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8 Steps toward Quality Care for Northern Indigenous Youth

What does good, non-stigmatized sexual healthcare look like for northern and indigenous youth? This question has become very important to me.

I have had the great privilege of discussing this question at length with youth across the Northwest Territories, the Yukon and Nunavut as a program facilitator for FOXY (Fostering Open eXpression among Youth), an arts based sexual health program that was awarded the 2014 Arctic Inspiration Prize and has taken the north by storm with its revolutionary approach to talking with youth about sexual health, sexuality, and relationships.

The following eight answers are woven from an amalgamation of candid, opened, group discussions with northern and indigenous teens.

  1. Tell them you’re glad they are there

One of the most powerful things you can do to encourage youth to access healthcare, to ensure a positive experience, and to help them spread the word to others, is to welcome them and congratulate them on taking steps to care for themselves. For many, and especially for youth, feeling unwelcomed, or even being treated with neutrality, can be detrimentally off-putting. A warm welcome and a high five for being there really goes a long way.

  1. Confidentiality

When you live in a small town, it can help a lot to be assured that your relationship with your healthcare provider is confidential. Of course, be honest about any restrictions that apply, especially when caring for youth, but confidentiality is so important when it comes to sexual and reproductive health and reminding people that their information is safe is an excellent step to a successful visit.

  1. Be accessible

In the north, healthcare is not always accessible, so you need to be as accessible as possible. This may be the first time, or the first time in a long time that someone has chosen to or been able to access your services – be thorough.

  1. Listen

The number one beef teens have with healthcare providers is that they don’t listen! Whether we don’t think they can understand, or just think they don’t know how to make good decisions, not listening to them is a sure way to shut them down and put up a barrier that will be more difficult to overcome the next time they need to access the healthcare system. After all, they are the experts on themselves and I promise we are much more likely to underestimate them than we are to overestimate them.

  1. Honour language barriers

Recognizing that many northern indigenous youth do not speak English as a first language is important. It is equally as important to balance that knowledge with the reminder that having English as a second language does not denote intelligence or ability to comprehend a concept. People can understand if you can put things the right way.

  1. Don’t assume gender or sexuality

Heteronormativity is a major deterrent for our LGBTQ2+ youth in accessing healthcare. By not assuming a patient’s gender or sexuality you are helping to overcome stigmatization and ultimately provide superior, more thorough care.

  1. Be trauma and violence informed

There is a push in medical circles in Canada right now to become more trauma and violence informed. This can help to provide very crucial services to a wide demographic in a way that will maximize receptiveness and efficacy. There is much that can be done in recognizing violence and trauma and knowing how to shape medical visits when you are working with a patient who is dealing with such experiences.

  1. Set them up for next time

You don’t know who will be providing their care next visit. Remind them not to give up if their next experience is less than ideal and that a second opinion is available, and a responsible option if they don’t feel they receive the care they need.

We all contribute to the legacy of our time, and I do hope that we are moving towards better services for all, including our northern and indigenous youth residing in small, outlying communities. These eight steps can take practice to become second nature, but are worth the extra effort. When we remind them that they are worth it, they remind us right back.

 

 

 

 

 

 

I live with a disability. It’s never stopped me from living my life to the fullest – and I have no complaints when it comes to my sex life. I recently started seeing this great girl and we’re totally into each other but when it comes to sex, she gets really nervous about hurting me or doing something wrong. I know my body and tell her constantly that she’s doing fine and what I need from her. What can I do?

co-written by Shaw Chard

Let’s discuss why being sexual with a person with a disability may be novel to your partner and how you both can use this information to grow and learn together.

Time for some background knowledge. Few of us are raised with adequate sexual education, and an oft-excluded factor which contributes to a good (hopefully great!) sex life is communication [1]. At the same time, the dominant discourse of sexuality is not inclusive of people with disabilities, both visible and invisible, and those people are seen as childlike, naïve, and incapable of sexual desire [2]. Sex-ed programs typically don’t include disability or communication in their curricula, and neither do media representations of sexuality. Because it’s never talked about, sexuality among people living with disability is assumed to either be non-existent or fundamentally “different”, which creates a divide between “normal people” and people living with disability [3].

Now, consider how these things may be affecting your partner and your sexual relationship. You’ve made it clear that you enjoy your sex life, that everything between you two in sexual situations is fine, and that you tell her what you need from her. But really, how much of that does she understand? Dominant sexual discourse is so exclusive; nobody talks about pleasure, planning, communication, and alternatives, so it’s no wonder that so many people are lost when it comes to any other idea of what sex can be. Both you and your partner were more than likely taught sexual education through this narrow lens, and although you have been able to find pleasure in tandem with, not despite of, your disability, it may be hard for your partner to get past what she’s learned. Change is not easy, and you can help each other by being as supportive as possible. Try to help her by introducing planning and open communication into your relationship.

When I say open communication, what I mean is that you not only be open with her, but with yourself: you have to be aware of and understand your own desires, as this is crucial to being able to communicate these things to your partner. If you care that she understands what you want, then you need to know what you want beforehand [4]. Even though you say you tell her she’s doing fine, and that you’ve let her know what you need from her, her nervousness could mean that she still doesn’t fully understand. Let your partner know that many people with disabilities, including yourself, don’t see their disabilities as detracting from their sex lives; on the contrary, many feel that their disabilities allow them to get more creative in the bedroom and allow for more open communication in sexual relationships [5]. Further, make sure you are inviting her to explain her wants and needs, and are validating and supportive of them when she opens up. This will facilitate better communication, and you two will likely feel closer, which cycles back to increasing confidence in sharing your desires and your abilities to achieve them in the future [6].

At the same time, you should both make an effort to be understanding of each other’s situations. You both learned that discussing sex is not the norm, but for you two that may simply not work. This is where planning comes into play. Sit down and discuss your respective wants, needs, and how to achieve both in an environment where you can really hear each other. Though the planning may seem like it detracts away from features we associate with good sex like ‘spontaneity’ or ‘immediate, silent understanding’, research has shown that this kind of open communication not only helps in the realm of sexual pleasure, but can also bring more closeness and intimacy into the relationship as a whole [7].

My advice may be starting to sound repetitive; how many times can I say communication? The point of it all is that, in any relationship, partners need to communicate with each other to make sure that everyone involved is getting the most out of their sexual relationship. Sometimes, you just need to be told what to do, and some relationships require more communication than others. There’s no reason that planning and discussion should be an impetus to your sex; on the contrary, it’ll likely make your relationship stronger and the sex better. I’ll dare to assume that most people want to enjoy their sex lives, and the best way to make sure that happens is to talk about your desires, your needs, and the desires and needs of your partner (or partners!). Now go forth, have a discussion with this great girl of yours, and then reap the benefits.


[1] Kaufman, M., Silverberg, C., & Odette, F. (2003). The ultimate guide to sex and disability: For all of us who live with disabilities, chronic pain, and illness (1st ed., pp. 1-345). San Francisco, California: Cleis Press

[2] Katari, S. (2014). Sexuality and Disability. Sexual experiences of adults with physical disabilities: Negotiating with sexual partners, 32, 499-513. doi:10.1007/s11195-014-9379-z

[3] Esmail, S., Darry, K., Walter, A., & Knupp, H. (2010). Attitudes and perceptions towards disability and sexuality. Disability and Rehabilitation, 32(14), 1148-1155. doi:10.3109/09638280903419277

[4] Kaufman, M., Silverberg, C., & Odette, F. (2003). The ultimate guide to sex and disability: For all of us who live with disabilities, chronic pain, and illness (1st ed., pp. 1-345). San Francisco, California: Cleis Press

[5] Katari, S. (2014). Sexuality and Disability. Sexual experiences of adults with physical disabilities: Negotiating with sexual partners, 32, 499-513. doi:10.1007/s11195-014-9379-z

[6] Katari, S. (2014). Sexuality and Disability. Sexual experiences of adults with physical disabilities: Negotiating with sexual partners, 32, 499-513. doi:10.1007/s11195-014-9379-z