Indigenous midwives are the key to addressing sexual and reproductive health inequities

It’s 2024 and Indigenous people in remote communities still don’t have access to basic sexual and reproductive health care. Meanwhile, Indigenous infant mortality and morbidity rates are higher than any population in Canada. Such gross inequities are a direct result of colonization, anti-Indigenous racism, and systemic underfunding of community-based Indigenous-led health services. To address these injustices, the government must take accountability by reinvesting in services like Indigenous midwifery. As Hill Times columnist Rose LeMay wrote on Jan. 8, “To paraphrase Cindy Blackstock: do the real work so you don’t have to apologize or pay out the settlements again.” Beginning in the 1950s, the federal government systemically removed Indigenous-led health care—including midwifery care—from Indigenous communities. As a result, many First Nations, Inuit, and Métis people must travel vast distances to access basic services like contraception and prenatal care. As a matter of policy, Indigenous women with low-risk pregnancies are routinely forced to leave their communities for birth, a practice colloquially known as “birth evacuations.” Ellen Blais is executive director of the National Council of Indigenous Midwives. Photograph courtesy of the Canadian Association of Midwives Forced birth evacuations lead to poor physical health outcomes and emotional, cultural, and social harms for Indigenous families and communities. Still, each year thousands of Indigenous people leave their loved ones to give birth, travelling up to thousands of kilometres away, often alone, to distant hospitals. According to federal occupational guidelines for nurses, pregnant people leave up to a month before their due date. They are placed in substandard housing, with little access to a support network, birth education, or adequate nutrition. These long-standing federal policies deepen the already profound health inequities faced by Indigenous people in Canada. Forced birth evacuations cause increased stress for expectant mothers, as well as increased risk of C-section, forced and coerced sterilization, and forced removal of newborns from their mothers by child welfare. The antidote to forced birth evacuations is having Indigenous midwives in every Indigenous community. When birth takes place in-community, it improves the mother’s experience, allowing her to be surrounded by her own language and culture. Family is present, and significant others have an opportunity to participate in the birth of their child. The risk of exposure to anti-Indigenous racism is reduced or eliminated when qualified Indigenous midwives provide care. With Indigenous-led midwifery care, we also spend less for better health outcomes. In 2022, the federal government spent $602.2-million on medical evacuations, including evacuations for birth. Indigenous midwifery is a sustainable, culturally rooted, community-based alternative. Indigenous midwifery is proven to result in positive health outcomes, and provides a balance of life and death within communities. We already have examples of this model’s success. Today, 92.2 per cent of deliveries in Nunavik, Que., are done in the community, through the work of Inuit midwives. The C-section rate in Nunavik has been documented at 6.5 per cent, far below the current 30 per cent Canadian average. Despite the proven benefits, Indigenous midwifery's growth has stalled because of barriers including systemic underfunding. In 2017, the federal government made a commitment and took small steps to grow investments in Indigenous midwifery. But it is not enough to address the vast inequities in sexual and reproductive health. The government needs to honour its 2017 commitment and continue to expand investments for Indigenous midwifery to help close health gaps for Indigenous communities (especially women and 2SLGBTQIA+ people). To do so would be a key step towards reconciliation. There is already strong support for this investment from the general public, Indigenous communities, and health-care providers. In a national survey conducted in 2022 and 2023 by the National Council of Indigenous Midwives, a whopping 93.1 per cent of Canadians agreed: Indigenous pregnant people should have access to care from qualified Indigenous midwives in their communities. The fact that Indigenous people in remote communities do not have access to basic sexual health services was described as “deplorable,” “disgusting,” “racist,” and “wrong.” We urge the federal government, and in particular Deputy Prime Minister Chrystia Freeland and Prime Minister Justin Trudeau, to honour initial commitments to grow Indigenous midwifery and address the Missing and Murdered Indigenous Women, Girls, and 2SLGBTQQIA+ People Calls to Justice; Article 24 of the United Nations Declaration on the Rights of Indigenous Peoples; and the Truth and Reconciliation Commission Calls to Action 22 and 23. Indigenous lifegivers deserve to give birth in safety, surrounded by loved ones. It’s time for the federal government to commit to reproductive justice for all. Ellen Blais, an Onkwehonwe midwife from the Oneida Nation of the Thames, is executive director of the National Council of Indigenous Midwives (NCIM). Megan Davies, NCIM advocacy and policy adviser, and Cassie Smith, Canadian Association of Midwives social media co-ordinator, contributed to this article. The Hill Times