This report is based on a participatory action research project conducted by a team of advocates from Equal Justice for All, a grassroots, anti-poverty organization located in Saskatoon. This project was part of a larger initiative sponsored by the Prairie Women's Health Centre of Excellence to examine social assistance policies in Manitoba and Saskatchewan, their impact on women's health, and women's access to justice as recipients of social assistance.

Seven focus groups were held with 43 women living on social assistance in five of the eleven administrative regions of Saskatchewan in April 2003. In focus group discussions, these women described the daily reality of their lives and the impact of social assistance policies on their physical and emotional health. They reported health problems that were made worse by inadequate nourishment, cold and damp suites, and the many stresses of living in poverty. Women on social assistance described how the low level of welfare benefits prevented them from meeting their fundamental needs, including food, housing, health care and transportation. This occurred despite the fact that provincial legislation mandates the provincial government to provide enough income for fundamental basic needs. And the federal government is responsible to transfer adequate funds to provinces to enable fair and just distribution of social services, as well as the more politically popular health and education services. Twice recently the Social and Economic Committee of the United Nations has chastised Canada, a wealthy first world nation, for its treatment of its poorest citizens.

Successive federal and provincial governments since 1980 have deliberately undermined the social contract with Saskatchewan's poorest citizens who have to depend on welfare benefits. For the past 23 years, the basic allowance rate has had no adjustment for yearly increases in the cost of living. In the 1980s advocates as well as workers inside the Department of Social Services had called on the Conservative government to increase the allowance for utilities, especially in winter, because their actual cost was robbing from the money allowed for food and clothing. In 1991, the NDP government removed the cap on utilities, but has not, in the 13 years since, removed the cap on allowances for rent and basic needs (food, clothing, personal hygiene, and furniture). Transportation allowances for city travel were eliminated in 1983 and have not been reinstated. Despite known increases in the rental costs in each region and despite the regulation that allows regional administrators to adjust rent allowances to reflect current market rates, 23 years have passed without a cost-of-living increase to cover the rising market costs of basic rental accommodations. Only one small increase was made in the mid-eighties. Nor have there been increases in benefits to reflect the yearly increases in the market basket cost of nutritious food or basic seasonal clothing.

The participants in this study described the effects of inadequate benefits on their access to nutritious food which is the basis for their own health and the health of their children. Many people turn to food banks, but food banks are not available in all areas and are not always accessible when needed. One of the most compelling stories we heard involved one mother who had to put her son, ill with pneumonia, back into foster care because he couldn't attend school lunches, the only food source left since food money was used to pay the rent. Only through advocacy by the Child Welfare Branch, was the family granted an extra $100 to cover the rental costs over the shelter allowance. Money diverted from food budgets to cover rental costs is causing women and their families to go hungry. Women in the focus groups described always worrying about food for their families and themselves.

The women reported difficulties in finding safe, adequate, affordable housing. Some people reported problems with mice and rat infestation and the associated risk of hanta virus infection as well as poor quality housing with broken steps, unsafe windows and poor insulation. Evictions were also experienced by participants in this study, due to unpaid portions of rent at month's end and the added impossibility of covering the owed portion of the damage deposit within two months. The women in this study confirmed that when they were forced to move, school attendance was disrupted and children fell behind in school. Women reported having no choice but to pay $50 - $100 or more out of their own basic allowance for the cost of shelter, even for some very poor shelter. No wonder they asked, "Don't We Count as People?"

Women described difficulties in getting coverage for medications, special diets and medical needs, even when these were prescribed by health professionals. Repeated requests for medical forms verifying lifelong disabilities were experienced as harassing and embarrassing. Some felt that the forms were unnecessary if no change was likely in long-term disabilities. Some women reported that they could not afford to cover the dispensing fees for prescription drugs, the cost of over-the-counter medications, or payments when doctors charged them over the department fee to complete a medical report. Health cards do not cover essential vitamins and some medications. Women reported that it was almost impossible to get adequate special diet coverage despite doctor verification of need; this made their recovery harder and depression worse.

Several women reported difficulties in accessing medical help because they had no bus fare or no money to hire rides to get to the doctor. Medical travel is allowed, but funds are not provided until after travel to appointments has been proven. Lack of transportation also made it difficult for women to see their welfare workers. Some serious health issues were related to the specific circumstances in particular locations. In one community, people became sick when the local water supply was contaminated with Cryptosporidium, yet income assistance workers refused extra money for Pampers for babies with severe diarrhea. They also refused to pay for over-the-counter medications prescribed to replace electrolytes for family members who became ill. In one reserve community, the administration refused extra moneys for safe water purchases despite contamination and discoloration of the local water supply that caused sore throats and damaged clothing.

Women raised concerns for themselves and their teenage daughters that the personal hygiene allowance of $15/person is totally inadequate to cover the extra costs of personal hygiene supplies needed during menstruation. Mothers of infants described that the cost of disposable diapers took their entire clothing allowance.

Women in this study faced additional hardships when their welfare benefits were reduced by the recovery of overpayments or advances. Since benefit levels are far below the poverty line, any reductions in benefits cause serious hardships. The so-called overpayments occurred when women were able to find small jobs where the pay exceeded their earnings exemption, or they had received some income tax rebate or inheritance that others in society are able to keep. Overpayments occurred when a child was taken into custody and entitlement to the Child Benefit was immediately cancelled. Monthly cheques were also routinely reduced to recover advances that had been requested to buy essential household furniture or seasonal clothing that was urgently needed. In addition, women described overpayments caused by departmental errors as the worst experience - losing precious benefits from subsequent cheques because of circumstances beyond their control.

Women described the everyday stresses of poverty and the toll that it took on their self esteem. In addition, family breakdown, addictions, and child apprehensions were frequently experienced or feared, and these deepened the health risks from emotional strain. When children were in foster care, a few of the mothers expressed faint hope for the future health of their families. However, with the help of advocates they were able to regain hope for their long-term parenting and their children's well being.

While some described positive and helpful interactions with social assistance workers, others described situations where they had difficulty reaching their workers, where their legitimate needs were not acknowledged, where they were not given adequate information about their eligibility for benefits, and where their requests for assistance were denied. Women frequently described the experience of being seen and treated as children by the system except "even children get nourished, don't they?" Having to seek charity or alternative financial help for clothes and other basic necessities did not allow these women to feel grown up. In addition, women reported often being treated disrespectfully as "second class citizens."

Some women felt that surveillance by the Department created additional stress within families and personal relationships. They felt that their sexual relationships had to be hidden in case the Department might consider a boyfriend a (paying) common law partner. When women tried to establish new relationships or reconcile with their children's father, they did so with fear of financial repercussions. They worried that the Department might reduce their benefits and start demanding recovery of 'overpayments', based on the assumption that the woman must be receiving financial support from a male partner.

Phases I and II of Social Services Redesign took place in Saskatchewan in 2002 and 2003. With Phase II of the Redesign which took place while this study was being conducted, every individual, including persons with disabilities and elder caregivers, is required to have a case plan to aid him/her towards independence and participation in his or her community through training, work or volunteering. The women in this study viewed this change skeptically and felt that it was unlikely to work without a significant change in the level of income benefits and changes in the workers' treatment of people on welfare. Some women saw this policy as further "blaming the victim" and pushing people away who really need the help.

Even before this current emphasis on labour force attachment, recipients, except those with disabilities that affect their employability, were required to look for paid employment. Those caring for small children were usually required by their workers to search for paid work even though they were already performing important unpaid work at home. The health giving role of child raising was not respected when mothers were expected to look for jobs even when breastfeeding. There seems to be no fair or consistent practice on this and worker "discretion" varies widely as to the ages of the children when mothers must enter the labour market.

Mothers in the focus groups described the stress and anxiety they felt when they were unable to meet their children's needs. They felt that it was unfair that 100% of maintenance payments and even orphan's benefits were deducted from their welfare budgets. This clawback of income meant that there was no extra money to pay for children's clothing, recreation, or school activities.

We admit to our bias in believing all persons need easy access to the knowledge and help of advocates. Our experience was confirmed in these focus groups of women on social assistance. Some said that without the help of their advocate, they would have literally died, committed suicide, or left their children in permanent care. Their access to advocates helped them gain dollars, respect, and self-esteem.

In addition to documenting their experiences, the focus group participants also proposed changes to improve income assistance in Saskatchewan. As one of the participants in this study pointed out, providing adequate income assistance would enable people to meet their basic needs, improve their health, and in all likelihood, reduce the costs to the health care system.

"The Income Security Department and the Department of Health should work together because the allotted budget causes undue stress on anyone on assistance, which in turn cause more health costs and/or hospital stays that cost more than if budgets were just raised to cover actual rents. The stress and pain from needs not being met would take another study just to show the cause and effect of these health issues."