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Faces of Childbirth: The Culture of Birth and the Health of the Greenlandic Perinatal Family
Nordic Council of Ministers, Nordic School of Public Health NHV.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

INTRODUCTION. This dissertation concerns childbirth and its position within the Greenlandic society. It takes a world relational view to health promotion during, focusing on the perinatal family and the importance of the mothers, the child, their families and the local community as equal pieces of a whole.

AIM. The aim of the dissertation is to present new concepts and knowledge concerning the health of the perinatal family in Greenland. It looks holistically at the place of birth with focus on the issue of support of the perinatal family. It seeks to present the perinatal family and its position within the Greenlandic society. It links the changes in health policy with the concepts of family, attitude and community structure. It draws on statistical, historical, anthropological and cultural data within the context of the Greenlandic perinatal family.

METHOD AND MATERIAL. The dissertation is comprised of four studies and uses multidisciplinary methods. Over an eight-year period from 2003 to 2011, narrative interviews and focus groups were collected at four sites in Greenland: Nuuk, Ilulissat, Sisimiut and Tasiilaq. Data included seven focus groups with 35 participants, supplemented with 18 individual interviews of mothers, fathers and Culture Bearers, as well as two literature studies. The mode of conducting focus groups and interviews was based on the principles in the Helsinki Declaration.

RESULTS. The perinatal family’s concepts of safety are often connected directly to access to family and community. Family is perceived as security, and lack of family support and network as insecurity. The concept of family and community is culturally specific and connected to the immediate family, extended family and kin. There is a cultural room for birth in Greenland, where the health of the perinatal family lies in their ability to strengthen the bonds within family, kinship and community networks. The mothers of the study perceived themselves as the bearers of their children; the fathers considered themselves to be the artisans and caregivers for their family; the community, including the extended family, deemed an important support network for the families.

CONCLUSION. It is important to understand the link that exists between traditional and cultural properties and the health of the child within the family. These are elements of the eco cultural pathways that are already integrated within the family interactions and could be a way to strengthen family interaction and health. Families and community support these traditions and in healthy eco cultural exchanges it enhances the child’s role as a health–promoting agent within the family. Greenlandic public health, health promotion programs and the national perinatal guidelines have a physical health focus, but do not address the mental, social and spiritual dimensions of perinatal health. This fragmented way of perceiving and implementing health does not support the relational worldview that is an integral part of the culture of Greenland, and thus many families struggle to exercise choice within the system

Abstract [da]

INDLEDNING. Afhandlingen omhandler fødselen og dets betydning i det grønlandske samfund, idet der anlægges et holistisk sundhedsfremmende syn på den perinatale periode og der fokuseres på vigtigheden af kvinder, børn, deres familier og lokalsamfundet som ligeværdige dele af helheden.

MÅL. Målet med afhandlingen er, at præsentere nye begreber og viden om sundheden om den perinatale familie i Grønland. Der ses holistisk på fødested og dens indflydelse på familiestøtte i den perinatale periode. Afhandlingen tilstræber at præsentere den perinatale familie og dens placering i det grønlandske samfund. Den forbinder ændringerne i sundhedspolitikken med begreberne familie, holdninger og samfundsstruktur. Den bygger på statistisk, historisk, medicinsk-antropologisk og kulturel data inden for rammerne af den perinatale sundhed i Grønland.

METODER OG MATERIALER. Afhandlingen indeholder fire studier som benytter sig af tværfaglige metoder. Der er i en otteårig periode fra 2003 til 2011 gennemført fokusgrupper og individuelle interviews, ligesom der er gennemført to litteraturstudier i samme periode. Det empiriske data er indsamlet fire steder i Grønland: Nuuk, Ilulissat, Sisimiut og Tasiilaq. Syv fokusgrupper med i alt 35 deltagere, er suppleret med 18 individuelle interview med kvinder, fædre og Kulturbærer. De anvendte metoder til gennemførsel af afhandlingens interviews og fokusgrupper er i overensstemmelse med Helsinki-Erklæringen

RESULTATER. For de perinatale familier er begrebet sikkerhed ofte knyttet direkte til familie og samfund. Familien opfattes som sikkerhed, og manglende mulighed for familie støtte og netværk opfattes omvendt som usikkerhed. Begrebet ansvar er for familien og samfundet kulturelt specifikt og er knyttet til den nærmeste familie, udvidede familie og slægtninge. Der findes et ‘kulturelt rum’ for fødsel i Grønland, hvor den perinatale families evne til at styrke båndene indenfor familien, slægtskabet og det lokale netværk er medvirkende til familiens sundhed. Lokalsamfundene, familierne og kvinderne i studierne opfatter sig selv som bærer af deres børn, fædrene opfatter sig som støtteskabende omsorgsgiverer for deres familie, og lokalsamfundet, herunder den udvidede familie, opfatter sig som et vigtigt støttenetværk for familierne.

KONKLUSION. Det er vigtigt at forstå det sammenhæng, der eksisterer mellem traditionelle og kulturelle egenskaber og barnets sundhed i familien. Disse er elementer af de øko-kulturelle stier, der allerede er integreret i familiens samspil og kan være måder hvorved familiens samspil og dens sundhed styrkes. Familierne og samfundet støtter disse traditioner og i en sund øko-kulturudveksling styrker det barnets rolle som sundhedsfremmende agent inden for familien. Grønlandsk folkesundhed, sundhedsfremmende programmer og de nationale perinatale retningslinjer har et fysisk sundhedsfokus, men der tages ikke højde for de mentale, sociale og åndelige dimensioner indenfor perinatal sundhed. Denne opsplittede måde at opfatte og gennemføre sundhed på, understøtter ikke det relationelle verdenssyn der udgør en integrerende del af kulturen i Grønland, hvofor mange familier kæmper for at udøve selvbestemmelse inden for systeme

Abstract [kl]

AALLARNIINEQ. Ilisimatuutut allaatigisap ernineq pillugu imarisaqarpoq, erninerullu kalaallit inuiaqatigiinni pingaaruteqassusia aamma sammineqarluni, erninerup nalaani ataatsimut isiginninnittaaseqarluni aammalu arnat, meeqqat, ilaqutaasa najukkamilu innuttaasut ataatsimoornermi naligiittut isigalugit.

ANGUNIAGAQ. Ilisimatuutut allaatigisami anguniagaavoq, isummat nutaat ilisaritissallugit kalaallillu ilaqutariit meeraalu erninerup nalaani peqqissutsimut ilisimasariaqartut sammineqassallutik. Ilisimatuutut allaatigisap anguniarpaa ilaqutariit ernininerup nalaani ilisaritissallugit aammalu erninerup kalaallit inuiaqatigiinni inissisimanera takutissallugu. Peqqinnissaqarnermi allannguutit eqqarsaatigalugit ilaqutariissuseq, isummersortarneq inuiaqatigiinnilu aqqissuusaaneq sammineqarput. Sumi inunngorsimaneq ataatsimut isiginnittaaseqarluni sammineqassaaq aammalu erninerup nalaanni sumi inunngorsimaneq ilaqutariinnut tunaartaanersoq. Allaaserisami paasissutissat Kalaallit Nunaanni erninerup iluani peqqinnissaqarnikkut tunngasutigut aamma statistikkikkut, oqaluttuarisaanikkut, antropologiskimik, biofysiskimik, kulturikkullu tunngavilersuutit atorneqassapput.

ILISIMATUSARNERMI NAJOQQUTASSANIK KATERSUINEQ. Atuagarsornikkut misissuinerit ukiuni arfineq pingasuni ingerlanneqarput ukioq 2003-miit ukioq 2011 ilanngullugu, soorlulusooq alaatsinaanneqartunik apersuinerit inunillu ataasiakkaanik apersuinerit ingerlanneqarsimallutik. Atuagassiaqarnikkut misissuinerit marluk ingerlanneqarsimapput, ilisimatusarnikkut paasissutissanik misissuinerit Kalaallit Nunaanni piffinni sisamaasuni ingerlanneqarsimalluni: Nuuk, Ilulissat, Sisimiut Tasiilarlu. Alaatsinaanneqartunik apersuinerit arfineq marluk, taakku katillutik 33-nik peqataasullit ingerlanneqarsimapput, tassungalu ilanngullugu inunnik ataasiakkaanik 18-iusunik arnanik, ataataasunik, kulturikkullu ersuttunik apersuinerit. Ilisimatusarnikkut sakkugineqartut ilisimatuutut allaatigisami apersuinermi alaatsinaanneqartunillu apersuinerit Helsinki-Erklæring naapertorlugu ingerlanneqarput

ILISIMATUSARNIKKUT INERNERI. Nunasiaajunnaarnermi ernineq arnanut namminerminut tunngatinneqarpoq taamaasilluni ernineq pillugu paasissutissat amerlagisassaanngitsutut oqaatigisariaqarlutik. Erninermut naalakkersuinikkut anguniakkat malittarisassallu sumiiffinni ataasiakkaani qinikkanit allaffimmilu aqutsisunit saqqummiunneqartarsimapput, qaqutiguinnartumillu arnanut ernilersunut aammalu najukkami inuiaqatigiinnut isumaqatiginninniutaasarsimallutik. Ilaqutariinnut erneqqajaasunut isumannaallisaaneq isummap imarisaatut isigalugu ilaquttariinnut inuiaqatigiinnullu tunngatinneqarput. Ilaquttariit toqqaannartumik isumannaallisaasutut isigineqarput, ilaqutariinnilu qanigisanilu tapersersuisoqarsinnaanngikkangat nalornineq pilersarluni. Akisussaaneq ilaqutariinnut inuiaqatigiinnullu isummap imarisaatut isigalugu kulturikkut immikkut isigineqarpoq qaniginerpaasanullu tunngatinneqarluni, ilaquttanut qanigisanullu allanut. Kalaallit Nunaanni erninermut tunngasut "kulturikkut immikkut inissaqartinneqarput", tamatumani erninerup nalaani ilaqutariit imminut qanilleqqajaallaqqissisarlutik, ilaqutariissuseq najukkamilu inuiaqatigiit ataqatigiinnerat peqqissutsimut tapertaalluartarlutik.

ILISIMATUSARNERUP NAAMMASSILERNERANI ISUMMIUSSAQ. Kalaallit ilaqutariit unamminartunik naapitsinermi naapertuulluartumik aaqqiisinnaasimapput, tamatumani nunarsuarmioqatigiinni aningaasaqarnikkut ineriartornermi inuiaqatigiillu malinnaataasumik ineriatorfiata kingunerisaannik pisimasut anigorluarsimallugit. Najukkami inuiaqatigiit, ilaqutariit arnallu misissuinermi meeqqanik nammattutut imminut paasinnipput, ataataasullu ilaqutariinni meeqqanut tapersersuisutut inuttullu isumaginnittutut imminut paasinnipput, aammalu najukkami inuiaqatigiit ilaqutariillu tamarmiusut ilaqutariinnut pineqartunut ataqatigiiaattut pingaarutilittut imminut paasillutik.

Place, publisher, year, edition, pages
Nordic School of Public Health NHV Göteborg, Sweden , 2013. , 92 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2013:4
Keyword [kl]
Kalaallit ilaqutariit, ernineq, ilaqutariit erninerup nalaanni, ilaqutariit meeraarartallit ataqatigiiaanik tapersersuisoqarnera
Keyword [en]
Greenlandic family, childbirth, perinatal family, health promotion, family support networks
Keyword [da]
Grønlandsk familie, fødsel, den perinatale familie, sundhedsfremme, netværk hos småbørns familie
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3781ISBN: 978-91-86739-54-6 (print)OAI: oai:DiVA.org:norden-3781DiVA: diva2:787231
Public defence
2013-04-18, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Danish)
Opponent
Supervisors
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2015-02-09Bibliographically approved
List of papers
1. Songlines and touchstones:: A study of perinatal health and culture in Greenland
Open this publication in new window or tab >>Songlines and touchstones:: A study of perinatal health and culture in Greenland
2013 (English)In: AlterNative: An International Journal of Indigenous Peoples, ISSN 1177-1801, Vol. 9, no 1, 87-101 p.Article in journal (Refereed) Published
Abstract [en]

Abstract: This paper aims to focus on how family and community in Greenland perceive support- giving during the perinatal period. It explores Greenlanders use of storytelling as a health- promoting tool in the perinatal period. It is research set in Greenland, but analysed in a larger context. Using an ethnographic approach to subject matter, the paper is based on a series of qualitative interviews and focus groups conducted between 2003 and 2011 with mothers and fathers. Ethnographic content analysis, interviews and dialogues with Culture Bearers were used to analyse and set the stories into a cultural perspective. The child was described as the centre of the family and the family as the bedrock of life. The mothers, fathers and Culture Bearers presented three main concepts in their stories: 1) my family ... a safe harbour, 2) the child as the centre of the family, and 3) the equal sharing of burden and joy

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3777 (URN)
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2015-02-09Bibliographically approved
2. Family support and the child as health promoting agent in the Arctic - "the Inuit way".
Open this publication in new window or tab >>Family support and the child as health promoting agent in the Arctic - "the Inuit way".
2012 (English)In: Rural and remote health, ISSN 1445-6354, Vol. 12, no 2, 1977- p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: In the context of the UN's 1990 'Convention on the Right's of the Child' 1990, and the associated definition of health promotion as a community's ability to recognise, define and make decisions on how to create a healthy society, this article describes and analyses how family support networks are conceived and present themselves in perinatal Inuit families.

METHODS: This literature review conducted an initial and secondary search using the keywords and combinations of the keywords: healthy families, health promoting families, resiliency, Arctic, Inuit, Family support, was executed in PubMed, Popline, CSA and CINAHL. The tertiary literature search was then combined with literature gleaned from literature lists, and other relevant articles were selected.

RESULTS: Individual members of the family contribute to the health of the family, but the child is often the catalyst for health promotion within the family, not only the siblings to the unborn child, but also the unborn child. Perinatal entities create their own networks that support and develop concepts of family and support systems. Resiliency, kinship and ecocultural process within the family are concomitant to the health of perinatal family and of the children.

CONCLUSION: More research is needed that moves children from being viewed as the receivers of health towards being seen as the promoters of health and an important actor as health promoting agent within the family.

Keyword
child health promotion, ecocultural pathways, Greenland, health promoting agents, health promotion, Inuit, resiliency, social network.
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3779 (URN)22553986 (PubMedID)
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2015-02-10Bibliographically approved
3. Literature review: The ‘logics’ of birth settings in Arctic Greenland
Open this publication in new window or tab >>Literature review: The ‘logics’ of birth settings in Arctic Greenland
2013 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 11, 79-88 p.Article in journal (Refereed) Published
Abstract [en]

Objective

to review literature on the physical place of childbirth in Greenland between 1953 and 2001, using a narrative review theory and a content analysis framework, the paper seeks to describe and analyse the change in perinatal health care structure in Greenland.

Design

findings were discussed within the framework of Daviss' Logics bringing into account scientific, clinical, personal, cultural and intuitive logics as well as economic, legal and political ‘logics’ concerning perinatal health care policies.

Setting

the literature study concerns the place of birth in Greenland, a self-governing constituency of 57,000 people, the world's largest island and with a predominately Inuit population with its own language and culture. Inuit population with its own language and culture.

Findings

the place of birth in Greenland has changed and focus has moved from birth as a personal and community act to birth within the private and political arena. New policies and guidelines for pregnancy and childbearing decisions are seldom negotiated with the women, families and their communities.

Conclusionspolicy changes have an influence on the social and cultural development of Greenland and it poses a challenge and a counter weight to the political and economic limitations that the government works within. Women and children are vulnerable groups and are directly affected by the changing perinatal health care and policy. It is important that when changing policy, the women and their families are part of the dialogue around chang

Keyword
Greenlandic Perinatal Policy; Inuit women; Literature review; Birth settings
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3778 (URN)
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2017-12-04Bibliographically approved
4. 'There was no other way things could have been.' Greenlandic women's experiences of referral and transfer during pregnancy.
Open this publication in new window or tab >>'There was no other way things could have been.' Greenlandic women's experiences of referral and transfer during pregnancy.
2010 (English)In: Anthropology & Medicine, ISSN 1364-8470, E-ISSN 1469-2910, Vol. 17, no 3, 301-13 p.Article in journal (Refereed) Published
Abstract [en]

The World Health Organization (WHO) has stated that referral practices along with midwifery care are a means of heightening the quality of perinatal care and lessening perinatal mortality and morbidity. In 2002, in response to high perinatal mortality and morbidity, a referral system was instituted nationally in Greenland, transferring all at-risk pregnancies to its national referral hospital. Little or no current research has focused on evaluation of the perinatal referral system or on the thoughts, beliefs, opinions and challenges faced by women and Greenlandic families themselves. The aim of this paper is to document how women referred to Nuuk because of at-risk pregnancies narratively constructed self-understanding and defined meaning during their period of separation from family and community; and how they dealt with the challenges they were presented with. Interviews were conducted with women upon their arrival at the national referral hospital and during fieldwork over a one-year period. Narrative framework was used for analysis. Coping theory and narrative theories were the theoretical base for structuring the narratives. Through their narratives, women presented their identities as mothers, community members and caretakers. Acceptance of referral was described as a means of protecting their unborn child and was where women found an inner source of strength to deal with their own anger, joy, anxiety and loneliness. The ability to accept referral was directly connected to their family and community and the support they found therein.

Keyword
Greenland, the Arctic, qualitative, pregnancy, indigenous people, childbirth
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3780 (URN)10.1080/13648470.2010.526696 (DOI)21153964 (PubMedID)
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2017-12-04Bibliographically approved

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