Indigenous people in Canada experience widespread mistreatment and disrespect during pregnancy and childbirth, according to new data from Canada's first national survey examining respectful maternity care.
The findings stem from RESPCCT (Research Examining the Stories of Pregnancy and Childbearing in Canada Today), a national study led by UBC midwifery professor Dr. Saraswathi Vedam and a pan-Canadian team of research, clinical and community partners. Between July 2020 and February 2022, the project documented the experiences of 6,096 people across Canada who had been pregnant or given birth in the previous decade.
Among 309 Indigenous participants, 63 per cent reported experiencing at least one form of mistreatment during childbirth, while nearly 75 per cent reported disrespect. The rates were significantly higher than those reported by racialized and white participants in the same survey.
The analysis, published June 30 in Frontiers in Global Women's Health , was led by Anishinaabe scholar Dr. Wanda Phillips-Beck and informed through ongoing engagement with Elder Roberta Price of the Snuneymuxw and Cowichan Nations, Indigenous co-investigators and parents on a Community Steering Council.
"These are not isolated incidents," said Dr. Phillips-Beck, an Indigenous Research Chair in Nursing at the First Nations Health and Social Secretariat of Manitoba, associate professor of nursing at the University of Manitoba, and lead author and co-investigator on the study. "They are manifestations of structural and interpersonal racism embedded within health-care systems that continue to exert control over Indigenous bodies and decision-making. The data reveals egregious violations of Indigenous peoples' rights within health-care settings, exposing the profound failure of health-care systems to uphold the protections affirmed in international human rights law."
The researchers mapped the experiences against the Truth and Reconciliation Commission of Canada's Calls to Action and the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), identifying gaps across multiple areas including the rights to security of the person, freedom from discrimination, culturally safe care, and free, prior and informed consent.
"Respectful maternity care is not just about individual interactions between a patient and a provider," said Dr. Vedam, senior author and co-investigator on the paper. "It means having a health-care system that upholds the rights of Indigenous women to dignity, safety, cultural continuity and self-determination. Canada has signed onto the frameworks that demand this. Our findings show those commitments have not translated into consistent practice at the point of care."
Harmful experiences reported by Indigenous participants during pregnancy and childbirth included:
- Feeling neglected during childbirth (39.6 per cent)
- Being left unattended when they needed help (37.1 per cent)
- Being ignored or refused care (34.8 per cent)
- Having treatment withheld or imposed without their consent (31 per cent)
- Being shouted at or scolded by a health-care provider (28 per cent)
- Receiving negative comments about their ethnicity, heritage or culture (8.4 per cent)
Younger Indigenous people and those with Indigenous partners reported the highest rates of mistreatment and disrespect.
The researchers identified factors associated with more positive care experiences. Indigenous respondents who received care from a midwife reported lower rates of mistreatment (41.3 per cent) than those who did not receive midwifery care (68.5 per cent).
The researchers say the findings underscore the importance of Indigenous-led and community-based approaches to maternity care, including expanded access to Indigenous midwifery services and anti-racism and trauma-informed education for health-care providers.
"Every person deserves to feel safe, respected and supported when bringing a child into the world," said Dr. Vedam. "Our hope is that this research contributes to meaningful change for Indigenous families and communities."
The study was funded by the Canadian Institutes of Health Research.
Interview language(s): English.
