Maternal Child Health Program in First Nations Communities

Frequently Asked Questions (FAQ)

What is the Maternal Child Health Program for First Nations Living on Reserve?

At the September 13 2004 Special Meeting of First Ministers and National Aboriginal Leaders, the Prime Minister announced additional funding for programs that promote the health status of Aboriginal people - one of these programs is the Maternal Child Health program in First Nations communities, on-reserve.

This program includes home visiting by Nurses and Family Visitors (experienced mothers in the community) as well as coordinating access to services for children with special needs.

It will provide support, information and linkages to other services for pregnant women and families with infants and young children allowing them to care for themselves.

The MCH program builds on other community programs which are important to pregnant women and families with infants and young children such as the Canada Prenatal Nutrition Program (CPNP), the Fetal Alcohol Spectrum Disorder (FASD) program, Nursing Services, Oral Health, and the Aboriginal Head Start on Reserve (AHSOR) program.

Why are Maternal Child Health Programs important, and how do they differ from other approaches?
In the past, health services in First Nations communities have focussed on treatment and crisis response. MCH takes a more proactive, preventative and strategic approach to promoting good health and preventing disease.

Early experiences are the foundation on which an individual’s life is built. In Canadian and international health systems, MCH programs have been shown to have a positive effect on the participating mother and child’s physical and mental health. In fact, effective MCH programs enhance the physical, psychological, cognitive, and social development of all family members.

Home visiting by nurses and family visitors – a key element of MCH programs – has been linked with improved parenting skills and quality of home environment, improved cognitive development of infants and young children, and the decreased incidence of unintentional injury. These visits have also improved detection and management of postpartum depression, improved rates of breast-feeding, and enhanced quality of social supports to mothers.

Cost-benefit analysis of two long-term home visiting studies, conducted by David Olds of the University of Colorado Health Sciences Center and his colleagues, indicate that the social and economic benefits of home visiting programs outweigh the costs by a ratio of more than five to one.

Interventions like MCH, that focus on improved reproductive health, prenatal and postpartum services, and early childhood development, present an opportunity to break the cycle of persistent gaps in life chances between Aboriginal and non-Aboriginal children. These kind of approaches are referred to as making strategic ‘upstream’ investments early in a child’s life.

Who is Health Canada trying to reach with its new MCH program?
The new MCH program will benefit pregnant women and families with infants and young children living in First Nations communities. As well, the reproductive health component of the program will focus on young adults and high school students.

For the past 10 years, provinces and territories have been strengthening their MCH programming because it has such a positive effect on the lives of pregnant women, families with infants and young children.

Currently, few First Nations communities have access to these programs. Up until now, there has been no comprehensive approach to the delivery of MCH services on-reserve that compares to what is offered in mainstream communities. Funding from the federal government’s “upstream” investments will support MCH programs in on-reserve communities.

First Nations people who live off-reserve will continue to access MCH programming from the province or territory in which they live.

What is the goal and objectives of the First Nations MCH program?
The immediate goal is the implementation of a comprehensive and coordinated program of MCH services in identified communities across Canada that will improve maternal, infant, child and family health outcomes. This will be done in consultation with Aboriginal organizations and communities, provinces, territories and other key stakeholders.

The long term goal of MCH services is to improve outcomes for First Nations mothers, infants and young children who live on-reserve, ensuring that all children can reach their developmental and lifetime potential.

How will the MCH program be implemented to ensure success?
Health Canada is taking a comprehensive, coordinated approach to its MCH program, targeting First Nations people living on reserve, that is “community-based and community-paced” - grounded in culture, values and language. It will build on the strengths of the community and existing programs, including support from Elders, CPNP, FASD, nursing services, and oral health programs. The community will be supported through the building of infrastructure, capacity and partnerships.The unique geographic realities of remote and isolated First Nations/I communities will also be respected.

Each MCH program will attempt to reach all pregnant women and new parents, with a strong focus on identifying families in the community who require additional supports. Staff for existing programs are unable to take on additional responsibilities, so it will be necessary to hire nurses and trained home visitors for the MCH program. The home visitors will be the primary point of contact for a community participants in the MCH program. Nurses will coordinate and support the home visitors’ efforts with clinical expertise and links to other community services.

Services through the proposed MCH program would include reproductive health, screening and assessment of pregnant women and new parents to assess levels of risk and family needs, as well as in-home visiting to provide follow-up and referrals, as required.

Targeted services for children/families at risk will:

1. Provide families with complex needs with a single entry point to services;

2. Provide service coordination and case management services;

3. Avoid duplication of services that can occur when a number of service providers are involved with a family; and,

4. Help children and families with complex needs to access AHSOR programs and CPNP, allowing them to benefit from integration with peers in a supportive setting.

In sum, the MCH program will be community-based, community-driven and community-involving. By building on community-specific cultural knowledge and ways of doing things, it will deliver the culturally appropriate services and supports that community members need, and that they will appreciate and accept.

What level of funding is being invested in the MCH program?
At the September 13, 2004 Special Meeting of First Ministers and Aboriginal Leaders on Health, the Government of Canada undertook to provide funding in key areas to promote Aboriginal health. An additional $700 M over five years was announced including $400 M over five years in upstream investments that focus on diabetes, suicide prevention and MCH, which includes Early Childhood Development (ECD). Of this, $110 million will be directly invested in the new MCH program and a further $35 million for Aboriginal Head Start On Reserve.

Will every First Nations community have a Maternal Child Health program?
The initial funding is not sufficient to provide an effective MCH program in every First Nations community. A phased-in approach will be used to introduce the program.

Dividing up the funding on a per capita basis would allow only the largest communities to offer a program. Instead, funding in the first year will be provided to communities that have capacity to provide an MCH program, based on criteria that have been developed in consultation with regional offices and First Nations organizations and communities.

Regional staff will work with these communities to develop multi-year MCH work plans, either at the community level or at an appropriate level such as a tribal council or regional health authority. Selected communities must commit to evaluating their program to help guide the development of MCH services in other communities.

At the same time, Regional staff will work with other communities to increase their capacity to meet the criteria and submit work plans in subsequent years.

Is five years enough time to make a real impact? What happens after the first five years?
The initial five-year period is only a beginning. The strong evaluation component built into our approach will help demonstrate the impact of the MCH program as a core public health program in communities.

To support expansion of the program, it will be crucial to demonstrate the positive impact MCH programs have on health outcomes for pregnant women and families with infants and young children as early as possible in the initial funding period.

How will Health Canada ensure that it’s MCH program doesn’t duplicate what is already being done by the Provinces?
Health Canada’s new MCH program intends to specifically address the current gaps between federal services and those provided by provinces, and to clarify roles and responsibilities. At the national level, MCH services are being planned with the Assembly of First Nations (AFN). Regional consultations will also inform this process. At the regional level, provinces, territories and First Nations organizations and communities will be involved in planning MCH services.

Policy Areas

Maternal Child Health Program in First Nations Communities