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Résumé

Renverser les effets intergénérationnels des

pensionnats sur les populations autochtones :
implications pour les orientations et les pratiques
en matière de santé
Dawn Smith, Colleen Varcoe et Nancy Edwards

Cet article recense la première vague de résultats issus d’une enquête sur les
opinions et les expériences de certains acteurs communautaires travaillant à
l’amélioration des soins offerts aux femmes enceintes et aux parents chez les
populations autochtones du Canada. La question du manque d’accès aux soins
prénatals est traitée ici à la lumière d’une analyse postcolonialiste définissant le
contexte historique et social. L’étude de cas proposée est fondée sur des
principes de recherche participative. Les données ont été recueillies au moyen
d’entretiens exploratoires et de discussions en petits groupes. L’échantillon
comprend des dirigeants communautaires, des fournisseurs de soins et des
membres de la communauté affiliés à deux services de santé autochtones dans
une région surtout rurale, tous choisis à dessein. Les participants des trois groupes
considèrent que la prestation des soins aux femmes enceintes, aux mères et aux
familles autochtones devrait tenir compte des priorités et des expériences de ces
dernières.Voilà pourquoi les auteures ont ajouté la question « Quelle importance
la grossesse et le parentage revêtent-ils aux yeux des parents autochtones » au
questionnaire d’entrevue. Selon les répondants, la prestation des soins doit abso-
lument tenir compte de la nécessité de « renverser » les effets intergénérationnels
des pensionnats. Les résultats suggèrent que la grossesse et le parentage doivent
être envisagés comme une expérience propre aux personnes et aux familles
appartenant aux communautés autochtones. Par ailleurs, il faut traiter les effets
intergénérationnels des pensionnats comme un instrument de violence collec-
tive et comme un facteur clé pouvant expliquer le traitement inégal que
subissent les Autochtones du Canada en matière de santé et d’accès aux services.
Mots clés : populations autochtones, pensionnats, grossesse et parentage

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Turning Around the Intergenerational

Impact of Residential Schools
on Aboriginal People:
Implications for Health Policy
and Practice
Dawn Smith, Colleen Varcoe, and Nancy Edwards

This paper reports on the first wave of results from a study exploring the views
and experiences of community-based stakeholders on improving care for
pregnant and parenting Aboriginal people in Canada.The issue of poor access
to prenatal care by Aboriginal women and families is viewed through a post-
colonial lens within a historical and social location.This case study was guided
by participatory research principles. Data were collected through exploratory
interviews and small-group discussions. The sample comprised purposively
selected community leaders, providers, and community members affiliated with
2 Aboriginal health-care organizations in a mainly rural region. Participants from
all 3 stakeholder groups expressed the view that care should be based on an
understanding of the priorities and experiences of the pregnant and parenting
Aboriginal women and families themselves.Therefore the research question
What are Aboriginal parents’ views of the importance of pregnancy and parenting?
was added to highlight the views and life experiences of Aboriginal parents.
“Turning around” the intergenerational impact of residential schools was identi-
fied as pivotal to care.The results suggest that pregnancy and parenting must be
understood as reflecting both the unique individual and family experiences of
Aboriginal people and the intergenerational impact of residential schools as an
instrument of collective violence and as a key factor in Aboriginal Canadians’
inequitable health status and access to health services.
Keywords: Aboriginal people, residential schools, health impact, pregnancy and
parenting, population health

Introduction

Two thirds of that last generation to attend residential schools has not
survived. It is no coincidence that so many fell victim to violence,
accidents, addictions and suicide.Today the children and grandchildren
of those who went to residential schools also live with the same legacy
of broken families, broken culture and broken spirit. (Chief Councillor
Charlie Cootes, cited in Royal Commission on Aboriginal Peoples
[RCAP], 1996, p. 22)

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Dawn Smith, Colleen Varcoe, and Nancy Edwards

From the mid-1800s until as late as 1996 an estimated 100,000

Aboriginal1 children aged 4 to 18 were removed from their families and
placed in residential schools as part of the Canadian government’s assim-
ilation plan to “deal with the Indian problem” (Indian and Northern
Affairs Canada, [INAC], 1998; RCAP, 1996). Along with the enforced
separation of young children from their families and communities, resi-
dential schooling entailed the deliberate suppression of language and
culture, substandard living conditions and second-rate education, and
widespread physical, sexual, emotional, and spiritual abuse (Aboriginal
Healing Foundation [AHF], 2002; INAC, 1998; Nuu-chah-nulth Tribal
Council [NTC], 1996; RCAP, 1996; United Church of Canada, 1998).
“Disclosures of abuse, criminal convictions of perpetrators, and findings
from various studies tell of a tragic legacy…that leave former students,
their families and communities to deal with issues such as physical and
sexual abuse, family violence, and drug and alcohol abuse” (INAC, 1998,
p. 1).As a result of the residential school system,
Aboriginal children learned to despise the traditions and accomplish-
ments of their people, to reject the values and spirituality that had
always given meaning to their lives, to distrust the knowledge and life
ways of their families and kin. By the time they were free to return to
their villages, many had learned to despise themselves. (RCAP, 1996,
p. 57)
The residential school system and its enduring impacts is a complex
and historically situated phenomenon.
While it is not uncommon to hear some former students speak about
their positive experiences in these institutions, their stories are over-
shadowed by disclosures of abuse, criminal convictions of perpetrators
and the findings of various studies such as the Royal Commission on
Aboriginal Peoples, which tell of the tragic legacy that the residential
school system has left with many former students. They, and their
communities, continue to deal with issues such as physical and sexual
abuse, family violence, and drug and alcohol abuse. (INAC, 2004,
p. 1)
Aboriginal people have sought an approach to healing that addresses
individual, family, and community needs arising from the legacy of
physical and sexual abuse at residential schools. In response, the federal
government has committed $350 million in support of a 5-year

1 The term Aboriginal “refers to organic political and cultural entities that stem histori-

cally from the original Peoples in North America, rather than collections of individuals
united by so-called ‘racial’ characteristics” (RCAP, 1996).These include the First Nations,
Inuit, and Métis peoples of Canada.

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Turning Around the Intergenerational Impact of Residential Schools

community-based healing strategy and has acknowledged that it is in the

interests of Aboriginal and non-Aboriginal people to support individuals,
families, and communities in their efforts to begin the healing process
(INAC, 2004).
Though there has been legal and political recognition, and the
commencement of a process of retribution for the enduring and inter-
generational impacts of residential schools (Government of Canada,
1998; United Church of Canada, 1998), the implications of residential
schools for health policies and programs have received limited attention.
Qualitative and quantitative research has begun to describe the long-term
health impacts of residential schools (Dion Stout & Kipling, 2003; NTC,
1996;Tait, 2003). For example, a qualitative study exploring the experi-
ences of close to a hundred survivors in one region of British Columbia
found that 93% of former residents reported extreme loneliness and
feelings of abandonment, 91% reported loss/suppression of language and
culture, 92% had witnessed abuse of other residents, 90% reported having
been abused in one or more ways (e.g., sexually, physically, emotionally),
76% reported having lost their self-respect or feeling inferior, and 84%
reported problems with relationships, family, parenting, and communica-
tion (NTC, 1996).
During a study focusing on learning from successful care for pregnant
and parenting Aboriginal women, the critical importance of the
Aboriginal participants’ vision for “turning around” the intergenerational
impact of residential schools (IGIRS) became central. Participants
viewed pregnancy and childrearing as an opportunity to turn around the
IGIRS on Aboriginal individuals, families, and communities. Orienting
care for pregnant and parenting Aboriginal people within this under-
standing will require a significant shift in the roles, relationships, and
intended outcomes of care. Understanding IGIRS as one of the root
causes of the inequitable health and social conditions experienced by
Aboriginal people has implications for the underlying purpose and
rationale of health policy, health programs, and the practices of health-
care providers more generally.
This paper focuses on this central finding from the study and
describes participants’ vision for “turning it around.”The participants’
experience of pregnancy and parenting, and therefore their care needs
and priorities, could be understood only in the context of their experi-
ences of and efforts to change the IGIRS and related colonizing influ-
ences and structures. Participants felt that understanding and acknowl-
edging the IGIRS as a root cause of poor health and social conditions
such as poverty, addictions, and violence was imperative for healing and
building strength.

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Dawn Smith, Colleen Varcoe, and Nancy Edwards

Background
The federal government has had jurisdiction over health services for First
Nations and Inuit people living on reserves since 1876 and passage of the
Indian Act (Government of Canada, 1985). Since that time, services have
been provided through the First Nations and Inuit Health Branch,
formerly known as the Medical Services Branch of Health Canada. At
present, a growing majority of First Nation communities have trans-
ferred, or are in a multi-year process of transferring, administration and
delivery of on-reserve health services from the federal government to
First Nation control (First Nations and Inuit Health Branch, 2005).
Health services for Aboriginal people living off-reserve are the responsi-
bility of provincial governments, and in most provinces are regionally
administered.
On-reserve maternal-child health care comprises pre- and postnatal
care and evacuation from rural, but not necessarily remote, settings to
provincial tertiary care facilities for birth (Smith, 2002). Pre- and
postnatal programs are delivered primarily by registered nurses in part-
nership with community health representatives, and are delivered
alongside several related programs such as the Canada Prenatal Nutrition
Program, the Fetal Alcohol Syndrome/Fetal Alcohol Effects Prevention
Program, and the Aboriginal Head Start On-Reserve Program. Services
vary considerably across the regions and among communities in terms of
presence, size, and scope (Health Canada, 2000).The result of this variety
of services is a collection of programs with independent administrative,
governance, and implementation systems, rather than a coherent, inte-
grated system of care. Further, continuity and depth of care over the
childbearing continuum are disrupted by evacuation for birth, high
turnover among nursing staff, and difficulty integrating the various
programs offered on-reserve (Smith).
Anecdotal and research evidence suggest that this model of maternal-
child health care has contributed to the health and social inequities expe-
rienced by Aboriginal women, children, families, and communities
(Adelson, 2004; Dion Stout & Kipling, 1999a, 1999b).Aboriginal people
have pointed out that new health and healing systems must embody
equitable access to services as well as health status outcomes, holistic
approaches to interventions, Aboriginal authority over health systems,
responsiveness to differences in cultures and community realities, and,
where feasible, community control over services (RCAP, 1996).The need
for change has been publicly acknowledged. For example, Romanow
(2002) asserts that “action must be taken to create new models to co-
ordinate and deliver health services,” address health needs further

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Turning Around the Intergenerational Impact of Residential Schools

upstream, adapt health services and programs to each community’s

unique cultural, social, economic, and political circumstances, and “give
Aboriginal people a direct voice in how health care services are designed
and delivered” (p. 212).
While the need for change is being recognized, studies describing
the problems related to maternal-child health care far outweigh those
describing appropriate alternatives for indigenous2 populations globally.
For example, the problem of late access or lack of access to care, poor
use of care, and poor pregnancy outcomes in Aboriginal women is well
documented (Baldwin et al., 2002; Bridge, 1999; De Costa & Child,
1996; Goldman & Glei, 2003; Heaman, Gupton, & Moffat, 2005;
Hoyert, Freedman, Strobino, & Guyer, 2001; Humphrey & Holzheimer,
2000; Luo, Kierans, et al., 2004; Luo, Wilkins, Platt, & Kramer, 2004;
Public Health Agency of Canada, 2005). Evidence suggests that
Aboriginal women and families require care that is more culturally
appropriate and more relevant to their needs and strengths (Battiste,
2000; Browne & Smye, 2002; Long & Curry, 1998; Powell & Dugdale,
1999; Sokolowski, 1995; Westenberg, van der Klis, Chan, Dekker, &
Keane, 2002). Evidence shows that culturally appropriate prenatal
services have resulted in improved client satisfaction with care, earlier
initiation of care, and higher rates of breastfeeding initiation and
duration among indigenous women, although definitions of “culturally
appropriate” interventions vary (Affonso, Mayberry, Inaba, Matsuno, &
Robinson, 1996;Affonso, Mayberry, Inaba, Robinson, & Matsuno, 1995;
Buchareski, Brockman, & Lambert, 1999; Nel & Pashen, 2003).
Research and evaluation studies (Affonso et al., 1995; Buchareski et al.;
Fisher & Ball, 2002; Martens, 2002; Nel & Pashen) have found that
community involvement in program design, implementation, and evalu-
ation results in improved participant satisfaction, early access to and
participation in care, improved health behaviours such as with regard to
nutrition, lower tobacco and alcohol consumption, and feelings of
mastery concerning infant care.
However, programs of research thus far have been conducted in single
settings, close to urban centres, and/or with particular populations. Given
the gap in knowledge to inform a responsive and sustainable approach to
care for pregnant and parenting Aboriginal people, research exploring the
views and experiences of Aboriginal and community-based stakeholders
is needed.

2 The term Aboriginal is used widely in some contexts (e.g., in Canada and Australia),

while the term indigenous is more globally inclusive.

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Dawn Smith, Colleen Varcoe, and Nancy Edwards

Method
The purpose of this study was to describe the perspectives of
community-based stakeholders on their experience in designing, imple-
menting, and evaluating care for pregnant and parenting Aboriginal
women and families.As the study progressed it became clear that partic-
ipants felt that care should be based on the priorities and experiences of
the women and families themselves.Therefore, the focus of the study
brought into the foreground the views and life experiences of the
Aboriginal parents in the sample, to answer the research question What
are the views of Aboriginal parents regarding the importance of pregnancy and
parenting?
The study takes a critical postcolonial stance (Battiste, 2000; Reimer-
Kirkham & Anderson, 2002) and uses participatory research principles
(Cargo, Levesque, Macaulay, & McComber, 2003; Fletcher, 2002;
Macaulay et al., 1998). Participatory research principles include expli-
cating power imbalances, subject-subject relations in the focus and
process of research, and application of the knowledge generated in the
inquiry to influence change in the research problem (Anderson, 2002;
Mill, Allen, & Morrow, 2001). Methods used to uphold these principles
in the study included critical reflexivity (Anderson et al., 2003; Browne,
2003), maintaining the integrity of participants’ voices in context (Dion
Stout, Kipling, & Stout, 2001; Kirby & McKenna, 1989), and taking
direct action on the research problem (Cargo et al.; Fletcher, 2002).
Participants’ experiences were viewed through a critical postcolonial
lens to explicate their efforts to understand, deconstruct, resist, and
transform the impact of colonialism and its institutions (Battiste, 2000;
Reimer Kirkham & Anderson, 2002). Postcolonial and participatory
research perspectives include diverse value systems, are sensitive to differ-
ences (Battiste), value all forms of knowledge, and seek to generate
knowledge that is relevant to stakeholders and is useful for solving
problems (Mill et al., 2001). A case study design (Yin, 2003) was used to
collect in-depth contextual data regarding the experience of individual
and organizational participants in improving care for pregnant and
parenting Aboriginal people in each setting (Abelson, 2001; Cowley,
Bergen,Young, & Kavanaugh, 2000; Dopson, 2003; Langley, Denis, &
Lamothe, 2003). Ethical approval for the study was granted by the Health
and Social Sciences ethical review board of the University of Ottawa, the
ethical review committee of the participating Tribal Council, and the
Chiefs and Councils of the participating communities.
In phase 1 of the study, 16 participants from provincial, regional, and
community-based organizations responsible for services for pregnant and
parenting Aboriginal people were selected using snowball sampling tech-

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Turning Around the Intergenerational Impact of Residential Schools

niques.They were interviewed by phone or in person. Participants were

asked to share their perspectives with regard to influences on the
pregnancy experiences of Aboriginal women and families.They were also
asked to identify health-care organizations with a reputation for having
developed prenatal services with high rates of early access and participa-
tion by Aboriginal women.
In phase 2, one urban and one rural Aboriginal health-care organiza-
tion located within a single region in a Canadian province agreed to
participate in the community-based case study. Research partnerships
were formed and research agreements developed with the two partner
organizations in order to identify ownership, control, access, and posses-
sion of the research process and products. Formalization of the agree-
ments followed the protocols and requirements of the partner organiza-
tions and communities. For example, a description of the study, including
cost/benefits to the community, was presented to local Chiefs and
Councils and necessary adjustments were made in order to secure their
support for the study. Once ethical approval was obtained, participants in
each setting were purposively selected with a view to obtaining a variety
of perspectives. Clients, family members, providers, managers and admin-
istrators, policy decision-makers, and community leaders were inter-
viewed.Table 1 shows the composition of the sample for phase 1 and for
each of the community settings in phase 2.
Over 60% of the total sample self-identified as Aboriginal and 90.4%
were women. Many of the Aboriginal participants chose to share their
personal experiences as children and as parents, grandparents, aunts, and
uncles. For many participants, it was imperative that their perspectives be
understood and acknowledged within personal, historical, and social

Table 1 Composition of Sample

Phase and Setting Total Aboriginal Identity Female

# # % # %
Phase 1 16 8 50 15 93.75
Phase 2 –
29 21 72.4 25 86.2
rural community
Phase 2 –
28 15 53.6 26 92.9
urban community
Phase 2 totals 57 36 63 51 89.5
Study totals 73 44 60.3 66 90.4

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Dawn Smith, Colleen Varcoe, and Nancy Edwards

contexts. As the purpose of this paper is to describe those experiences

and their significance, the paper draws extensively on the interviews with
Aboriginal community members, providers, and leaders.
Data were collected by the first author using one-to-one exploratory
interviews and small-group discussions during field work for a period of
3 months in the two settings. In response to the opening question,“Tell
me a bit about yourself and your experiences related to pregnancy and
parenting,” many participants chose to share their personal experiences
growing up and becoming parents, grandparents, aunts, and uncles.
Although it was not a planned area of exploration, residential schools
emerged as central to participants’ experiences and their efforts to make a
difference for the children of the future. Supplementary documents and
field notes were included in the data set. Interviews were audiotaped and
then transcribed by a third party.
During a long period of immersion in the data, the first author used
NVivo software and an interpretive descriptive method to analyze the
data (Thorne, Reimer Kirkham, & O’Flynn-Magee, 2004). “The intel-
lectual task of the analyst [is] to engage in a dialectic between theory and
the data, avoiding theoretical imposition on one hand and atheoretical
description on the other, in the quest for a coherent rich interpretation
that allows apriori theory to be changed by the logic of the data”
(Thorne et al., p. 4). During the course of carrying out this analytic task
it became clear that turning around the IGIRS pervaded the participants’
experience of becoming and being parents. “Turning it around” was
therefore brought into the foreground in the purpose and ontological
landscape of the study.

Findings
“Turning it around,” a central and overriding theme of the project,
reflected a sense of hope based on understanding and confronting the
IGIRS:
We are turning it around… We are going to be better parents for our
children because we are healing. And our children won’t experience the
legacy. I mean, that is my hope, that my children won’t experience the pain
and things like that, that they will have an understanding, and what they
will acquire is the gift of…resiliency and the gift of survival, but not the
pain of the abuse and everything else. (parent/provider/leader)
“Turning it around” had three sub-themes: understanding the IGIRS,
healing, and building strength and capacity. A fourth, cross-cutting, sub-
theme of turning it around, “rebuilding our cultures in contemporary

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Turning Around the Intergenerational Impact of Residential Schools

contexts,” was interwoven within participants’ journey through succes-

sive cycles of understanding the IGIRS, healing, and building strength
and capacity.
Understanding and Acknowledging
the Intergenerational Impact of Residential Schools
“Turning it around” starts with and depends on “understanding and
acknowledging the IGIRS.” Participants described many levels of discon-
nection and alienation resulting from the IGIRS. Because children were
removed from their families over multiple generations, cultural teachings,
parenting skills, and community identities were disrupted:
It’s so intergenerational.You have generations of people who have been
affected by the trauma.… I have talked to people who have got five gener-
ations of trauma coming down. So you have four or five generations of
people who haven’t been able to connect, who haven’t had a sense of spir-
ituality, who haven’t been able to make firm attachments with their care-
givers. It is a direct result of residential school violence. (provider)
Participants described how residential schools shamed and belittled
Aboriginal values, beliefs, practices, and people. For those attending resi-
dential schools, this resulted in disconnection or dissociation from painful
feelings, low self-esteem, negative identity as an Aboriginal person, and
lack of respect for traditional beliefs and practices. Because these experi-
ences occurred during a formative period of emotional and moral devel-
opment, they became encoded into identity, beliefs, and behaviour
patterns:
They all went to residential schools except the youngest.And, again, that’s
when we are starting to work on the child’s confidence and esteem too.
…the older kids in residential school are told:“You are good for nothing.
You are just an Indian.You will never amount to anything.” (parent/
provider)
Participants conveyed the powerful influence of this encoding process
in their stories about the role of “teachings” in human social, emotional,
and moral development. They described “teachings” as how children
learn to interpret the world and their place in it.Teachings are the values,
beliefs, knowledge, and practices that make up a person’s culture. In
children, they shape identity and ways of being in relationships.
Participants described how residential school survivors pass on to their
children the residential school teachings with which they grew up.The
cycle continues as their children take up residential school teachings and
then subconsciously pass them on to their own children:

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Dawn Smith, Colleen Varcoe, and Nancy Edwards

To be really perfectly honest, for years we weren’t even considered citizens

— or people, for that matter.There were certain things that…stereotyping
— we were this and we were that. So that attitude, I went through that,
and I think in a sense I passed that on to my kids, you know, without me
really saying it so much, and anyway I think that is where it comes from.
It’s hard to see. Sometimes I don’t notice it until I start talking about it.
Sometimes we have to forgive ourselves for what we did to our kids, for
what we passed on to them. (elder/parent)
Participants described the IGIRS as the root of a downward spiral of
addiction, violence, and poverty in individuals, families, and communities:
The IGIRS is seen as underlying a lot of the substance abuse issues, the
sexual abuse and the physical abuse. So to get [to] the root of the problem,
there was more attention put on the experience of residential school.
(provider)
As emotional, spiritual, and social well-being were compromised by
IGIRS and people became caught in the downward spiral of addiction,
violence, and poverty, their strength and ability to successfully manage life’s
challenges diminished. For example, many participants described leaving
home as a preteen or teenager to escape the chaos and interpersonal
violence in their family, home, and community. This often meant
dropping out of school to look for work, finding only unskilled or
seasonal jobs and inadequate housing.These difficulties further alienated
them from family, community, and culture, perpetuating the downward
spiral.
Healing
Healing from the trauma brought on by the IGIRS is the second sub-
theme of “turning it around.” Participants explained that if things are to
be different for their children and grandchildren, if the cycle is to be
broken, then they have to face their own trauma resulting from the
IGIRS and the intergenerational transmission of residential school
teachings in order to stop the downward spiral of behaviours, cope with
life’s challenges, and find ways of healing.They described healing as a
self-determined process, for individuals, families, and communities.
Participants described their healing journey as a gradual back-and-forth
process of facing up to and forgiving oneself and others for the hurts,
changing beliefs about oneself and others, and accepting responsibility for
oneself and one’s choices. Healing requires courage, determination,
persistence, and support:
People need to do their own work…their own healing work: develop the
skills, the life skills, the decision-making skills, the comfort with themselves.

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Turning Around the Intergenerational Impact of Residential Schools

And that’s one part. But then another part is the relationships thing…the
relationship with self, the relationship with family, relationship with
community. And I think number one is that you really have to get your
relationship with yourself sorted out. (grandmother)
Participants identified forgiving self and others for past hurts and
acknowledging strengths as important aspects of healing. One parent said,
“I’m afraid to admit when I’m wrong; I’m afraid, but I have the ability
to forgive.” Participants expressed the view that part of healing is
changing personal core beliefs, particularly regaining respect for self and
all living things:
We don’t need to be powerful; we just need to be equal, to respect each
other. Letting it all go to hate, that is not good for your inside.You got to
think about your own body, deal with it, heal it and not fill it with hate.
Turn things around. Let’s do it with love and respect for each other
as women and in turn feed it to our children. (parent/community
member)

Building Strength and Capacity

Building strength and capacity was described as a significant priority for
individuals, families, and communities, in order to address the deficits
resulting from decades of the IGIRS. Healing was seen as a process of
going back to make sense of, to accept, and to heal the losses and hurts
resulting from the IGIRS. Building strength and capacity was about
acquiring the skills and resources to move forward towards one’s vision
for a better future. Participants described their efforts to develop the
knowledge, skills, confidence, and networks of support required to work
towards their vision for strong and healthy people, families, and commu-
nities. Developing goals according to their own priorities, beliefs, and
vision for the future was described as a necessary and significant part of
capacity building.
Participants’ experiences and efforts in building strength and capacity
were focused at individual, family, and community levels. At the indi-
vidual level the efforts included returning to school, reaching out, devel-
oping healthy support networks, and renewing spiritual practices.
Community capacity building was reflected in many of the interviews.
One participant described a community’s coming together, talking, and
building the capacity to set and achieve goals:
[Treaty negotiations] brought the community together to talk about the
problems, to talk about the issues, to talk about what we wanted. And
really, what they did in the development of treaty negotiations is they said,
“This is what we want in economic development, this is what we want in

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Dawn Smith, Colleen Varcoe, and Nancy Edwards

education, this is what we want in social development.”They went

through everything, and what they did without realizing it is that they
just did their long-term goals. And then once they realized what they
wanted, then of course they started doing things about it. (leader)
Parents and community leaders described collective efforts to rebuild a
strong infrastructure and a positive social environment in order to
support parents in making better choices. One community leader
described years of commitment and tenacity on this issue:
I will always stand for making this community safe for women and
children. And I need the support of everyone here. I can’t do it myself. I
can’t be everywhere.When you see something, you have to speak up about
it. I’m always telling people that we all have responsibility for making this
a safe, healthy community. Like, if you see someone molesting a child over
there, it is your responsibility to speak up. (community leader/parent)
The emphasis on rebuilding positive parenting capacity and skills cut
across many programs and sectors. Initiatives that were successful fit into
all three sub-themes — understanding the IGIRS, healing, and building
strength and capacity — to create a supportive environment for individuals
and families as they moved through their own process of “turning it
around”:
There’s more linkage there now.They [have] a lot of parenting initiatives
that they did at a school level, which would get the kids before they were
pregnant actually, and then…a lot of parenting support for young parents,
or teen parents themselves, and…a lot of professional workers who had
been given training in developing parenting programs and parenting
support programs… So I think that the issues that relate to residential
schools that affect a person’s ability to parent in a healthy way were
probably addressed in those programs. In addition, there was…the
[Residential Schools] Survivor Program. (provider)
Role models, mentors, and support people were described as important to
capacity building. Many participants described the importance of having
even one person who believed in them and showed them that it was
possible to achieve their goals and dreams. For many participants, having
a single person — a sister, an aunt, a grandparent — believe in them and
witness their struggles and achievements played a significant part in
turning childhood adversity and trauma into resilience, coping, and
acquiring life skills.
There’s a lot that happens in our communities, and I think one of the big
challenges for me was getting past that whole idea that there was no way I
could be successful and be a mother. And I think that one of the things

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Turning Around the Intergenerational Impact of Residential Schools

that greatly helped me was the fact that my mom was a teen mom. She
was 16 when I was born, 15 when she got pregnant. And everyone said
that she should either have an abortion or give me up for adoption…when
I was born her doctor said to her, “There’s no way that you are going to
provide her with a good life, and you are going to be condemning this little
girl to a horrible life and she will never amount to anything.” And my
mom did not stop working her butt off to make sure that I had a really
good life, and I did. And so I guess from seeing her I knew that all hope
was not lost. I knew that if I just worked really, really hard…I could get
there. Unfortunately I think that not everybody grows up being able to see
that. (parent)

Rebuilding Our Cultures in Contemporary Contexts

The sub-theme rebuilding our cultures in contemporary contexts cut across all
aspects of “turning it around,” because it is a healing, reconnecting
activity in itself and because it was viewed as at the root of strong people,
families, and communities. Rebuilding our cultures in contemporary contexts
reconnects people with their culture and is rooted in a strong positive
identity:
How do you change society? But that’s where the cultural pride comes
in — to have strong cultural teachings and strong pride in who you
are, [and] to really give children a sense of pride in who they are.
(parent/provider)
Reconnecting with their culture and nurturing a strong positive
cultural identity was viewed by the participants as an opportunity to
reconnect with themselves. For the participants, the process of rebuilding
their culture also reconnected families and provided them with oppor-
tunities to heal broken relationships. Family members reached out to
learn, discuss, and make decisions about how to adopt traditional ways
and teachings. For the participants, reclaiming their culture was an affir-
mative process that engaged them in the upward spiral of “turning it
around”: understanding how the IGIRS influences parenting behaviours,
forgiving, accepting and recovering from past hurts, and coming together
to build a different future for themselves and their children.
However, participants acknowledged that reconnecting with their
culture meant that they had to work through multiple impacts of the
IGIRS simultaneously.They had to mend relationships, learn how to
engage with each other in a healthy way, identify lost cultural teachings
and work out how they will be practised today, and help the person and
family reframe their cultural identities and beliefs:

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Dawn Smith, Colleen Varcoe, and Nancy Edwards

There’s a lot of disjoining in our communities.We talk about how we have

these strong family bonds…these strong cultural bonds, but quite honestly
I don’t believe they are there, all together. For instance, if we were to sit
down and talk about a practice such as a coming-of-age ceremony, truly
people would, like, say,“You’re doing it wrong…”There’s no appreciation
for the real differences between people.We are really, really focused on
making sure that everybody does it right — our way.There’s a huge
cultural loss and a huge problem of identity, both culturally and as a
family. (parent/leader)
Rebuilding our cultures in contemporary contexts was often described
as challenging, as people debate how to manage, grow with, and live
traditional cultural teachings given today’s social, geographical, and occu-
pational realities. It is not a matter of simply reclaiming traditions; rather,
it entails the creation of a new culture that honours tradition and
identity. For example:
It depends. If you’re in more of an urban area maybe you’ll draw on, say,
the Cree cultures and a mix of cultures, Métis cultures.Whereas…say [large
First Nation], who are really strong and they’re feeling comfortable, they
draw maybe more from one culture. But if you go outside of the [large First
Nation] tribe group, to, say, a Friendship Centre, it’s quite different how
they might approach it. So I think that diversity exists — how they do
their teachings and how they involve the family and the mother. (leader)

Discussion
According to international law, “forcibly transferring children of the
group to another group” is a form of genocide, or state-perpetrated
collective violence intentionally targeting a population group with the
aim of destroying it (Convention on the Prevention and Punishment of the
Crime of Genocide, 1951, cited in Krug, Dahlberg, Mercy, Zwi, & Lozano,
2002, p. 216).The long-term individual and population health effects of
genocide are well documented.They include increased rates of depres-
sion and anxiety, psychosomatic ailments, suicidal behaviour, intra-familial
conflict, substance abuse, and antisocial behaviour (Krug et al., p. 216).
“Intergenerational transmission of mental health sequellae (of collective
violence) has also been documented, with offspring of holocaust
survivors reporting higher rates of current and lifetime post-traumatic
stress disorder symptoms than control subjects, despite similar self-
reported rates of traumatic experiences in both groups” (Yehuda et al.,
cited in Krug et al.). Thus an extended burden of disease may be
conferred on communities already coping with a multiplicity of
genocide-related health consequences (Adler, Smith, Fishman, & Larson,

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Turning Around the Intergenerational Impact of Residential Schools

2004). In the case of Canada’s Aboriginal peoples, the residential school

system was just one in a collection of human rights abuses: being
required to stay on reserve (written permission to leave was required
until the mid-1960s), loss of work because of traditional activities such as
fishing or hunting, denial of rights of citizenship such the right to vote
or to own land (Furniss, 1995, 1999; NTC, 1996; RCAP, 1996), and a
host of others.
Aboriginal participants’ experiences of and explanations for intergen-
erational transmission of the traumas inflicted by the residential school
system are congruent with evidence on the impact of childhood trauma
on neurobiological (National Clearinghouse on Child Abuse and
Neglect, 2001), moral, and emotional development (Tangney & Dearing,
2002).Trauma during childhood often results in withdrawal and dissoci-
ation, with the person being cut off from his or her feelings (Dion Stout
& Kipling, 2003;Tangney & Dearing).The unhealthy relationship behav-
iours modelled in residential schools, such as coercion, abuse, and neglect,
as well as dissociation from feelings, constrains opportunities for affected
children to develop the skills necessary to form healthy relationships
(Dion Stout & Kipling, 2003).These problems are complicated by the
dysfunctional coping behaviours, such as alcohol and drug use, that they
pick up from residential school staff in order to escape from the spiritual
and emotional pain, loneliness, and isolation (AHF, 2005; Dion Stout &
Kipling, 2003; NTC, 1996; RCAP, 1996). Survivors then pass on the
resulting identities, beliefs, and patterns of social behaviour.
Participants’ experiences with turning around the IGIRS extend the
evidence on resilience, recovery from trauma, and cultural continuity into
the domain of care during pregnancy and parenting. For example, partic-
ipants stated that having at least one person witness either their painful
experiences or their successes was critical to their progress in “turning it
around.”This finding echoes the conclusion of many studies that being
connected to at least one other person is a significant factor in the health
of survivors of trauma such as severe violence or child sexual abuse
(Brown, Henggeler, Brondino, & Pickrel, 1999; Gilgun, 1990; Hall, 1996;
Rew, 2002;Testa & Miller, 1992;Wilcox, Richards, & O’Keeffe, 2004).
Dion Stout and Kipling (2003) synthesize evidence on resilience to
identify its potential contribution to facilitating resilience among resi-
dential school survivors and their family members.The results from the
present study suggest that understanding the IGIRS may tap into sources
of resilience that serve to transform parenting and family relationships
and to avert the intergenerational transmission of patterns set by residen-
tial schools.
Participants’ experiences of rebuilding our cultures in contemporary
contexts resonates with evidence on the positive impact of community-

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Dawn Smith, Colleen Varcoe, and Nancy Edwards

based efforts to rebuild First Nations cultural continuities devastated by

decades of colonization (Chandler & Lalonde, 1998).The results of this
study extend the significance of this work on cultural continuity into the
domain of pregnancy and parenting.
The present study contributes to the emerging body of evidence on
cultural safety (Browne, 2001; Browne & Smye, 2002) by raising the issue
of safety in the context of care during pregnancy and parenting.
Culturally safe care entails an understanding of the history of coloniza-
tion and its impact on Aboriginal people, attention to power relations in
health-care relationships, and the fostering of safe, supportive relation-
ships (Polashek, 1998;Wood & Schwass, 1993).The present findings add
to the literature on cultural safety by demonstrating the importance of
bringing these issues to the fore in the design and delivery of safe and
supportive policies and programs.
Implications
Understanding and acknowledging the IGIRS emerged as central to
participants’ vision for a better future for their children, and thus as
salient to safe and supportive health-care relationships. Understanding and
acknowledging the IGIRS requires an understanding of the pathway of
devastation that results from multiple levels of disconnection and
alienation when people undergo decades of genocidal policy and social
relationships.The resulting downward spiral of addiction, violence, and poverty
is often racialized as being an Aboriginal “characteristic” instead of
recognized as the consequence of collective violence (Browne, 2001;
Reimer Kirkham & Anderson, 2002).
Colonialist health policies and practices and colonialist relations in
general are reinforced by silence on the subject of residential schools,
both within and outside of Aboriginal communities, and racialized expla-
nations for the inequitable health and social conditions endured by
Aboriginal people (AHF, 2005; Adelson, 2004). Health policy and
programs may inadvertently reinforce stereotypes if addictions and
violence, rather than IGIRS, are conceptualized as the root cause of
health and social inequalities.The underlying assumption is that charac-
teristics of Aboriginal people actually explain increased rates of addiction
and violence.When policies and practices are based on racialized expla-
nations of health and social conditions, the result is unresponsive and
unsafe services. Such racialized explanations may also be responsible for
the pattern, among Aboriginal people, of poor access to and use of main-
stream pregnancy and parenting programs.The health and social condi-
tions resulting from the IGIRS cannot be reversed unless the views and
experiences of Aboriginal people are recognized and unless their vision

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Turning Around the Intergenerational Impact of Residential Schools

for change is brought into the foreground of maternal-child health policy

and practice.
The present results suggest that the understanding of community-
based stakeholders with regard to both the root causes of and acceptable
approaches to safe and supportive care in Aboriginal communities must
be part of the discourses that shape health policy and programs as well as
training programs for health professionals. Health status and experiences
like pregnancy and parenting must be seen within a broad understanding
of the impact of colonization on Aboriginal people. The unique life
experiences and life meanings of individuals, families, and communities
must also be acknowledged. Practitioners must develop a critical under-
standing of colonization as a process of collective violence perpetrated to
“deal with the Indian problem.” However, safe practice also requires
respect for individual responses to the IGIRS shaped by the interplay of
diverse personal, family, and community contexts. Further, system differ-
ences related to geographical location, population size, and governance
arrangements also contribute to variations in experiences and meanings
with regard to both individuals and communities.

Conclusion
The foregrounding of Aboriginal parents’ explanations for the root causes
of poor health and social conditions in their communities represents a
paradigm shift for maternal-child health policy and programs and profes-
sional practices, which have positioned Aboriginal people themselves as
“the problem” and focused efforts on the downstream effects of residen-
tial schools.The sub-themes in the participants’ stories serve as a prescrip-
tion for action, on the part of both Aboriginal and non-Aboriginal
people, with regard to relationships, programs, and policies to bring the
culture back by acknowledging the profound effects of IGIRS, empha-
sizing healing, and focusing on strength and capacity. Such a perspective
will enable health policy, organizations, and providers to work in closer
harmony with Aboriginal people to achieve their vision, instead of rein-
forcing the colonizing relations that are a legacy of the past and a feature
of everyday practice.
Such a shift will require nurses to develop the individual competen-
cies necessary for culturally safe nursing practice. Further research is
needed to explicate competency development processes that will build
partnerships between Aboriginal organizations and communities and to
identify implications and actions for the nursing education and practice
organizations that oversee our professional responsibilities to the public.

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Dawn Smith, Colleen Varcoe, and Nancy Edwards

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Yin, R. K. (2003). Case study research: Design and methods, 2nd ed. London: Sage.

Dawn Smith, RN, MN, is a doctoral candidate in Population Health at the

University of Ottawa, Ontario, Canada. Colleen Varcoe, RN, PhD, is Associate
Professor, School of Nursing, University of British Columbia,Vancouver, Canada.
Nancy Edwards, RN, PhD, is Professor, School of Nursing and Department of
Epidemiology and Community Medicine, and Director, Community Health
Research Unit, University of Ottawa, and Academic Consultant, City of Ottawa
Health Department.

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