some military family members identified a few ways that could be considered to enhance the support for other military families who have children with ASD. Many expressed the desire to connect with other military families who are already at the new location to help map out options for how to access ASD-related services; some wanted this to be a formalized opportunity whereas others felt it would be important that it happen outside of official channels.

Many [families] expressed the desire to connect with other military families who are already at the new location to help map out options for how to access ASD-related services.

Opportunities to provide augmented and current information for families were also discussed, with some expressing a desire for a single point person who can help them navigate across school, community and health services. However, one participant indicated this type of formalized approach could result in parents receiving “filtered information” without any indication of how effective the services really are.

This qualitative study raised some important issues, but there is much left to learn. How might some of these opportunities be realized within existing formal and informal networks for incoming families? How could the disruptions and delays to health care access that military families report be reduced across provinces? What, if any, kinds of options might there be to offset the financial implications for parents when publicly funded services are absent or inaccessible? Are the differences for those who move within provinces similar to those who move across provinces? Exploring these questions through further research – with the insights and participation of families – will be key in supporting Canada’s diverse military families.

 

Dr. Heidi Cramm is the Interim Co-Scientific Director at the Canadian Institute for Military and Veteran Health Research (CIMVHR) and recipient of the 2016 Colonel Russell Mann Military Family Health Research Award.

 

Notes


  1. Heidi Cramm et al., “Making Military Families in Canada A Research Priority,” Journal of Military, Veteran and Family Health 1:2 (November 2015). Link: http://bit.ly/2zx46G1.
  2. Learn more with A Snapshot of Military and Veteran Families in Canada. Link: https://bit.ly/2fM3xmP.
  3. Geraldine Dawson, “Early Behavioral Intervention, Brain Plasticity, and the Prevention of Autism Spectrum Disorder,” Development and Psychopathology 20:03 (July 7, 2008). Link: 
  4. Nathan Battams, “A Snapshot of Military and Veteran Families in Canada,” Statistical Snapshots (November 2016). Link: https://bit.ly/2fM3xmP.
  5. Most of the families who participated in the study were married, and one-third of them had both parents serving in the Canadian Armed Forces (CAF). Most of the families represented serving members in the Regular Forces, primarily in the Army.

A Snapshot of Families and Food in Canada

Food is at the heart of family life. A biological necessity for our survival and well-being, food is also much more than that. What we choose to eat is often more than just a matter of personal preferences and whims; in many instances, what we eat reflects our cultural, community and family identities. Sometimes, our choices are made for us based on the availability and accessibility of food.

Regardless of the context, families adapt and react to ensure that dietary needs are being met. Some families have many opportunities to eat together, and these family meals provide a setting where family dynamics and relationships often “play out,” whether it’s in the delegation of cooking roles, discussing an upcoming family vacation or arguing over who has to do the dishes. Sometimes families – particularly those with busy schedules or high mobility – opt to eat meals “on the go.”

explores the evolving relationships between families and food in Canada, including research and statistics about family meals, eating patterns, nutrition, food security and more.

Highlights include:

  • More than 6 in 10 Canadians (62%) surveyed in 2017 said they eat dinner as a family at least five times per week.
  • More than one-quarter (26%) of Canadians surveyed in 2017 agree with the statement, “My work–life balance does not permit me to prepare and/or eat my meals at home.”
  • The most recent data indicates that 12% of households across Canada (1.3 million) experienced food insecurity in 2014, home to 3.2 million people.
  • More than half (52%) of Inuit living in Inuit Nunangat1 aged 25 and over lived in food-insecure households in 2012.
  • In 2015, households across Canada spent an average $8,600 on food, an increase of 9.9% since 2010.
  • 4 in 10 of those who said it’s become more difficult to afford groceries said they’ve been choosing less healthy options in the aisle to manage the rising prices.
  • According to a 2017 study, more than three-quarters of Canadians aren’t meeting Canada Food Guide recommendations for fruit and vegetable consumption, with a resulting estimated economic burden to society of is $4.39 billion per year.
  • More than 863,000 people across Canada accessed food banks in March 2016 alone (40% of whom lived in family households with children), 28% higher than in 2008.
  • Research shows that the widespread malnutrition experienced by Indigenous children in Canada’s residential school system has had (and continues to have) a multi-generational impact on the health and well-being of their children and grandchildren, contributing to higher rates of chronic conditions.

This bilingual resource will be updated periodically as new data emerges. Sign up for our monthly e-newsletter to find out about updates, as well as other news about publications, projects and initiatives from the Vanier Institute.

 


This Statistical Snapshot publication is dedicated to David Northcott, CM, OM, retired Executive Director of Winnipeg Harvest Food Bank and a founder of both the Canadian Association of Food Banks and the Manitoba Association of Food Banks. David recently completed his second full term on the Vanier Institute Board of Directors, where his enthusiasm, dedication to family well-being and generous heart has had an impact on the entire Vanier Institute team.

 

Notes


  1. From Statistics Canada: “Inuit Nunangat is the homeland of Inuit of Canada. It includes the communities located in the four Inuit regions: Nunatsiavut (Northern coastal Labrador), Nunavik (Northern Quebec), the territory of Nunavut and the Inuvialuit region of the Northwest Territories. These regions collectively encompass the area traditionally occupied by Inuit in Canada.” Link: .

Grandparent Health and Family Well-Being

Rachel Margolis, Ph.D.

Canada’s 7.1 million grandparents and great-grandparents make unique, diverse and valuable contributions to families and society, serving as role models, nurturers, historians, sources of experiential knowledge and more. As with the general population, the grandparent population in Canada is aging rapidly, sparking some concern in the media and public discourse about the potential impact of this “grey tsunami.”

However, despite being older, data show that the health of grandparents has improved over the past 30 years. This trend can positively impact families, since healthy grandparents can have a higher capacity to contribute to family life and help younger generations manage family responsibilities such as child care and household finances.

Improving grandparent health enhances their capacity to contribute to family life and help younger generations manage family responsibilities.

Canada is aging, and so are its grandparents

The aging of the grandparent population mirrors broader population aging trends across the country. According to the most recent Census in 2016, 16.9% of Canada’s population are seniors, nearly double the share in 1981 (9.6%) and the highest proportion to date. This growth is expected to continue over the next several decades: projections show that nearly one-quarter (23%) of Canadians will be 65 or older by 2031. Furthermore, the oldest Canadians (aged 100 and over) are currently the fastest-growing age group: there were 8,200 centenarians in 2016 (up 41% since 2011), and projections from Statistics Canada show that this group is likely to reach nearly 40,000 by 2051.

In this context, it’s perhaps no surprise that the overall grandparent population is also aging. The share of grandparents who are seniors grew from 41% in 1985 to 53% in 2011, and the share of grandparents who are aged 80 and older has grown even faster, nearly doubling from 6.8% in 1985 to 13.5% in 2011.

Life expectancy increases fuel grandparent population aging

One of the underlying factors fuelling the aging of the grandparent population is the fact that Canadians are living longer. According to Statistics Canada, life expectancy at birth has continued to rise steadily, reaching 83.8 years for women and 79.6 years for men in 2011–2013. This represents an increase of about a decade over the past half-century, with women and men gaining 9.5 years and 11.2 years, respectively, since the years 1960–1962.

In addition, more people are reaching seniorhood than in the past because of mortality declines at ages below age 65. Data from Statistics Canada shows that the average share of female newborns who can expect to reach age 65 rose from 86% for those born in 1980–1982 to 92% for those born in 2011–2013, while this share increased from 75% to 87% for males during the same period.

People are also living longer as seniors, as reflected in ongoing increases in life expectancy at age 65 – a useful measure of the well-being of older populations since it excludes mortality for those who do not reach seniorhood. According to estimates from Statistics Canada, life expectancy at age 65 in 2011–2013 was 21.9 years for women and 19 years for men – up by 3 years and 4.4 years, respectively, from 1980 to 1982.

Delayed fertility contributes to the aging of the grandparent population since it increases the age of transitioning into grandparenthood.

Another contributing factor to the aging of grandparents is the fact that on average, women are having children at older ages than in the past – a fertility trend that increases the age of transitioning into grandparenthood. The average age of first-time mothers has risen steadily since 1970, from 23.7 to 28.8 years in 2013. The number of first-time mothers aged 40 and older has also grown, rising from 1,172 in 1993 to 3,648 in 2013 (+210%). As more women postpone childbearing until later in life, their transition to grandparenthood will also likely occur later. Today’s new grandparents are baby boomers, a generation in which many women delayed fertility for education and work experience. Their children are also having children later, and the fertility postponement of two generations together is influencing the pattern of later entry into grandparenthood.

Despite the aging of grandparents, grandparenthood accounts for a growing portion of many people’s lives. Even though people are becoming grandparents later, they are living longer as grandparents. The longer period of time spent in the grandparent role can extend opportunities for forming, nurturing and strengthening relationships with younger generations. According to my recent research, the average number of years that someone can expect to spent as a grandparent given today’s demography in Canada is 24.3 years for women and 18.9 years for men – that’s approximately two decades in which they can continue to play a major role in family life.

Despite being older, grandparents are healthier

In addition to living longer, data from the General Social Survey (GSS) suggest that grandparents in Canada today are far more likely to report living in good health than in the past. The proportion who rate their health as “good/very good/excellent” has increased from 70% in 1985 to 77% in 2011, while the share reporting “fair/poor” health has fallen from 31% to 23%. Overall, the odds of grandparents reporting that they are in good health are 44% higher in 2011 than in 1985.

A number of trends have contributed to health improvements among grandparents and older Canadians in general over the past half-century. There have been significant advances in public health that have facilitated disease prevention, detection and treatment. Among other factors, this has led to major reductions in deaths from circulatory system diseases (e.g. heart disease), which has been one of the biggest contributors to gains in life expectancy among men over the past half-century.

Another factor contributing to improvements in the health of grandparents in Canada is the rising educational attainment of this population. Research shows that education can improve health both in direct and indirect ways throughout life. Direct impacts can include enhancing one’s health literacy, knowledge, interactions with the health care system and patients’ ability and willingness to advocate for themselves when engaging with health care providers. Indirect impacts can include an increase in one’s resources (e.g. income) or occupational opportunities (e.g. being less likely to have a physically demanding and/or risky job, and more likely to have a job with health benefits).

Education has been associated with greater health, which is significant because the share of grandparents who have completed post-secondary education has more than tripled over the past three decades.

These are important factors to consider in the Canadian context, since the share of grandparents who have completed post-secondary education has more than tripled over the past three decades, from 13% in 1985 to nearly 40% by 2011.

Healthy grandparents can facilitate family well-being

Grandparent health can have a significant impact on families. When a grandparent (or multiple grandparents) is living in poor health, families are often the first to provide, manage or pay for care that supports their well-being. This is particularly true for senior grandparents receiving care at home; the Health Council of Canada estimates that families provide between 70% and 75% of all home care received by seniors in Canada.

Data from the 2012 GSS show that nearly 3 in 10 Canadians (28%) reported providing caregiving to a family member in the past year, and aging-related needs were the most commonly cited reason for care (reported by 28% of caregivers). Grandparents accounted for 13% of all Canadians who received care, and they were also the most frequent recipients of young caregivers’ (aged 15 to 29) assistance, 4 in 10 of whom cited a grandparent as the primary recipient.

While 95% of caregivers say they’re effectively coping with their caregiving responsibilities, research has found that in some contexts, it can have a negative impact on their well-being, career development and family finances. This can be particularly true for the three-quarters of caregivers who are also in the paid labour force, accounting for more than one-third of all working Canadians.

On the other hand, when grandparents are living in good health, families can benefit in a variety of ways. In addition to the fact that it means they are less likely to require caregiving assistance, they are also more likely to be able to make positive contributions to family life, such as providing child care and contributing to family finances.

Grandparents provide child care to younger generations

Many grandparents play an important role in caring for their grandchildren, which can help parents in the “middle generation” manage their child care and paid work responsibilities. A number of economic, social and environmental trends have converged in recent decades that have increased the significant contributions they make to families with regard to child care.

Many grandparents play an important role in caring for their grandchildren, which can help parents in the “middle generation” manage their child care and paid work responsibilities.

Over the past four decades, the share of dual-earner couples in Canada has increased; in 1976, 36% of couples with children included two earners, a rate that nearly doubled to 69% by 2014. In more than half of these couples (51%), both parents worked full-time, which means they were more likely to rely on non-parental care for their children. This is supported by data from the 2011 GSS: while nearly half (46%) of all parents reported relying on some type of child care for their children aged 14 years and younger in the past year, the rate was higher (71%) for dual-earner parents with children aged 0 to 4 and children aged 5 to 14 (49%).

The evolution in family structure and composition across generations has also contributed to more families relying on non-parental care for their children. The share of lone-parent families has increased significantly over the past 50 years, rising from 8.4% of all families in 1961 to approximately 16% in 2016. Data from the 2011 GSS show that nearly 6 in 10 lone parents of children aged 4 and under (58%) report that they rely on non-parental care.

Sometimes grandparents are solely responsible for raising their grandchildren when no middle (i.e. parent) generation is present. The 2011 GSS counted 51,000 of these “skip-generation families” in Canada, which was home to 12% of all grandparents who live with their grandchildren. Some of those who live with their children are more likely than others to live in skip-generation homes, such as people reporting a First Nations (28%), Métis (28%) or Inuit (18%) identity (compared with 11% among the non-Indigenous population).

Lastly, many parents may rely on grandparents for help with child care if they can’t find quality, regulated child care spaces in their communities. In 2014, the availability in regulated, centre-based child care spaces was only sufficient for one-quarter (24%) of children aged 5 and under across Canada. While this is a significant increase from 12% in 1992, it still leaves more than 3 in 4 children in this age group without an available regulated child care space. The availability of child care (or a lack thereof) is significant, since it can affect whether or not parents in coupled families can both participate in the paid labour market.

The cost of child care can also lead parents to turn to grandparents for child care assistance. This is particularly true for families living in urban centres. One 2015 study on the cost of child care in Canadian cities, which used administrative fee data and randomized phone surveys conducted with child care centres and homes, found that the highest rates in Canada were in Toronto, where estimates showed median unsubsidized rates of $1,736 per month for full-day infant care (under 18 months of age) and $1,325 for toddlers (aged 1½ to 3).

Grandparent involvement can enhance child well-being

Regardless of the reason grandparents spend time with their grandchildren, their involvement in family life can benefit the well-being of children. Studies have shown that grandparent involvement in family life is significantly associated with child well-being – in particular, it has been associated with greater prosocial behaviours and school involvement. The benefits aren’t limited to children, either, as other research has shown that close relationships between grandparents and grandchildren can have a positive impact on mental health for both. Among First Nations families, grandparents have also been found to play an important role in supporting cultural health and healing among younger generations.

Research shows that grandparent involvement in family life is significantly associated with child well-being, including greater prosocial behaviours and school involvement.

The broader context of improving grandparent health is good news for many families, since their better health can make it easier to participate in activities with children and grandchildren, and research shows that these interactions with younger kin can be more rewarding in this context.

Many grandparents play an important role in family finances

Improvements in grandparent health can also enhance their capacity to engage in paid work, which can improve their own finances and facilitate contributions to younger generations.

Improvements in grandparent health also enhance their capacity to engage in paid work, which can improve their own finances and facilitate contributions to younger generations.

While there isn’t much recent data on the employment patterns of grandparents in Canada per se, rising rates of working seniors have been well documented over the past several decades. Between 1997 and 2003, the paid labour force participation rate for seniors ranged between 6% and 7%, but this has steadily increased to around 14% in the first half of 2017 (and an even higher rate of 27% for those aged 65 to 69). Since approximately 8 in 10 seniors in Canada are grandparents, it’s clear that a growing number of grandparents are working today.

The potential for grandparents to contribute to family finances through paid work can be particularly important for the 8% who live in multi-generational households. According to data from the 2016 Census, this is the fastest-growing household type, having grown in number by nearly 38% between 2011 and 2016 to reach 403,810 homes. Similar to patterns found among skip-generation families, this living arrangement is more common among Indigenous and immigrant families, which both represent a growing share of families in Canada.

Skip-generation living arrangements are more common among Indigenous and immigrant families, which both represent a growing share of families in Canada.

Data from the 2011 GSS showed that among the 584,000 grandparents living in these types of homes, more than half (50.3%) reported that they have financial responsibilities in the household. Some were more likely than others to contribute to family finances: rates were significantly higher for those living in skip-generation households (80%) and multi-generational households with a lone-parent middle generation (75%).

Opportunities are growing for grandparent–family relationships

While the aging of the general and grandparent population in Canada presents certain societal challenges, notably with regard to community care, housing, transportation and income security, their rising life expectancy and improving health present growing opportunities for individuals and families. Many grandparents already help younger generations with fulfilling family responsibilities, such as child care and managing family finances, and this will continue in the years ahead – a positive side of the story that is often lost in narratives about the “grey tsunami.”

As the health of grandparents has improved over the years, many have been able to enjoy a greater quantity and quality of relationships with younger family members. As families adapt and react to their evolving social, economic and cultural contexts, they will continue to play an important – and likely growing – role in family life for generations to come.

 


Rachel Margolis, Ph.D., is an Associate Professor in the Department of Sociology at the University of Western Ontario.

 

All references and source information can be found in the PDF version of this article.

Published on September 5, 2017

Facts and Stats: Families and Active Leisure in Canada (2017 Update)

Whether it’s swimming at the beach in the summer, tobogganing in the winter or playing organized sports throughout the year, many families enjoy being physically active in their leisure time, and this exercise can have a positive impact on our individual and family well-being. However, there is growing concern that many people aren’t meeting the recommended guidelines for physical activity, as busy schedules and “screen time” can interfere with our best efforts to keep moving.

Learn about how Canadians of all ages are keeping fit and having fun with our updated fact sheet on families and active leisure in Canada!

Download from the Vanier Institute of the Family.

 


Published on July 25, 2017

In Context: Understanding Maternity Care in Canada

If it takes a village to raise a child, it certainly takes one to bring a child into this world. New and expectant mothers receive care from many people throughout the perinatal period, and the networks and relationships that support them can play a major role in ensuring the health and well-being of new mothers and their newborns.

Childbirth is a milestone, an exciting time when the family grows and a new generation begins. It’s also a period of significant child development – a time of great vulnerability but also of great opportunity to benefit from healthy nurturing.

The experience of pregnancy, childbirth and postnatal care continues to evolve through the generations. Rates of maternal mortality (women dying as a result of pregnancy and childbirth), maternal morbidity (women developing complications as a result of childbirth) and infant mortality all saw significant declines throughout the 20th century following medical advances and improvements in maternal care, nutrition and general living standards.

Maternal and Infant Mortality in Canada

Maternal mortality dropped from 508 deaths per 100,000 live births in 1931 to 7 per 100,000 in 2015.

Infant mortality rates fell from an average of 76 deaths per 1,000 live births in 1931–1935 to 4.9 per 1,000 in 2013.

In the 1800s to the mid-1900s, maternity care in Canada typically took place in the local community and birth occurred in the home, with families and midwives routinely providing care to new and expectant mothers. However, with the development of medicare throughout the 20th century, births and maternity care gradually moved into hospitals and medical clinics, with care being delivered primarily by medical professionals such as doctors and obstetricians – a trend sometimes referred to as the “medicalization of childbirth.”

By the early 1980s, the vast majority of births occurred in regional hospitals, where family physicians or obstetricians were present and assisted by obstetrical nurses. Partners and other family members became largely left out of the childbirth process, often relegated to waiting rooms. Following birth, babies were placed in nurseries, separated from their mothers – a situation that was sometimes traumatic for mothers and their newborns.

Hospitals eventually started allowing the rooming in of mother and baby to facilitate mother–infant attachment and support breastfeeding for the health and well-being of both. During the rooming-in period, nurses would provide new mothers with information for the recovery period, such as instruction about breastfeeding and postnatal care. Throughout this transition in postnatal care practices, the length of time women spent in hospital after having a baby decreased significantly, from an average of nearly five days in 1984–1985 to 1–2 days after vaginal delivery today.

Today, partners are more involved in the birthing process and the perinatal period generally than in the past. Most are present for births, taking on a greater role in these first moments of their children’s lives and in the child rearing in the years that follow. It is more common for couples today to conceptualize childbirth as a shared experience, and many people use language that reflects this trend (“We’re expecting,” etc.).

 

What is maternity care?

Maternity/perinatal care (hereafter referred to as maternity care) is an umbrella term encompassing a continuum of care provided to the mother and child before, during and after birth. This includes prenatal/antenatal care (care during pregnancy), intranatal care (care during labour and delivery) and postnatal/postpartum care (care for the mother and newborn following birth). Since both mothers and infants undergo major changes throughout the perinatal period, maternity care entails a diverse range of health monitoring and care.

Prenatal/antenatal care (hereafter referred to as prenatal care) monitors and supports the health and well-being of mothers and the developing fetus prior to birth. Fetal health is monitored through screening and diagnostics, such as ultrasounds and blood tests. Health providers also closely track the mother’s health during this period; expectant mothers are provided with information about pregnancy, fetal development, physical comfort, testing, planning for delivery and preparing for parenthood.

Most women (87%) say they were supported by a partner, family or friends throughout the prenatal period.

According to the 2009 Canadian Maternity Experiences Survey, most women (87%) say they were supported by a partner, family or friends throughout the prenatal period. This support, as well as the care provided by health practitioners, can be particularly important during this time when many (57%) women report most days as being stressful. During pregnancy, maternal stress can have an impact on the well-being of the baby, leading to premature birth and/or low birth weight.

Nearly all expectant mothers (95%) report that they started prenatal care in their first trimester. Certain groups were more likely than others to report that they did not start prenatal care in the first trimester, however, such as women aged 15–19 years, those with less than high school education or those who live in low-income households. One of the main reasons cited for not starting care early in the pregnancy was lack of access to a doctor or health care provider.

Intranatal/intrapartum care (hereafter referred to as intranatal care) refers to the care and assistance provided to mothers during labour and childbirth. This involves facilitating the delivery itself in a safe and hygienic manner as well as monitoring the health of mother and child throughout the delivery process. This care is most often provided in hospitals, with mothers receiving care from a variety of health practitioners including obstetricians/gynecologists (reported as the main health care provider during labour and birth by 70% of surveyed mothers), family doctors (15%), nurses or nurse practitioners (5%) or midwives (4%).

Whether provided by a spouse, partner, friend, family member, midwife or doula (or some combination thereof), emotional support during this time is important. Research shows that women who receive continuous social support are more likely to have a shorter labour (i.e. fewer hours) and a vaginal birth, are more likely to report feeling happy with their labour and birth experience and are less likely to use pain medication.

Research shows that women who receive continuous social support are more likely to have a shorter labour and a vaginal birth, and are more likely to report feeling happy with their labour and birth experience.

Postnatal/postpartum care (hereafter referred to as postnatal care) supports mothers and newborns following childbirth, and involves health monitoring and routine assessments to identify any deviation from expected recovery following birth, and to intervene, if necessary.

The postnatal period accounts for the first six weeks of a child’s life – a “critical phase” in which examinations and care from health practitioners play an important role in ensuring the well-being of the mother and child, according to the World Health Organization (WHO).

In their 2013 postnatal care guidelines, WHO outlines best practices including postnatal care in the first 24 hours to all mothers and babies (regardless of where the birth occurs), ensuring that healthy women and their newborns stay at a health facility at least 24 hours and are not discharged early, and have at least four postnatal checkups in the first 6 weeks following childbirth.

According to the Maternity Experiences Survey, more than 7 in 10 women (73%) rated their health as “excellent” or “very good” by 5 to 14 months postpartum. However, more than 4 in 10 women in Canada (43%) said they experienced a “great deal” of problems with at least one postpartum health issue during the first three months following childbirth, such as breast pain (16% of women), pain in the vaginal area or in the area of the caesarean incision (15%) and back pain (12%).

Postnatal support can be important in mitigating postpartum depression, which is reported by 10%–15% of mothers in developed countries. Research has shown that maternal stress during pregnancy, the availability of social support and a prior diagnosis of depression are all significantly associated with developing postpartum depression. Studies have also shown that emotional support from partners and other family members throughout the perinatal period can reduce the likelihood for postpartum depression and emotional distress for mothers and newborns.

Postnatal care services vary across regions and communities in Canada. These can include informational supports, home visits from a public health nurse or a lay home visitor, or telephone-based support from a public health nurse or midwife.

Privately delivered postnatal services have become more prevalent over the past several decades, with postpartum doulas advertising high-intensity supports such as newborn care, breast- and bottle-feeding support, child-minding services, meal preparation, household chores and more. However, these private services often involve out-of-pocket costs that can limit accessibility for some families.

 

Who provides maternity care?

In addition to the care and support provided by family members and friends, modern maternity care is delivered by a range of health practitioners including family physicians, obstetricians/gynecologists, nurses, nurse practitioners, midwives and birth doulas – all of whom make unique contributions in the continuum of care.

Family physicians provide care to most new mothers throughout the perinatal period and can be involved in all stages of maternity and infant care, though not all provide the full range of care. Fewer physicians across Canada are providing maternity care than in previous decades: the share of family physicians in Canada delivering babies declined from 20% in 1997 to 10.5% in 2010. Today, a growing number of care tasks and responsibilities are being delivered by other medical practitioners, such as obstetricians and midwives.

Most family physicians who report being involved in maternity and newborn care provide “shared care,” offering prenatal care to a certain point (often between 24 and 32 weeks), after which they transfer care to another provider (e.g. obstetricians, midwives or another family physician who delivers babies). Some attend deliveries, but rates vary widely between provinces and the availability of other health providers.

Obstetricians and gynecologists (OB/GYNs) are providing a growing amount of intranatal care in Canada – though not all do so, and rates vary across the provinces. With specialized knowledge and expertise in pregnancy, childbirth and female sexual and reproductive health care (including surgical training, such as caesarian sections), many also serve as consultants to other physicians and are involved in high-risk pregnancies.

Nurses constitute the largest group of maternity care providers in Canada. They can be involved throughout the entire perinatal period, providing a range of care services including childbirth education, pre-birth home care services to women in high-risk situations, assistance during childbirth and sometimes follow-up care to new mothers. Following childbirth, nurses often provide information to new mothers while preparing them for discharge, educating them about topics such as breastfeeding, bathing, jaundice, safe sleep, postpartum mental health, nutrition and more.

Nurse practitioners (NPs) are registered nurses who play a wide variety of roles in health care. They sometimes serve as primary care providers for low-risk pregnancies, performing a variety of tasks such as physical examinations, screening and diagnostic tests, and postnatal care. When providing or facilitating maternity care, NPs often work in interdisciplinary teams with other health professionals such as physicians and midwives. In hospital settings, they also work in labour and delivery units, postpartum units, neonatal intensive care units and outpatient clinics. Due to the breadth of their training and expertise, NPs play important roles in rural and remote communities, where many provide a full range of health care services.

Due to the breadth of their training and expertise, nurse practitioners play important roles in rural and remote communities, where many provide a full range of health care services.

Midwives provide primary care to expectant and new mothers throughout the entire perinatal period, and are playing a growing role in modern maternity care in Canada. They provide a range of care services, including ordering and receiving tests, accompanying women at home or in birthing centres, admitting women for hospital births, as well as assisting with breastfeeding, the early days of parenting and monitoring postpartum healing. Midwives work collaboratively, consulting with, or referring to, other medical professionals when appropriate.

The role of midwives has evolved over the past several decades, with a growing number assisting in all settings where care may be needed – at home, in the community and in hospitals, clinics or health units. There has been increasing emphasis on specialization and training, as midwives have become recognized by and incorporated into most (but not all) provincial/territorial health care systems across the country.

Doulas provide non-clinical/medical support, working with new mothers and their families as well as health care practitioners such as physicians, midwives and nurses. Doulas are not regulated; they focus largely on emotional and informational support, and they do not provide direct health care or deliver babies.

There are different types of doulas for different stages in the childbirth process. Antepartum doulas provide emotional, physical and informational support during the prenatal period. This can include informing new mothers and their families about support groups, techniques for enhancing physical comfort and helping with home care tasks such as errands and meal preparation. Birth doulas support new mothers and their partners during labour and delivery, including emotional and informational assistance and supporting physical comfort. Postpartum doulas support new mothers after the baby is born, providing information about topics such as infant feeding and soothing techniques, and sometimes helping with light housework and childcare.

Perinatologists provide care in the event of high-risk pregnancies (e.g. pregnancy in the context of chronic maternal health conditions, multiple births or genetic diagnoses). They are trained as OB/GYNs and then receive specialized education to facilitate complicated pregnancies. OB/GYNs refer patients to perinatologists when needed, but continue to work collaboratively to support maternal health.

 

Unique experiences: childbirth in rural and remote areas in Canada

Maternity care in rural and remote areas (including Canada’s northern regions) faces unique challenges due to distances from medical facilities and specialized equipment, less peer support for care providers, as well as a limited number of physicians available for on-call services, and fewer caesarean section and anaesthesia capabilities/services compared with urban centres.

Rural maternity care is most often provided by teams of family physicians, nurses and midwives – in fact, in some communities, they’re the only health practitioners providing maternity care. Rural family physicians are far more likely to provide obstetrical care than their urban counterparts, though over the past several decades, many rural communities have seen a reduction in the number of family physicians providing maternity care and closures of maternity wards.

Due to the limited availability of maternity care providers and services in rural and remote regions, many expectant mothers travel to urban centres to give birth. According to a 2013 report from the Canadian Institute for Health Information, more than two-thirds of rural women in Canada (67%) report that they gave birth in urban hospitals, 17% of whom travelled more than two hours to deliver their babies. Rates are far higher in the North: two-thirds of surveyed mothers in Nunavut and half of those in the Northwest Territories report that they gave birth away from their home community.

Two-thirds of surveyed mothers in Nunavut and half of those in the Northwest Territories report that they gave birth away from their home community.

This has an impact on the well-being of many Indigenous women living in northern regions, many of whom have had to fly to hospitals far from their homes, land, languages and communities to receive maternity care at tertiary or secondary care hospitals (see Indigenous Midwifery in Canada textbox). When surveyed, the majority of mothers reported that leaving home to have their babies was a stressful experience and that it had a negative impact on their families. In April 2016, the federal government announced that it would provide financial compensation to allow someone to travel with Indigenous women who need to leave their communities to give birth.

The number of community hospitals offering obstetrical care in northern regions has fallen since the 1980s. However, a number of birthing centres have opened to fill this care gap, such as in Puvirnituq (Nunavik), Rankin Inlet (Nunavut) and in Inukjuak (Quebec). These facilities have helped women with low-risk pregnancies remain in their communities; however, those with complications or requiring a caesarian birth often still have to travel to give birth.

 

Unique experiences: new and expectant mothers new to Canada

Canada is home to many immigrant families, which have represented a growing share of the total population. In 1961, 16% of people in Canada reported that they were born outside the country – a rate that increased to 21% by 2011.

Immigration has an impact on the maternity experiences, such as when women decide to have children. Research shows that immigrants have relatively fewer births in the two-year period before migration, which is often followed by a “rebound” in fertility afterward. According to researchers Goldstein and Goldstein, “Fertility preferences of movers may more closely resemble those of the destination country than those of the source country even before they arrive.”

Studies have explored a number of reasons why fertility can be affected by the immigration experience, including temporary separation of spouses during the migration process, a conscious decision to delay childbearing until access to supports such as child allowances is ensured and economic disruption during migration and in the early period (while parents are securing paid employment).

Recent immigrants are significantly more likely than their Canadian-born counterparts to live in multi-generational households (those with three or more generations living under one roof); 21% of immigrants aged 45 and older who arrived in Canada between 2006 and 2011 reported that they live in shared homes, compared with 3% of the Canadian-born population. As such, new and expectant mothers in multi-generational homes may benefit from having more family members nearby to provide care and support.

With regard to accessing maternity care services, research has shown that many immigrant women generally have the opportunity to receive the necessary maternity care services, but rates of satisfaction with maternity care vary greatly across Canada. Some report having faced barriers to accessing and utilizing maternity care services, including (but not limited to) a lack of information about or awareness of the services (sometimes the result of language barriers), insufficient support to access the services (i.e. navigation of the health care system) and discordant expectations between immigrant women and service providers. In some areas, doulas provide valuable emotional, informational and navigation support to immigrant women during the perinatal period.

Social support (e.g. from family, friends and community members) has been identified by immigrant parents as a key factor in accessing maternity care. This circle of support can play an important role in connecting new and expectant mothers from outside Canada with maternity care, and can work with health care and service providers to ensure these women receive “culturally congruent and culturally safe” maternity care.

 

Maternity care: supporting Canada’s growing families

Pregnancy and childbirth are major life events, not only for new mothers, but also for their families, friends and communities. While there have been many changes in family experiences over the generations regarding pregnancy, childbirth and the postnatal period, there have also been some constant threads: the value and importance of quality care, the diversity of experiences across Canada, and the joy and excitement that can accompany this memorable and life-changing milestone.

 


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This content was reviewed by Dr. Marilyn Trenholme Counsell, OC, MA, MD, retired family physician and former Lieutenant Governor (New Brunswick), former Minister of Family (N.B.) and Senator (N.B.).

All references and source information can be found in the PDF version of this article.

Published May 11, 2017

A Snapshot of Workplace Mental Health in Canada

At some point in our lives, we are all affected by mental illness, whether through personal experience or that of a family member, friend, neighbour or colleague. Mental health conditions can have a significant impact on individuals, but they can also “trickle up” to have a detrimental effect on workplaces, communities, the economy and society at large – no one remains untouched. It is therefore vital that support for mental health be multi-faceted and every bit as prevalent as the conditions it seeks to address.

Stigma remains a major barrier to care for those living with a mental illness, many of whom are receiving, and benefiting from, care and support from their families.

This edition of the Vanier Institute of the Family Statistical Snapshots series explores mental health, families and work – three key parts of our lives that intersect and interact in complex ways that affect our well-being.

Highlights include:

  • 4 in 10 Canadians have a family member with a mental health problem.
  • At least 500,000 employed Canadians are unable to work due to mental health problems in any given week.
  • Mental illness accounts for an estimated 30% of all disability claims and 70% of disability costs.
  • Stigma remains an issue, with 1 in 5 surveyed Canadian employees saying they believe that whether or not someone becomes mentally ill is “fully within their control.”
  • 4 in 10 surveyed Canadian employees say they would not tell their manager if they were experiencing a mental health problem.
  • More than 7 in 10 Canadians who are affected by a family member’s mental health problem provided care to them, and 68% say they are not embarrassed about their family member’s mental health condition.

 

Download from the Vanier Institute of the Family.

Sleep and Families

Dr. David B. Posen, M.D.

Sleep is a family affair. When everyone gets what they need, there are benefits for all. When someone is short-changed, it affects everyone else. Research about sleep deprivation is now as compelling as the dangers of smoking 50 years ago, according to Dr. Charles Czeisler, head of the Division of Sleep Medicine at Harvard Medical School, yet many households in Canada are lacking in this vital family resource. This shortage – fuelled by long working hours, new technologies and a 24/7 culture – not only affects productivity at work, performance at school and overall health, but also has a profound effect on families and family life.

What does sleep do for us?

Sleep has many different functions. Sleep is when we restore our physical energy. It’s a time of deep rest and healing, like a “mini-hibernation.” Stress hormones are shut off, heart rate decreases, blood pressure drops, metabolism rate slows and core body temperature falls. It’s when growth hormones are secreted, important for growing children but also contributing to cell repair and replacement in adults. It’s when our immune system is most active, producing T-lymphocytes that fight infection. It’s when hormones affecting hunger and satiety (leptin and ghrelin) are secreted, affecting appetite, food intake and body weight.

Symptoms of sleep deprivation are also symptoms of stress.

Sleep isn’t just important for our bodies, but our minds as well, since it affects mental function. This is when we do our “mental housekeeping,” processing and organizing our previous day’s experiences while discarding irrelevant information (such as what colour sweater someone was wearing on the subway). It is also when we reinforce memory tracks and consolidate new learning. In fact, research shows we actually increase our learning when we sleep.

Symptoms of sleep deprivation are also symptoms of stress. In other words, sleep deprivation shows up in our bodies as stress, in terms of physiological symptoms. When we don’t get enough sleep, cortisol (the main hormone in chronic stress) stays higher longer and has a damaging effect on the body. When we are sleep-deprived, we are less resilient in dealing with stressful situations, less effective problem solvers, less creative and innovative, less affable and can become difficult to get along with.

How sleep (and lack of sleep) affects families

Our sleeping patterns and family lives share a complex relationship, and deprivation affects not just individuals, but families and family systems as well. To examine the impact, let’s first look at cohabiting couples. This usually involves sleeping together, which leads to a number of interesting dynamics that can affect the quantity and quality of sleep a couple receives. When two people share a bed, there are important factors that can affect their sleep that have to be negotiated (or agreed upon), such as the size of their bed, the firmness of their mattress, the temperature of their bedroom and the presence of electronics. Research has shown that light emitted from TVs, smartphones, tablets or light-emitting e-readers can interfere with a good night’s rest.

The time at which one partner goes to sleep or wakes up in the morning can affect the other partner. If a couple has incompatible schedules, both of their sleeping patterns can be negatively affected by the actions and routines of each other. One person may stay up later than they would like because their partner wants to spend more time with them – thus depriving themselves of sleep. Discussion between sleeping partners is crucial to both getting their required amount of sleep. The decisions and agreements made not only affect whether each partner is getting the sleep that they individually need, but also represent negotiations that can either cause conflict in a relationship or provide opportunities for consideration, respect and compromise.

From the start of a live-in relationship to the later stages of our lives, sleep affects members of every family, both individually and collectively.

These are the conscious decisions affecting the bedroom and sleep. But there are involuntary factors as well. One of the biggest disrupters of sleep is a noisy or restless bed partner. The most common issues are snoring and frequent movement in bed. There are many causes of snoring, some mechanical (e.g. sleeping position) and others physiological (e.g. enlarged tonsils and adenoids, large uvula). What’s fascinating is that some snoring can actually reach industrial-strength decibel levels, rattling windows and even disturbing sleepers in other bedrooms – and yet the snorer sleeps through the racket.

Two of the most common sleep disorders are obstructive sleep apnea and restless legs syndrome. With sleep apnea, one of the partners actually stops breathing many times during the night (in fact, many times an hour), often startling themselves awake in order to breathe. Restless legs syndrome causes people to feel discomfort in their legs that is relieved only by continually moving them around, which again can be quite disruptive to the other person in the bed. If this occurs later in life, some couples may decide to move to separate beds or bedrooms to manage their sleep.

A new parent’s life is full of obstacles to sleep

For couples who decide to have children, a whole new variety of factors are brought into the household that affect sleeping patterns and sleep management. This begins with pregnancy. Expectant mothers often have trouble sleeping due to the increasing size of the fetus, the ability to feel the baby moving and increased trips to the bathroom at night. After the baby arrives, disrupted sleep becomes the norm. Babies cry to communicate when they’re hungry, in need of a diaper change or needing to be settled. This can be disruptive to both the new mother (especially if she is breastfeeding) and her partner. This is always a challenging time for getting enough rest, which means it’s an important time for negotiation.

As children get older (around 3 or 4 years of age), they are able to get up and dressed by themselves. Decisions have to be made as to whether a parent gets up with them or whether they train their kids to go to the family room or basement and entertain themselves so their parents can remain in bed. Many parents create a dependency where children expect company and attention from the time they wake up, robbing one or both parents of the extra sleep they need.

Teenagers have a physiological need for more slumber

The next chapter in the parents’ sleep continuum is when children reach early adolescence. This is when something called “phase-shift delay” occurs, where teenagers start to stay up later and then can’t wake up in the morning – a process often misunderstood by parents. Parents often complain that their children are party animals at night (when they won’t go to bed) and then lazy slugs in the morning (when they can’t, or won’t, get up for school). In fact, there’s a biological basis for this. In adults, cortisol levels start to fall at about 10 p.m. and the sleep hormone melatonin is secreted. That’s when we fall asleep. Then, somewhere between 6 and 8 a.m., melatonin secretion stops and we get a surge of cortisol. This allows us to wake up and start our day.

Among teenagers, this whole process is delayed by one or two hours. Cortisol doesn’t shut off and melatonin doesn’t kick in until later in the evening, and the reverse process doesn’t occur until an hour or two later in the morning. Adolescents stay up late because they are not tired yet – it’s physiological. If they don’t wake up in the morning at the same time they used to, it’s likely because their brains are still in “sleep mode” for an extra hour or two. So when they won’t wake up, it’s because they can’t wake up – except with great difficulty.

Teenagers often face a clash between their physiological and academic needs.

Many jurisdictions have moved high school start times to 9 a.m. or even 10 a.m., which is a better biological fit for teenagers. These districts have noticed better attendance at school, improved academic performance and fewer behavioural problems when students are allowed to get the sleep they need in the time frame that corresponds to their physiology. There are also benefits to families from this rescheduling of school hours, as it can reduce morning conflict involved with getting kids up and improve mood and cooperation at home because teens are better rested.

Teenagers often face a clash between their physiological and academic needs. One issue is accomplishing late-night homework and studying for exams. Teenagers are often sleep-deprived (they need nine to 10 hours a night and most are lucky if they get seven), and when you add to that the tendency to stay up well past midnight, finishing assignments or cramming for exams, the problem can become magnified considerably. The more tired they are, the less well they perform on the very tests they stayed up late to study for. Teenagers who also work part-time jobs while going to school face additional challenges, since they must balance school and work with their relatively demanding sleep requirements.

Dr. Stanley Coren, a psychologist at UBC in Vancouver, did a meta-analysis on the effect of sleep deprivation on IQ scores. The results were quite startling. In a newspaper interview, Dr. Coren states that “one hour’s lost sleep out of eight results in a drop of one point of IQ and for every additional hour lost, you drop two points. And it accumulates. So if you cheat on sleep by two hours a night over a five day week, you’ve lost 15 points.”

Functional MRIs show the same thing. With sleep deprivation, electrical activity in the brain decreases. For students who pull all-nighters, by late afternoon the next day, their mental function is significantly impaired and their performance plummets. Even the next morning, their cognitive function is seriously compromised.

Shiftwork creates irregular sleep requirements

Another factor that can have an impact on sleep within families is shift work. I was a family doctor for 17 years, which involved being on call at least once a week, working nights in the ER and being available to deliver babies after midnight. This often involved the phone ringing or my pager going off in the middle of the night, which was disruptive to my wife. The same scenario plays out in families of anyone who has to be available for overnight emergencies – doctors, operating room nurses, hospital technicians, security people or even business owners when there is a security breach at night.

People who work an overnight shift are working against their own physiology.

It also affects people who are regular shift workers, such as police, firefighters, ambulance drivers, paramedics, security guards, factory workers and office cleaners. People who work an overnight shift are actually working against their own physiology. They are being required to be awake at the time when their bodies and brains are biologically programmed for sleeping. After their shift, they go home to try to get some sleep.

This has an effect on everyone in the family, who are then required to maintain as quiet a home environment as possible. This includes everything from limiting or abstaining from radio and TV, phone conversations to spending time indoors with their friends. Any kind of noise might disrupt the sleeping family member who is in desperate need of sleep during the day, when that person’s body is programmed to be awake. The need for other family members to accommodate the irregular sleep requirements of shift work can cause friction, and so discussion, explanation and negotiation are very important.

Sleep requirements change as we age because our bodies change

At the other end of the life-cycle spectrum are circumstances such as menopause for women, where sleep deprivation can be a result of hot flashes or night sweats. As men get older, prostate enlargement often leads to frequent trips to the bathroom at night. People often find it hard to get back to sleep. Many disabilities, which become more prevalent with age, can also affect our sleep, such as shortness of breath due to lung or heart conditions, as well as aches and pains from arthritis, injuries or other musculoskeletal conditions.

Sleep disorders can affect us more as we age. Obstructive sleep apnea becomes more common, especially if a person has gained weight. This is a very underdiagnosed and undertreated condition where sleep deprivation takes a toll. Even though people with sleep apnea may be getting the requisite number of hours in bed and asleep, they are getting the quantity but not the quality of sleep they need. Incidentally, this is where a family member may be an asset: the sleep apnea is often first identified by the partner, not by the patient.

Sleep is a family affair

Sleep is one of the three basic pillars of good health, along with nutrition and exercise. From the start of a live-in relationship to the later stages of our lives, it affects members of every family, both individually and collectively. Awareness of our requirements, and those of other family members, is key to managing our sleep and avoiding the consequences of deprivation. We need to understand sleep so we can talk about and act upon it with serious consideration. Sleep really is a family affair with widespread effects on our physical and mental well-being, and sleep management provides us with opportunities to strengthen our family relationships by being helpful, respectful, understanding and considerate of one another.

 


Dr. David Posen is a bestselling author (Always Change a Losing Game: Winning Strategies for Work, Home and Health and The Little Book of Stress Relief), international keynote speaker and seminar leader who specializes in stress and change management. His latest book, Is Work Killing You?, explores the relationship between work and well-being.

The Current State of Military Family Research

Heidi Cramm, Deborah Norris, Linna Tam-Seto, Maya Eichler, and Kimberley Smith-Evans

Since the 1990s, the nature, frequency, and intensity of military operations have shifted, and these shifts have, in turn, had an impact on the families of Canada’s military personnel. Operational tempo has increased and has been almost continuous, and the roles of Canadian Armed Forces (CAF) personnel1 have changed from “peacekeepers to peacemakers to warriors.” In 2013, the Office of the Ombudsman, National Defence and Canadian Forces released its seminal report on military family health and well-being, On the Homefront: Assessing the Well-being of Canada’s Military Families in the New Millennium. This report brought into view the contexts, meanings, and consequences associated with recent changes in CAF military operations for members, Veterans, and families.

The Ombudsman’s report noted that mobility, separation, and risk have an impact on most serving military members and their families for much of their military careers.2 Canadian military families relocate three to four times more often than their civilian counterparts, with little input as to where, when, or for how long, disrupting continuity of access to health care services. Frequent relocations also affect children’s participation in school, academic progress, and access to educational accommodations for those with identified disabilities or learning exceptionalities.3 Relocations also disrupt non-military family members’ employment opportunities and the family’s capacity to care for vulnerable family members such as aging parents. Protracted separations from family as a result of training or deployment are not uncommon, and the risk that military personnel face during intensive training and deployment speak to the possibility of permanent injury, illness, or death.4 Although Canadian military families value and take pride in their family member’s military service, mobility and separation, along with the “relentless upheaval of military life,”5 can be highly disruptive to families. Civilian family members interviewed for the report shared their concern that their children were “paying a price for their parent’s service to the nation.”6

“…mobility, separation, and risk have an impact on most serving military members and their families for much of their military careers.”

Although Canadian military family research has been ongoing for approximately 25 years, efforts to develop this body of research were, until recently, hampered by the lack of funding for civilian research and the infrastructure to support collaboration. This has recently changed via the networks established through the Canadian Institute for Military and Veteran Health Research. At present, research involving present-day military families focuses overwhelmingly on the US experience. In recent years, this literature has paid greater attention to understanding how military life affects families and how resilience can be enhanced within military families.7 Resilience is defined as “positive adaptation, or the ability to maintain or regain mental health, despite experiencing adversity.”8

“In recent years, [military family research] has paid greater attention to understanding how military life affects families and how resilience can be enhanced within military families.”

On the whole, the research examining military families has tended to take a risk or problem perspective.9 Very little research has explored the factors, or combination of factors, that support successful and ongoing resilience within military family life.10 Little is known about the mechanisms that foster resilience. Instead, emphasis has been placed on the effects of deployment across mental health, social, academic, and behavioural domains.11–14 For example, the mental health of both the deployed and the at-home parent can affect children at different times. The Children on the Homefront study in the United States, which explored the impact of military operations on children’s well-being, described how the mental health of the non-deployed parent had a significant impact on the number of emotional, social, and academic challenges children experience both during deployment and during the reintegration of the deployed parent.15 A recent report that reviewed the Canadian and international research on the impact of operational stress injury (OSI) on family health and well-being16 suggested that it has a negative impact on family dynamics and the health and well-being of family members. Furthermore, it appears that family members experience more emotional, psychological, behavioural, social, and academic problems and are also more vulnerable to experiences of neglect or abuse than other families.17

“…the mental health of both the deployed and the at-home parent can affect children at different times.”

The extent to which these research findings resonate with the Canadian experience is unclear. Canadian military families, especially those who are not actively serving, express “concern that relatively little is known on the subject from a Canadian context.”18 Although many of the findings may be generalizable to Canada, critical differences require more extensive and intensive knowledge of the unique needs of Canadian military children, spouses, and families.19 For instance, in Canada, unlike in the United States, military families are dependent on the civilian health care system and need to repeatedly navigate access to a family doctor as well as any required specialists, often across provincial jurisdictions in which systems and eligibility for services may differ. Rather than enjoying continuity of care, members of military families find themselves on new wait lists with each move, with limited ability to engage in routine health maintenance with a regular health provider. Many Canadian military families travel back to their physician from their previous posting because they have been unsuccessful in securing one in their current residence. If members of the family have medical needs or disabilities, navigating new health care systems can be onerous and frustrating, with eligibility and reimbursement policies causing considerable stress. This can be complicated if civilian health care providers have “limited understanding of the particularities of military life, which can also impact care quality and continuity.”20

The challenges military families face in navigating the health system can be echoed in the school systems. Twenty years ago, 80% of CAF families lived on base and attended a Department of National Defence school there. Not only does that school system no longer exist, 85% of CAF families now live off base and attend community schools21 in which civilian personnel have little awareness of military life stressors and their impact on spouses and children. Moreover, unlike the United States or the United Kingdom, Canada has no federal government department that provides financial resources to provincial school districts to tailor programming for children in military families transitioning into their schools, experiencing parental deployment, or living with a parent with an OSI.22, 23 If a student has a disability and requires educational accommodations in school, the assessment and resource allotment process begins anew with each school transition, which creates significant stressors for families.24

“…it is critical that unique health issues and needs be carefully defined and understood in a Canadian context.”

Although programming and services have been developed in Canada to target families, including crisis support, peer support, psychoeducation, and counselling services through organizations such as the Military Family Resource Centres (MFRCs), offerings vary by location and centre. Canada has also demonstrated leadership in developing family-centred programs and services such as “The Mind’s the Matter” webinar series for adolescents.25 The extent to which most of these programs and services have been based on evidence or rigorously evaluated for efficacy is unclear, however.

To ensure that the spouses and partners of military members and the almost 64,100 Canadian children growing up in military families enjoy the same levels of health as their civilian counterparts, it is critical that unique health issues and needs be carefully defined and understood in a Canadian context. Although clarifying these needs is critical, research must also explore the knowledge and skills that educators, health care practitioners, and community partners require to effectively engage and support military families and ultimately create the foundation for evidence-informed interventions and programming.

 


Authors

Heidi Cramm, School of Rehabilitation Therapy, Queen’s University, Kingston, ON

Deborah Norris, Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS

Linna Tam-Seto, School of Rehabilitation Therapy, Queen’s University, Kingston, ON

Maya Eichler, Department of Political and Canadian Studies, Mount Saint Vincent University, Halifax, NS

Kimberley Smith-Evans, Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS

 

This article is an excerpt from “Making Military Families in Canada a Research Priority,” which includes a discussion about future research priorities. The original article, published online in the Journal of Military, Veteran and Family Health in November 2015 (Volume 1 No. 2), can be accessed on the journal’s website.

 

REFERENCES

  1. Ombudsman Department of National Defence and Canadian Forces. On the Homefront: Assessing the Well-being of Canada’s Military Families in the New Millennium. Ottawa: Office of the Ombudsman, National Defence and Canadian Forces, 2013.
  2. Ibid.
  3. Bradshaw CP, Sudhinaraset M, Mmari K, et al. “School Transitions Among Military Adolescents: A Qualitative Study of Stress and Coping.” School Psych Rev. 2010;39(1):84–105.
  4. Ombudsman Department of National Defence and Canadian Forces.
  5. Ibid.
  6. Ibid.
  7. Saltzman WR, Lester P, Beardslee WR, et al. “Mechanisms of Risk and Resilience in Military Families: Theoretical and Empirical Basis of a Family-Focused Resilience Enhancement Program.” Clin Child Fam Psychol Rev. 2011;14(3):213–30.
  8. Herrman H, Stewart DE, Diaz-Granados N, et al. “What Is Resilience?” Can J Psychiatry. 2011;56(5):258–65. Medline: 21586191
  9. Easterbrooks MA, Ginsburg K, Lerner RM. “Resilience Among Military Youth.” Future Child. 2013;23(2):99–120. Medline: 25518694
  10. Palmer C. “A Theory of Risk and Resilience Factors in Military Families.” Mil Psychol. 2008;20(3):205–17.
  11. Aronson KR, Perkins DF. “Challenges Faced by Military Families: Perceptions of United States Marine Corps School Liaisons.” J Child Fam Stud. 2013;22(4):516–25.
  12. Cederbaum JA, Gilreath TD, Benbenishty R, et al. “Well-Being and Suicidal Ideation of Secondary School Students from Military Families.” J Adolesc Health. 2014;54(6):672–7. Medline: 24257031
  13. Cozza SJ. “Children of Military Service Members: Raising National Awareness of the Family Health Consequences of Combat Deployment.” Arch Pediatr Adolesc Med. 2011;165(11):1044–6. Medline: 21727261
  14. Chandra A, Lara-Cinisomo S, Jaycox LH, et al. “Children on the Homefront: The Experience of Children from Military Families.” Pediatrics. 2010;125(1):16–25. Medline: 19969612
  15. Ibid.
  16. . “Operational Stress Injury: The Impact on Family Mental Health and Well-being. A Report to Veterans Affairs Canada.” 2015.
  17. Ibid.
  18. Ombudsman Department of National Defence and Canadian Forces.
  19. . “Impacts of Military Life on Families: Results from the Perstempo Survey of Canadian Forces Spouses.” Ottawa: Defence R&D Canada, 2009.
  20. Ombudsman Department of National Defence and Canadian Forces.
  21. . Canadian Forces Morale and Welfare Services; n.d. [cited 2015 Sep 10]. “Debunking Myths: The Canadian Forces Family Lifestyle.”
  22. Ombudsman Department of National Defence and Canadian Forces.
  23. National Military Family Association. Department of Defense Support to Civilian Schools Educating Military Children. Alexandria (VA): The Association, 2006.
  24. Ombudsman Department of National Defence and Canadian Forces.
  25. Military Family Support Services. Canadian Forces Morale and Welfare Services; n.d. [cited 2015 Sep 10]. “The Mind’s the Matter: Understanding a Family Member’s OSI.”

 

When Cupboards Are Bare: Food Insecurity and Public Health

Nathan Battams

(Updated September 6, 2017)

Food security is an issue that is deeply intertwined with the health and economic well-being of families. It is a serious social, economic and public health concern, felt not only by the estimated 1.3 million households in Canada that reported experiencing food insecurity in 2014 (12% of households, home to 3.2 million people), but also by the communities in which they live. When families face obstacles in securing the quantity and quality of meals they need to thrive, it becomes all the harder for them to be healthy and live productive, happy lives.

When the Canadian Medical Association consulted Canadians about public health issues in a series of town hall meetings in 2013, food insecurity was identified as one of the main social determinants of health. Without a stable and healthy food supply, people are more likely to develop a range of health issues, such as heart disease, diabetes, stress and even food allergies.

While there are multiple contributing factors to food insecurity, including geographic isolation, food literacy and transportation issues, economic insecurity is at the heart of the matter.

Since the beginning of the Great Recession in 2008, families have increasingly depended on food banks and other community supports for essential support securing the quantity and quality of food they need. According to Food Banks Canada, the number of people who accessed food banks across the country in March 2016 (863,492) was 28% higher than in 2008, and more than 40% of households receiving food were families with children.

Some individuals are more likely than others to experience food insecurity. Food insecurity rates were higher than the national average in 2014 for people with an Aboriginal identity () and for Black people (29%). A 2016 study also found that some households are more likely than the national average to experience food insecurity, including (but not limited to):

  • Households with children under age 18 (15.6% versus a 10.4% food insecurity rate for households without children)
  • Lone-parent families headed by women (33.5%)
  • Households in Nunavut (60%)
  • People living in rented households (25%)
  • Households with an income below the Low Income Measure (29.2%)

Research from Statistics Canada has suggested that adults experience food insecurity at higher rates than children (8.2% compared with 4.9%) because parents are protecting their youngsters from food insecurity by reducing the variety and quantity of their own meals so their children can eat better. Despite this, children across Canada are affected by food insecurity, with children and youth accounting for 36% of those helped by food banks in March 2016.

Food banks and community supports were never intended to be permanent solutions to food insecurity. Many organizations providing food to families are feeling the pressure resulting from the economic downturn. Faced with increased demand, some food banks have had to reduce the assistance they provide – a reality with serious consequences for the health and well-being of families in Canada.

There are multiple contributing factors to food insecurity, including geographic isolation, food literacy and transportation issues, but economic insecurity is at the heart of the matter. Families can’t eat when they don’t have the power to buy. Rates of food insecurity vary widely across Canada, reaching as high as 47% in Nunavut and the Northwest Territories in 2014. Some people face disproportionately high rates of low income, such as sole-support mothers and Indigenous people, and are therefore also more likely to experience higher levels of food insecurity.

Food bank users typically make do with limited financial resources, which is reflected in patterns of food bank use: nearly half (45%) of households who accessed food banks in March 2016 relied on social assistance as their primary source of income. However, Canadians who earn the majority of their income through paid labour are also accessing food banks, accounting for 15% of those assisted in the same month.

Whether it comes as a result of improving the health or increasing the wealth of Canadians, access to the quality and quantity of food we need is essential for living well and reaching our full potential.


This is an edited and updated version of an article that was originally featured in Transition magazine in spring 2013 (Vol. 43, No. 2).

Nathan Battams is responsible for publications, communications and social media at the Vanier Institute of the Family.

Putting the “F” in EFAP: The Evolution of Workplace Mental Health Supports

Craig Thompson

Over the past several decades, mental health has become an increasingly popular topic in public discourse, fuelled in part by our increased understanding of the many ways it affects all levels of society. When people experience changes to their mental health, their family members – always at the “front lines” – are typically the first ones to feel the effects. Family is society’s most adaptable institution. Families respond by adjusting to meet the needs of their members as best they can. In light of this, a growing number of organizations have offered assistance to employees and their families through Employee and Family Assistance Programs (EFAPs) to manage mental health in the workplace. By looking at the evolution of these services, we can learn how and why the “F” in EFAP first emerged, and how it has grown in importance over time.

The early years: Occupational Alcoholism Programs (OAPs)

Occupational Alcoholism Programs (OAPs) were first introduced in Canada in the late 1950s. Predecessors of the EFAPs, they were focused primarily on alcohol and the devastating impact alcohol has on the health and well-being of employees who experience dependency. These programs were typically delivered through the occupational health and medical departments of large industrial organizations in the manufacturing sector.

Employees would sometimes seek out these services through their own initiative, but more often than not were assisted or referred by their manager, supervisor or union steward. The focus of assistance was almost solely on the individual and the alcohol, and did not include the family. The dependent employee would be put on a strict program that included attending Alcoholics Anonymous meetings, and their compliance would be closely monitored. If the individual relapsed after this treatment, it would usually lead to termination and no further support was provided by the employer. Their future would then depend solely on what level of support their family members could muster – if they were still around.

The formative years: Employee Assistance Programs (EAPs)

During the 1970s and mid-1980s, employers expanded the scope of these programs beyond alcohol, and they became known as Employee Assistance Programs (EAPs). Previous research on occupational productivity had shown that alcohol dependency was just one of many issues that could have an impact on a person’s performance, productivity and health in the workplace.

Although alcohol addiction was still seen as a problem, it became increasingly clear that workplace programs could benefit from including support for other issues that can affect productivity, such as other addictions, mental illness, serious health conditions or major life events such as births and deaths. More employers began to understand the value of offering EAPs and, as a result, mid-size, regional, national and global companies introduced programs in their organizations.

EAPs would typically offer short-term, solution-focused counselling, paid for by the employer, with either an average number of sessions or a predetermined maximum number of sessions allotted. EAPs were never intended to provide longer-term care, but when that was necessary, the provider would make a referral to an affordable and appropriate resource. EAPs were increasingly managed by human resources (HR) instead of occupational health and safety or medical departments.

During their prime working years, many people face concerns about their mental health, which EFAPs can help them to manage. Studies have shown that mental health conditions are not only costly to individuals, but also to the organizations to which they belong:

• Depression will rank second only to heart disease as the leading cause of disability worldwide by the year 2020.

• Disability represents anywhere from 4% to 12% of payroll costs in Canada; mental health claims (especially depression) have overtaken cardiovascular disease as the fastest-growing category of disability costs in Canada.

Some employers also started to understand the importance of families in the equation of employee attendance, concentration and focus. Emotional distress, family/personal relationships, child care, eldercare and health care started to get employers’ attention. Many began reaching out directly to family members at home to increase awareness and usage, and to help mitigate the negative impacts of these issues on performance and productivity. Communication materials were specifically designed for spouses and dependants, and creative methods were used to reach out to family members. Program admission was further expanded to include eligible young adults and family members who were attending post-secondary education institutions.

At first, utilization of these programs and services by families remained low, prompting further attempts to increase awareness and usage. One of the factors that limited their use was the fear that personal information would be shared with a counsellor or EAP practitioner and have consequences for the employee at work. Although EAP services were confidential (and remain so), the concerns about confidentiality and privacy protection understandably impaired users from taking advantage of services. During this period, 5% to 7% of the employee population accessed EAP services on any given year, with less than 1% attributed to family members.

While the first generation of EAPs was delivered by internal staff (usually MDs and occupational health nurses), this new generation of programs was typically outsourced to external firms that provided a broader range of professionals and specialty practitioners, including psychologists, counsellors and other health providers. This contributed to broadening the legitimacy of EAPs; however, these programs were still being offered primarily by larger companies and therefore were not yet mainstream. As a result, those who did not work for these firms were typically underserved.

The growth years: Employee and Family Assistance Programs (EFAPs)

The late 1980s through the mid-1990s were marked with important progress in this field. First, EAPs started providing an ever-expanding array of services, including responses for addictions, family/marital relations and psycho-emotional issues. These “broadbrushed” EAPs also recognized the importance of providing services for work relationship issues, financial, legal, aging parent and other non-work-related concerns. With this expansion in scope, EAPs began to take greater hold across a broad range of industries, sectors and workplaces.

Over time, a growing body of research demonstrated that investments by employers in EAPs resulted in various cost benefits, including reduced absenteeism, lower turnover, fewer medical costs and overall higher employee productivity. With this data, EAP providers were able to engage an increasing number of employers of various sizes in other industries to implement an EAP. The level of acceptance grew considerably and, with it, thousands of families and individuals gained access to resources and care.

Providers began offering toll-free 24/7 access to counsellors to eliminate barriers to reaching assistance if and when it was needed. Increased efforts to reach out to the homes of employees did increase family member utilization; however, in most programs, dependant use averaged 5% to 10% of the total utilization. Attention was also now being given to prevention and health promotion through the provision of resource materials, workshops and seminars. Stress management workshops were a central part of the education efforts, with the goal of giving participants the knowledge and tools to remain healthy and productive at work. EAPs also expanded to include services related to dealing with conflict in the workplace, managing workloads realistically and communicating effectively.

Current EFAP Referral Patterns: Percentage of Calls Received, by Issue

45%   Marital and family problems
25%   Psychological (depression, anxiety, self-image)
15%   Work-related problems
10%   Substance abuse/alcohol abuse
5%     Personal trauma/crisis

Another major step during this phase was the rebranding of Employee Assistance Programs to Employee and Family Assistance Programs (EFAPs). Although most programs had already included the family, this formal change explicitly identified the family as a key stakeholder in the provision of services. Credit needs to be given to the stewards of the MacMillan Bloedel EFAP for having the wisdom and vision to be this apparent and inclusive. They were the first to coin this term, which has become the standard reference for these types of services in Canada. This simple insertion spurred on greater interest in program enhancements for the family into the next phase of evolution.

The maturing years: Today’s EFAPs

From the mid-1990s to today, EFAPs have grown in popularity to the extent that most large and mid-size employers offer some form of program. Even smaller employers (i.e. fewer than 50 employees) have started to offer programs through group plans or community initiatives. This has been largely due to the partnerships that have developed between EFAP providers and group insurance providers in which the group plan can include the EFAP as another option for employers to offer. A range of counselling models (assessment and referral, short-term counselling, etc.) surfaced, varying depending on the organizational culture, industry and program in question. Employers had more models to choose from. During this phase, a wider range of services was made available by telephone, face to face or, more recently, online.

Online services increased accessibility, as they could be reached outside of the workplace from mobile devices and personal computers. This mode of access has increased the use by family members, and future expansion is expected. Online resources such as educational modules on parenting, communicating emotion, enriching relationships and dealing with aging parents are all now common offerings and can be accessed at home or on the road.

Prevention and health promotion has recently expanded to include wellness. A growing number of employers are assisting employees (and their families) to take charge of their overall health, including emotional, psychological and physical well-being. Health risk appraisals (HRAs) have become increasingly available; individuals can benchmark their current health risks and learn how to reduce those risks. Many employers are taking a holistic approach to employee health and wellness, and they are recognizing the importance of the family unit in maintaining and enhancing healthy choices and decisions. Overall employee health is increasingly seen as a vital part of an organization’s “bottom line” thanks to a growing body of research demonstrating direct links between employee well-being and rates of engagement, absenteeism and productivity.

Costs of Mental Illness in the Workplace

  • In any given week, more than 500,000 Canadians are absent from work because of mental illness.
  • More than 30% of disability claims and 70% of disability costs are attributed to mental illness.
  • Approximately $51 billion each year are lost to the Canadian economy because of mental illness.

Current and emerging legal requirements are now compelling greater numbers of employers to ensure that their workplaces are psychologically safe and built on relationships of civility and respect. In 2013, the federal guidelines for the National Standard of Canada for Psychological Health and Safety in the Workplace were introduced to help organizations actively work toward creating psychologically healthy and safe environments for employees.

This standard was developed using evidence-based research from a variety of scientific and legal disciplines; it outlines existing knowledge on the psychological health and safety of workers, and provides guidelines and recommendations for promoting and maintaining healthy workspaces. While the standard is voluntary, there is still an obligation for employers to provide some degree of care based on current and evolving legislation and case law. As Dr. Martin Shain, who has written extensively on psychological safety in the workplace, says, “A psychologically safe workplace is no longer a nice to do, but is now a must do.”

The future of EFAPs

In the early days, when services focused on alcoholism, employers could readily fire an employee for non-compliance. In today’s climate, whether in response to legislation or regulations, or in compliance with voluntary standards, more employers are providing access to professional assistance and treatment to address the myriad of mental and physical conditions that may disable or impair an employee. After an employee reaches out seeking treatment, employers are taking greater steps to accommodate his or her return to work. As the dialogue on the reduction of stigma surrounding these issues grows in volume and intensity, more workers, families and communities are getting assistance.

The evolution of EFAPs demonstrates a growing interest within organizations to integrate care for the employees, ensuring that family circumstances are considered and enabled. Whether the result of legal obligation or efforts to increase performance and productivity, or out of care for employee well-being, a growing number of employers now take psychological health and safety in the workplace seriously. As interest and investment in EFAPs and employee well-being grows, further breakthroughs are bound to occur. Although it is difficult to anticipate with great accuracy what the future of employee assistance may look like, families will most likely remain a central component of future approaches.

 


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Craig Thompson, MEd, MBA, has been a clinician, business developer, account manager and business leader in the field of EFAP and Disability Management for nearly three decades. Over this period, he has worked with thousands of employers and employees and their families with a purpose of improving their lives and enhancing workplace effectiveness.

 

 

Modern Maternity Care in Canada

Cecilia Benoit

Georgina, a mother of Mi’kmaq heritage, is in the last stage of her pregnancy. Reluctantly, she is preparing to leave her home community of Port-aux-Basques, located on the southwestern tip of Newfoundland, to give birth in the only remaining maternity hospital in her health region, the Western Memorial Regional Hospital in Corner Brook, 220 kilometres away from her family and friends. Her chances of having a maternity doctor or midwife she knows attend her birth are slim to none, and there is a 30% chance that her baby will be delivered by Caesarean section.

Millennium Development Goal 5, to improve maternal health, is one of the United Nations Millennium Development Goals (MDGs). Of the eight MDGs, the least progress has been made toward the right of every woman to the best possible maternity care. Indigenous, poor and rural and remote women such as Georgina are especially compromised. While Canada made major strides throughout the 20th century to improve maternal health and build a universal maternity care system, many shortcomings remain, including but not limited to the medicalization of childbirth and inequitable access to maternity providers.

History of childbirth in Canada

Pregnancy and childbirth are significant life events in all cultures. In earlier times, midwives were the primary care providers. Care during pregnancy typically took place in the local community and birth occurred in the home.

Medicalization of maternity care in Canada, while significantly predating the development of the modern welfare state, became enshrined and solidified within the package of policies and regulations that accompanied the adoption of universal health care, known as “medicare,” which was implemented and formally adopted in 1972.

While Canada’s health care model is often referred to as a simple single payer health care system, funding and delivery of insured services are in fact much more complex. They involve federal and provincial/territorial governments, community services, private insurance companies and individuals.

Most physicians work in private practice, with their services paid from the provincial/territorial insurance plans. Funding for the insurance plans comes from the general revenues of the provinces/territories, with additional transfer payments from the federal government through the Canada Health and Social Transfer or, more recently, the Canada Health Transfer.

Under medicare, only physician-provided maternity care services were covered by the public health care system, which resulted in shifting the role of midwives (women) to medical doctors (mostly men). In the publicly funded health care system that was created, physicians also retained their right to remain private entrepreneurs, establishing their practices wherever they deemed appropriate.

The system created through medicare did not address the pre-existing disparity in the availability of physician services and solidified the hospital as the control centre of the maternity care system. Due to concerns about modesty and fear of contagion, it also excluded partners and other kin from participating in the age-old event of childbirth.

Modern childbirth in Canada

By the early 1980s, virtually all women across the country were delivering their babies in regional hospitals, attended by a maternity physician or obstetrician and assisted by obstetrical nurses. But these institutional changes left women lonely and new fathers sidelined. Research shows that women who have the support of a partner during labour require less pain relief and feel more positive about the birth. As research began to show the importance of healthy parent–child attachment, the health care system responded by allowing partners to be active participants in the birthing process. Partners today are present for the majority of births, taking on a greater role not only in these first moments of their children’s lives, but also with child rearing and household management in the years that follow.

Maternal deaths rose in Canada from 6 to 12 per 100,000 births between 1990 and 2013.

In 2013, UNICEF ranked Canada 22nd out of 29 high-income countries for infant mortality rates, with the rate substantially higher among Indigenous peoples.

Canada currently boasts the lowest maternal mortality rate in the American continent, reflecting improvements throughout the 20th century in women’s education, their nutrition, control of their fertility and universal coverage of physician services. Yet maternal deaths rose in Canada from 6 to 12 per 100,000 births between 1990 and 2013. By contrast, Japan and a number of European countries today have mortality rates half the Canadian rate or lower. Equally disconcerting, in 2013, UNICEF ranked Canada 22nd out of 29 high-income countries for infant mortality rates, with the rate substantially higher among Indigenous peoples.

In recent decades, the number of family doctors involved in maternity care delivery has significantly declined, as has the number of hospitals offering maternity care services. At the same time, the percentage of deliveries attended by obstetricians has increased substantially; for example, obstetricians currently attend 80% of hospital births in Ontario.

Caesarean section rates have also steadily increased, with the total national rate increasing from 17.6% in 1995 to 22.5% in 2001, and 27.3% in 2013 (see table below). The current rate of Caesarean section births ranges from a high of 32% in British Columbia and 31% in Newfoundland and Labrador to a low of 23.1% in Saskatchewan and 21.41% in Manitoba. According to the World Health Organization, Caesarean section rates below 10% indicate underuse of this life-saving procedure, while rates above 15% are deemed to show overuse. Overuse of Caesarean section has been linked to higher morbidity in mothers, including an increased risk for depression and post-traumatic stress, lower breastfeeding rates and a greater likelihood of future complications in pregnancy. Despite popular media images of maternal demand for Caesarean section, there is little evidence that the increase in the national rate in the last 20 years, and the even more surprising current cross-country variation, is based on mothers’ demand for a convenient pain-free birth – the so-called “too posh to push” argument.

 

Modern midwifery in Canada

Beginning with Ontario, British Columbia and Quebec in the 1990s, and spreading across most other regions since, midwives have received formal education and become regulated, and their services have been publicly funded. Yet the occupation still remains unregulated and unfunded in Newfoundland and Labrador, Yukon, Prince Edward Island and New Brunswick. Moreover, only 9% of births in Canada are currently attended by a midwife. While the percentage of midwife-attended births is higher in some regions (e.g., 19% in British Columbia), the demand outstrips the supply, with a substantial proportion of women in all parts of the country wanting access to a trained, publicly funded midwife but unable to find one.

Women with lower education, younger mothers, women without a partner and women living in rural and remote areas or socio-economically disadvantaged communities have the least access to publicly funded midwifery services. The Association of Ontario Midwives estimates that as many as 40% of women who want to see a midwife in Ontario are currently unable to find one, and women in other provinces are also experiencing frustration trying to find midwifery care. Following developments in Quebec and Manitoba, Ontario recently funded two free-standing, midwifery-led birth centres. Yet this option is not available for many non-Indigenous and Indigenous women, such as Georgina mentioned above, who instead experience loneliness, disconnection from their local maternity traditions and isolation from family; the overall result is “stressful births.”[ii]

Modern postpartum care in Canada

The length of time Canadian women spend in hospital following childbirth has decreased dramatically during the modern period, from a mean of five days in 1984–85 to just less than two days after vaginal delivery today. Hospital stays are costly; early hospital discharge for mothers and their newborns helps administrators control or reduce obstetrical care expenditures. For some women with strong support systems and access to publicly funded physician or midwifery services, early discharge from hospital is usually a welcomed occasion.

As in earlier times, family support can be crucial in the postpartum period. Fathers and/or partners across Canada, with the support of parental leave policies, are playing a much bigger role after childbirth than in previous generations – a shift in family roles that continues to this day. According to Statistics Canada, 31% of recent fathers across the country claimed or intended to take parental leave in 2013 – a significant increase from 3% in 2000. The rate is much higher in Quebec, particularly since the introduction of the Quebec Parental Insurance Plan (QPIP), which is the only plan in the country that specifically provides paternity leave. Since the introduction of QPIP in 2006, uptake has almost tripled, from 28% in 2005 to 83% in 2013.

But for women without these familial and formal options, the result can lead to negative health outcomes for themselves and their infants. Provincial and territorial health care systems cover a limited range of postnatal care services. At the federal level, this has traditionally been restricted to the provision of informational supports by the provinces and the publication of national guidelines for maternity and newborn care. In some regions, an optional home visit by either a public health nurse or a lay home visitor is still available, while in other regions, services following discharge from hospital have been reduced to a telephone call to a new mother from a public health nurse.

Privately delivered postnatal services have emerged to fill this care gap. There currently exist no published research studies on the for-profit postnatal services that currently exist in Canada. Postpartum doulas who advertise online often propose tangible, high-intensity supports such as newborn care, breast- and bottle-feeding support, child-minding services, meal preparation, household chores and so on. Unfortunately, relatively high out-of-pocket costs make these forms of support accessible only to those who are able to pay for them. Doulas who advertise online generally charge around $25 per hour, or anywhere from $100 to $1,000 for overnight or week-long package deals, respectively. Research studies in this emerging area of practice are needed to determine the scope of practice and outcomes for mothers and their families. There is currently no information available on user demographics, patterns of use or outcomes associated with these forms of commodified care, though such information would offer insight into the types and levels of unmet needs that exist.[iii]

The future of maternity care in Canada

As is clear from our history, midwives were the main maternity care providers in what is now Canada before the arrival of European settlers and up to the modern period. Midwives provided not only crucial technical care, but also social support to enhance the health and well-being of women and babies in homes and local communities. Modernization of maternity care involved the move from midwives and natural childbirth into the medicalization of childbirth, with obstetricians replacing family doctors as the maternity providers, and labour and delivery restricted to fewer and fewer hospitals. High Caesarean rates and the associated unnecessary morbidity for mothers is one outcome of this modern system of care. The return to midwifery and the integration of midwives into our health care system have thus far been insufficient, as midwives are too few in number, they are concentrated in urban centres and their services are not equally available in all provinces/territories.

As the country works toward achieving MDG 5, as families become more complex and partners become more involved in childbirth and child care, and as we have access to more research on how to increase positive health outcomes for mothers and newborns, the health care system will continue to evolve and adapt to ensure the availability and effectiveness of maternity care in our communities from coast to coast to coast.

 


Cecilia Benoit, PhD, is a Scientist at the Centre for Addictions Research of British Columbia, Professor in the Department of Sociology at the University of Victoria and former co-leader of the Women’s Health Research Network. She is also recipient of the 2016 Governor General’s Awards in Commemoration of the Persons Case.

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SOURCES

[i] Cecilia Benoit et al., “Medical Dominance and Neoliberalisation in Maternal Care Provision: The Evidence from Canada and Australia,” Social Science & Medicine, 71:3 (August 2010), accessed August 24, 2015. http://bit.ly/1Jv2r5j.

[ii] Cecilia Benoit et al., “Maternity Care as a Global Health Policy Issue,” The Palgrave International Handbook of Healthcare Policy and Governance, Ellen Kuhlmann, Robert H. Blank, Ivy Lynn Bourgeault and Claus Wendt (Eds.). Basingstoke: Palgrave, 2015. .

[iii] Cecilia Benoit et al., “Privatisation & Marketisation of Post-birth Care: The Hidden Cost for New Mothers,” International Journal for Equity in Health, 11:1 (October 2012).

 

The Health Care Experiences of LGBTQ+ Seniors

Laura Zuccaro

Updated on September 8, 2015

With 4.9 million Canadians aged 65 and older in 2011 and close to 6,000 centenarians, Canada – like many countries – is facing an aging population.((Statistics Canada, “Age and Sex Highlight Tables, 2011 Census,” 2011 Data Products, page last updated November 23, 2016. Link: .)) Many older Canadians are managing chronic or episodic illnesses, disabilities or conditions that make for frequent encounters with the health care system. When seeking medical attention, LGBTQ+ seniors face discrimination that can act as barriers to care. The main hurdles for LGBTQ+ seniors include identifying oneself as gay, lesbian, bisexual, transgender or queer, and experiencing discrimination.((Shari Brotman, Bill Ryan and Robert Cormier, “The Health and Social Service Needs of Gay and Lesbian Elders and Their Families in Canada,” The Gerontologist 43:2 (2003). Link: http://bit.ly/1ggcMmo.))

According to Statistics Canada, the use of the health care system (e.g. having a regular doctor, consultations with health care professionals and receiving preventive screening tests) by gay, lesbian and bisexual Canadians varies by sexual identity, and their health care choices differ from those of heterosexual seniors.((Michael Tjepkema, “Health Care Use Among Gay, Lesbian, and Bisexual Canadians,” Health Reports 19:1, Statistics Canada catalogue no. 82-003-X (March 2008). Link: .)) Many seniors only discuss their sexual orientation in relation to their care, and many service providers avoid discussing issues relating to sexual orientation when making care plans. Research performed at McGill University revealed a “don’t ask, don’t tell” passive approach toward revealing sexual orientation in the health care system.((Brotman, Ryan and Cormier.))

Many seniors only discuss their sexual orientation in relation to their care, and many service providers avoid discussing issues relating to sexual orientation when making care plans.

Many gay and lesbian seniors have support from their biological families and children and grandchildren; others rely on friends considered as family, also known as “chosen families” or “fictive kin.”((Brotman, Ryan and Cormier.)) Health care providers do not always understand this broad definition of family and therefore it is common for same-sex partners to identify themselves as friends or roommates in order to avoid being treated differently. This can often make it difficult for LGBTQ+ partners to show affection or be acknowledged as the patient’s spouse.

A number of studies on gay and lesbian seniors and their caregivers have found that they may experience both actual and anticipated discrimination via homophobic or heterosexist attitudes or policies in the health care system. Actual discrimination has been reported in hospital practices surrounding visiting hours, such as LGBTQ+ caregivers being denied acknowledgement as family members when seeking to visit their partners. Anticipated discrimination could affect seniors’ willingness to reveal their sexual orientation or even access services due to prior negative experiences. Both forms of discrimination pose a challenge to both the possibilities of self-identifying as a gay or lesbian senior and receiving appropriate care.((Shari Brotman et al., “Coming Out to Care: Caregivers of Gay and Lesbian Seniors in Canada,” The Gerontologist 47:4 (2007). Link: .))

In order to address the biases within the health care system, current research has suggested that specialized services designed to engage dialogue between gay and lesbian community health professionals and enhance integration would have a significant impact on the health care experiences of LGBTQ+ seniors in Canada.((Brotman et al.)) Such services would include training sessions for health care workers on the needs of gay and lesbian seniors; hiring gay and lesbian health care workers; using gender-neutral language in discussions about identity and relationships; ensuring confidentiality; specialized facilities (e.g. Kipling Acres, a long-term care facility and gay-positive environment that provides services to seniors in Toronto), support groups or telephone support lines; and community outreach programs. These services aim to reduce the barriers between LGBTQ+ seniors and their health care providers and improve health care interactions for both the care provider and the patient.

Laura Zuccaro is a second-year medical student at the University of Ottawa.


Originally published in Transition, Vol. 44, No. 3, in July 2014.

Updated on September 8, 2015