“My first daughter called me to motherhood and my second daughter called me to birth work.”

That’s how Miranda Kelly (Tilyen), she/her/, Director of Indigenous Women & Family Health for Vancouver Coastal Health – Aboriginal Health, opened her CGSHE Spotlight Series talk on Decolonizing Research & Practice. CGSHE’s Spotlight Series was launched earlier this year as an educational webinar series of leading Indigenous community and clinical practice experts to bridge the gap between research, policy, and practice. Following a powerful opening from Elder Roberta Price, Kelly (Tilyen) walked almost 300 virtual attendees through a timeline of Indigenous birth and reproductive health on the unceded lands now called Canada, leaving no shameful detail of our collective past unearthed.

A full spectrum doula, Kelly (Tilyen) is of of Stό:lō and mixed settler ancestry. She was raised in her home community, Soowahlie First Nation and holds a Master of Public Health from the University of British Columbia. She outlined how the policies of settler colonialism have negatively harmed birthing for Indigenous people, acting as a site of ongoing colonization. “These are current events. They’re not historical, and they continue to impact lives today,” she said.

“My vision and hope for Indigenous people and families and birth workers is that we can really invest our energy in reimagining how we see Indigenous birth and reproductive justice…and have our allies do some of the heavy lifting of transforming systems of oppression.”

Two trends interweave these colonial policies: the separation of Indigenous people from the land, and the separation of Indigenous children from their families. “The Indian Act created reserves and impacted the way we access our lands, which had wide implications for our health and wellbeing if you consider that the reserves cut off or restricted access to hunting and harvesting areas, fishing areas that our people used, and the infrastructure on reserve was often very lacking. Even today we have communities that don’t have access to clean drinking water, that have poor housing quality.” Alongside the genocide of residential “schools”, a federal policy mandating that physicians and nurses attend births meant Indigenous people could not be supported by their traditional midwives. In the late 1960s, the federal government implemented an evacuation policy, requiring Indigenous people who were pregnant to leave their communities to give birth in hospital.

According to Kelly (Tilyen), things started to change in the early 1970s with the repeal of the Sexual Sterilization Act which although not targeted to Indigenous people, disproportionately impacted Indigenous peoples’ reproductive rights. A shift in First Nations health governance meant a reclamation of Indigenous ownership and sovereignty in health services and health care decision making. But the BC government did not ban “birth alerts” – the practice of flagging Indigenous parents arriving in hospital to birth their babies to social workers, often leading to apprehension – until 2019. Data from CGSHE/UBC shared earlier this year by Thumath, Bingham and colleagues demonstrates that the forced removal of Indigenous children continues as an ongoing colonial policy of institutional racism. Allegations of social workers in BC forcing Indigenous children in foster care to have IUDs inserted indicate a continued colonial approach and human rights violations of Indigenous people’s reproductive health.

“Just because legislation is repealed or policy is changed, that doesn’t always translate into change in practice or attitudes or societal norms or beliefs,” Kelly (Tilyen) explained. “Our health system was built on racist policy, and the system still retains those racist attitudes, assumptions, norms and practices. We all want to believe that violence and genocide are events of the past but we know they’re not.” She pointed to the In Plain Sight report, a damning indictment of British Columbia’s health care system that exposes anti-Indigenous racism. Authored by the Hon. Dr. M.E. Turpel-Lafond (Aki-Kwe), the report chronicles “widespread systemic racism against Indigenous people” in the form of stereotyping, discrimination and prejudice, resulting “in a range of negative impacts, harm, and even death”, with Indigenous women particularly affected. [source]

“What can we do, as individuals?” Kelly (Tilyen) asked. The path forward has been laid out repeatedly: in the 1998 Royal Commission on Aboriginal Peoples, the 2015 Truth and Reconciliation report and the 2019 Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls, as well as 2020’s In Plain Sight report. “They make recommendations, calls to action, calls for justice – they’re very clear in the approaches we can take to decolonize Canada and its various systems, including the health care system.” She acknowledged the way forward can feel overwhelming: “There are a lot of recommendations and we can’t do all of them. So find where you have influence and let’s get creative when we think about how we can operationalize those recommendations. Look at your local community where you live and play – what kind of work is going on there? What are the local Indigenous people doing and how can you support them and… the ongoing work to decolonize?”

The work is already underway in terms of approaches to decolonizing birth and reproductive health, Kelly (Tilyen) said. “I want to honour every single Indigenous baby that is born because that is the resurgence and resistance. Every single Two-Spirit and queer and person that loves themselves for who they are, that is resistance and resurgence. Every baby wrapped in a moss bag, every baby carried in a cradle board, that is resistance and resurgence. I raise my hands to every I person out there celebrating our reproductive wellness and reclaiming the power of indigenous birth and parenthood.”

Kelly (Tilyen) ended her talk with a call to action to settlers and “allies-in-training”: “My vision and hope for Indigenous people and families and birth workers is that we can really invest our energy in reimagining how we see Indigenous birth and reproductive justice and being able to be on the land with our plants and our aunties and dear elders and learn from one another and have our allies do some of the heavy lifting of transforming systems of oppression.”

Watch Miranda Kelly (Tilyen)’s talk, Decolonizing Indigenous birth work and reproductive health here.