Reclaiming Indigenous Birth

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Economic Assessment of Travel for Birth

Research Question

What is the evidence about the costs of travel for birth for First Nation, Métis, Inuit and/or Indigenous birthing persons in Canada and globally?

The Economics of Obstetric Evacuation

Obstetric evacuation is a policy that requires First Nations and Inuit people who live on reserves or in rural and remote areas to travelto urban hospitals for birth. While not encoded in Canadian legislation, the policy is specified in clinical practice guidelines and is reinforced by the lack of alternatives (FNIHB, 2011; Jumah et al., 2021; Kaufert & O’Neil, 1990; Lawford, 2016; Lawford &Giles, 2012; Lawford et al., 2018, 2019). For First Nations people and Inuit, the FNIHB Clinical Practice Guidelines for Nurses in Primary Care outlines the requirement to “arrange for transfer to hospital for delivery at 36‒38 weeks’ gestational age according to regional policy.”
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Participants

The participants in this review are Indigenous people who provide midwifery care and Indigenous clients or patients who give birth. Indigenous people around the world have distinct social, cultural, economic and political characteristics and share a common experience that their ways of life are different from dominant societies where they live. The term Indigenous recognizes the rights-based principles of self-identification of the Indigenous nation, collective, community, culture or group. In Canada, Indigenous peoples identify as First Nations, Inuit, and Métis peoples. Recognizing that not all Indigenous people identify with these terms, our search accounted for diverse terminology that Indigenous populations use to describe themselves. We included Indigenous women and gender diverse Indigenous people who give birth. All ages among people giving birth were included.

Concept

We examined midwifery models of care that are led by, and designed for, Indigenous people. We defined a midwifery model of care as a practice that includes one or more midwives who deliver care to people in pregnancy, birth, and the postnatal period. We excluded studies that did not incorporate the experiences and knowledge of midwives. This review also excluded studies that only reported on nurses or other healthcare providers’ perspectives on midwifery models of care.

Context

Studies that were conducted in Canada were included as we are interested in Canada’s unique history, policies, and socio-economic conditions and how these factors intersect, and shape midwifery models of care provided to Indigenous populations.

A review of studies in US, Australia and New Zealand is forthcoming. These countries will be included due to their similar socioeconomic, political, colonial and historical contexts. These countries, including Canada, are industrialized, capitalistic, and democratic and share in a history of direct, settler colonization by the British Empire.

Types of Sources

This review included the following documents: peer-reviewed articles published in English at any time period up to the data of the search; any empirical and theoretical studies; all qualitative, quantitative, and mixed methods research studies, including literature reviews, systematic reviews (with or without meta-analysis), scoping reviews, interviews, and focus groups.

Search strategy

We developed a search strategy in consultation with an information specialist with expertise in Indigenous health (see Appendix). We searchedthe following databases: Ovid EMBASE (1947–2022), CINAHL (1981–2022), Ovid Healthstar (1966–2022), PubMed, ScienceDirect, PROS- PERO, and Cochrane Database of Systematic Reviews.

References

  1. Adams, S. J., Burbridge, B., Obaid, H., Stoneham, G., Babyn, P., & Mendez, I. (2021). Access to ultrasound imaging: A qualitative study in two northern, remote, Indigenous communities in Canada. International Journal of Circumpolar Health, 80(1), Article 1961392. https://doi.org/10.1080/22423982.2021.1961392
  2. Cardinal, S. (2018). “Lost births,” service delivery, and human resources to health.
  3. Chamberlain, M., Nair, R., Nimrod, C., Moyer, A., & England, J. (1998). Evaluation of a midwifery birthing center in the Canadian north. International Journal of Circumpolar Health, 57(Suppl 1), 116–120.
  4. Chamberlain, M., & Barclay, K. (2000). Psychosocial costs of transferring indigenous women from their community for birth. Midwifery, 16(2), 116–122. https://doi.org/10.1054/midw.1999.0202
  5. Chamberlain, M., Barclay, K., & Moyer, A. (2001). Aboriginal birth: Psychosocial or physiological safety. Birth Issues, 10(3), 81–85.
  6. Chatwood-Affleck, S., Lippman, A., Joseph, L., & Pekeles, G. (1998). Indications for transfer for childbirth in Inuit women at the Inuulitsivik Maternity. International Journal of Circumpolar Health, 57(Suppl 1), 121–126.
  7. Cooper, E., & others. (2021). Patient healthcare experiences in the Northwest Territories, Canada: An analysis of news media articles.
  8. Kornelsen, J., & Grzybowski, S. (2005). Safety and community: The maternity care needs of rural parturient women.
  9. Kornelsen, J., & Grzybowski, S. (2006). The reality of resistance: The experiences of rural parturient women.
  10. Lawford, K. M., Giles, A. R., & Bourgeault, I. L. (2018). Canada’s evacuation policy for pregnant First Nations women: Resignation, resilience, and resistance. Women and Birth, 31(6), 479–488. https://doi.org/10.1016/j.wombi.2018.01.009
  11. Lawford, K. M., Bourgeault, I. L., & Giles, A. R. (2019). “This policy sucks and it’s stupid:” Mapping maternity care for First Nations women on reserves in Manitoba, Canada. Health Care for Women International, 40(12), 1302–1335. https://doi.org/10.1080/07399332.2019.1636805
  12. Lee, V., & others. (2022). Returning childbirth to Inuit communities in the Canadian Arctic.
  13. Milnes, A. R., & others. (1993). A retrospective analysis of the costs associated with the treatment of nursing caries in a remote Canadian aboriginal preschool population.
  14. O’Driscoll, T., & others. (2011). Delivering away from home: The perinatal experiences of First Nations women in northwestern Ontario.
  15. O’Neil, J. D., & others. (1988). Inuit concerns about obstetric policy in the Keewatin region, N.W.T.
  16. O’Neil, J. D., & others. (1991). Obstetric policy for the Keewatin Region, N.W.T.: Results of the childbirth experience survey.
  17. Van Wagner, V., Epoo, B., Nastapoka, J., & Harney, E. (2007). Reclaiming birth, health, and community: Midwifery in the Inuit villages of Nunavik, Canada. Journal of Midwifery & Women’s Health, 52(4), 384–391. https://doi.org/10.1016/j.jmwh.2007.03.025
  18. Varcoe, C., & others. (2013). Help bring back the celebration of life: A community-based participatory study of rural Aboriginal women’s maternity experiences and outcomes.
  19. Brown, H., Varcoe, C., & others. (2011). The birthing experiences of rural Aboriginal women in context: Implications for nursing. Canadian Journal of Nursing Research, 43(4), 100–117.
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