Challenging oppressive maternity health care in Canada

The COVID-19 pandemic has unleashed an unprecedented wave of research, analysis, critique and challenges on health-care systems. However, we must resist the temptation to view failings in these systems as a matter of contemporary shortcomings.

While the health outcomes facing marginalized populations are 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 ineffective and unsustainable health-care services.

Canada, like many other countries, was founded on colonialism, which is often framed as something from the past having no association with current times. But this is not the truth – we are in an ongoing colonial project geopolitically 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 health-care systems – for example – are deeply rooted in Eurocentric, Judeo-Christian ideologies and practices that oppress Indigenous peoples’ philosophies, values, knowledge creation and kinship relationships.

As health-care researchers, we strongly assert it is vital to acknowledge and recognize the existence and practice of our ongoing colonization project in health-care services, programming and education, and within medicine itself, because Indigenous peoples’ knowledge systems have been marginalized and tokenized. The invisibility of these areas of colonization is ethically unsound 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 colonizers, Indigenous peoples have fought to protect their customary practices, languages and ways of health and wellness. Yet, nationally coordinated and funded assimilation efforts, such as the Indian Residential School system, have resulted in the degradation and criminalization of Indigenous peoples, including their customary healing practices and practitioners.

Improving health care must begin by recognizing the interconnected webs of colonization that are woven into all health-care systems in Canada.

A good place to start would be at the beginning – maternity and birth.

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 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 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.

It is only by understanding the past that we can make sense of the present and imagine a future that liberates us all.

While the term decolonization has become a buzzword, especially following the Truth and Reconciliation Commission reports, we advocate for the recognition of colonization in health, including 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 their health and wellness.

Beginning in the late 1800s, Canada introduced European-trained obstetricians to those who lived on reserves. Alongside the medicalization of childbirth, the criminalization of Indigenous health-care 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 Canada’s evacuation policy that requires that pregnant people between 36- and 38-weeks of gestation in remote settings be relocated to urban settings to await labour and birth. In addition to physically removing pregnant people from their families, communities and customs and practices, the evacuation policy results in increased experiences of racism, isolation, fear, distress, sadness and loneliness, all of 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.” These colonial maternity care practices established during a time of aggressive assimilation have resulted in the current disjointed approach to maternity care for Indigenous peoples. In fact, evacuation for birth has not resulted in what was purported to be the goal – comparable outcomes. In fact, the infant mortality rate for Indigenous peoples in Canada ranges from two to four times that of non-Indigenous people.

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. Indigenous peoples’ customary practices and practitioners must be reframed as necessary components of health care across Canada and globally. The exclusion and even criminalization of Indigenous people who are health-care providers – like Indigenous midwives – deliberately create oppressive barriers.

For those of us with influence in health-care systems, we must work toward the creation of inclusive health care that promotes a plurality of knowledge systems; we must put the 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.

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