Indigenous people living in rural Canada are 16 times more likely to have to travel 200 km or more to give birth than non-Indigenous people, underscoring the need for more access to birthing facilities and providers for Indigenous families in rural regions, found new research published in CMAJ (Canadian Medical Association Journal).
Using data from the Canadian Maternity Experiences Survey (MES), this study included 3100 mothers living in rural and small towns in Canada and weighted the sample to represent 31,100 mothers, totaling 1800 Indigenous and 29,300 non-Indigenous mothers. First Nations women living on-reserve were excluded from the MES. Indigenous mothers were younger and were more likely to be single, have lower levels of education, have an income under $30,000 a year, have experienced abuse and have been admitted to hospital during pregnancy than non-Indigenous mothers.
Taking these factors into account, the study found that in rural areas, 23% of Indigenous people travelled 200 km or more to give birth compared with only 2% of non-Indigenous people.
“Our findings show an Indigenous and non-Indigenous disparity in geographic access to birthing within rural areas and suggest that this disparity is not primarily driven by medical complications of pregnancy, birth complications requiring cesarian delivery or other birth complications,” writes Dr. Janet Smylie, St. Michael’s Hospital, Unity Health Toronto and the University of Toronto, with coauthors.
In Canada, Indigenous people are more likely to live in rural and remote regions than in urban areas. The study accounts for this, and the authors suggest that this discrepancy in travel distances can be attributed to a lack of birthing facilities and providers near rural Indigenous communities—a legacy of colonial policies that prioritized non-Indigenous settlements for locating quality health care facilities.
“Given the size of the Indigenous and non-Indigenous disparity in access to birth close to home identified by our study, the documented negative impacts of birth away from home for Indigenous families, and existing recommendations, there is a clear need to advance policies that support more equitable geographic access to birthing for Indigenous families in rural areas,” write the authors.
The authors suggest that supporting Indigenous midwives and other health professionals as well as involving Indigenous leaders and communities in health service planning and delivery could increase access to birth closer to home for Indigenous peoples living in rural and remote areas.