GENDER-BASED VIOLENCE AGAINST INDIGENOUS WOMEN IN THE CANADIAN HEALTH CARE SYSTEM & THE DIVISION OF POWERS.

• Author: MacDermaid, Katie

"I am not free while any woman is unfree, even when her shackles are very different from my own."

--Audre Lorde

Stupid as hell. Only good for sex. Better off dead. These are only some of the disparaging remarks made about Joyce Echaquan, a 37-year-old mother who was admitted to a Joliette, Quebec hospital on September 28, 2020 for stomach pain. (1) She died several hours later while under the care of the nursing staff. Echaquan was given morphine despite her insistence that she would have an adverse reaction to it. Apart from being ridiculed in French, a language she could not understand, she had also been tied down to her bed. The hospital staff, having shown a blatant disregard for their patient's quality of care and for her life, refused to listen to her concerns. Echaquan died from an allergic reaction to the morphine prescribed. (2) This was not Echaquan's first mistreatment in a healthcare setting; making her wary enough to film the encounter. The last hours of her life were recorded and uploaded to her Facebook account. How many other women have suffered a similar fate but did not have proof? This is not a first for many Indigenous women in Canada, nor will it be the last.

Gender-based violence against Indigenous women in Canada is not only a human rights violation, but a collective healthcare problem. The Canadian National Health Insurance Program, referred to more commonly as Medicare, is designed to ensure that all Canadians have equal access to hospitals and physicians. Instead of having one standard plan, there are 13 provincial and territorial health care insurance plans. (3) According to section 92 of the Constitution Act, healthcare falls under the responsibility of the provinces, and therefore allows provinces to administer their own healthcare plan. According to section 91 of the Constitution Act, however, Indigenous peoples fall under the responsibility of the federal government, making the proper care and treatment of Indigenous peoples a divided jurisdictional issue. Those who are impacted most by the decisions and consequences of these issues are women and children. There has long been jurisdictional debates over the rights of Indigenous peoples, but perhaps none so callous as arguing over who should pay for their healthcare treatment. Ultimately the dispute boils down to: who will foot the bill? The quarrel over funding and the lack of a standard procedure means that more energy is expended on finances than on the healthcare of Indigenous peoples. The goal of this paper is to demonstrate how this division of powers issue contributes to gender-based violence against Indigenous women, and in turn, further contributes to their oppression and inability to fully participate in their citizenship; a citizenship that was founded upon their land, no less.

Statistics show that Indigenous women face significantly higher levels of violence, both sexual and domestic, than non-Indigenous women. (4) Despite Indigenous women making up the largest part of women who are assaulted in Canada, they are the most likely to die or receive less than adequate treatment in healthcare. (5) This issue is circular: the more women who are assaulted, the more likely they are to require medical treatment, and the more likely they are to require medical treatment, the more likely they are to receive below adequate care and suffer exponentially for seeking it. This is not an isolated issue. Indigenous women are less likely to have access to reproductive healthcare, safe abortions, and overall, are less likely to receive compassion and care from healthcare providers. Some of the reasons why healthcare is so hard to access include lack of services in remote locations, cost of travel off-reserve, and racism in the healthcare system--which endangers both the proper course of treatment and access to these services. If women are unable to easily access healthcare services, especially where reproductive resources are concerned, they lose agency over their bodies and their choices, which has a negative impact on their self-worth. This leads to further instances of trauma, which results in issues within the family, such as intimate partner violence, child abuse, and addiction issues becoming more prevalent.

Violence against women and the treatment they receive in healthcare are correlated, and the government has historically perpetuated this cycle by not actively legislating to protect these women or by not intervening in some capacity. By turning a blind eye to the individual practices and systemic racism in the provinces, Indigenous women are more at risk for mistreatment--even though they are supposedly under the protection of the federal government, and have been promised as much. Racist practices, continued today, are expressly contrary to the inquiry into Missing and Murdered Indigenous Women and Girls (MMIWG), the Truth and Reconciliation Commission's Calls to Action (TRC), and the United Nations Declaration on the Rights of the Indigenous Person (UNDRIP).

To a large extent, the degree of intimate partner violence and the abhorrent history of abuse in the reproductive healthcare system, has contributed to a legacy of distrust among Indigenous peoples. The remnants of these discriminatory practices continue to affect the level of care provided to Indigenous women today. This narrow issue is simply a microcosm of the larger issue of systemic racism in Canada. There are many contributing factors at the root of racist medical practices in a healthcare setting, including a general lack of awareness. Many healthcare professionals--from receptionists to doctors--charged with caring for Indigenous women, do not see systemic racism as a problem. Policy and governmental change are driven by social attitudes and perceptions. Until there is an unqualified demand for better quality services from society as a whole, the government will see no reason to invest in them. Research into these topics are underfunded, under-researched, and underrepresented, which contribute to a lack of visibility about Indigenous women's issues in these areas.

Ultimately, why is it that Indigenous peoples experience some of the worst healthcare practices in Canada, despite its national healthcare coverage system? The following three sections will address how the division of powers contributes to the detriment of Indigenous women in the healthcare system. The first section will explore how colonial myths have contributed to the heightened levels of violence against Indigenous women in Canada. The second section will focus on the abusive and oppressive medical practices affecting agency and rights of Indigenous women. The last section will focus on weaving the previous two sections together by affirming that gender-based violence is a public healthcare problem which does not fully allow Indigenous women to engage in their citizenship, thereby constituting a blatant human rights violation, contrary to federal commitments, such as the TRC and MMIGW, and contrary to international human rights frameworks, such as UNDRIP. This section will focus on federalism issues that are at play in the healthcare system, specifically when it comes to equal access and funding. Successive government commitments to different human rights frameworks are lacking in the implementation stages concerning Indigenous peoples, making it both a deeply federal and provincial issue. The universal healthcare program exists to ensure everyone has equal access to medical services, regardless of socio-economic background or status. This public system ensures there is no price tag on health. It promises to treat everyone with dignity. Unfortunately, this concept is still illusionary for many Indigenous communities. The provinces look to the federal government for guidance, but their fluid policies are better known for what they do not say, rather than what they do say. Hospitals are meant to save lives; not take them.

Colonial Myths and their Contribution to Heightened Levels of Violence Against Indigenous Women in Canada

Indigenous women suffer from poorer healthcare and social outcomes compared to their male counterparts, and more blatantly, compared to non-Indigenous women. The reality of being an Indigenous woman in Canada today is not comforting. Indigenous women and girls are 12 times more likely to be murdered or go missing than any other woman in Canada, and 16 times more likely than Caucasian women. (6) They are also more likely to be assaulted, robbed, kidnapped, and in addition, make up the majority of people in Canada who are trafficked. (7) Due to these stressors and circumstances, it is therefore no surprise that Indigenous women suffer from higher rates of heart disease and stroke, higher rates of suicide, disproportionately live as single parents in poverty, and are more often criminalized. (8) The health and wellbeing of Indigenous people continues to lag behind that of the overall Canadian population in virtually every measure, and most research points to racism as a primary factor.

Gender-based administrative violence is a deeply colonial strategy and, for the most part, a wide range of medical practices "are the result of nonaccidental and systematic production of institutional violence that cannot be disentangled from the goals of ongoing settler occupation and dispossession of Indigenous lands." (9) These practices include forced sterilization, poor birth outcomes, and discrimination. There are wide disparities for maternal health care between Indigenous and non-Indigenous women: Indigenous women experience higher rates of adverse outcomes, including stillbirth and prenatal death, and, in some cases, low-birth-weight infants, prematurity and infant death. (10) Reasons for this include lack of access to health treatment within remote communities and the cost of travel to hospitals from reserves. Indigenous peoples living in rural areas are often subject to worse...