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Elise Frith 100405095
WMST 1220
Forced Birth Evacuations and Midwifery in Canada

Summary:
The effects of settler-colonialism has left Indigenous people with proximal, intermediate,
and distal health adversities (p6), notably of which is the removal and subjugation of Indigenous
health facilities (Murdock et al., 2024). Today, Indigenous women living in rural and remote
locations are forced to leave their communities and families to give birth in hospitals, leaving
them displaced from their cultural norms and practices; this is referred to as forced birth
evacuation (Murdock et al., 2024). This practice was created as early as 1892 to undermine and
colonize Indigenous birthing practices (Murdock et al., 2024) and is continued today, posing
exacerbated health risks due to the COVID-19 pandemic.
Analysis:
The Euro-Canadian model of health as a strictly physical, autogenic condition overlooks
the societal adversities forced upon Indigenous Peoples, whose idea of health is much broader,
and includes their cultural ties and practices. This colonization of Indigenous health care is itself
a health adversity (Reading, 2018, p. 9). Residential schools left children “poorly-fed, ill-clothed,
and overworked” (Reading, 2018 p. 9) and although these specific practices have since ended,
colonialism continues in other ways. Evacuations for birth to urban cities, often hundreds of
kilometres away from their communities, is just one of the long-standing risks imposed by
settler-colonialism and the removal of Indigenous healthcare (Murdock et al., 2024). More
recently, Indigenous women have discussed their self-assessed risk of evacuation during the
COVID-19 pandemic, potentially travelling to large hospitals in cities where COVID outbreaks
were much more serious, and restrictions for many meant they were not allowed another person
to accompany them (Murdock et al., 2024). The choice between giving birth with no access to
medical care, or evacuating, often alone, left Indigenous women with no “good” option. Diseases
introduced to Indigenous Peoples from non-Indigenous populations is not a new story; European
diseases have historically “devastated” communities (Reading, pp. 7, 2018). This is part of an
ongoing discussion regarding Indigenous Peoples self-determination and self-governance in
healthcare, and whether the system currently implemented is furthering the harm done by
settler-colonialism (Murdock et al., 2024).

Summary:
Amid the struggles within Canada’s healthcare system, Indigenous women living in rural
and remote communities are pushing for closer access to birthing services, and for those services
to include traditional cultural practices (Dangerfield, 2023, n.p). Their absence often leads to

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negative emotional and physical health outcomes, as highlighted by advocacy groups such as the
National Council of Indigenous Midwives, who are calling for the expansion of midwife
associations, and government support for traditional births (Dangerfield, 2023, n.p). The absence
of adequate maternal care for Indigenous women that is close to home has been discussed as a
continuation of colonialist genocide (Gabriel, 2023, p.140).
Analysis:
Sturgeon Lake First Nation in Saskatchewan is home to the first—and only—healing
lodge that incorporates Indigenous cultural practices (Dangerfield, 2023, n.p). In February 2022,
the community celebrated the first traditional birth in over 50 years, marking a significant
milestone but also highlighting the long road to re-establishing these practices (Dangerfield,
2023). However, traditional births remain rare, as most First Nations women in Canada still lack
access to midwives. This issue stems from Canada's changing healthcare system and the removal
of Indigenous healthcare practices due to colonial policies less than a century ago (Dangerfield,
2023, n.p). As a result, Indigenous women are often disconnected from their own healthcare,
with Yukon being the only province to officially endorse traditional practices (Gabriel, 2023, p.
135). A 2021 study published in the Canadian Medical Association Journal found that 23% of
Indigenous women traveled 200 or more kilometers for childbirth, compared to only 2% of
non-Indigenous women (Dangerfield, 2023, n.p.). Urban hospitals, often lacking Indigenous
midwives, do not integrate traditional practices such as fire setting or "smudging" ceremonies,
which are vital to ensuring a safe birth in First Nations communities (Dangerfield, 2023, n.p.;
Gabriel, 2023, pp. 140). Research supports the positive health outcomes of including cultural
practices in childbirth (Gabriel, 2023, pp. 139). Canada “lags behind” (Gabriel, 2023., pp. 140)
other nations in recognizing culture as integral to healthcare, creating unsafe environments in
urban hospitals and forcing many Indigenous women to seek care elsewhere, while these
alternatives remain severely underfunded (Gabriel, 2023,p. 140; Dangerfield, 2023, n.p). The
physician shortage in rural areas, coupled with anti-Indigenous racism, exacerbates this issue,
leaving Indigenous women vulnerable, as seen in the tragic death of Joyce Echaquan in 2020
(Dangerfield, 2023, n.p). Indigenous self-determination is crucial to the decolonization process,
and without it, the healthcare system risks perpetuating the harms of colonialism (Gabriel, 2023,
p. 140).

Summary:
The First Nations community in rural Manitoba, Opaskwayak Cree Nation, is working to
re-establish local birthing practices to improve maternal and infant health outcomes. Currently,
there are significant disparities in infant and maternal health outcomes between Indigenous and

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non-Indigenous populations. To combat this, the community is developing a culturally safe
birthing center that combines modern healthcare with traditional practices. The center will
provide midwifery services and integrate practices like smudging ceremonies and sacred fires,
which are essential to Indigenous birthing traditions. The goal is to create a supportive
environment that reduces the stress of birth evacuations and empowers Indigenous women to
give birth in a familiar, culturally meaningful setting (Pauls, 2024, n.p).
Analysis:
​
Our health is a culmination of genetics, identity, and most importantly-our environment
(Dawes, 2022 p. 3). It is not “faulty” genetics that put Indigenous women at increased risk of
infant death (Pauls, 2024, n.p), low and high birth-weights, gestational diabetes and poverty
(Dawes, 2022 p. 5). Health adversities, particularly among First-Nations peoples, are the effects
of settler-colonialism translated into the 21st century (Dawes, 2022 p. 5). Colonialism stripped
all Indigenous healthcare, ceasing the passed-down knowledge of midwifery, and now is only
beginning to be rebuilt (Dawes, 2022 p. 5; Pauls, 2024 n.p). Now, post-colonialism, Indigenous
people are subjugated to less ideal and more remote land and healthcare, as anti-Indigenous
racism is present in “all levels of healthcare” (Dawes, 2022 p. 5). These compounded events,
while now recognized, are yet to be reconciled. Still today, most rural and remote First-Nations
communities are without easy access to urban hospitals, and most affected are pregnant women,
who either risk home-birth or evacuating, sometimes for months at a time (Pauls, 2024, n.p). The
Maternal Child Health program in Opaskwayak Health Authority, started by community
members in an effort to recruit midwives, improves mothers’ access to healthy foods during and
after their pregnancy (Pauls, 2024, n.p). This solution has hope of being more than a band-aid
solution, as it addresses the deep-rooted health disparities within the community (Pauls, 2024,
n.p), and acknowledges the role played by poor nutrition in health outcomes (Dawes, 2022 p. 9).
Birthing centres, midwives, doulas, and parent-support groups are steps in the right direction for
improving healthcare to a point where parenthood is exciting, rather than costly and inaccessible
(Pauls, 2024).
Summary:
​
The midwifery policy in Canada is rooted in patriarchal and colonialist values, which
exclude Indigenous women from recognition and financial benefits for their healthcare
contributions (Reading, 2018; Benoit et al., 2024, n.p). Despite midwifery services being
accessed by 25% of British Columbia’s population in 2021, midwives are not recognized as
primary care providers due to lack of funding and institutional support. Colonial and patriarchal
systems have devalued these roles, with midwifery only gaining recognition in Prince Edward
Island recently. Indigenous midwives have historically provided culturally safe healthcare, and
calls for equitable funding and recognition continue (Benoit et al., 2024, n.p).
Analysis:

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​
The basis of midwifery policy in Canada is based upon patriarchal and colonialist
rhetoric and excludes women, particularly Indigenous women, from the monetary benefits and
recognition of their role in healthcare (Reading, 2018, p. 8; Benoit, Mellor, Pambrun & Mason,
2024 n.p). When considering that 25% of all people in British Columbia accessed midwifery
services in 2021, it is irrefutable that midwives are primary care providers, yet they lack both the
ability and funding to call themselves such. In recent years, B.C has implemented a systematic
reform introducing 22 new primary healthcare services to address the unmet health needs of the
province, but excluded midwifery and reproductive services. Colonialism and patriarchal
systems have devalued these female-dominated careers, excluded them from government
funding, medicalized Indigenous women’s health and have since done very little to re-establish
the practices (Reading, 2018, p. 6; Benoit, et. al., 2024, n.p). Midwifery only last year became
unrestricted as a legitimate practice in Prince Edward Island, and until the 1990’s they were
unrecognized and unregulated, marginalizing the practice as an illegitimate form of care (Benoit
et. al., 2024). Indigenous midwives have long practiced culturally and clinically safe births,
STI-treatments, and sexual health, and there have been many calls to adequately fund and
acknowledge midwives as primary care providers (Benoit, et. al., 2024, n.p). The persistent
marginalization of midwifery not only affects the practitioners themselves but also undermines
the healthcare choices available to women, particularly Indigenous women, in their own
communities (Benoit, et. al., 2024). Patriarchal and colonialist values stand between women,
whose ability to provide healthcare predates the existence of male-model medical education, and
who deserve to be recognized and compensated for the role they continue to play (Benoit, et. al.,
2024, n.p).
Summary:
Indigenous women and babies face higher maternal and infant mortality rates due to
unfavorable childbirth experiences and systemic discrimination (Hayward & Cidro, 2021, p. 216;
Turpel & White Hill, 2020, p. 22). Research reveals that women from various ethnicities,
especially Indigenous women, experience humiliation, abuse, and abandonment during childbirth
(Hayward & Cidro, 2021, p. 216). Indigenous women also leave emergency departments at
higher rates than other groups, often feeling unsafe and stereotyped (Turpel & White Hill, 2020,
p. 29). Despite the United Nations Declaration on the Rights of Indigenous Peoples' emphasis on
cultural preservation, healthcare systems fail to support these practices, worsening health
outcomes (Hayward & Cidro, 2021, p.217; Turpel & White Hill, 2020, p.22).
Analysis:
Several theories have been put forward as to why Indigenous women and babies
experience higher maternal and infant mortality rates, most of which acknowledge the
unfavourable circumstances in which women are expected to give birth (Hayward & Cidro,
2021, p. 214). Interviews with women of various ethnicities from 18 countries found that “subtle
humiliation of women, discrimination against certain sub-groups of women, overt humiliation,

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abandonment of care and physical and verbal abuse” (Hayward & Cidro, 2021, p. 216) were
present during their childbirth experiences. These distressing experiences are especially
prevalent among Indigenous patients, who report feeling less safe and more stereotyped within in
the healthcare system. Indigenous women leave the emergency department at a rate 11 times
higher than other residents, despite it being against medical advice (Turpel & White Hill, 2020,
p. 29). This troubling trend highlights the deep-rooted issues in healthcare settings, where
Indigenous women often feel alienated, ignored, or disrespected. Furthermore, Indigenous
women struggle to uphold their cultural traditions, particularly in environments where they are
subjected to pervasive racism during their most vulnerable moments (Turpel & White Hill, 2020,
p. 22) (Hayward & Cidro, 2021, p. 214). The United Nations Declaration on the Rights of
Indigenous Peoples (UNDRIP), often regarded as the “most comprehensive” (p. 214) document
on the rights of Indigenous people, emphasizes the importance of preserving cultural traditions in
conjunction with modern medicine. Despite these ideals, current urban hospitals fail to support
these cultural practices, which further exacerbates the poor birth experiences and outcomes for
Indigenous women and babies (Hayward & Cidro, 2021, p. 217). This failure to integrate cultural
competence into healthcare settings has been widely acknowledged as a significant contributing
factor to the ongoing disparity in maternal and infant mortality rates within Indigenous
populations (Turpel & White Hill, 2020, p. 22; Hayward & Cidro, 2021, p. 217). In accordance
with the recommendations of UNDRIP, there must be a large system reform to address health
disparities, and to ultimately de-colonise our healthcare system (Hayward & Cidro, 2021, p.
220).
References:

Gabriel, Mikaela. 2023. “Strangers in Our Homeland: The Impact of Racism across Healthcare
Policy and Delivery for Indigenous Peoples in Canada.” In Critical Perspectives in
Public Health Feminisms, edited by Renée Monchalin, 132–43. Toronto, ON: Canadian
Scholars. In I. Syed (Comp.) WMST 1220; Women and Health, Vancouver, BC: Langara
College
Dangerfield, K. (2023, September 27). Inside the push to end ‘birth evacuations’ in Indigenous
communities. Global News.
DOI:https://globalnews.ca/news/9961516/indigenous-mothers-canada-birth-evacuation-tr
uth-and-reconciliation/
Pauls, K. (2023, February 25). How one First Nation hopes to bring birthing back to the
community and improve outcomes. CBC News.
DOI:https://www.cbc.ca/news/canada/manitoba/first-nation-births-community-mortality1.7327276

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Dawes, Daniel, Christian Amador, and Nelson Dunlap. 2022. “The Political Determinants of
Health: A Global Panacea for Health Inequities.” In Oxford Research Encyclopedias:
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Vancouver, BC: Langara College
Turpel-Lafond, Mary Ellen, and Eliot White-Hill. 2020. “What We Found.” In In Plain Sight :
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Hayward, A., & Cidro, J. (2021). Indigenous birth as ceremony and a human right. Health and
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Benoit, C., Mellor, A., Pambrun, N., & Mason, M. (2024, June 11). Indigenous midwifery is
stalled. Policy Options.
https://policyoptions.irpp.org/magazines/june-2024/indigenous-midwives/
Reading, Charlotte. 2018. “Structural Determinants of Aboriginal Peoples’ Health.” In
Determinants of Indigenous Peoples’ Health : Beyond the Social, Second edition, p. 3-17,
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Murdock, M., Campbell, E., Durant, S. et al. Indigenous Peoples’ evaluation of health risks
when facing mandatory evacuation for birth during the COVID-19 pandemic: an
indigenous feminist analysis. BMC Health Serv Res 24, 1174 (2024).
https://doi.org/10.1186/s12913-024-11489-9