title: Aboriginal women's experiences of accessing health care when state apprehension of children is being threatened.
abstract: OBJECTIVE
  To report findings from a study examining the impact of the threat of child removal on Aboriginal women's experiences accessing of healthcare services.
  
  
  BACKGROUND
  A wealth of data highlights the higher proportion of Aboriginal children in government care in Canada compared with non-Aboriginal children. Aboriginal women experience poorer health outcomes than non-Aboriginal women and face significant barriers to healthcare access. However, little is known about how these phenomena may intersect.
  
  
  METHODS
  The study was conducted in two phases: (1) a secondary analysis of interviews with Aboriginal women and healthcare providers (n = 7) that were collected for a larger study; and (2) primary interviews with Aboriginal women (n = 9) and healthcare providers (n = 8), conducted between July-October 2011.
  
  
  METHODS
  Postcolonial feminist perspectives and the principles of exploratory, qualitative research guided this ethnographic study. Data were analysed using principles of thematic analysis and interpretive description.
  
  
  RESULTS
  Aboriginal women whose children are involved with the child protection system often experience complex sociopolitical and economic challenges, which intersect with the threat of apprehension. Such threat did not impact women's decisions to seek healthcare services for their children, but experiences of racism, prejudice and discrimination in mainstream healthcare agencies and the fear of child apprehension influenced their decisions to access health care for themselves in ways that deterred access.
  
  
  CONCLUSIONS
  Racism, judgment and discrimination towards Aboriginal mothers in healthcare agencies must be addressed. Educating healthcare providers about culturally safe approaches to care is critical to mitigating the ongoing impact of colonialism and its effects on health of Aboriginal people.
authors.affiliation: School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Denison
authors.forename: Colleen
authors.initials: C
authors.lastname: Varcoe
authors.forename: Annette J
authors.initials: AJ
authors.lastname: Browne
mesh_terms: D002170:Canada; D002648:Child; D003657:Decision Making; D005260:Female; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D044382:Population Groups
keywords: aboriginal women; cultural safety; ethnography; nursing; postcolonial; racism; state apprehension