Sacred Journey: Healthy Womanhood in a Pacific Northwest Tribe

Background: American Indian/Alaska Native (AIAN) communities have traditionally held an esteemed view of women’s roles in promoting and sustaining healthy families and communities. Historical trauma scholars have detailed the destructive effects of colonization resulting in prevailing AIAN health disparities. Specific attention has been paid to the health of AIAN women, who are at higher risks for substance use, interpersonal violence and HIV/STIs than the general U.S. population. This research examines understandings of womanhood among AIAN women in a tribal community and how that guides individual and community pathways to health and wellness. We investigate the intersection of culture and gender within the context of intervention design and the applicability of these findings in addressing AIAN health disparities.   

Method: Using a community-based participatory research model, this research developed through a partnership between a tribal coalition and a university research institute after the coalition identified historical trauma, physical and sexual abuse, and substance use as high priority health concerns for young women on their reservation. Analysis drew on qualitative data from 47 tribal members: 1) focus groups with tribal women aged 17 – 45 years (N=36) and 2) semi-structured interviews with tribal leaders and elders (N=11). Transcripts were analyzed using an inductive thematic approach, drawing on both within- and cross-case information to identify themes of womanhood and conceptualizations of health and wellness. To provide cultural validity, findings were reviewed with members of the tribal coalition as they were developed.

Results:  Indigenous women had a complex and nuanced understanding of how their health is related to gender and the overall wellbeing of the Tribe. Individual health was embedded in the health of their tribal community (e.g., healthy relationships, access to role models, and learning from elders). Discussing sexual health was a way that young women brought up both positive and negative issues of gender and gendered power. Substance abuse, violence and other health barriers were contextualized within historical trauma, including unresolved cultural disruptions such as changes to traditional gender roles. Being and becoming a healthy woman included the need for reclaiming and reconstructing traditionally situated support systems and relationships. Participants detailed the ways in which their tribal community promoted positive and negative health practices and offered ideas about how to increase positive health opportunities and better access to health services.

Implications: Social and physical environmental factors in this tribal community interact to create both barriers and facilitators to achieving health and wellness. AIAN research continues to highlight pathological outcomes at the expense of identifying potentially important culturally-responsive components of effective interventions to address health disparities. This research suggests that culturally-relevant interventions and adaptations incorporate holistic approaches to wellbeing and be guided by community strengths. Understanding culturally grounded perceptions of women’s health is an essential aspect of effective program development for many populations experiencing health disparities. Health promotion efforts that integrate needs at the individual and community level are more promising in cultural contexts that include a history of colonization and discriminatory practices.