Preconception Care for Indigenous Communities

Guidance for Health Care Providers

Key Messages for Providers

  • Preconception care provides an important opportunity to support reproductive health and improve maternal and infant outcomes for Indigenous peoples in Canada.
  • Indigenous communities experience inequities in reproductive health outcomes that are linked to colonialism, systemic racism, and barriers to culturally safe health care, rather than biological differences.
  • Providing culturally safe, trauma-informed care and supporting Indigenous self-determination in health care are essential components of equitable preconception care.
  • Routine clinical encounters provide opportunities to identify health risks, build trust, and support reproductive goals before pregnancy occurs.

Indigenous Health Clinical Reminder

Providing culturally safe care for Indigenous patients involves recognizing the ongoing impacts of colonialism and systemic inequities within health systems.

Clinicians can support respectful and culturally safe care by:

  • Acknowledging the historical and ongoing impacts of colonialism and racism
  • Listening to patient experiences without judgment and validating those experiences
  • Respecting Indigenous knowledge, cultural practices, and community supports
  • Supporting patient autonomy and shared decision-making
  • Collaborating with Indigenous-led health services when possible

Trust-building and respectful communication are essential components of culturally safe care.

Why Equity Matters in Preconception Care

Indigenous peoples in Canada have historically experienced systemic inequities in access to health care and social services. These inequities are rooted in the ongoing impacts of colonial policies, including residential schools, forced relocation, and discrimination within health systems.

These structural factors influence health outcomes through:

  • Barriers to accessing timely care
  • Geographic and transportation challenges
  • Socioeconomic inequities
  • Experiences of racism or discrimination in health systems
  • Intergenerational trauma

Preconception care offers an opportunity to build respectful relationships, address health risks early, and support culturally appropriate care before pregnancy.

Clinical Pearl: Culturally Safe Care Improves Engagement and Trust.

Acknowledging historical and ongoing harms in health systems and providing respectful, culturally safe care can strengthen patient–provider relationships and improve access to care.

Core Clinical Principles

Equitable preconception care for Indigenous patients should emphasize:

  • Culturally safe and trauma-informed care
  • Respect for Indigenous knowledge and perspectives
  • Patient-centred communication
  • Continuity of care and relationship-building
  • Integration of medical and social risk assessment
  • Collaboration with Indigenous-led health services where possible

Providers should recognize that trust-building may take time and requires respectful, consistent care.

Routine Screening and Assessment

Preconception visits should include assessment of both clinical health risks and social determinants of health.

Screening should be:

  • Routine
  • Non-judgmental
  • Repeated over time
  • Independent of pregnancy intention

Areas to assess include:

  • Chronic health conditions
  • Mental health and psychosocial stress
  • Substance use
  • Access to primary care and community supports
  • Housing stability and food security
  • Experiences with health care systems

Understanding broader social and cultural contexts can help providers tailor care appropriately.

Core Clinical Priorities

Chronic Disease Optimization

Chronic conditions such as diabetes, hypertension, and obesity can affect pregnancy outcomes and should be addressed before conception.

Key Preconception Actions

  • Screen for chronic conditions
  • Optimize disease management before pregnancy
  • Review medications for pregnancy safety
  • Provide accessible follow-up care

Mental Health and Intergenerational Trauma

Mental health and intergenerational trauma can influence reproductive health and engagement with care.

Key Preconception Actions

  • Screen for depression, anxiety, and psychosocial stress
  • Provide trauma-informed care
  • Offer referral to culturally appropriate mental health supports
  • Recognize the impacts of intergenerational trauma on health and well-being

Substance Use and Harm Reduction

Substance use may be linked to broader social determinants and trauma.

Key Preconception Actions

  • Screen for alcohol, tobacco, and substance use
  • Provide harm-reduction counselling
  • Offer referrals to culturally safe treatment services
  • Integrate substance use and mental health care where possible

Reproductive Life Planning and Autonomy

Preconception counselling should support reproductive autonomy and informed decision-making.

Key Preconception Actions

  • Ask about reproductive goals without assumptions
  • Provide counselling on pregnancy planning and contraception
  • Encourage folic acid supplementation and health optimization prior to pregnancy
  • Support shared decision-making about pregnancy timing

Communication and Relationship-Building

Respectful communication and culturally safe care can strengthen engagement with health services.

Helpful conversation prompts include:

  • “What has your experience with health care been like so far?”
  • “Are there any barriers that have made it harder to access care?”
  • “What matters most to you as you think about your future health or pregnancy plans?”
  • “Is there anyone in your community or support network you would like involved in your care?”

Providers should respect patient preferences regarding involvement of family members, Elders, or community supports.

Referral Pathways and Community Supports

Collaboration with community-based services can improve continuity of care.

Consider referral to:

  • Indigenous-led health services or community health centres
  • Mental health and trauma-and violence-informed counselling services
  • Substance use treatment programs
  • Social work for housing, financial, or community supports
  • Prenatal and parenting support programs

Where possible, providers should support connections with culturally appropriate and community-based services.

Practical Clinical Actions

Preconception care for Indigenous patients can be incorporated into routine visits.

At routine visits, consider:

  • Asking about reproductive goals
  • Screening for chronic disease and mental health conditions
  • Assessing social determinants of health
  • Asking about barriers to accessing care
  • Providing culturally safe, patient-centred counselling
  • Connecting patients with Indigenous community resources
  • Arranging follow-up care and referrals

Small changes in routine clinical encounters can help improve reproductive health outcomes and strengthen trust in health systems.

Resources for Health Care Providers

To support culturally safe, trauma-informed preconception care for Indigenous patients, the following resources provide clinical guidance, education, and community-based supports.

SOGC HUB

Trauma and Violence-Informed Care
A resource hub that provides information, tools, and learning resources to support trauma and violence-informed practice in health care.

Policy Statement

Sexual and Reproductive Health, Rights, and Realities and Access to Services for First Nations, Inuit, and Métis in Canada
An SOGC joint policy statement that outlines sexual and reproductive health rights, realities, and access to care for First Nations, Inuit, and Métis peoples in Canada, with a focus on culturally safe and equitable services.

Indigenous-Led and National Resources

National Collaborating Centre for Indigenous Health
A Canadian Indigenous health resource hub that provides publications, webinars, tools, and knowledge resources to support First Nations, Inuit, and Métis health and health equity.

First Nations Health Authority
A First Nations-led health organization that provides health programs, resources, and culturally safe care information to support the wellness of First Nations people and communities in British Columbia.

Native Women’s Association of Canada
A national Indigenous organization that provides advocacy, programs, and culturally relevant resources to support the health, rights, and well-being of Indigenous women, girls, Two-Spirit, transgender, and gender-diverse people in Canada.

Indigenous Services Canada
A Government of Canada resource hub that provides information on programs, services, and supports for First Nations, Inuit, and Métis peoples, including health and wellness resources.

Canadian Indigenous Nurses Association
A national Indigenous nursing organization that supports Indigenous nurses and promotes Indigenous health nursing to improve the health of Indigenous Peoples in Canada.

Indigenous Physicians Association of Canada
A national Indigenous physician organization that provides advocacy, mentorship, and resources to support Indigenous health and wellness in Canada.

Centre of Excellence for Women’s Health
A Canadian resource hub that shares research, publications, and culturally grounded resources to support Indigenous women’s health and well-being.

Resources for Patients

Questions and Answers: Preconception health for Indigenous individuals, families and communities
An SOGC and Canadian Indigenous Nurses Association resource that highlights preconception health considerations for Indigenous peoples and supports informed, culturally safe care.

The Society of Obstetricians and Gynaecologists of Canada (SOGC)