A narrative exploration of the right to health in the lives of Indigenous women

Abstract

This study explores, through critical narrative analysis, the understanding of Indigenous women about conditions that they need to be healthy, and how their stories and reflections provide a critique that can inform thinking around the right to health. Literature from varied disciplinary perspectives describes the right to health, and a body of health human rights, as conceptual tools that identify the conditions all people require to be healthy, encompassing not just health care and access to material goods, but equality, culture, power and participation. Literature also provides some critique of human rights, and indicates that their alignment with dominant discourses and powers may be a barrier to their effectiveness for Indigenous people. With reference to Habermas’ theories of communicative action, including the colonization thesis, the lifeworlds of 14 Indigenous women were explored in relation to the institutional discourse of health human rights. The study finds that in the stories that women shared there was some validation of human rights instruments relating to health, which identify as rights violations health harms such as violence, disruption of families, experiences of racism, and lack of support for mental health. However, women’s interpretation of these events often differed from institutional discourse in that they located responsibility for violations less in the people or organizations that harmed them, and more in processes of colonization carried out by successive Canadian governments, that effectively undermined their rights and their health. As they reflected on their stories, women identified a right to knowledge about history and the impact of colonization on Indigenous people as being important to their physical and mental health. Other findings are that a rights-based assessment of women’s health that focuses on experiences of violations and harms may be perceived as deficit-based. To be more meaningful to Indigenous women, a discourse of human rights in health could speak to their strengths and resources, and support broadly defined goals in physical, spiritual and mental health by removing barriers to agency. This study joins a body of other research in finding that explicit rights-based participation in service delivery and health policy development and evaluation may help to avoid abuses in the future, but may require more autonomous forms of governance and service delivery to address longstanding power imbalance and distrust. The study concludes that a discourse of health human rights can better meet the needs of Indigenous women when colonialism is named as a human rights abuse and the primary cause of health inequity that affects their families and communities, reinforcing their life world knowledge with rights-based accountability, and creating common understanding in the public sphere.