This thesis investigates the development and implementation of health promotion strategies and methods in remote Aboriginal communities via the Kimberley Aboriginal Health Promotion Project (KAHPP), a project funded under a grant from the Commonwealth Department of Health and Family Services and conducted by the School of Public Health at Curtin University of Technology. The aim of the project was to investigate the effectiveness of health promotion strategies and methods in remote Aboriginal communities and to develop structures for implementing effective Aboriginal health promotion programs.There were three main research components in this study: an assessment of health indicators; an assessment of the intervention impact; and an assessment of the media component of the intervention. The research methodology included the development of a culturally appropriate survey instrument and the conduct of cross-sectional surveys of three remote Aboriginal communities with differing historical circumstances in the Kimberley region. The questionnaire and field study methods were piloted in 1990 and the main study conducted in 1991 1[superscript].A health promotion intervention was conducted based on an approach originally developed in the Northern Territory 2[superscript]. The intervention employed community development and mass media strategies. Community members nominated health issues that they wished to address, from which 'storyboards' were created for health promotion advertisements to appear on remote television on a paid schedule 3[superscript]. Representative random samples of adult males and females from three remote Aboriginal communities were surveyed according to a range of attitudinal and behavioural health indicators. A post-test survey assessed media reach and impact and pre-post surveys assessed relevant changes in the communities.The cross-sectional survey ++ / of health indicators found differences between communities in terms of self-assessed health and risk behaviours. These are discussed in terms of the historical differences between communities and with respect to each community's current situation. Respondents from all communities rated environmental factors as important in their contribution to health, and generally more so than individual lifestyle behaviours.The study demonstrated that television has the potential to reach the vast majority of Aboriginal people in remote communities in the Kimberley. There was some indication that participation in the development of advertisements was associated with higher recognition and more positive assessments of that advertisement. No significant differences in selected indicators of community 'empowerment' were detected following the intervention.The thesis methodology has contributed to the development of a set of guidelines for the conduct of survey research in remote Aboriginal communities, 4[superscript] and has guided the formation of Aboriginal health promotion units in Western Australia and elsewhere.1. Spark R, Binns C, Laughlin D, Spooner C, Donovan RJ. Aboriginal people's perceptions of their own and their community's health: results of a pilot study. Health Promotion Journal of Australia 1992; 2(2):60-61.2. Spark R, Mills P. Promoting Aboriginal health on television in the Northern Territory: a bicultural approach. Drug Education Journal of Australia 1988; 2 (3):191-198.3. Spark R, Donovan RJ, Howat P. Promoting health and preventing injury in remote Aboriginal communities: a case study. Health Promotion Journal of Australia 1991; 1(2):10-16.4. Donovan RJ, Spark. R. Towards guidelines for conducting survey research in remote Aboriginal communities. Australian and New Zealand Journal of Public Health 1997; 21:89-94.

This study concerned a primary health care approach to trachoma control in two Central Australian Aboriginal communities. The World Health Organization (WHO) has advocated that the best method to control trachoma is the SAFE strategy (Surgery, Antibiotics, Facial hygiene, and Environmental improvements), and this approach was adopted. / The communities, Pipalyatjara and Mimili, with populations slightly less than 300 each, are located in the Anangu Pitjantjatjara (AP) lands of Central Australia, in the northwest corner of the South Australia territory. At Pipalyatjara, a full SAFE-type intervention was undertaken, with the ‘E’ component designed and implemented by the NHC (Nganampa Health Council Inc.). At Mimili, only a SAF-type of intervention was implemented. / Baseline data was gathered for 18 months from March 1999 through September 2000 (five visits to Pipalyatjara and four at Mimili), and included determining trachoma prevalence levels using the WHO system, facial cleanliness, and nasal discharge parameters. A trachoma health program was implemented at the end of this period and a one-time dose of azithromycin was given in September of 2000. The chief focus of the study was children under 15 years of age. / Improvements in road sealing, landscaping, and the creation of mounds were started to improve dust control. Concurrently, efforts were made in the houses of the residents to improve the nine healthy living practices, which were scored in two surveys, in March 1999 and August 2001. Trachoma prevalence, and levels of facial cleanliness and nasal discharge were determined at 3, 6, and 12 months following antibiotic administration. / In children less than 15 years of age, the pre-intervention prevalence level of TF (Trachoma Follicular) was 42% at Pipalyatjara, and 44% at Mimili. For the 1-9 year age group, the TF prevalence was 47% and 54% respectively. For TI (Trachoma Intense), the pre-intervention prevalence was 8% for Pipalyatjara, and 9% for Mimili. The TF prevalence, adjusted for clustering, and using only individuals present at baseline and follow-up (3, 6, and 12 months post-intervention), was 41.5%, 21.2%, 20.0%, and 20.0% at Pipalyatjara respectively. For Mimili, the corresponding prevalence figures were 43.5%, 18.2%, 18.2%, and 30%. / In the 1-9 year age group, a lower TF prevalence existed between the pre-intervention and 12-month post-intervention points at Pipalyatjara compared to Mimili. The TF prevalence after the intervention was also lower for males compared to females, when the cohorts were grouped by gender, rather than community. It is posited that reinfection was much higher at Mimili within this age group, however, in both communities, there appeared to be a core of females whose trachoma status did not change. This is speculated as mainly being caused by prolonged inflammation, though persistent infection C. Trachomatis cannot be ruled out. / Facial cleanliness and nasal discharge continued to improve throughout the intervention at both communities, but at the 3-month post-intervention point no longer became a good predictor of trachoma. / It is not known whether the improvements in the environment at Pipalyatjara were responsible for the reduction in trachoma prevalence 12 months after the intervention, relative to Mimili.

During the early 1980s the Warlpiri at Yuendemu, a remote Aboriginal community in Central Australia, began their own experiments in local television and radio production. This was prior to the launch of the AUSSAT satellite in 1985 which brought broadcast television and radio to remote Australia for the first time. There was concern amongst remote Aboriginal communities, as well as policy makers, that the imposition of mass media without consultation could result in permanent damage to Aboriginal culture and language. As a result, a policy review 'Out of the Silent Land' was published in 1985 and from that developed the Broadcasting in Remote Aboriginal Communities Scheme (BRACS) which allowed communities to receive radio and television from the satellite. BRACS also provided the option to turn off mainstream media and insert locally produced material. This study of the Warlpiri at Yuendemu has found that, since the original experiments, they have enthusiastically used modern communication technology including radio, video making, locally produced television, and, more recently, on-line services. The Warlpiri have adapted rather than adopted the new technology. That is they have used modern communications technology within existing cultural patterns to strengthen their language and culture rather than to replace traditional practices and social structures. The Warlpiri Media Association has inspired other remote broadcasters and is now one of eight remote media networks that link to form a national network via the National Indigenous Media Association of Australia. The Warlpiri have actively adapted modern communication technology because it is to their advantage. The new technology has been used to preserve culture and language, to restore, and possibly improve, traditional communications and to provide employment and other opportunities for earning income. It appeals to all age groups, especially the elders who have retained control over broadcasts and it also provides entertainment.

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Since the early 1970's a rapid increase has been experienced in the number of Aboriginal homeland communities being established throughout the Northern Territory. While educational services commenced to many homeland communities as early as 1972/3, such services did not commence in the Elcho Island area until 1983/4. Since this time educational services have been provided to eleven homeland communities in the Elcho Island area. Of the eleven educational programs established, five continued to operate at the end of 1989. It is established that homeland schools in the Elcho Island area differ significantly in characteristics of student enrolment, frequency of student attendance and in the homeland school's ability to continue to function as a viable community initiative. On the basis of the data presented in the study, the following four levels of classification of homeland schools is established; highly functional homeland schools, moderately functional homeland schools, minimally functional homeland schools, and homeland schools that have ceased operating. It is revealed that enrolment and attendance data, traditionally utilised by government authorities to prioritise the allocation of limited resources between competing homeland communities, is in fact a poor indicator for assessing a homeland community school's long term viability. This study identifies the following three sociological characteristics as being strongly correlated to the long term viability of homeland schools in the Elcho Island area; land affiliation, parental residency, and family mobility. From the analysis of the data, three recommendations are proposed; 1. In assessing the long term viability (functional status) of a homeland community school, educational administrators should analyse the three sociological indicators; land affiliation family mobility, and parental residency as an alternative to the more traditional method of relying primarily upon enrolment and attendance data. 2. In the allocation of scarce resources, especially resources of a fixed capital nature, to homeland community schools, priority be given to those homeland community schools that fit the profile of a moderate to highly functional homeland school. 3. Minimally functional homeland schools need access to resources in order to provide the educational programs requested by the local community. Resources provided for this category of homeland school need to be easily re-located should the educational program be suspended at the homeland community.

This thesis is based on fieldwork I carried out between December 1987 and June 1989 while living with the residents of a small Warlpiri Outstation Community situated ca. 75 km north-west of Tennant Creek in the Northern Territory of Australia. Colonialism is a process whereby incommensurate gender regimes impact differently on women and men and this is reflected in the indigenous response which affects the socialization of Western things. The notion of the indigenous KIRDA-KURDUNGURLU reciprocity is shown to be consistent with a gender system and to articulate all exchange relations as pro-creative social relationships. This contrasts with the Western capitalist system of production and social reproduction of gendered individuals in that it does not ascribe gender to biological differences between women and men but is derived from a land based social division between Sister-Brother. Social relationships are put under great strain in an effort to socialize Western things for Warlpiri internal use, I argue that the colonization of Aboriginal societies is an ongoing process. Despite the historical shift from a physical all-male frontier to the present day cross-cultural negotiations between Aborigines and Non-Aborigines, men still privilege men. The negotiation process for ownership of a Community Toyota is the most recent phenomenon where this can be observed. Male privilege is established by linking control over the access to the Community Toyota with traditional rights to land. However, the Toyota as Western object has a Western gender identity as well. By pitting women against men it engages people in social conflict which is brought into existence through an organisation of Western concepts based on an alien gender regime. But Western things, especially the Community Toyota, resist socialization because the Warlpiri do not produce these things. Warlpiri people know this and, to satisfy their need for Western things, they engage them in a process of social differentiation. By this process they can be seen actively to maintain the Western system in an effort to maintain themselves as Warlpiri and to secure the production of Western things. This investigation of the cultural response to Western influences shows that indigenous gender relations are only maintained through a socially stressful process of socializing Western things.

Negative perceptions of being Aboriginal persist and policies such as self-determination are generally perceived to have failed despite many texts to the contrary. This thesis examines assumptions and presuppositions within contemporary writings and practices, determining in the process, conditions seeming necessary for decolonising ways of living and research. Much closer attention is required not only to developing better understandings, but especially to articulating explanations via the reality of deep structures, their powers and causal mechanisms underpinning social life generally and in particular, the lived experience of oppressed communities. Neo-Nietzscheanism and post-structuralism tend to see reality as merely constructed. Maximising movements of solidarity with the oppressed must express the freedom of everyone in any particular place. The thesis begins by exploring the nature and significance of philosophical underlabouring (clearing the ground) for decolonisation as self-emancipation. It then engages with issues of value, truth and power by means of establishing a critical realist dialogue between two sets of writings. Key works by Australian (Japanangka West, Yolnju) Maori (Tuhiwai Smith) and American (Moonhawk Alford, Taiaiake Alfred) First Nations thinkers in modernity's colonial context are retroductively analysed in order to suggest what must be the case (in terms of being and becoming) for decolonisation to be possible. Works by philosophers currently establishing and applying Bhaskarian transcendental dialectical critical realist and/or meta-Realist principles of self-emancipation are critiqued in relation to their compatibility with decolonisation. Terms of reference within this dialogue are then supplemented from within writings by a range of others (Fanon, Said, Otto and Levinas), selected for their perceived significance in developing a dialectical praxis of personal and social transformation through spirit within the domain of strengthening community and protecting children.

Thesis (PhD)-- Macquarie University, Division of Environmental and Life Sciences, Dept. of Chemistry and Biomolecular Science. 2006. / Bibliography: p. 229-249. / Ch. 1. Introduction -- ch. 2. An ethnobotanical study with the Kamilaroi and Muruwari Aboriginal communities and relationship building -- ch. 3. Biological assay methods and optimisation -- ch. 4. Ethnopharmacological study of Eremophila sturtii -- ch. 5. Ethnopharmacological study of Exocarpos aphyllus -- ch. 6. General conclusions -- Appendices. / This study covered the documentation of first-hand medicinal plant knowledge of Aboriginal communities in northern New South Wales through the isolation and characterisation of bioactive compounds from Aboriginal medicinal plants. / Mode of access: World Wide Web. / xx, 249 p. col. ill., maps, ports

Les Inuits sont le plus petit groupe autochtone au Canada. Les femmes inuites présentent des risques beaucoup plus élevés d’issues de grossesse défavorables que leurs homologues non autochtones. Quelques études régionales font état d’une mortalité fœtale et infantile bien plus importante chez les Inuits canadiens par rapport aux populations non autochtones. Des facteurs de risque tant au niveau individuel que communautaire peuvent affecter les issues de grossesse inuites. Les relations entre les caractéristiques communautaires et les issues de grossesse inuites sont peu connues. La compréhension des effets des facteurs de risque au niveau communautaire peut être hautement importante pour le développement de programmes de promotion de la santé maternelle et infantile efficaces, destinés à améliorer les issues de grossesse dans les communautés inuites. Dans une étude de cohorte de naissance reposant sur les codes postaux et basée sur les fichiers jumelés des mortinaissances/naissances vivantes/mortalité infantile, pour toutes les naissances survenues au Québec de 1991 à 2000, nous avons évalué les effets des caractéristiques communautaires sur les issues de grossesse inuites. Lorsque cela est approprié et réalisable, des données sur les issues de grossesse d’un autre groupe autochtone majeur, les Premières Nations, sont aussi présentées. Nous avons tout d'abord évalué les disparités et les tendances temporelles dans les issues de grossesse et la mortalité infantile aux niveaux individuel et communautaire chez les Premières Nations et les Inuits par rapport à d'autres populations au Québec. Puis nous avons étudié les tendances temporelles dans les issues de grossesse pour les Inuits, les Premières Nations et les populations non autochtones dans les régions rurales et du nord du Québec. Les travaux concernant les différences entre milieu rural et urbain dans les issues de grossesse chez les peuples autochtones sont limités et contradictoires, c’est pourquoi nous avons examiné les issues de grossesse dans les groupes dont la langue maternelle des femmes est l’inuktitut, une langue les Premières Nations ou le français (langue majoritairement parlée au Québec), en fonction de la résidence rurale ou urbaine au Québec. Finalement, puisqu'il y avait un manque de données sur la sécurité des soins de maternité menés par des sages-femmes dans les communautés éloignées ou autochtones, nous avons examiné les issues de grossesse en fonction du principal type de fournisseur de soins au cours de l'accouchement dans deux groupes de communautés inuites éloignées. Nous avons trouvé d’importantes et persistantes disparités dans la mortalité fœtale et infantile parmi les Premières Nations et les Inuits comparativement à d'autres populations au Québec en se basant sur des évaluations au niveau individuel ou communautaire. Une hausse déconcertante de certains indicateurs de mortalité pour les naissances de femmes dont la langue maternelle est une langue des Premières Nations et l’inuktitut, et pour les femmes résidant dans des communautés peuplées principalement par des individus des Premières Nations et Inuits a été observée, ce qui contraste avec quelques améliorations pour les naissances de femmes dont la langue maternelle est une langue non autochtone et pour les femmes résidant dans des communautés principalement habitées par des personnes non autochtones en zone rurale ou dans le nord du Québec. La vie dans les régions urbaines n'est pas associée à de meilleures issues de grossesse pour les Inuits et les Premières Nations au Québec, malgré la couverture d'assurance maladie universelle. Les risques de mortalité périnatale étaient quelque peu, mais non significativement plus élevés dans les communautés de la Baie d'Hudson où les soins de maternité sont prodigués par des sages-femmes, en comparaison des communautés de la Baie d'Ungava où les soins de maternité sont dispensés par des médecins. Nos résultats sont peu concluants, bien que les résultats excluant les naissances extrêmement prématurées soient plus rassurants concernant la sécurité des soins de maternité dirigés par des sages-femmes dans les communautés autochtones éloignées. Nos résultats indiquent fortement le besoin d’améliorer les conditions socio-économiques, les soins périnataux et infantiles pour les Inuits et les peuples des Premières Nations, et ce quel que soit l’endroit où ils vivent (en zone éloignée au Nord, en milieu rural ou urbain). De nouvelles données de surveillance de routine sont nécessaires pour évaluer la sécurité et améliorer la qualité des soins de maternité fournis par les sages-femmes au Nunavik. / Inuit are the smallest Aboriginal group in Canada. Inuit women are at much higher risks of adverse birth outcomes than their non-indigenous counterparts. Both fetal and infant mortality has been reported to be much higher among Canadian Inuit vs. non-indigenous populations in some regional studies. Both individual and community-level risk factors may affect Inuit birth outcomes. Little is known about the relationships between community characteristics and Inuit birth outcomes. Understanding the effects of community-level risk factors may be critically important for developing effective maternal and infant health promotion programs to improve birth outcomes in Inuit communities. In a postal code linkage-based birth cohort study based on the already linked stillbirth/live birth/infant death data files for all births in Quebec, from 1991 to 2000, we assessed the effects of community characteristics on Inuit birth outcomes. While appropriate and feasible, birth outcomes data on another major Aboriginal group, First Nations, are also presented. We first assessed individual- and community-level disparities and trends in birth outcomes and infant mortality among First Nations and Inuit versus other populations in Quebec. Then we studied trends in Inuit, First Nations and non-Aboriginal birth outcomes in the rural and northern regions of Quebec. Because there is limited and inconsistent evidence concerning rural versus urban differences in birth and infant outcomes for Indigenous peoples, we investigated birth and infant outcomes among Inuit, First Nations and French (the majority in Quebec) mother tongue groups by rural versus urban residence in Quebec. Finally, since there was a lack of data on the safety of midwife-led maternity care in remote or Aboriginal communities, we examined birth outcomes by primary birthing attendant type in two sets of remote Inuit communities. We found large and persistent disparities in fetal and infant mortality among First Nations and Inuit versus other populations in Quebec based on individual- or community-level assessments. There was also a disconcerting rise of some mortality outcomes for births to First Nations and Inuit mother tongue women and to women in predominately First Nations and Inuit communities, in contrast to some improvements for births to non-Aboriginal mother tongue women and to women in predominately non-Aboriginal communities in rural or northern Quebec. Living in urban areas was not associated with better birth and infant outcomes for Inuit and First Nations in Quebec despite universal health insurance coverage. Risks of perinatal death were somewhat but not significantly higher in the Hudson Bay communities with midwife-led maternity care as compared to the Ungava Bay communities with physician-led maternity care. Our findings are inconclusive, although the results excluding extremely preterm births are more reassuring concerning the safety of midwife-led maternity care in remote Aboriginal communities. Our results strongly indicate a need for improved socioeconomic conditions, perinatal and infant care for First Nations and Inuit peoples, no matter where they live (remote northern, rural or urban areas). Further routine surveillance data are needed for assessing the safety and improving the quality of midwife-led maternity care in Nunavik.

Les Inuits sont le plus petit groupe autochtone au Canada. Les femmes inuites présentent des risques beaucoup plus élevés d’issues de grossesse défavorables que leurs homologues non autochtones. Quelques études régionales font état d’une mortalité fœtale et infantile bien plus importante chez les Inuits canadiens par rapport aux populations non autochtones. Des facteurs de risque tant au niveau individuel que communautaire peuvent affecter les issues de grossesse inuites. Les relations entre les caractéristiques communautaires et les issues de grossesse inuites sont peu connues. La compréhension des effets des facteurs de risque au niveau communautaire peut être hautement importante pour le développement de programmes de promotion de la santé maternelle et infantile efficaces, destinés à améliorer les issues de grossesse dans les communautés inuites. Dans une étude de cohorte de naissance reposant sur les codes postaux et basée sur les fichiers jumelés des mortinaissances/naissances vivantes/mortalité infantile, pour toutes les naissances survenues au Québec de 1991 à 2000, nous avons évalué les effets des caractéristiques communautaires sur les issues de grossesse inuites. Lorsque cela est approprié et réalisable, des données sur les issues de grossesse d’un autre groupe autochtone majeur, les Premières Nations, sont aussi présentées. Nous avons tout d'abord évalué les disparités et les tendances temporelles dans les issues de grossesse et la mortalité infantile aux niveaux individuel et communautaire chez les Premières Nations et les Inuits par rapport à d'autres populations au Québec. Puis nous avons étudié les tendances temporelles dans les issues de grossesse pour les Inuits, les Premières Nations et les populations non autochtones dans les régions rurales et du nord du Québec. Les travaux concernant les différences entre milieu rural et urbain dans les issues de grossesse chez les peuples autochtones sont limités et contradictoires, c’est pourquoi nous avons examiné les issues de grossesse dans les groupes dont la langue maternelle des femmes est l’inuktitut, une langue les Premières Nations ou le français (langue majoritairement parlée au Québec), en fonction de la résidence rurale ou urbaine au Québec. Finalement, puisqu'il y avait un manque de données sur la sécurité des soins de maternité menés par des sages-femmes dans les communautés éloignées ou autochtones, nous avons examiné les issues de grossesse en fonction du principal type de fournisseur de soins au cours de l'accouchement dans deux groupes de communautés inuites éloignées. Nous avons trouvé d’importantes et persistantes disparités dans la mortalité fœtale et infantile parmi les Premières Nations et les Inuits comparativement à d'autres populations au Québec en se basant sur des évaluations au niveau individuel ou communautaire. Une hausse déconcertante de certains indicateurs de mortalité pour les naissances de femmes dont la langue maternelle est une langue des Premières Nations et l’inuktitut, et pour les femmes résidant dans des communautés peuplées principalement par des individus des Premières Nations et Inuits a été observée, ce qui contraste avec quelques améliorations pour les naissances de femmes dont la langue maternelle est une langue non autochtone et pour les femmes résidant dans des communautés principalement habitées par des personnes non autochtones en zone rurale ou dans le nord du Québec. La vie dans les régions urbaines n'est pas associée à de meilleures issues de grossesse pour les Inuits et les Premières Nations au Québec, malgré la couverture d'assurance maladie universelle. Les risques de mortalité périnatale étaient quelque peu, mais non significativement plus élevés dans les communautés de la Baie d'Hudson où les soins de maternité sont prodigués par des sages-femmes, en comparaison des communautés de la Baie d'Ungava où les soins de maternité sont dispensés par des médecins. Nos résultats sont peu concluants, bien que les résultats excluant les naissances extrêmement prématurées soient plus rassurants concernant la sécurité des soins de maternité dirigés par des sages-femmes dans les communautés autochtones éloignées. Nos résultats indiquent fortement le besoin d’améliorer les conditions socio-économiques, les soins périnataux et infantiles pour les Inuits et les peuples des Premières Nations, et ce quel que soit l’endroit où ils vivent (en zone éloignée au Nord, en milieu rural ou urbain). De nouvelles données de surveillance de routine sont nécessaires pour évaluer la sécurité et améliorer la qualité des soins de maternité fournis par les sages-femmes au Nunavik. / Inuit are the smallest Aboriginal group in Canada. Inuit women are at much higher risks of adverse birth outcomes than their non-indigenous counterparts. Both fetal and infant mortality has been reported to be much higher among Canadian Inuit vs. non-indigenous populations in some regional studies. Both individual and community-level risk factors may affect Inuit birth outcomes. Little is known about the relationships between community characteristics and Inuit birth outcomes. Understanding the effects of community-level risk factors may be critically important for developing effective maternal and infant health promotion programs to improve birth outcomes in Inuit communities. In a postal code linkage-based birth cohort study based on the already linked stillbirth/live birth/infant death data files for all births in Quebec, from 1991 to 2000, we assessed the effects of community characteristics on Inuit birth outcomes. While appropriate and feasible, birth outcomes data on another major Aboriginal group, First Nations, are also presented. We first assessed individual- and community-level disparities and trends in birth outcomes and infant mortality among First Nations and Inuit versus other populations in Quebec. Then we studied trends in Inuit, First Nations and non-Aboriginal birth outcomes in the rural and northern regions of Quebec. Because there is limited and inconsistent evidence concerning rural versus urban differences in birth and infant outcomes for Indigenous peoples, we investigated birth and infant outcomes among Inuit, First Nations and French (the majority in Quebec) mother tongue groups by rural versus urban residence in Quebec. Finally, since there was a lack of data on the safety of midwife-led maternity care in remote or Aboriginal communities, we examined birth outcomes by primary birthing attendant type in two sets of remote Inuit communities. We found large and persistent disparities in fetal and infant mortality among First Nations and Inuit versus other populations in Quebec based on individual- or community-level assessments. There was also a disconcerting rise of some mortality outcomes for births to First Nations and Inuit mother tongue women and to women in predominately First Nations and Inuit communities, in contrast to some improvements for births to non-Aboriginal mother tongue women and to women in predominately non-Aboriginal communities in rural or northern Quebec. Living in urban areas was not associated with better birth and infant outcomes for Inuit and First Nations in Quebec despite universal health insurance coverage. Risks of perinatal death were somewhat but not significantly higher in the Hudson Bay communities with midwife-led maternity care as compared to the Ungava Bay communities with physician-led maternity care. Our findings are inconclusive, although the results excluding extremely preterm births are more reassuring concerning the safety of midwife-led maternity care in remote Aboriginal communities. Our results strongly indicate a need for improved socioeconomic conditions, perinatal and infant care for First Nations and Inuit peoples, no matter where they live (remote northern, rural or urban areas). Further routine surveillance data are needed for assessing the safety and improving the quality of midwife-led maternity care in Nunavik.