Topic: Wellbeing

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.”

A Snapshot of Families and Food in Canada 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.

Download A Snapshot of Families and Food in Canada from the Vanier Institute of the Family

 

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: http://bit.ly/2gbzaqo.

Grandparent Health and Family Well-Being

Rachel Margolis, Ph.D.

Download this article in PDF format.

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 Facts and Stats: Families and Active Leisure in Canada from the Vanier Institute of the Family.

 

Published on July 25, 2017

In Context: Understanding Maternity Care in Canada

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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

Lived Experience: Understanding Families Affected by Incarceration

Farhat Rehman

Incarceration has an impact on thousands of families across Canada. When a person is sentenced to time in prison, their families are often profoundly affected; they are separated from a son, daughter, sibling, parent or other relative. Feelings of stigma, guilt and shame are common, and can be compounded when the sentenced family member is also living with a mental health condition – a reality for many incarcerated individuals and their families.

My family life has been profoundly affected by incarceration ever since my son was sentenced in 2001. When the chasm of the prison system had swallowed him up, the world appeared dark with no hope of seeing daylight. Our lives took a drastic turn on that ominous day. Our family’s lives and relationships were forever changed.

As a mother, I couldn’t help but wonder over and over again why my son had committed such a serious criminal act. Why did his mind work this way? What could have been done to prevent this catastrophe? Why, after years of treatment in the mental health system, had he still fallen through the cracks? What could I have done differently that would have prevented this crime from taking place and tearing apart two families? Since then, there have been daily reminders as I speak to him and visit him in prison. For us, his family, the impact of my son’s action have sunk in gradually over time. The nightmare of prison has played havoc with his mental health conditions with all the ups and downs of a roller coaster, and it’s become a constant source of worry for our family.

The nightmare of prison has played havoc with his mental health conditions with all the ups and downs of a roller coaster, and it’s become a constant source of worry for our family.

 

Incarceration affects family relationships, family traditions and family futures

As we have learned, in-person visits can be traumatic for the visitor. When visiting someone in prison, you have to first pass through layers of security such as the ion scanner (a drug-scanning device known for detecting false positives). Otherwise, you risk being turned away, which can seriously impact the inmate’s prison life.

There is no occasion that is celebrated as a family where I don’t feel my son’s absence. The festivities, the good food and laughter lack the genuine happiness that can come from family gatherings. This is never really talked about openly.

Family members will occasionally ask about my son and he may receive birthday cards from family and friends, but there is a kind of hesitation to discuss such a sad subject and ruin a festive atmosphere. The fact a family member has not been seen among you for almost 16 years registers low on the Richter scale of family life.

These days, as I contemplate the possibilities of the future, I wonder if this will be the time that my son will be able to start to turn his life around. Will he convince the authorities that he is deeply remorseful and resolved to never offend again? Will he be seen as worthy of being allowed to be paroled out of prison and into the community, where he can start the long process of healing and repairing the ravages of a lengthy period of incarceration? Will he be able to reintegrate himself into our family, one that misses him terribly but has adapted to life in his absence?

The love and light of support gets families through

While I contemplate these questions daily, I am grateful for the support of those around me. When my son – and my family – first began our journey with the justice system, I felt like I was travelling down an uncharted road. Despite being well connected to community, there was no real support I could turn to where others would understand what it was like to have a son in prison.

Despite being well connected to community, there was no real support I could turn to where others would understand what it was like to have a son in prison.

In November 2010, a community activist and expert connected to the Church Council on Justice and Corrections and a crisis worker at the John Howard Society (JHS) introduced me to ‬another mother with a son in prison. We all met for the first time at JHS in December 2010 – three mothers coming together with common experiences and goals.

From this shared experience, Mothers Offering Mutual Support (MOMS), a support group for women, was born. The first formal MOMS meeting occurred on December 15, 2010. Our meetings take place at the local JHS building, during the first Thursday of the month. JHS has generously donated this space to us so we can meet in a location with privacy.

We now total more than 45 members, all of whom feel immensely grateful to be able to come together and climb out of the black hole we fell into when our children were convicted of an offence resulting in their incarceration. Now we come together to support each other and find ways to help them in a meaningful and constructive way. Mothers whose sons have completed their sentence or are on parole continue to support and guide the new members who join the group.

A loving family on the outside can play an important role in advocating, financially supporting and providing loving contact to offset the indelible ravages of incarceration. Through MOMs, we are able to support each other as we support our incarcerated children.

A loving family on the outside can play an important role in advocating, financially supporting and providing loving contact to offset the indelible ravages of incarceration.

The harsh realities of incarceration are with us, but together we encourage each other to take one day at a time. We have been working to ensure the justice system facilitates rehabilitation and education, with a focus on physical and mental well-being and supporting our sons or daughters while they serve their sentences and plan for their futures. This has provided us with opportunities to engage in dialogue with government and community leaders about human rights. Policies and programs benefit from understanding our lived experiences and our perspective as mothers. We have been encouraged by increased public awareness of these issues.

As you can imagine, for some moms and family members, issues of stigma and safety keep us fearful of speaking out publicly, even though we are worried sick and lose sleep thinking about the condition of our children. We do not want to add to our shame and worry by being on the receiving end of insensitive or negative comments.

As mothers affected by incarceration, we meet regularly to share our experiences and our shock, pain and heartbreak. Working together gives us energy to focus on strategies to equip ourselves with knowledge and best practices to keep ourselves and our loved ones hopeful and healthy. We are determined to achieve humane and just treatment for our loved ones in prison as we work together to strengthen the ties that bind us in our struggle as families affected by incarceration.

 

Farhat Rehman is co-founder of Mothers Offering Mutual Support (MOMS), a support group for women with incarcerated family members.

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Published on March 14, 2017

Supporting the Health of Mothers and Their Babies in the Context of Incarceration

Dr. Ruth Elwood Martin and Brenda Tole

When a friend told Ruth Elwood Martin that there was a need for a part-time family physician to work in a women’s correctional centre, her immediate thought was that there was no way she could work in a prison clinic. She perceived that it was the lowest kind of medical job, only for those doctors who were unable to find any other type of work.

Ruth is not sure what drew her to start practising medicine in a prison, but she did. On that first day in 1994, she felt like she was visiting another planet, passing through those gates, experiencing another world and learning from the people inside it. Ruth saw more pathology and more tragic medical diagnoses than she had seen in a year in her regular family practice in Vancouver’s West Side.

In the clinic, women told her about traumatic events they endured as children, young teenagers and women. Ruth would put down her pen, bearing witness to their lives, and listen to medical and social histories she could not imagine enduring. That first day in her new position changed Ruth’s life forever and she knew that prison health would become her calling. Ruth has often reflected that if she had been dealt the same childhood cards as the women she met, she might be sitting in their chairs.

In 2003, Brenda Tole was assigned to oversee the remodelling of an older facility that had housed provincially incarcerated men and to open it as the “Alouette Correctional Centre for Women” (ACCW), a medium-security facility to house provincially sentenced women. If you are a parent with school-aged children, you will have noticed how the school principal greatly influences the overall ethos of a school. In a similar manner, the warden of a prison influences the ethos of the institution, which in turn influences the overall health of the inmates.

From the day it opened in 2004, Brenda shaped the tone and ethos of ACCW. She maintained that if you expect both staff and incarcerated individuals to treat each other with respect, they will rise to meet those expectations, at least most of the time. That’s how she planned and that’s how she ran ACCW, not on the basis that 1% of the population may breach those expectations.

Brenda knew that the more she gave people opportunities, the more they valued the opportunities and responded positively. The more she gave responsibility to the women for doing things themselves, and the more she talked with the staff about her plans, the better the situation would be for everyone.

During a meeting of key health care players planning for health care delivery at the new ACCW, Brenda met Sarah Payne, the director of Fir Square at BC Women’s Hospital, a maternity unit for substance-using mothers. Babies who remained with moms at Fir Square had positive health outcomes compared with the health of babies that were taken away from their moms at birth.1 Sarah asked Brenda to consider the possibility that babies born to incarcerated mothers who came to the BC Women’s Hospital for their delivery might return with their mothers to ACCW, in order to foster breastfeeding, attachment and nurturing.

Separation through incarceration negatively affects the health of new mothers and their infants

With peer-reviewed academic literature growing on the subject, Brenda had good reason to consider this proposal. Evidence shows that one of the most compelling motivators for incarcerated women is pregnancy and their children. International correctional practices that promote contact between women and their children have shown benefits for both. Positive results have been seen in visits, email, tapes, telephone calls and letters. Children of incarcerated women are negatively impacted if the contact with their mother is limited or absent. Although it is accepted around the world that nursing infants and/or small children benefit from remaining with their incarcerated mothers, this was rarely seen in Canada at that time.

Many incarcerated women have dependent children. Worldwide, an estimated 6% of incarcerated women are pregnant while serving prison time.2 An estimated 20,000 children each year are affected by the incarceration of their mothers in Canada,3 where women tend to be held in correctional centres that are large distances from their children and families due to the limited number of correctional facilities for women across the country.

The provision of mother–child units to women in prison who have given birth to their infants while incarcerated is considered normal practice in most countries in the world. Published reports of such units exist for 22 countries, including England, Wales, Australia, Brazil, Denmark, Finland, Germany, Greece, Italy, the Netherlands, New Zealand, Russia, Spain, Sweden, Switzerland, some US states, Kyrgyzstan, Ghana, Egypt, Mexico, India and Chile.4, 5, 6

One of the reasons for keeping incarcerated mothers with their newborn babies is that it facilitates breastfeeding, which the World Health Organization reports has health benefits for the infant and new mother.7 According to international health experts, babies should be exclusively breastfed until they are six months old if possible, and then continue to be breastfed on demand until they are two years of age. Babies who are not breastfed may be at increased risk for diabetes, allergies and gastrointestinal and respiratory infections.8

In addition to the well-known health and nutritional benefits, some research has shown that breastfeeding can contribute to psychosocial development9 – the associated physical contact, eye contact and the quality of feeding promote mother–child attachment. However, establishing and maintaining breastfeeding on demand is not possible unless mothers and babies can be housed together with 24-hour contact.

Typically, mothers who return to prison without their babies after giving birth are prescribed milk-binding pills and are often prescribed antidepressants. In this situation, many mothers experience profound grief and debilitating guilt, despair and hopelessness. Many resort to substance use as a coping strategy. 

Mother–child unit developed to support well-being of incarcerated mothers and their babies

In 2005, Brenda asked Ruth, “As the prison physician, what is your opinion about the idea of incarcerated women who deliver babies in hospital being able to return here with their babies?” Ruth felt it was the most sensible idea she had heard in years, and she then expanded her prison medical practice to perform new roles, such as newborn examinations, breastfeeding coaching and addressing medical questions about newborns.

Through collaboration and partnership with several other ministries and community agencies, a mother–child unit was developed at ACCW based on the best interests of the child. With the support of Corrections Branch Headquarters, the ACCW health care team, correctional staff (both managers and frontline staff) and other provincial ministry personnel, it was decided ACCW could facilitate the return of mothers and babies to ACCW when recommended by BC Women’s Hospital and agreed to by the Ministry of Children and Family Development (MCFD), who had final authority over the placement of the child.

The decisions to place the mother and child together at the correctional facility were made by an interdisciplinary team consisting of the key staff from BC Women’s Hospital, ACCW health care, ACCW administration and the MCFD. If the mother was Indigenous, the pertinent Indigenous communities were consulted, when applicable. The mother and her family were included in all stages of this process. The support and services that Fir Square offered the mother before and after the birth fostered the mother’s confidence in parenting and in participating in the planning of her future and that of her baby. All checks and balances were put in place to ensure that ACCW was a safe and positive environment for the mothers and babies, with the cooperation of the mothers, other incarcerated women and correctional staff.

Incarcerated women who gave birth and who were deemed by MCFD able and willing to provide appropriate parental care were allowed to keep their infants in their care while in prison. During the initiative’s duration (2005–2007), 13 babies were born to incarcerated mothers, nine of whom lived in prison with their mothers and stayed there until their mother’s release. Eight babies were breastfed for the duration of their mother’s prison stay. Fifteen months was the longest stay of any infant in prison. The babies’ health and development was monitored by the community public health nurses, ACCW health care providers and MCFD social workers.

Release planning for the majority of the mothers and babies included placement at a residential supportive residence for women with substance use histories of the Fraser Health Authority, which took mothers and their young infants. The residential placement staff aimed to facilitate the transition of these women into the community.

Being involved in the initiative with BC Women’s Hospital had a profound positive effect on the women directly involved, the correctional staff and other incarcerated women, and the ministries and community agencies who partnered with ACCW.

Mother–child unit facilitates maternal involvement

Initially, other agencies and ministries were surprised and cautious regarding the proposal of the newborn babies returning to the facility with their mothers. The team at ACCW and BC Women’s Hospital took the time and facilitated many discussions and held meetings for all stakeholders to contribute to the program’s success.

Initially, the rights of the infant to be with the mother for attachment, bonding and breastfeeding was overshadowed for some by the feeling that this “privilege” should not be afforded to incarcerated mothers. As the initiative continued, the attitudes of many began to shift from cautious and guarded to comfortable and supportive. Community agencies were willing to provide supportive services to the children and mothers within the correctional facility. The collaboration reduced the need for ACCW to develop programs and services specific to the incarcerated population.

The mothers involved expressed great joy and were grateful that they could continue to breastfeed and nurture their babies at the correctional facility. They participated in parenting classes provided by a community agency through visits by the public health nurses and the MCFD worker. They also participated in health examinations by the ACCW physician to ensure the safety and health of their babies. Several of the mothers were permitted to go out into the community on escorted passes, both before and after the birth of their babies, to participate in various programs offered by community agencies that welcomed their participation.

Other women who did not have the opportunity to be with their children had to deal with the reminder of the pain they suffered as a result of being away from their own children. Seeing the babies at ACCW triggered feelings of loss, but a general feeling of hope permeated the entire population and the atmosphere at the facility was more positive in many ways. Incarcerated women wrote about their experiences as part of a prison participatory health research project, and their writing was later published in a book titled Arresting Hope.10

Seeing other ministries and agencies support this initiative had an impact on many of the incarcerated women. Most had very little trust in government agencies due to previous negative interactions. Seeing the agencies working together to ensure the babies stay with their mothers gave them a different perspective from which to view these groups. Some voiced a new interest to work with agencies to initiate contact with their own children with whom they had lost contact, or to work to improve their own lives to make a better life for their children.

For many, seeing the mothers and babies thrive at the facility and be released into the community together continued to reinforce the feeling that this initiative was not only the child’s right but also the right thing to do for the child.

Mother–child unit upheld by BC Supreme Court

In 2008, Brenda retired from ACCW and the BC Corrections Branch Headquarters shut down the prison mother–child unit. Amanda Inglis and Patricia Block, whose babies were born after the unit had closed, became appellants in a five-year legal case that led to a BC Supreme Court hearing in May 2013. During the women’s compelling testimony, Patricia told the court that there were as many as five different people caring for her daughter while they were separated. She tried to continue to breastfeed her baby while in prison, she said, but had difficulties in doing so.

At one point, her daughter’s foster mother stopped using the breast milk that Patricia had pumped because she worried it “wasn’t good milk.” Patricia had to inform the MCFD, who then ordered the foster mother to provide the breast milk to her baby. Patricia said that pumping milk in her prison cell for her newborn baby, who was then staying with relatives, gave new meaning to the phrase “crying over spilt milk.”

In December 2013, Honourable Judge Carol Ross ruled in Inglis v. British Columbia (Minister of Public Safety) that the cancellation of the mother–child unit infringed the Charter right to security of the person (section 7) of the mothers and babies affected by the decision, and that the infringements were not in accord with the principles of fundamental justice. The ruling also held that the cancellation constituted discrimination and violated section 15(1) of the Charter, the right to equality of the members of the affected groups, namely provincially incarcerated mothers who wished to have their baby remain with them while they serve their sentence and the babies of those mothers.

The judge directed the government of British Columbia to administer the Correction Act Regulation in relation to this issue in a manner consistent with the requirements of sections 7 and 15(1), and she gave six months to provide an opportunity for the government to correct the unconstitutionality of the present situation and comply with the Court’s direction.11

Guidelines developed to facilitate program adoption across Canada

The Collaborating Centre for Prison Health and Education (CCPHE) hosted a two-day working meeting in March 2014 at the University of British Columbia to generate best practice evidence-based guidelines to inform the implementation of mother–child units across Canada. Experts were invited to present during four panel discussions entitled “The Rights of the Child,” “The Correctional Context,” “Pathways and Programs” and “Evaluation.”

Thirty stakeholder organizations were invited to contribute to the writing of the guidelines by selecting delegate representative(s) to participate in the working meeting. Delegates included those from BC Corrections Branch, Correctional Service Canada, New Zealand Corrections and Women in2 Healing (formerly incarcerated mothers).

The CCPHE contracted Sarah Payne to write an initial guideline framework based on her analysis of the meeting proceedings. A “content analysis” method was used to ensure that all themes developing from the meeting data were captured in the emergent guidelines. As a final stage, international resources and research publications, which had been presented by experts as evidence during the working meeting, were reviewed.

The resulting Guidelines describe 16 guiding principles and best practices required for optimal child and maternal health inside a correctional facility, including the correctional context, pregnancy, birth, education, correctional and medical care, discharge planning and community partner engagement. Delegates from BC Corrections Branch and Correctional Service Canada, who attended the writing meeting, incorporated the Guidelines’ principles and best practices into their respective organizations’ policies and procedures.

Follow-up evaluations of the mother–child unit currently under way

The ACCW mother–child unit was established on the principle that babies should accompany their mothers back to the ACCW, which was supported by the 2013 BC Supreme Court ruling that deemed it unconstitutional to separate the two. Currently, the “new” BC provincial program and the federal program (as well as programs in the U.S.) are based on the principle that it is a privilege for the incarcerated mother rather than a right: incarcerated pregnant women have to submit an application and go through a difficult, stressful and protracted approval process.

Some infants now currently reside with their mothers in federal women’s correctional facilities across Canada. However, bringing babies to live with their mothers inside provincial correctional facilities has been slow, even though a refurbished mother–child unit opened in July 2014 at ACCW. More education and understanding about the cultural, epigenetic, legal and permanent health impacts of a decision to remove a baby at birth can help support maternal and infant health in prisons across Canada.

A 10-year follow-up evaluation of the ACCW mother–child unit that ran from 2005 to 2007 is currently under way. Through in-depth interviews with mothers whose infants lived at ACCW, this evaluation is exploring their experiences and the current health and social development of their children.

Each of the mothers interviewed to date have reported that the decision to have her baby live with her in prison transformed her life. Each woman attributed the quality and quantity of time that she spent with her baby in ACCW to making a positive long-term impact on the mother–child relationship, and each reported that she now has an exceptionally close relationship with her child. Each woman also spoke very affectionately about her child’s attributes, with kindness and a caring nature as foremost.

 

Notes

  1. Ronald R. Abrahams et al., “Rooming-in Compared with Standard Care for Newborns of Mothers Using Methadone or Heroin,” Canadian Family Physician 53:10 (October 2007), http://bit.ly/2k4K29I.
  2. Marian Knight and Emma Plugge, “The Outcomes of Pregnancy Among Imprisoned Women: A Systematic Review,” BJOG: An International Journal of Obstetrics and Gynaecology 112:11 (December 2005), doi.org/10.1111/j.1471-0528.2005.00749.x.
  3. Alison Cunningham and Linda Baker, Waiting for Mommy: Giving a Voice to the Hidden Victims of Imprisonment. London, ON: Centre for Children and Families in the Justice System, 2003.
  4. Helen Fair, “International Profile of Women’s Prisons,” World Prison Brief (February 7, 2008), http://bit.ly/2knx0BM.
  5. Kiran Bedi, It’s Always Possible: Transforming One of the Largest Prisons in the World. New Delhi: Stirling Paperbacks, 2006.
  6. Women’s Prison Association, “Mothers, Infants and Imprisonment: A National Look at Prison Nurseries and Community-Based Alternatives,” Institute on Women & Criminal Justice (May 2009), http://bit.ly/2hwPK0L.
  7. World Health Organization, “Infant and Young Child Feeding,” Fact Sheet (September 2016), http://bit.ly/1o6MEg8.
  8. Health Canada, “Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months,” A joint statement of Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada (2013), http://bit.ly/LTH03C.
  9. Grace S. Marquis, “Breastfeeding and Its Impact on Child Psychosocial and Emotional Development,” Encyclopedia on Early Childhood Development (March 2008), http://bit.ly/1cESBkC.
  10. Ruth Elwood Martin, Mo Korchinski, Lyn Fels and Carl Leggo, eds., Arresting Hope: Women Taking Action in Prison Health Inside Out. Inanna Publications, 2014.
  11. Inglis v. British Columbia (Minister of Public Safety), 2013 BCSC 2309 (SC), H.M.J. Ross, http://bit.ly/2jiUVk0.

Dr. Ruth Elwood Martin is a Clinical Professor in UBC’s School of Population and Public Health and recipient of the 2015 Governor General’s Award in Commemoration of the Persons Case.

Brenda Tole is the former warden at the Alouette Correctional Centre for Women from the time it opened in 2004 until her retirement in 2008.

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Published on February 7, 2017

The Canadian Debate on Spanking and Violence Against Children

Kathy Lynn

Just as families have evolved across generations, so too have our ideas about parenting, children and the social norms regarding discipline. While there is always diversity in what people feel is appropriate, there has been a significant shift across generations away from authoritarian parenting styles toward a more compassionate view that treats children as rights-bearing individuals rather than property.

Despite this societal shift, the use of corporal punishment in the form of “spanking”1 is legally protected under section 43 of Canada’s Criminal Code, also known as the “spanking law.” Section 43 reads as follows:

Every schoolteacher, parent or person standing in the place of a parent is justified in using force by way of correction toward a pupil or child, as the case may be, who is under his care, if the force does not exceed what is reasonable under the circumstances. R.S.C., 1985, c. C-4

This defence first appeared in the Criminal Code in 1892 and has changed little since.2 Discussions about what to do with section 43 have an interesting and active history stretching back to the 1970s and earlier, but it is still on the books today.

“Spanking” in the Courts

Section 43 has been challenged a number of times over the past 30 years. In 1998, the Canadian Foundation for Children, Youth and the Law started a rights-based legal action in the Ontario Superior Court to challenge the constitutionality of section 43 of the Criminal Code on the basis that it violates the Canadian Charter of Rights and Freedoms and the United Nations’ Convention on the Rights of the Child.

The challenge was dismissed by the Ontario Superior Court and the Ontario Court of Appeal. Despite the dismissal, the government argued that physical force should be discouraged as a normative technique of correction. The case then moved on to the Supreme Court of Canada, but, in its January 2004 decision, the Supreme Court held that section 43 did not infringe on the Charter. It did, however, set out a series of judicial limitations (which do not appear in the Criminal Code) on corporal punishment:

  • Only parents may use reasonable force solely for purposes of correction.
  • Teachers may use reasonable force only to “remove a child from a classroom or secure compliance with instructions, but not merely as corporal punishment.”
  • Corporal punishment cannot be administered to children under two or to teenagers.
  • The use of force on children of any age “incapable of learning from [it] because of disability or some other contextual factor” is not protected.
  • Discipline by the use of objects or blows or slaps to the head is unreasonable.
  • Degrading, inhuman or harmful conduct is not protected, including conduct that raises a reasonable prospect of harm.
  • Only minor corrective force of a transitory and trifling nature may be used.
  • The physical punishment must be “corrective, which rules out conduct stemming from the caregiver’s frustration, loss of temper or abusive personality.”
  • The gravity of the precipitating event is not relevant.
  • The question of what is “reasonable under the circumstances” requires an objective test and must be considered in context and in light of all the circumstances of the case.3

The current legal context has led to confusion and conflict due to contradictions between the definitions of assault outlined in criminal law and definitions of child abuse found in provincial and territorial law, as outlined by the Ontario Public Health Association:

“… a provincial or territorial child welfare authority may investigate a report of parental physical abuse of a child, conclude that she is at risk in her family and apprehend her. When this happens, police may lay a charge of assault. However, section 43 provides parents with a legal defence against such a charge. This has led to situations which seem to defy logic, in which the definition of “a child in need of protection” in provincial and territorial law leads to the child’s apprehension, but the protection afforded to parents under section 43 of the Criminal Code leads to their being acquitted of assault.”

There have been many legislative attempts to have section 43 repealed or amended, with 17 private member’s bills being tabled in Parliament since 1994, though none have succeeded. Senator Céline Hervieux-Payette has introduced numerous bills; however, to date, all have died at various stages of reading due to elections and prorogations of Parliament.4

Pressure to repeal section 43 has also mounted from the international stage since Canada signed the UN Convention on the Rights of the Child. Article 2 of the Convention states that signatories “take all appropriate measures to ensure that the child is protected against all forms of discrimination or punishment on the basis of the status, activities, expressed opinions, or beliefs of the child’s parents, legal guardians, or family members.”5

In response to reports from Canada regarding the action it has taken to meet the requirements of the Convention, the United Nations Committee on the Rights of the Child recommended that physical punishment of children in schools and families be prohibited and that section 43 be removed from the Criminal Code. However, no action was taken and the law remains on the books. To date, 51 countries have banned the physical punishment of children in all settings.

Most recently, the Truth and Reconciliation Commission (TRC) recommended repealing section 43 as the sixth of its final report’s 94 calls to action. “The Commission believes that corporal punishment is a relic of a discredited past,” it reads, “and has no place in Canadian schools or homes.”6 The federal government has since committed to accepting all calls to action outlined in the TRC report.

“…corporal punishment is a relic of a discredited past, and has no place in Canadian schools or homes.”

– Final Report of the Truth and Reconciliation Commission

 

“Spanking” Research

A most compelling body of research has been developed around the question of physical punishment of children. In June 2016, Dr. Elizabeth Gershoff, Associate Professor at the University of Texas at Austin, and Andrew Grogan-Kaylor, Associate Professor of Social Work at the University of Michigan, published a literature review that includes a wide range of studies on corporal punishment of children. They found that the research has been consistent. Spanking is at best ineffective and at worst harmful to children.7

A series of meta-analyses have demonstrated that in addition to increases in aggressive behaviour in children, spanking has been associated with increases in mental health problems into adulthood, impaired parent–child relationships, delinquent behaviour and criminal behaviour in adulthood.8 There is also research showing that a risk that initial “corrective” spanking can progress to child abuse.9

The research shows that hitting children is ineffective – instead of teaching children the reasons their behaviour needs to change, it simply causes the child pain and engenders fear. Studies have shown that children need to internalize reasons for behaving in appropriate ways.10 Spanking teaches them to behave in order to avoid physical punishment. When the threat of physical punishment is gone, children find no reason to behave appropriately. Spanking can lead to some children considering violence toward others as a problem-solver. A violent attitude can also work to reduce family cohesion.

The Future of “Spanking” in Canada

Evidence shows that children do not learn appropriate behaviour from being physically hurt. While children need to be accountable for their behaviour, modelling positive behaviours and teaching them to self-regulate, communicate their feelings and ask for help are more effective. Parents play an important role in socializing children, teaching how certain actions and behaviours are not acceptable and providing opportunities to develop the skills to function well in society.

For teaching children to grow and mature into responsible, capable and contributing adults, spanking is not the way. Violence against children should be against the law, not defined by it. We know there are more compassionate and effective ways to raise children to be capable young adults.

 

Corinne Robertshaw: A Committed Advocate

Corinne Robertshaw was a lawyer with the federal government in the 1970s. She became concerned about injuries and deaths of children caused by parents. She determined that section 43, which provides legal defence for assault against children, was a factor contributing to these injuries and deaths. She produced a study on child deaths caused by physical punishment (Discussion Paper on Child Protection in Canada, February 1981).

In 1990, she retired and dedicated the rest of her life to seeing the repeal of section 43. She created a national, multidisciplinary committee to mobilize Canadians interested in the issue and to continue to develop evidence and arguments in favour of repeal. She died in January 2013 and Corinne’s Quest: End Physical Punishment of Children was formed to continue her work and honour her legacy.

 

Notes

  1. The term “spanking” is used in this article to include corporal punishment and the use of “corrective” physical force against children.
  2. Laura Barnett, “The ‘Spanking’ Law: Section 43 of the Criminal Code,” Parliamentary Information and Research Service (June 20, 2008), http://bit.ly/2d3ZvWi.
  3. “What’s the Law?” Corrine’s Quest, accessed September 27, 2016, http://bit.ly/2dwYIJ2.
  4. Coalition on Physical Punishment of Children and Youth, “Physical Punishment Update #16,” Joint Statement on Physical Punishment of Children and Youth (March 2016), accessed September 27, 2016.
  5. United Nations, “Convention on the Rights of the Child,” Treaty Series (November 20, 1989), http://bit.ly/1fGCcXV.
  6. Truth and Reconciliation Commission, “Canada’s Residential Schools: The Legacy,” The Final Report of the Truth and Reconciliation Commission of Canada (December 2015).
  7. Elizabeth Gershoff and Andrew Grogan-Kaylor, “Spanking and Child Outcomes: Old Controversies and New Meta-Analyses,” Journal of Family Psychology, 30:4 (June 2016), doi:10.1037/fam0000191.
  8. Elizabeth Gershoff, “Corporal Punishment by Parents and Associated Child Behaviors and Experiences: A Meta-Analytic and Theoretical Review,” Psychological Bulletin, 128:4 (July 2002), doi:10.1037//0033-2909.128.4.539.
  9. Joan Durrant et al., “Punitive Violence Against Children in Canada,” Centre of Excellence for Child Welfare (March 31, 2006), http://bit.ly/2czf1mO.
  10. Elizabeth Gershoff, “Spanking and Child Development: We Know Enough Now to Stop Hitting Our Children,” Child Development Perspectives 7:3 (July 10, 2013), doi:10.1111/cdep.12038.

Kathy Lynn is a parenting speaker, author and chair of Corinne’s Quest.

This article was reviewed by Rina Arseneault, C.M., Associate Director of the Muriel McQueen Fergusson Centre for Family Violence Research (MMFC) at the University of New Brunswick.

Published on November 15, 2016

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 A Snapshot of Workplace Mental Health from the Vanier Institute of the Family.

Building Resilience at Home with Distance Coaching

While we all strive to ensure positive mental health and well-being for ourselves and our families, mental health conditions affect most households at some point, directly or indirectly. Children are no exception, with an estimated one in five schoolchildren living with mental health, behavioural or neurodevelopmental disorders.1

Both early intervention and quality, evidence-based care are essential to supporting children with these conditions and building their resilience. For some families, however, it isn’t always possible to access face-to-face intervention services. Lengthy clinic wait times, fear and/or experience of stigma and long travel distances can make it challenging to access appropriate services.

This can be particularly true for military families, in which a parent may have unpredictable schedules that often involve a greater amount of travel, separation, routine disruptions, transitions and overall stress than their civilian counterparts. Due to their high mobility and frequent moves, military families also commonly experience difficulties maintaining continuity of care for their children.2

Flexibility can facilitate mental health care for families

Clinic-based mental health services offer a variety of programs and supports to youth, but many lack the flexibility that families require to support these children while managing other family and work responsibilities. Children’s school schedules often don’t align with available mental health services, and repeated absences due to the need to attend regular appointments at a clinic can have an impact on children’s academic performance and their social relationships with friends and peers.

It may also be difficult or impossible for many parents to take the necessary time off work to bring a child to face-to-face appointments, either because they lack the necessary flexibility at work or because doing so would incur financial hardship. Nearly 7 in 10 couple families with at least one child under 16 have two employed parents, and in three-quarters of these couples, both parents work full-time.3 For single-parent families, the impact of missing work to accommodate appointments can be particularly difficult. Flexibility can be all the more important when seeking support for their children in military families, which often experience high mobility and deployments.

The Strongest Families Institute provides family-centred mental health care

Founded in 2011, the Strongest Families Institute (SFI) is a not-for-profit corporation designed to provide flexible, evidence-based and stigma-free mental health support to children customized to their needs and family realities. Based on six years of research at the Centre for Research in Family Health at the IWK Health Centre in Halifax, Nova Scotia, SFI programs and modules are now accessible across the country. SFI has been nationally recognized for social benefits by the Mental Health Commission of Canada (2012) and was the recipient of the Ernest C. Manning Encana Principal Award (2013).

SFI programs use a family-centred approach, directly engaging and involving family members throughout the process. Families can play a powerful role in facilitating quality mental health care because of their familiarity with the child’s circumstances. They also have a unique ability to provide valuable feedback to service providers throughout the engagement process.

Developing skills to build resilience… from a distance

SFI programs are focused on skill-based learning that fosters mental health and resilience skills through the use of psychologically informed educational modules that help families manage behavioural conditions or difficulties (e.g. not listening, temper or anger outbursts, aggression, attention deficits or hyperactivity) and anxiety (e.g. separation, generalized, social, specific fears).

SFI employs a unique distance coaching approach, utilizing technology to directly support families over the phone and the Internet in the comfort, privacy and convenience of their own home.4 Research has shown that distance coaching can result in significant diagnosis decreases among children with disruptive behaviour or anxiety conditions.5

“[My coach] has taught me a lot of skills that I was not aware of – especially in the conditions of the ever-changing military family life situation – and helped us deal with a lot of challenges. [My child] is more patient and approachable now. He knows how to deal with stress when his father is away [deployed]. His grades and behaviour at school have improved as well, he has fewer outbursts and the teachers have noticed the difference as well.”

– Parent of a 9-year-old participant in the Active Child program (Behaviour)

SFI’s Parenting the Active Child Program focuses on child behaviour for ages 3 to 12. In this program, parents and their children work together to create structured plans to help manage specific challenges a child may experience during particular times or activities. For example, parents and children can work together to develop a plan to make outings such as a trip to the grocery store or long trip in the car more enjoyable by using program skills. Through this simple but structured and guided approach, parents together with their children and the coach can work toward and reward good behaviour. By using the family home as a base for learning rather than a clinic setting, many of the issues of stigma are avoided. Families receive a series of written materials and skill demonstration videos, delivered either through handbooks or by smart-website technology, which teach one new skill per week to implement as part of their daily living activities.

The SFI anxiety program for 6- to 17-year-olds, Chase Worries Away, helps family learn life skills to defeat worries such as separation anxiety, performance issues, social anxiety and specific fears that are commonly related to the challenges of military life. SFI also runs a program for children ages 5 to 12 called Dry Nights Ahead, which helps with nighttime bedwetting.

Coaches ensure stability and guidance throughout the program

Children and families are supported and guided throughout the SFI programs by highly trained and monitored coaches. These coaches engage in structured weekly telephone calls that follow protocolized scripts, complementing the material families receive. During each session, the family’s coach reviews the skill that has been developed throughout the week and uses evidence-based strategies, such as role-playing and verbal modelling, to practise the skills and assess progress.

Schedules are flexible and customizable to accommodate families regardless of where they are located or where they move. This flexibility and focus on distance coaching can be particularly valuable for military families, bridging the geographical divide during separations resulting from postings so that the continuum of care is maintained. Moreover, during a posting, coaches help the families plan for the transition and they remain available during and after to encourage the maintenance of skills. This focus on planning supports families during potentially disruptive transitions, such as during a change of school or daycare.

The coach can be a familiar, centralized contact/support for the family, regardless of the move location. Coaches have high military literacy – understanding of the unique experiences of military families and the “military life stressors” that can have an impact on military families, such as high mobility, extended and/or unexpected separation and risk. Care and support is customized to the realities and needs of each family.

“[The program] helped me quite a bit, especially in everything anxiety, I still have other issues, but in terms of anxiety it has become less of a problem for me, socially, being independent, things I wouldn’t have done before, school stress has reduced quite a bit. They were the main things I was focused toward, and this has decreased stress for me.”

– 16-year-old participant in the Chase Worries Away program (Anxiety)

 

Transferable learning: Flexible support for diverse and unique families

SFI programs have demonstrated success, with families reporting high satisfaction. Rigorous testing and randomized trials show positive outcomes, with lasting effects one year later, targeting mild and moderate conditions. Programs have been found to have an 85% or better success rate in overcoming the child’s presenting problems, with an attrition rate of less than 10%. Data shows a strong impact on strengthening family relationships, parental mood/stress scores and child academic performance.

Families and their children are unique, and there is no “one-size-fits-all” solution to manage mental health or behavioural or neurodevelopmental disorders. Flexibility in SFI program design and availability can enhance the use and effectiveness of mental health supports, since families can receive support outside of traditional clinic settings and schedules. By using distance coaching and continued family support through structured calls with coaches, families engaged with SFI can receive care that is flexible, effective and respectful of their experiences and realities.

About the Strongest Families Institute

The Strongest Families Institute (SFI) is a national, not-for-profit organization that delivers distance, evidence-based programs to children and families who face issues impacting mental health and well-being. Founded in 2011, SFI seeks to provide timely delivery of services to families when and where they are needed by using technology, research and highly skilled staff.

Over the years, SFI has formed many partnerships to improve its services. Some of these partnerships have helped them deliver services to military and Veteran families, including Military Family Services – Ottawa, Bell True Patriot Love Foundation (Bell Let’s Talk) and a project collaboration with CIMVHR.

 

Notes

  1. Ann Douglas, Parenting Through the Storm (Toronto: HarperCollins, 2015).
  2. Heidi Cramm et al., “The Current State of Military Family Research,” Transition (January 19, 2016).
  3. Sharanjit Uppal, “Employment Patterns of Families with Children,” Insights on Canadian Society (June 24, 2015), Statistics Canada catalogue no. 75-006-X, http://bit.ly/1Nen7gR.
  4. Patricia Lingley-Pottie and Patrick J. McGrath, “Telehealth: A Child-Friendly Approach to Mental Health Care Reform,” Journal of Telemedicine and Telecare 14 (2008): 225–26, doi:10.1258/jtt.2008.008001.
  5. Patrick J. McGrath et al., “Telephone-Based Mental Health Interventions for Child Disruptive Behavior or Anxiety Disorders: Randomized Trials and Overall Analysis,” Journal of the American Academy of Child and Adolescent Psychiatry 50, no. 11 (2011): 1162–72, doi:10.1016/j.jaac.2011.07.013.

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.

Work–Family Conflict Among Single Parents in the Canadian Armed Forces

Alla Skomorovsky, PhD

The demands of military life can be particularly stressful for military families due to deployments, relocations, foreign residency, periodic family separations, risk of injury or death of the military member, and long and unpredictable duty hours.

Although military families can usually manage demands individually, research has shown that competing and intersecting demands leave some feeling overwhelmed. This can be particularly true for single parents in the Canadian Armed Forces (CAF), who often manage these multiple roles with fewer resources. This could help explain why enlisted single parents (men and women) have been shown in previous research to be less satisfied with military life than their married counterparts.

Work–family conflict occurs when demands in the work domain are incompatible with demands in the family domain. Despite growing evidence that work–family conflict could be a considerable problem in Canada’s military families, the number of studies examining this topic is relatively small. In a recent qualitative study, the majority of single CAF parents reported that they were able to balance work and family life, but they admitted it was a challenge, primarily because many single parents are often the sole caregivers and financial providers for their families. As one study participant put it,

“So far, the balance between my professional life and my personal life has been quite good. But it’s difficult of course when it’s just me – having to stay late, for example, and still having to work on my phone. I have to have a BlackBerry because I can’t stay late – not as late as I used to anyway. But pretty good, overall.”

Little research exists about work–family conflict in Canada’s military families

Single CAF parents may face multiple deployments and must deal with being separated from their children and not being able to care for them. Caregiver arrangements may be more complicated in these families, as, for example, the children may have to relocate to another city to live with grandparents when their mother or father leaves for a mission. In addition, single parents who experience frequent relocations may find it challenging to establish or re-establish local social networks, which are often a valuable source of support.

A few studies have suggested that single-parent military families have unique military life-related challenges and substantial work–family conflict, but there isn’t much research about this topic in a Canadian context. Director General Military Personnel Research and Analysis (DGMPRA) conducted a study to address this gap and explore the main concerns of single CAF parents. An electronic survey was distributed to a random sample of Regular Force CAF members who had children 19 years of age or younger and were single, divorced, separated or widowed. In total, the results were available for 552 single parents.

Single parents identified financial strain as a top concern; this is consistent with previous research showing that economic hardship is a leading cause of stress for single parents, both military and civilian. The second challenge for single parents was the worry about their child’s health and well-being. Although it has not been previously identified in research of civilian single parents, it is possible that this type of strain was high due to frequent parental absences related to deployment, training, unpredictable/inconsistent hours of work or overtime, common aspects of a military lifestyle. More than 60% of respondents identified financial strain and worry about health and well-being to be of considerable or extreme concern for them (see Figure 1). A large number of these parents (over 50%) were also concerned about dealing with adolescent years, doing the right thing for their children and their heavy demands and responsibilities.

 

Single-CAF-Parents_Chart1

Managing parental and work responsibilities is not impossible, but it is hard

Single parents were asked to rate the extent to which their responsibilities as a service member and as a parent are in conflict. Most do not find it impossible to meet both parental and work responsibilities (see Figure 2). However, about 55% of respondents believe that it is not easy to be both a good parent and service member and feel divided between work and family responsibilities. About 44% of these parents believe it is hard to balance military and parental roles. This is consistent with previous research showing that single military parents are susceptible to experiencing work and family conflict.

 

Single-CAF-Parents_Chart2

 

Further, participants were asked two questions about family life challenges due to occupational demands. When asked about the influence of work on family life, the vast majority of single military parents reported that work interferes with family life to at least some extent (see Figure 3). Approximately 70% of respondents noted that occupational demands sometimes conflicted with their family life, and 64% disclosed that they had missed family events due to occupational requirements.

In order to examine organizational support available to single parents in greater detail, single parents were asked whether they were aware of CAF programs and policies that could assist them in managing family and work demands. The results demonstrate that many single CAF parents are not aware of services available to them. For example, less than 10% of the participants mentioned that they were aware of Military Family Resource Centre services available to single military parents. This feeling was shared by a participant in the previously-mentioned qualitative study:

“Not everything is well advertised; you need to go and ask. If you are moving to the larger city, look for housing close to a [Military Family Resource Centre].”

Single-CAF-Parents_Chart3

 

Single CAF parents would benefit from work–family supports and greater awareness

Many single CAF parents are thriving, but the work–family conflict remains a considerable concern for some. A qualitative study participant expressed:

“I’m mainly concerned that being in the Canadian Forces may throw something unexpected at me, where I will be left in a position to choose between my career or my children.”

Single CAF parents could benefit from an increased awareness of, and access to, family assistance programs (e.g., Family Care Plans) and other programs, including counselling services. Furthermore, increasing awareness among managers and leaders about the work–family conflict challenges of single CAF parents could foster a more flexible and accommodating work environment. Finally, the ability of these parents to manage work and family responsibilities could be enhanced by tailoring programs and services to single parents (e.g., support groups) in order to increase emotional and instrumental support.

Although this research examines the main challenges and work–family conflict among single-parent CAF families, this is only a first step toward a full understanding of their well-being and unique needs. To further address the current gaps in knowledge, DGMPRA has developed a comprehensive research program related to military families, collaborating extensively with academia (e.g., via Canadian Institute for Military and Veteran Health Research). This body of research seeks to enhance the lives of Canadian military personnel, Veterans and their families. Supporting families is codified in the Canadian Forces Family Covenant, which acknowledges the immutable relationship between the state of military families and the CAF operational capacity.

 

We recognize the important role families play in enabling the operational effectiveness of the Canadian Forces and we acknowledge the unique nature of military life. We honour the inherent resilience of families and we pay tribute to the sacrifices of families made in support of Canada…

Canadian Forces Family Covenant

 

Consistent with the Family Covenant, it is important to continue developing the expert knowledge necessary to care for these families and to find ways to best meet their unique needs and ensure their individual and family well-being.

 

Dr. Alla Skomorovsky is a research psychologist at Director General Military Personnel Research and Analysis (DGMPRA), where she is a leader of the Military Families Research team. She conducts quantitative and qualitative research in the areas of resilience, stress, coping, personality and well-being of military families.

Dr. Skomorovsky received the inaugural Colonel Russell Mann Award for her research on work–family conflict and well-being among CAF parents at Forum 2015 – an event hosted by the Canadian Institute for Military and Veteran Health Research.

This article can be downloaded in PDF format by clicking here.

 

Suggested Reading

T. Allen, D. Herst, E. Bruck and M. Sutton, “Consequences Associated with Work-to-Family Conflict: A Review and Agenda for Future Research,” Journal of Occupational Health Psychology, 5(2), 278–308 (2000).

G.L. Bowen, D.K. Orthner and L. Zimmerman, “Family Adaptation of Single Parents in the United States Army: An Empirical Analysis of Work Stressors and Adaptive Resources,” Family Relations, 42, 293–304 (1993).

A.L. Day and T. Chamberlain, “Committing to Your Work, Spouse, and Children: Implications for Work–Family Conflict,” Journal of Vocational Behavior, 68(1), 116–130 (2006).

A. Skomorovsky and A. Bullock, The Impact of Military Life on Single-Parent Military Families: Well-Being and Resilience (Director General Military Personnel Research and Analysis Technical Report DRDC-RDDC-2015-R099), Ottawa, ON: Defence Research and Development Canada (2015).

(Still) Eating Together: The Culture of the Family Meal

Paul Fieldhouse

For most Canadians, eating is a daily event so routine, so ordinary that it is taken for granted. But it is also a central part of social relationships and cultural rituals, as well as a symbolic and a material means of coming together. Across cultures and time, food sharing is an almost universal medium for expressing fellowship; it embodies values of hospitality, duty, gratitude, sacrifice and compassion. The shared meal is an opportunity not only to eat, but also to talk, to create and strengthen bonds of attachment and friendship, to teach and learn. Not surprisingly, the family meal is often celebrated as a supremely important component of family life.

The modern family meal

In order to understand “family meals,” it is important to first clarify what the term means. The phrase seems simple enough, but upon examination, the notion of the “family meal” is revealed as convenient shorthand for an idea that may be more imagined than real.

A common image that might come to mind is a happy nuclear family of mom, dad and kids sitting around a nicely laid table enjoying the fruits (and other products) of a largely invisible kitchen production process. Certainly this is an image perpetuated, if not created, by mid-20th-century advertising and popular TV and magazine culture. It has firmly established itself as a cultural ideal, something to be aspired to and emulated – the ultimate symbol of perfect family unity and stability.

It doesn’t take much of a historical read to see that this nuclear concept of the family meal is a fairly modern phenomenon. In Victorian Britain, the children of aristocratic and wealthy families were more likely to eat in the nursery or kitchen with their nanny or the servants, or to eat in communal dining rooms at boarding schools, than to sit at the “family table.” In low-income households, there might not even be a table to sit around.

For young children, “table talk” may be the main source of exposure to family conversation and the expression of thoughts, ideas and emotions.

In North America, “proper” family mealtimes became part of the middle-class consciousness during the second half of the 19th century. During the economic growth and prosperity of the post-war years, the “traditional” idea of the family meal became, perhaps briefly, the norm across social classes.

There are, of course, many types of families and household relationships. What does this mean then for what can be considered a family meal? Does everyone in the family have to be present? Do they have to be eating the same foods? Do they have to be sitting around a table? Does the food have to be prepared from scratch, or at least in the home? Does everyone have to be part of the same household? What if friends or visitors are present – is it still a family meal?

Some attempts to define a family meal include formulas such as at least one adult and one child eating together, two or more people eating together, or members of the same household eating together. Each of these definitions may be necessary but not sufficient to define the family meal and, without common definitions, assessing how common family meals are – and if and how they are changing – becomes very difficult.

The rhythm and role of the family meal

As an everyday ritual, the family meal can be seen as a symbol of shared family life. It organizes the family, regularly bringing family members together and contributing to their physical, mental and social well-being. It provides a rhythm and predictable structure to the day, which can be psychologically reassuring. On the physical or biological level, it is a way to manage the nutritional needs of family members. The extent to which it is successful in so doing depends on a large number of factors, including access to affordable and nutritious food, nutritional knowledge, and food buying and food preparation skills.

The appearance of a meal on the family table represents the outcome of time-consuming and skilled activities that involve both mental decision making and physical work. This work of “deciding and doing,” which applies to all steps of getting a meal, from planning menus to shopping, preparation and serving, is largely invisible and taken for granted.

While this work is still predominantly performed by women, men are increasingly taking on a larger role in family meal preparation than in the past. Cooking a family meal can be an enjoyable and fulfilling task, but it also demands trade-offs in time, money and emotional capital.

With all the work involved, the provision of a family meal is a symbolic demonstration of the care of the meal provider. It may veer more toward love or toward duty, but it always shows commitment to the family group. By sharing meal-related tasks, from shopping to food preparation, table-laying and clearing-up, all family members can participate in this exercise of responsible family solidarity. Failure to do so may be a source of family tension. On the other hand, research has shown that being unable to regularly produce the idealized family meal may provoke feelings of inadequacy and frustration.

Children and teens benefit from family meals

The dinner table is an important place for the socialization of children. The family meal is a prime setting for their introduction to the rules and norms of accepted behaviour and family values and expectations. For toddlers and preschoolers, it teaches what is considered culturally acceptable food and, on a more basic level, what is considered food and non-food.

From a nutritional perspective, family meals provide opportunities for exposing children to a variety of healthy food choices and for modelling healthy eating behaviours, encouraging new tastes and learning to respect appetite as a guide to satiety. But just as healthy choices can be modelled, so can unhealthy ones. If the typical family meal consists of starchy, fatty or high sugar items, with fruit and vegetables making rare appearances, then this pattern will be learned and likely continued.

At family mealtimes, children learn developmental skills, such as holding a cup or manipulating chopsticks, and acquire and develop language and literacy skills through the flow of conversation. For young children especially, “table talk” may be the main source of exposure to family conversation and the expression of thoughts, ideas and emotions.

The lament for the lost family meal may actually be a reaction to perceived or feared change in family structures and arrangements.

Through the exchange of stories, anecdotes and news, children learn about the adult world and the interests and attitudes of their parents, while adults get to learn about the interests and attitudes of their children’s world. At family mealtimes, parents know where their kids are; they can gauge their moods and needs, and uncover and help solve problems.

Research has also suggested that the family meal has a “protective effect.” Children and adolescents who eat more frequently with the family may consume better quality diets and are less likely to be overweight. They have fewer emotional problems and greater academic achievement, and they may be less likely to adopt risky behaviours such as drug and alcohol abuse.

It is not clear what it is about the family meal that is protective. Furthermore, it is difficult to isolate family mealtime from other familial influences. A recent study by two U.S. sociologists suggests that most of the associations between family meals and positive outcomes for youth can be traced to family socio-economic characteristics that make it more likely that they will actually have family meals.

Family meals are changing as families change

Throughout history, the family meal has come to represent the family itself in the public mind, and there is evidence that every generation has lamented its demise. Even in the 1920s, worries were being expressed about how leisure activities and the rise of the car were undermining family mealtimes!

Sociologist Anne Murcott has suggested that the “ideal” is closest to reality among middle-class families, the group that is most anxious about its perceived loss. The family meal represents stability during times of change. The lament for the lost family meal may actually be a reaction to perceived or feared change in family structures and arrangements.

Market research survey polls provide wildly varying data on family meals, making it difficult to draw reliable conclusions. For example, in 2013 a commercial market research company provided a report to their clients that showed eight out of 10 Canadians families had a family meal at least four times a week. In Quebec, this was nine out of 10. In a survey performed for a different client in 2014, the same company reported that only two out of 10 families eat family meals more than twice a week and that 5% of families never had family meals.

While market research data may be contradictory, academic studies and government data on family meals are relatively scarce. Evidence from the U.S., the U.K. and Scandinavia has pointed to family meals happening about half the time. U.S. data for 2003–2013 from the Child Trends Data Bank showed little change in frequency of family meals reported by children, which for six to seven days a week remained at around 55% for 6- to 11-year-olds and 30% for 12- to 17-year-olds. A 2010 U.K. survey suggested that 25% of families ate together nearly every day, while one in 10 families never had an evening meal together and one in five spent less than 10 minutes at the table together.

Instead of mourning the demise of the family meal, we can look for ways to reinvigorate our relationship with food and thus with our families, friends and wider community through intentionally eating together.

Canadian data for the period 1996–2005 showed that workers were spending less time on family activities, including family meals, and were more likely to eat at least one meal alone. The 2010 General Social Survey conducted by Statistics Canada reported that Canadians spent about one-quarter of their waking hours on food-related activities (eating meals at home or at restaurants as well as cooking/washing up), of which 60–70 minutes was devoted to eating meals in the home, with younger people spending the least amount of time on this activity. Another consumer report in 2011 claimed that 55% of Canadians spent 15 minutes or less on preparing a meal.

While this data suggests that time for family meals has diminished, it doesn’t indicate directly whether the number and type of family meals are changing. However, demographic changes in living arrangements are likely to have an impact. In 2011, according to the Canada census, one-person households made up 27.6% of all homes, a threefold increase since 1961 that is especially notable in Quebec.

It is little wonder then that eating alone is becoming common. Recent U.S. polling data suggests that even outside of the home, six out of 10 meals are eaten alone.

What does seem to hold true is that the majority of people still want and value family meals, however they define them. In the U.K. study mentioned above, three-quarters of people wanted to make more effort to sit down together for a family meal. At the same time, many people admit to facing a multitude of barriers in putting this into practice.

Lack of time, work demands, busy social lives, scheduled activities – especially after-school activities for children – and increased opportunities for eating away from home are among the factors militating against the family meal. Lunch has largely disappeared as a family meal, and breakfast may not be far behind as parents report a lack of time to prepare breakfast for their children before school.

People are more inclined to eat when and where they want to in more informal and unstructured ways.

A 2012 workplace consultant report revealed that three in 10 workers don’t take lunch breaks and four in 10 eat alone at their desks. The picture is quite different in France, where the ritual of the shared meal is still a core element of collective everyday life, and in Italy, where three-quarters of the population sit down to lunch in their own homes.

Whereas snacks and mealtimes are spread throughout the day in North America, in France there are three big spikes at morning, noon and night, indicating that traditional meal patterns are strong. At 1 p.m., almost half the French are sitting down to lunch; at 8:15 p.m., more than one-third are having supper. Whether it is a family meal or a meal shared with friends or co-workers, 80% of meals are eaten in the company of others.

Statistics about family meals don’t describe anything about the nature and quality of those events. It is evident that eating patterns are changing in response to changing societal arrangements, including work roles and technology. The concept of set mealtimes to be eaten in the company of specified family members, such as the “three meals a day” pattern familiar to many older people – particularly of European heritage – has largely given way to a less structured, more ad hoc system, aptly described as “grazing.”

At the same time as there are increasing barriers to sit-down, at-home, all-family-members-together meals, food is increasingly available, especially in urban centres, on a 24/7 basis outside the home at restaurants, malls, drive-ins and even non-food outlets, such as big box stores and garden centres. People are more inclined to eat when and where they want to in more informal and unstructured ways.

Future of the family meal

Families may still eat together – though this is often at malls, in fast-food restaurants or in cars en route to the basketball game or dance rehearsal – but to what extent do these constitute family meals? The common elements of food and family are still there, but what may be missing are some of the symbolic and culturally meaningful dimensions of the home-based family meal, some of the cultural learning opportunities and the structure that family mealtimes can bring to the day. When eating in the family car, for example, a parent may not be able to demonstrate the loving and responsible role of provider in the same way, it could be harder for them to teach food manners while in motion and this setting may not invoke the same sense of a refuge from the public sphere or reminder of family unity.

Eating together, whatever and wherever that may be, can help build and strengthen bonds between family members.

Even here, though, care must be taken when making assumptions. Is it not possible to have a conversation about one’s day or to enquire about homework while on the road or sitting around the fast food restaurant table? Some critics have doubted this, yet other studies suggest that when families eat out, they behave in ways very similar to home.

Eating together, whatever and wherever that may be, can help build and strengthen bonds between family members. Perhaps instead of mourning the demise of the family meal, we can look for ways to reinvigorate our relationship with food and thus with our families, friends and wider community through intentionally eating together.

We can take what we believe is good about family meals and put it into practice every time we eat. We can re-envisage mealtimes as a time for conviviality and social bonding. Forsaking the lonely desk lunch and the solo car meal, we can seek out company to share food and community.

 

Paul Fieldhouse is an adjunct professor in the Department of Human Nutritional Sciences at the University of Manitoba and a nutrition policy and research consultant for the Manitoba government. He has an Interdisciplinary Ph.D. in Food and Religion.

This article is a reprint of (Still) Eating Together: The Culture of the Family Meal, originally published in Transition magazine (Vol. 45 No. 1).

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 can be downloaded in PDF format here.

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. Norris D, Cramm H, Eichler M, Tam-Seto L, Smith-Evans K. “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. Dursun S, Sudom K. “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. Military Family Support Services. 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.”

 

Modern Motherhood: The Unique Experiences of Women with Physical Disabilities

Lesley A. Tarasoff

There is very little research concerning pregnancy, labour, birth and motherhood among women with physical disabilities and women with disabilities more broadly. While most women face a variety of social and emotional pressures to have children, research has found that women with disabilities have a very different experience, as they are often pressured not to have children. Many of these girls and women experience “training against motherhood” as soon as they are diagnosed as having a disability. Despite these pressures, there are many women with physical disabilities who are also mothers. Although in Canada it is difficult to determine just how many women with physical or mobility-limiting disabilities are mothers, data from the United States suggests that they are becoming mothers at similar rates to women without disabilities.

As part of a long-term project, a diverse group of women with physical or mobility-limiting disabilities in the Greater Toronto Area have been interviewed about their experiences during the perinatal period – pregnancy, labour, birth and early motherhood. Drawing on other research studies and preliminary findings from this project, this article looks at some of the unique experiences of women with physical disabilities during the perinatal period.

While most women face a variety of social and emotional pressures to have children, research has found that women with disabilities are often pressured not to have children.

There are many misconceptions about women with physical disabilities, including the idea that they cannot or should not become mothers. Women with physical disabilities are often on the receiving end of disability and reproductive “microaggressions.” Initially conceptualized with regard to racial and ethnic minority groups, microaggressions refer to “the brief and commonplace, daily verbal, behavioral, and environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative … slights and insults on the target person or group.” Disability or ableist microaggressions include things such as exclusion, messages of undesirability, messages of burden, assumptions, pity and astonishment (e.g., the realization that a person with a disability is capable of achievements).

For women with disabilities who are pregnant or who are mothers, these ableist beliefs and patterns of behaviour are often compounded with what some call reproductive microaggressions. These can be direct, such as denying privacy by asking when a woman will have a baby, or indirect, such as expressions of gratitude for having a “healthy child.” Underlying many reproductive microaggressions is reproductive privilege (i.e., the traditional idea or ideal of which women should be mothers [read: white, middle-class, heterosexual, women without physical disabilities]), together with the idea that motherhood is the most exalted form of identity for women.

Jane, one of the research project participants – a married and employed mother of two with a spinal cord injury – shared her thoughts about her perinatal experience. While it was positive overall, largely thanks to her strong advocacy skills and a great team of health care providers, she still experienced a number of negative social interactions commonly experienced by women with physical disabilities in the perinatal period. Sometimes these interactions were overtly discriminatory and negative, such as when a stranger on the sidewalk told her she “shouldn’t be allowed to have children.” Other times, the microaggressions were less explicit. Like many women with physical disabilities, Jane found that many people didn’t see pregnancy as a possibility for her or recognize her as being pregnant as they might have with other women. She often encountered subtle reactions of surprise (astonishment) to her pregnancy and status as a mother while in public spaces such as waiting rooms. Sometimes the microaggressions she described took the form of differential treatment, such as the time she was asked in a grocery store whether she had her daughter “naturally” – noting that it’s unlikely a mother without a disability would have been asked the same question.

Research suggests that women with physical or mobility-limiting disabilities are becoming mothers at similar rates to women without disabilities.

Microaggressions at the intersection of disability and reproduction can also take the form of denying identity or personality by asking a mother without disabilities “Is that your baby?” or of desexualizing women with disabilities through comments such as “I can’t believe you have a baby.” These comments were occasionally directed at Jane, who said that many people she encountered assumed that she had adopted. Microaggressions sometimes take on a patronizing form, such as when people say they feel “inspired” by women with disabilities who decide to have children. Finally, microaggressions also include assumptions of helplessness and infantilizing remarks directed at these mothers, such as asking “Do you need help with your baby?”

Despite the assumption that spinal cord-injured women are able to give birth only via Caesarean section, research reveals that they can have vaginal births. “Everyone still thinks that I had a C-section,” says Jane, acknowledging this misconception.

Indeed, a growing body of research indicates that many women with physical disabilities experience fertility no differently than their counterparts without disabilities and they are capable of becoming pregnant and experiencing vaginal delivery. Though limited, there is some research concerning the pregnancy outcomes of women with physical disabilities. Some of this research suggests that expectant mothers who have physical disabilities may experience common symptoms of pregnancy more severely, and that pregnancy can temporarily or permanently “alter the course” of the disability.

Perinatal outcomes among women with physical disabilities vary depending on the type and severity of their disability. “As much as I want to say that my pregnancy was the same as everyone else’s,” Jane says, “I do admit that there probably were higher risks of complications with mine to a certain degree.” For instance, she noted that her mobility worsened during the course of her pregnancy – a change that she says wasn’t fully recognized by care providers. Indeed, studies reveal that health care providers generally do not know a great deal about the interaction of pregnancy and disability. Jane cited an example of her nurses not knowing a lot about the different catheter options.

Likewise, many of the women with physical disabilities who were interviewed, including Jane, reported feeling frustrated with the lack of perinatal information available to them and often experienced feelings of isolation because it was difficult to find others to share their experiences with. “I found it very frustrating that there is so little research. So any question I had, nobody could give me an answer,” she says. “It was always like, ‘We don’t really know. We’re not really sure.’” In addition to informational barriers, many women with physical disabilities report encountering inaccessible care settings. Jane cited examples such as places with bathrooms or showers she couldn’t access or fit her wheelchair into.

Disabled or not, at one time or another, everybody needs assistance, and it is rare that someone really, truly raises a child single-handedly.

Exploring how women with physical disabilities experience the perinatal period will provoke an interrogation of the self, of what is “normal” and what accessibility is, as well as what independence looks like. Parents with disabilities, like all parents, are creative and adaptable. In many cases, formal resources and supports are not available or accessible, and so some parents with disabilities may rely on unconventional resources and other supports to fulfill their roles effectively. At one time or another, everybody needs assistance whether they have a disability or not, and it is rare that someone really, truly raises a child single-handedly.

Moreover, for some mothers with physical disabilities, becoming a parent takes focus away from their disability and places it on other aspects of their lives, such as the new bond between parent and child as well as the child’s imagination and creativity. As Jane puts it, “Becoming a mom is probably the best thing that I did because it totally lessened … my focus or other people’s focus on my disability. My parents ask way less about my own health; they ask more about the kids.”

In particular, Jane talked about how her physical inability to do certain activities with her young son has led to opportunities to bond and play with him in other ways:

“[My son] knows that I do all the creative stuff with him, so I do all the artwork… he kind of sees us [my husband and me] as having those different [roles] … I love doing imaginative things and I think that’s important for his growing and learning … so for me what’s really boosted my confidence in parenting is that I have that ability or that gift to do that with him and the daycare has commented that he’s such a really imaginative kid…”

A number of other mothers who were interviewed shared similar stories about their relationships with their children and talked about how becoming a mother enhanced their confidence.

Many of the mothers also worried about how their children might be treated in school when other children found out that their mother has a disability: “Kids can be mean… I don’t want people to make fun of him because of me.” One mother with a congenital condition that often limits her mobility, as well as causes hearing and vision problems, arthritis and chronic pain, noted, however, that she uses her disability as a learning opportunity for her young son: “I don’t want him to make fun of anybody. I am trying to tell him that everyone is different.”

The experiences of women with physical disabilities during the perinatal period, including their parenting experiences, provide learning opportunities for all families and their children. This ongoing research project will help to develop resources for women with physical disabilities and health care providers and shed light on some of the positive experiences that they have during the perinatal period. Listening to and documenting the stories and experiences of women like Jane will be integral to this process of providing support.

 

Lesley A. Tarasoff is a Ph.D. candidate in Public Health at the University of Toronto. She conducts research in the area of women’s sexual and reproductive health, with a focus on women with physical disabilities and sexual minority women. For more information about her research, visit www.latarasoff.com.

Learn more:

Lesley A. Tarasoff, “We Don’t Know. We’ve Never had Anybody Like You Before”: Barriers to Perinatal care for Women with Physical Disabilities,” Disability and Health Journal 10:3 (July 2017). Link: http://bit.ly/2fmk65C.

Lori E. Ross, Lesley A. Tarasoff, Abbie E. Goldberg and Corey E. Flanders, “Pregnant Plurisexual Women’s Sexual and Relationship Histories Across the Life Span: A Qualitative Study,” Journal of Bisexuality (August 11, 2017). Link: http://bit.ly/2wfhZaN.

Lesley A. Tarasoff, “Experiences of Women with Physical Disabilities during the Perinatal Period: A Review of the Literature and Recommendations to Improve Care,” Health Care for Women International 36:1 (July 2013). Link: http://bit.ly/2hqbiQE.

Update: In September 2017, a community report was published based on this research into the experiences of women with physical disabilities. “Becoming Mothers: Experiences of Mothers with Physical Disabilities in Ontario” is now available to download on Lesley’s website.

 

SOURCES

Judith Rogers, The Disabled Woman’s Guide to Pregnancy and Birth (New York: Demos Medical Publishing, 2006).

Corbett Joan O’Toole, “Sex, Disability and Motherhood: Access to Sexuality for Disabled Mothers,” Disability Studies Quarterly 22:4 (2002).

Lisa I. Iezzoni, Jun Yu, Amy J. Wint, Suzanne C. Smeltzer and Jeffrey L. Ecker, “Prevalence of Current Pregnancy Among US Women with and without Chronic Physical Disabilities,” Medical Care, 51:6 (June 2013).

Alette Coble-Temple, Ayoka Bell and Kayoko Yokoyama, The Experience of Microaggressions on Women with Disabilities: From Research to Practice and Reproductive Microaggressions and Women with Physical Limitations. Presentations at the American Psychological Association Annual Convention (August 2014).

Derald Wing Sue, Jennifer Bucceri, Annie I. Lin, Kevin L. Nadal and Gina C. Torino, “Racial Microaggressions and the Asian American Experience,” Cultural Diversity and Ethnic Minority Psychology, 13:1 (2007).

Ayoka K. Bell, Nothing About Us Without Us: A Qualitative Investigation of the Experiences of Being a Target of Ableist Microaggressions (2013 doctoral dissertation), retrieved from ProQuest Dissertations and Theses (dissertation/thesis number 3620204).

Heather Kuttai, Maternity Rolls: Pregnancy, Childbirth and Disability (Fernwood Publishing, 2010).

Caroline Signore, Catherine Y. Spong, Danuta Krotoski, Nancy L. Shinowara and Sean Blackwell, “Pregnancy in Women with Physical Disabilities,” Obstetrics & Gynecology, 117:4 (2011).

Suzanne C. Smeltzer and Nancy C. Sharts-Hopko, A Provider’s Guide for the Care of Women with Physical Disabilities and Chronic Health Conditions (2005).

Published on December 3, 2015

Updated on September 25, 2017

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 (26%) 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.

 

This article can be downloaded in PDF format by clicking here.

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.

Download this article in PDF format.

 

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. http://bit.ly/1NPii1r.

[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). http://bit.ly/1ikd1BS.

 

Suggested Reading: “‘I Don’t Have Time for This!’: A Compassionate Guide to Caring for Your Parents and Yourself”

By Katherine Arnup, PhD

Aging, illness and dying are realities that we all will face at some point, in our family circles and ultimately in our own lives. Despite this fact of life, most people in the Western world are hesitant to discuss this inevitable journey with our loved ones, despite the importance of these conversations in preparing for the future.

In her new book, “I Don’t Have Time for This!”: A Compassionate Guide to Caring for Your Parents and Yourself, award-winning author Dr. Katherine Arnup provides a thoughtful and informative guide to beginning essential conversations with our parents about the end of life, tools and strategies for caregiving, keys to releasing guilt and regret, advice about asking for and receiving help, and the positive impact that facing aging, illness and death can have on our lives (and those around us).

“Katherine Arnup has been able to capture the complexity of life and living in family relationships while guiding us gently through the inevitability of death and dying. Documenting both sides of the caregiving/receiving experience, this important and timely resource helps us summon the courage to have the sometimes difficult conversations with loved ones and service providers – and with ourselves. A validation for those who have been a part of an end-of-life experience and an inspiration for all of us who expect to be part of one in the future – even if it is only our own.” – Nora Spinks, CEO, Vanier Institute of the Family

To learn more about the family experiences of death and dying in the Canadian context, read Death, Dying and Canadian Families – a 2013 report by Dr. Arnup, published as part of the Vanier Institute’s Contemporary Family Trends series. This report explores the death denying/defying culture of the Western world and its implications for families in Canada while rooting the discussion in four key contexts: Canada’s aging population, the realities of chronic illness and the need for care, the gap between desires and reality regarding the location of death, and the impact on families and family life.

About Katherine Arnup, PhD

Katherine Arnup is a social historian, life coach and retired university professor. She is the author of the award-winning book Education for Motherhood: Advice for Mothers in Twentieth-Century Canada, editor of the first book on lesbian families in Canada (Lesbian Parenting: Living with Pride and Prejudice) and author of more than three dozen articles on marriage, motherhood, lesbian and gay families, aging, death and dying.

Strength in Diversity: Positive Impacts of Children with Disabilities

Michelle R. Lodewyks

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When it comes to exploring the experiences of families raising children with disabilities, studies tend to focus on the perceived negative impact of the disability on the family. These families are commonly viewed as “victims” who face excessive caregiving demands, emotional distress, physical and/or financial burdens and interpersonal difficulties, while the children are portrayed primarily as sources of stress and anguish. This tragedy dialogue supports an assumption that families with children with disabilities experience “chronic sorrow” and perpetuates the perception of disability as something to be avoided or eradicated. These perceptions have a major influence on today’s assumptions about – and reactions to – disability, including how professionals respond to children with disabilities and how society views and responds to children at birth. Consequently, the general public tends to overlook many positive impacts and meaningful contributions that children with disabilities make within their families, communities and society in general.

In order to explore the positive impact disability can have within families, a qualitative, interview-based study was performed to add narrative depth to the research. All of the parents and children interviewed identified a variety of positive effects the children have had on their families and contributions the children have made to family life. The most unsurprising discovery was the affirmation that a child with a disability can have some of the same positive effects on their families and make some of the same contributions as any other child. Highlighting these similarities is critical, given the tendency for children with disabilities to be distinguished from other children and viewed as less likely to affect their families in positive ways. Yet perhaps even more meaningful was the discovery that children with disabilities can also have unique positive effects and make unique contributions to families and family life.

Raising a child with a disability provides opportunities for personal growth

Parents in the study reported an ability to more readily recognize and appreciate the value, potential and strengths of a person with a disability as a result of their parenting experiences. Many described how their experiences left them with a greater acceptance of diversity, a stronger belief that there is an inherent and intrinsic value in people and a “more balanced appreciation for what people are about.”

One participant said her experience gave her a new perspective on how to help individuals she works with; she learned not to place limits on people or tell them what they can or cannot do, but instead help them strive for self-improvement. Siblings of children with a disability experienced attitudinal changes brought about by this family relationship. For these siblings, increased exposure to disability in their family environment made them more comfortable around other children with a disability, and they discovered a new-found enthusiasm for getting to know people with disabilities in general.

Children with a disability often exceeded expectations and did not necessarily comply with what is typical for their diagnoses, often being nothing close to the worst-case scenarios predicted by some doctors. As one participant stated, “I don’t know what my parents would have thought about people with disabilities before I came around, but I think it’s just… shown them that it really doesn’t mean that much… you can still be productive and still have goals and not really let anything stop you, as hard as that is sometimes.”

All of the parents in the study perceived themselves as having acquired new or enhanced positive character attributes as a result of raising a child with a disability. Attribute changes included family members learning to open their hearts and to be more loving, warm, caring, creative, balanced, gentle, calm, outgoing, responsible, independent and less selfish.

The positive attribute change most commonly reported by parents of a child with a disability was that they became more tolerant and accepting. As family members learned to be more accepting of diversity and of people’s behaviours, they cultivated a greater respect for other families of children with disabilities and experienced more compassion toward people in general.

Several parents commented that their child made them an overall “better person,” “better parent” or made other family members “better people.” Some of these effects carried over into the workplace: one participant perceived himself as a “better person at work” because of the understanding his son has given him about autism. This understanding has enabled him to relate to staff and other people in a different way; he supports his colleagues by helping them understand and interpret the behaviour of a co-worker who also has autism.

Parents experience pride, joy and strengthened relationships

All parents in the study reported positive emotions their children have fostered in them. A sense of pride was the most common. One parent recognized that some of the things that evoke a sense of pride “may not be the same as what other people [her son’s age] are doing,” yet she maintained she had numerous reasons to be proud. Parents expressed pride in, or were impressed by, their children’s knowledge or creativity, their sense of right and wrong, their methods for overcoming fears, their ability to put their minds to something and take a chance, and for being their own advocates. Additionally, all 10 children reported the positive emotions they also felt they evoked in family members – more than half believing they made their family proud.

One mother insisted she derives more excitement from the little things in life than many other people and that she “celebrate[s] things that other people don’t even think about celebrating” because of her daughter. Another explained her pride in her daughter as follows: “Disability-wise, I’m very proud of her because she hasn’t let her disability control her life. She’s got multiple disabilities… And she doesn’t let that slow her down… It would be too easy to say, ‘Oh, I can’t do this’ and give up… She’s always willing to push the limits and do the best that she can.”

Many parents talked about having met people, gained friendships and made new connections thanks to their child. While any child can expand a family’s social network, certain examples were attributed to the family’s particular circumstances. For one couple, connecting themselves to other families through the creation of a support network for parents with similar experiences has been valuable, as they have been able to offer support to other parents who have approached them for advice and guidance.

Despite one parent noting that having a child with a disability may make some families “fall apart,” many parents perceived that their child strengthened their marriage or made the parents and/or family stronger. Two of the parents felt they had become better at communicating and sharing with their spouse thanks to their child. The father in this couple talked about the difficulty he and his wife experienced when their son was first diagnosed and described the role each played in helping the other get through the “tough parts.” Their experience, he explained, has made him and his wife “more free to talk about things and feelings,” thus improving their communication.

A few parents mentioned how their child added a fresh perspective and/or insight to the family. One father commented on the value of his son’s insight and identified this as something he appreciates most about him: “His insight into things is so different than anybody else. He thinks differently than we do… and I love hearing his insight. He adds such a dimension to our house… I just can’t imagine not having that dimension in our home. It’s… such a core of who we are in this house. He’s so amazing.”

Referring to his natural gifts when it comes to writing and composing music, one of the children insisted that having autism has given him the ability to be hyperfocused and successful with music. He concluded, “I think the music is a positive impact. It can impact everyone else, too, if they hear it.”

When asked how she makes a difference in her family, another one of the children replied, “I suppose it would be a little less lively without me. There wouldn’t be as many interesting dinner conversations.” She also referred to “the whole yin and yang thing” and how she counterbalances the mellowness in her family.

Families learn from their unique experiences and seek to share their knowledge

Before concluding the interviews, all participants were asked what they would like other people to understand about them, their family and/or their experience. Parents shared that their experiences are “not all rosy” – that there have been “challenges,” “struggles,” “obstacles” and “tough times.” Yet parents did not necessarily hold the child responsible for any negative aspects of their experience. One parent admitted that her struggles adjusting to her child’s disability had less to do with the child than with other people’s preconceptions and the parents’ own feelings regarding what their experience would be like. She explained, “There was no question, that period of time where you struggle with it – a bit of a denial thing. Well, you almost grieve, but you come to the conclusion that those feelings are more about you, and what you thought, or what other people might be thinking.”

Other parents agreed that any anger, stress, anxiety and/or crises they may have experienced resulted from having to deal with the ignorance of other people and a general lack of societal understanding rather than from the child. One mother requested that people reconsider their use – or misuse – of certain labels, explaining that, while people with intellectual disabilities are often labelled as hindered in some way, “the hindrance is very often on the so-called ‘normal’ people for lack of understanding them.”

These findings coincided with those from an earlier study in which parents suggested that the sorrow they experienced originated largely from having to deal with recurring messages of negativity and hopelessness from other people, such as professionals, the health system, other family members and friends. This suggests a source of stress and negativity outside the child and that a family’s perceptions about their child may be determined, at least in part, by the surrounding cultural beliefs about disability. Therefore, if society holds negative attitudes toward disability and the surrounding cultural perceptions are largely negative, negativity can be transmitted to the family – to parents’ views of, and beliefs about, their children and to their parenting.

The parents in the study also wished to dispel negative assumptions others might associate with their child and place any negativity in context of the bigger picture. Some described their experience “as a gift instead of a burden,” and insisted it is not a source of anything negative to have a child with a disability in the family, emphasizing that they are not sorry for the way their child has changed their lives. While acknowledging the stress, hard work and commitment required to raise a child with a disability, other parents commented on the unfortunate nature of other people not realizing how rewarding the experience can be. One father reframed his experience raising his son in the following way: “You want a catastrophe? You want tragedy? You know what, let me pick up a paper and show you about somebody who died in a car accident. Let me show you about a young mother that was killed. Let me show you about the tsunami. Those are tragedies. This is a curveball. All you’ve got to do is learn how to hit curves and you’ll be fine… And it’s not easy, but you learn to grow with it.”

Among the most common requests from parents were that assumptions not be made based on disability and that people recognize each child’s ability and potential. Parents insisted that their children can give a lot to society and deserve respect and requested that people make an effort to learn from their children. Elaborating, one parent cautioned, “I was just thinking in terms of the impact of… people with Down syndrome on the world… We’ve been trying to basically eradicate this group of people by all the blood testing and stuff. It devalues the lives that they have. And they have something to offer… They’ve got something really special that we need to sit up and take note of because we could learn a lot from them.”

When asked what they wanted to share with others, similarly powerful messages came from the children. One of the children wanted others to “understand that I have disabilities, but I’m not a worse person for it.” Another child offered the following take-away message: “Lots of people have the perception that I’m kind of slow… I want them to know that I really do know a lot about the world and what’s going on, and it hasn’t stopped me – having cerebral palsy, being in a wheelchair – I’m not an unaware person. I have big ambitions and a bright future. I don’t want them to feel sorry for me, because I think I’m going to have a really good and interesting and fun life!”

The positivity of embracing diversity goes beyond the family

Learning from families who view their circumstances in a positive light, making these perceptions more readily available to the general public and coming to view the experience of raising a child with a disability as one that is not necessarily tragic – but rather enriching and rewarding – can have a variety of positive implications. These findings can provide medical professionals (particularly those involved in prenatal screening and diagnosis) with practical information to share with families when a diagnosis is given. These findings might also benefit other parents currently raising a child with a disability by encouraging them to focus more closely on what their child adds to their life.

In presenting these findings, this study is not denying the existence of challenges and negative family experiences. Sharing these findings is also not suggesting that everything will automatically improve for families who struggle raising a child with a disability. Yet the belief is that appreciating the strengths and positives has potential for beneficial change. There is also evidence that focusing on the children’s positive impacts and contributions may serve to control the meaning and level of stress associated with the experience. This could be helpful in the adaptation process. If more families see their experiences in a positive light, perhaps they can assist in altering widespread perceptions of the impact of disability, provide support to new parents and relieve some of the fear and anxiety around the idea of raising a child with a disability. In doing so, the hope is that a more affirmative way of viewing disability could be promoted.

 

Michelle Lodewyks is an Instructor in the Disability and Community Support Program at Red River College as well as a graduate of the Master’s Program in Disability Studies at the University of Manitoba.

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