Low-income mothers typically have limited resources with which to respond to the multiple demands they face. Health promotion programs for this group tend to focus on developing skills and knowledge in areas such as parenting and cooking. While this kind of personal skill development is important, it does not address the more fundamental determinants of health. The purpose of this project was to bring together low-income mothers of preschool-aged children who wanted to learn more about making their community a healthier place to live.

Methods

In May 2000, two groups of low-income mothers (seven to eight women in each) who had previously taken part in skill-building programs began meeting in Saskatoon, with two facilitators. Onsite childcare and transportation were provided. Over six weekly meetings, the women talked about their communities and the changes they would like to see, shared their experiences and ideas, and learned how to plan actions. They took photos of their communities with single-use cameras and created two large murals depicting community influences on health.

In September 2000 the women resumed meeting as a single group (with attendance varying from three to eleven). The women presented their murals to invited guests. Next, they decided to focus on poverty as a key determinant of the problems they were experiencing. They shared their stories of living in poverty, and the facilitators provided information about the prevalence and causes of poverty. Finally, the idea arose of putting their stories and other material from the project into a book. The remaining sessions were spent planning and working on the book. From September through June 2001, they met 19 times.

The participants ranged in age from early twenties to late thirties. Most had two or three children and about two-thirds were single parents. About half were members of First Nations. Most received social assistance, while a few had part-time paid employment or income from a partner. Some owned their homes; others rented apartments or houses of varying quality, mostly in the inner city. Several had recently left abusive relationships. Thus, while all self-identified as "low-income mothers," their living situations varied considerably.

Findings

The findings of this project include what was learned about the process of creating the murals; the women's thoughts about and experiences with healthy and unhealthy communities; factors that support low-income mothers' participation in their communities; and the causes, effects, and modifiers of "parenting in poverty."

Murals

The purpose of the murals was to engage the women in a group activity that would result in a visual representation of the healthy and unhealthy elements of communities they had been discussing. The women selected clippings from a variety of printed materials, including the photos they had taken, and arranged them onto a large sheet of paper, adding words of their own. Both groups depicted unhealthy aspects of communities on the left side of the mural and healthy elements on the right; one of the groups bridged the two with concepts such as "understanding," "creativity," "hope," and "involvement."

The women greatly enjoyed working together on this activity. Assembling the visual images of the positive and negative aspects of their communities was very satisfying for them and many felt it helped deepen their understanding of the issues and how to address them. They were proud of this tangible accomplishment and eager to share it.

In September 2000, the two groups came together to show their murals to the members of the Community/Research Team who had not been directly involved in the meetings and another guest from Saskatoon District Health. The women spoke about how the project had given them hope and lessened their feelings of isolation; how they had enjoyed working together with women from different backgrounds; how much they wanted to make change in their communities; and what the murals meant to them. The guests responded enthusiastically to the murals and the women's presentations.

Healthy and Unhealthy Communities

In addition to the murals' visual representation of healthy and unhealthy communities, the report contains a summary of their thoughts on this topic. Above all, participants emphasized the importance of a healthy social environment-the way people treat each other and work together. They spoke of having control over their communities; treating each other with respect and courtesy; freedom from violence and discrimination; a sense of belonging to and responsibility for their community; co-operation, sharing, and caring; valuing children and elders; and creating a place for healing. In terms of the economic environment, the participants described a community in which all members have adequate incomes and access to the basic necessities, where amenities such as grocery stores, clinics, and schools are conveniently located and people work together to do things better, in ways that don't necessarily cost more. Finally, participants wanted a physical environment that is safe (e.g., playgrounds free of broken glass and needles; streets that can be safely crossed) and attractive. They stressed the importance of housing that is affordable, secure, in good condition, and not crowded.

While those living in Saskatoon's inner city experienced their communities as being generally unhealthy, participants from other neighbourhoods reported problems, too. These included neighbours not knowing or caring about each other, discrimination against Aboriginal individuals, and lack of access to the special programs and services offered in the core neighbourhoods. So low-income families who live in more advantaged neighbourhoods may avoid most of the social and physical problems of the inner city, but they often pay the price of greater stigma and racism.

Supports for Participating in Community

While all the participants wanted to help move their communities toward the vision described above, they found actually taking action to be a challenge. Even participating in this project regularly was difficult for many of the women. The women identified a number of influences on their ability to participate effectively in their communities. These ranged from the practical, such as awareness of opportunities, time, and skills, to more complex psychological factors, including self-confidence; believing one has the right to ask for better treatment and that change is possible; communication, conflict resolution and other skills, and having a stable enough life to free up energy for social action.

Within this project, regular attendance was hampered by a variety of factors, related to participants' parenting responsibilities, their need to earn money, and the instability of their families, both immediate and extended. Participants found it hard to work on project activities on their own for the same reasons.

Causes and Effects of Parenting in Poverty

In this report, the experiences of the participants are synthesized in two diagrams. The first portrays the factors that typically lead to a woman becoming a low-income parent. The path usually, but not always, begins with her own upbringing. Growing up in poverty, in an unstable family, increases the likelihood of ending schooling prematurely, especially if an unplanned pregnancy occurs. Lack of support from the child's father and addiction to alcohol or drugs further impede a woman's chances of returning to school or finding work. Later in life, mothers may end up in poverty if they choose to care for their children full-time, or are unable to find acceptable work, and their partner is unable to support the family adequately or they are single parents with unreliable child support. Community factors such as schools' support for pregnant and parenting students, access to childcare, and level of social assistance provided to parents of young children without paid employment can strongly influence whether or not an individual's circumstances lead to her 'parenting in poverty.'

The second figure shows the physical and mental health consequences of parenting in poverty. Parents are unable to provide their children and themselves with a healthy diet; they are forced to live in inadequate, often unsafe housing in dangerous, unhealthy neighbourhoods, or to pay more than they can afford to live somewhere better. Low-income mothers often have poor self-esteem, reinforced by their reliance on charity and/or social assistance and their feelings that they are not giving their children the kind of upbringing they would like to. They get little recognition for doing a good job as mothers; on the contrary, they are frequently criticized, stigmatized, and devalued. They have few opportunities for respite from parenting, especially if they are single, and the constant demands of caring for small children make it hard for them to always be the kind of parent they want to be.

IMPLICATIONS AND RECOMMENDATIONS FOR WOMEN'S HEALTH POLICY AND PROGRAMMING
Out of these findings, we have identified eight specific implications, with associated recommendations for women's health policy and programming. These deal with the following areas:

1. Providing adequate financial support (whether through social assistance, wages, or a combination) to enable all families to meet their basic needs.
2. Providing more recognition for and respite from parenting, including financial support for parents caring for young children.
3. Enabling all parents to access childcare that meets their standards, if they are employed outside the home or taking classes.
4. Increasing the availability of safe and healthy housing for low-income families and strengthening the communities in which they live.
5. Offering effective programs to prevent and treat addictions in low-income communities.
6. Supporting low-income mothers to develop skills required to engage in social action.
7. Reducing the stigma associated with being poor in a materialist society.
8. Making 'the system' more accessible and responsive to low-income individuals.
9. Enabling all low-income families to access helpful services and programs without stigma, and increasing community members' control over such programs.

Conclusions

The report concludes with the participants' reflections on the project. The main factors they valued were having the opportunity to talk about issues with other adults, to share their personal concerns and feel understood; the general harmony and productivity of the group; and, above all, the production of something tangible, the book of stories, in which they take great pride.

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