Earlier this year, as folks across Canada were eagerly anticipating COVID-19 vaccine rollouts, an Inuit family in Sanikiluaq, Nunavut, was grieving the loss of a loved one. Silatik Qavvik had travelled from Nunavut to Winnipeg to give birth to her baby girl but contracted COVID-19 in the process and passed away after spending a month on a ventilator.
At first, this may seem like another life claimed by the virus – but Qavvik’s death is different. Her death is the result of Health Canada’s birth evacuation policy and an appalling lack of government-funded maternity care in rural and remote Indigenous communities.
The evacuation policy, present since the 1960s, mandates that all pregnant First Nations and Inuit people (regardless of health risk) living on rural, remote and northern reserves leave their communities near the end of their third trimester and travel to urban hospitals to give birth. Moreover, the recent closure of the Rankin Inlet birthing centre (with trained Inuit midwives) has forced hundreds of pregnant Indigenous people to travel during a pandemic for maternity care, thus placing them at high risk for exposure to COVID-19. Most times, patients are evacuated before their due date and, because of high air travel costs, often travel with no family accompaniment to unfamiliar communities.
Forced obstetric evacuation has led to the slow but steady erasure of Indigenous cultures, ceremonies, practices and practitioners related to birth. The underfunding and systematic discreditation of Indigenous midwifery and community birthing is harming Indigenous Peoples. Patients who are removed from their communities may face significant language barriers, substantial personal costs and are disconnected from their families, leading to traumatic birth experiences for some patients.
Some may argue the policy was instituted to improve health outcomes and some research has indeed shown improvements for high-risk pregnancies. However, there is no conclusive data demonstrating improvements for low-risk pregnancies, making the non-negotiable, blanket birth evacuation problematic. In fact, some research has reported poorer outcomes such as an increased risk of postpartum depression, increased need for medical interventions during labour and higher rates of complications. Canadian healthcare and medical education systems pride themselves on being grounded on patient autonomy and wishes, however these same principles are not being applied to Indigenous Peoples.
Not only is individual decision-making removed through this policy but it shuffles pregnant patients through complicated health-care systems operated by various levels of governments, and the coordination between governments is notoriously absent. When travelling from their communities to urban centres, patients interact with federal, provincial, and municipal services. Very little effort is made by these systems to provide continuity of care and continuity of information. This could explain why Indigenous infants have a mortality rate two to seven times higher than non-Indigenous infants. Language barriers and systemic racism embedded in health-care systems make it increasingly difficult for Indigenous patients to advocate for themselves when receiving care.
Across Canada, many maternity care services in small rural hospitals have been closed and Indigenous midwifery programs have also been severely underfunded and underappreciated. This shifts birthing from communities to hospitals, effectively marginalizing Indigenous Peoples. During the pandemic, the implementation of this policy has placed unnecessary stress on expectant parents. Strict travelling restrictions have made it even harder for friends and families to be present during labour and birth.
Clearly, there is a dire need to return birthing services to Indigenous communities – a meaningful step toward reconciliation and health equity in a population significantly impacted by settler colonialism.
All governments must put adequate measures in place to prevent infectious exposure for pregnant patients forced to evacuate during the pandemic. Indigenous patients and communities have demonstrated exceptional resiliency in navigating their pregnancy journeys but it is time we all put into place policies, practices and resource allocations that allow Indigenous Peoples to thrive on their own lands and waters. Coordinated efforts must be made to achieve a holistic approach that centres Indigenous patients as experts in their care and active participants in decision-making.
We offer our deepest condolences to the family, friends and community of Silatik Qavvik.