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Challenging Oppressive Maternity Healthcare in Canada

Authors: Stephanie Ragganandan Hon. BSc, York University & Dr. Karen Lawford midwife and PhD, Queen’s University

At no time in the present era have healthcare systems been subject to the same extent of research, analysis, critique, and challenge as they have been during the global COVID-19 pandemic. There is a temptation to view any failings in these systems as a matter of contemporary shortcomings. While the health outcomes facing marginalized populations are certainly exacerbated by 21st century technological, economic, and social disparities, in addition to being disproportionately impacted by COVID-19, it is crucial we remember the root cause of these disparities. It is only by understanding the past that we can make sense of the present and imagine a future that liberates us all from oppressive, ineffective, and unsustainable healthcare services.

Canada, like many other countries across the world, was founded on colonialism. Colonialism is often framed as something from the past and as having no association with current times, but this is not the truth. We are living in an ongoing colonial project that is geo-politically known as Canada.

What is colonialism? It is the process by which one group takes control of another group’s lands, resources, and governance authorities and maintains that group in a state of subordination based on the beliefs of racial and cultural inferiority of the subordinated group. In Canada, the legal, education, and healthcare systems—for example—are deeply rooted in Eurocentric, Christian ideologies and practices that purposefully oppress Indigenous Peoples’ philosophies, values, ways of making knowledge, and kinship relationships.

As healthcare researchers, we strongly assert it is vital to acknowledge and recognize the existence, maintenance, and practice of the ongoing colonization project in Canada via Euro-Canadian healthcare services, programming, and education, and within medicine itself, because Indigenous Peoples’ knowledge systems are currently marginalized, made irrelevant, and tokenized. The invisibility of these areas of colonization is ethically unsound, immoral, and does not contribute to the Truth and Reconciliation Commission of Canada’s Calls to Action, specifically Calls 18-24.

We are especially committed to drawing attention to the implications of colonization on the sexual and reproductive health of Indigenous Peoples. Since contact with white Christian colonizers, Indigenous Peoples have fought to protect their customary practices, languages, and ways of health and wellness. Yet, nationally coordinated and funded assimilation efforts via various genocidal mechanisms, such as the Indian Residential School system, have resulted in the degradation and criminalization of Indigenous Peoples including their customary healing practices and practitioners.

We strongly assert that the process of improving current systems-wide healthcare must begin by recognizing the interconnected webs of colonization that are woven into all colonial healthcare systems in Canada.

Comprehensive Gender-Inclusive Sexual and Reproductive Health Care

Indigenous customary practices and practitioners that support and manage pregnancy, labour, birth, and postpartum periods have sustained Indigenous Peoples on these lands since time immemorial. In fact, their technologies, skills, and medicines were used by white Christian settlers when they first invaded these lands to ensure their own pregnancies were conducted in a safe manner. Over time, the Euro-Canadian biomedical model and its practitioners purposefully marginalized and criminalized Indigenous knowledge and practices. The ability of Indigenous Peoples to determine how to achieve their own health and wellness eventually became—and continues to be—oppressed. Consequently, the health of Indigenous Peoples from a Euro-Canadian lens shows that Indigenous people are less healthy than non-Indigenous people. But, healthcare systems in Canada continue to refuse to see, let alone acknowledge, the harm they have caused to Indigenous Peoples via neglect, refusal of care, and structurally ingrained colonial oppressions.

While the term decolonization has become a buzzword, especially following the Truth and Reconciliation Commission of Canada reports, we advocate for the recognition of colonization in health, which includes education, training, programming, funding, and practice. High-quality, comprehensive gender-inclusive sexual and reproductive health care for Indigenous Peoples can be achieved, but we must first come to terms with the extent to which colonization has purposefully obstructed the health and wellness of Indigenous Peoples.

Canada’s Evacuation Policy for Indigenous Peoples

Beginning in the late 1800s, the Government of Canada decided to introduce European-trained obstetricians to those who live on reserve. Alongside the medicalization of childbirth, the criminalization of Indigenous healthcare practices and practitioners, the immigration of British trained nurse-midwives, and the establishment of Indian hospitals, birthing for Indigenous Peoples shifted from home and community to nursing stations, then Indian hospitals, and now urban hospitals. The federal policy driving this relocation of birth is underpinned by the Government of Canada’s evacuation policy, which requires that pregnant people between 36- and 38-weeks of gestation are relocated to urban settings to await labour and birth. In addition to physically removing pregnant people from their families, communities and pregnancy customs and practices, the evacuation policy results in increased experiences of racism as well as feelings of isolation, fear, distress, sadness, and loneliness, which can lead to post-partum depression.

Canada’s evacuation policy supported “...colonial goals to civilize and assimilate [Indigenous Peoples] into a generic Canadian body.” So, colonial maternity care practices established during a time of aggressive assimilation and civilization tactics, which were implemented and funded by the Government of Canada, have resulted in the current, disjointed approach to maternity care practices for Indigenous Peoples. In fact, evacuation for birth has not resulted in comparable outcomes: the infant mortality rate for Indigenous Peoples in Canada ranges from two to four times that of non-Indigenous people. Clearly, the justification that the evacuation policy improves the maternal and infant outcomes is unfounded. It is thus clear that the Euro-Canadian biomedical model of maternity care must change so that Indigenous Peoples can realize the health and wellness they so deserve.

What’s Next?

Indigenous Peoples’ customary practices and practitioners must be reframed as necessary components of healthcare systems across Canada and globally. The exclusion and even criminalization of Indigenous People who are healthcare providers—like Indigenous Midwives—deliberately creates oppressive barriers to health and wellness for Indigenous Peoples.

It is extremely important to understand colonialism within the historical and contemporary contexts because it globally impacts Indigenous Peoples byways of land destruction, separation from family through colonial training programs (e.g. the Indian Residential School System), and the oppression of Indigenous customary philosophies, values, ways of making knowledge, and kinship relationships.

For those of us with influence in Euro-Canadian healthcare systems, we must work towards the creation of inclusive healthcare that promotes a plurality of knowledge systems, and put these systems and practitioners who provide care for Indigenous Peoples at the forefront of our agendas. We must also contemplate the nature and extent of repairs that are required to bring justice to those who have suffered at the hands of colonial systems.

It is time to acknowledge the ongoing colonial violence in healthcare and dismantle the oppressive cultures that constitute Canadian healthcare systems.

**If this is an issue you are passionate about, consider becoming a supportive member of the National Aboriginal Council of Midwives (NACM) here.**

Here is a list of benefits of a supportive membership from the NACM

  • Act of reconciliation and allyship
  • Promote the growth of Indigenous midwifery
  • Contribute to the improvement of reproductive and child health in Indigenous communities
  • Receive NACM newsletter