Sacred and Strong

Sacred and Strong – Upholding Our Matriarchal Roles: The Health and Wellness Journeys of First Nations Women and Girls Living in BC

About the Report • Report Aims • Report Structure • About the Data • Background • Report Partnership

​​​​​​​​​​​​​​​​​About the R​​​​eport​

Sacred and Strong is a report about the health and wellness of First Nations women and girls living in BC. Grounded in First Nations perspectives of wellness, it contains data, stories and teachings about the mental, emotional, physical and spiritual health and well-being of First Nations women at every phase of life.

You can download the full report or individual sections, or open specific pages for highlights. From each page you can also download the full report or the related individual section.  

Full Report (2021 release)

Technical Supplement (2022 release)

To all First Nations women and girls. All of you. You are beautiful. You are loved. You are resilient. May you be free from pain and suffering. May you be safe. May you love yourself. May you be healthy. May you feel strong. May you find your roots and feel grounded, connected, supported. – Melanie Rivers, Tiyaltelwet, Squamish First Nation

Report ​​Aims

Sacred and Strong has four main aims:

  • to honour missing and murdered Indigenous women and girls and their families and communities
  • to highlight the strength and resilience of First Nations women and girls and celebrate the many ways they are thriving
  • to be a benchmark for actions and collective progress in addressing the TRC's calls for action, the NIMMIWG calls for justice and Addressing Racism's recommendations as well as the United Nations Declaration of the Rights of Indigenous People
  • to be a reference point against which to measure improvements in data collection and First Nations data governance

Report Str​ucture

Sacred and Strong is organized into five sections roughly representing chronological life stages: infancy (including perinatal), childhood, youth, adulthood and elderhood. The sections are organized by theme and a set of common topics:

  • Healthy, Self-Determining Women and Communities – Roots of Wellness focuses on connections to ancestors, culture, language and ceremony, connections to land, water and territory, and connections to community
  • Supportive Systems focuses on the ongoing intergenerational legacy of colonialism and mainstream systems that women interact with, that is, for education, health, food, housing, employment, income and justice
  • Healthy Bodies, Minds and Spirits focuses on mental wellness and nurturing the spirit, on sexual well-being and reproductive justice, and on healthy bodies

The topics are exemplified and illustrated by information specific to the life stage, in the form of infographics, personal stories and examples of “promising practices".

About the ​Data 

Every “data point" included in Sacred and Strong represents a strong, resilient First Nations individual who is a member of a family, community and Nation.

In addition to honouring the individuals represented in the statistics, Sacred and Strong is committed to upholding First Nations data governance principles and advancing First Nations decision-making and control over their data.

The data, however, is limited by certain constraints. These include:

  • a lack of gender-diverse data: most of the available data does not reflect the full spectrum of gender identifications. Health system datasets currently only reflect binary sex categories (male/female) and do not capture a person's gender identity; as well, health surveys do not differentiate between sex (which is biologically determined) and gender (how a person self-identifies) and do not ask that participants identify their sex or gender beyond the binary “male/female"
  • a lack of region-specific data: provincial reporting conceals the significant diversity and unique strengths of the 203 distinct and self-determining BC First Nations communities. Neither are important differences that exist between urban and rural, and on-reserve and off-reserve communities discernible in this level of reporting
  • a lack of current data and data delays: much of the available data is dated and therefore does not reflect the many social, cultural, economic, political and legal changes that have occurred over the past decade. These changes include reclamation of cultural practices and traditions in many communities, evolving BC First Nations relationships with different levels of government and the impacts of public health emergencies in BC, including the toxic drug crisis and the COVID-19 global pandemic


B​etween May 2017 and December 2018, more than 2,380 families shared their stories through the truth-gathering process of the National Inquiry into Missing and Murdered Indigenous Women and Girls (NIMMIWG) . The testimonies recounted the unique spirits of these stolen sisters and laid bare the heartbreak and devastation that families and communities feel every day as a consequence of their absence.

Echoing the voices of those who shared their truths as part of previous initiatives, including the Truth and Reconciliation ​​Commission of Canada (TRCC) , the Royal Commission on Aboriginal Peoples (RCAP) and the Missing Women Commission of In​quiry (MWCI) , the NIMMIWG testimonies shone a light on the attitudes and systems that stigmatize, disadvantage and harm First Nations women and girls. They reiterated the importance of self-determination and self-governance, adequate and sustainable funding, and Nation-led and distinctions-based initiatives in restoring First Nations women and their communities to thrive.

The Addressing Racism Commission (ARC) report, In Plain Sight, published in 2020, also brought forward recommendations for addressing Indigenous-specific racism and discrimination within the BC Health system – racism and discrimination that disproportionately targets Indigenous women.

Sacred and Strong attempts to restore women and girls to the centre of efforts to enhance First Nations health and wellness. It is also new approach to reporting in that it focuses on the aspects that First Nations women and girls themselves see as important to their health and holds up the health and wellness of First Nations women and girls as an indicator of the health and wellness of society as a whole.

Report P​artnership

Sacred and Strong is the result of a partnership between the FNHA Office of the Chief Medical Officer and the Office of the BC Provincial Health Officer.

 About the term "woman"

Sacred and Strong honours and celebrates the strengths of all First Nations people living in BC who identify as or express themselves as women, including cisgender females, trans women, non-binary people and those who identify Two-Spirit or Indigiqueer. 

The binary term “woman" is used throughout Sacred and Strong, but please note that this term may not accurately reflect the gender and sexual identities of all of those reflected in the experiences, data and stories included.

 About the artwork

The artwork for Sacred and Strong was created by Melanie Rivers, Tiyaltelwet (Squamish First Nation).

Melanie Rivers is a mixed media artist and expressive arts guide. She draws from her traditional ancestry in her art and her classes (see her poem Ancient Forests in the report). 

In her art, Melanie depicts the strength, realness and vulnerability of women. She believes that art has many medicines to share with us – stillness, joy, connection – and by building self-compassionate art practices, we can experience these medicines on a regular basis.​

 Contact Us

​Office of the Chief Medical Officer