Examining Evacuation for Birth Policy in Ontario, Canada, and the Influence of Health Systems’ Cultures on the Provision of Perinatal Care for First Nations Peoples Relocated Outside Their Community for Birth

Abstract

Introduction: First Nations peoples are subjected to evacuation birth policy, through the First Nation Inuit Health Branch (FNIHB), whereby federally employed nursing personnel at FNIHB nursing stations arrange transport at 36 weeks’ gestation or sooner, resulting in the relocation of birth outside of their communities.

Objectives: 1) Describe where First Nations peoples are being evacuated within the province of Ontario based on referral patterns. 2) Describe the influence of the dominant western culture within the federal and Ontario healthcare systems related to the provision of perinatal care provided to First Nations peoples who are evacuated out of their communities to give birth.

Methods: Guided by focused ethnography and anti-oppression theory, I collected documentary data from FNIHB about evacuation for birth, as well as survey and interview data from 15 perinatal care providers working within the province of Ontario who have cared for evacuees.

Results: Utilizing reflexive thematic analysis, I outlined overarching referral patterns established through institutional agreements that dictate where evacuees are sent for birth. I explain different facets of structural oppression present in perinatal care culture and its influence of provision of care, including lack of continuity of care; hyper-medicalization of care; centering of whiteness in policy and practice, and; a lack of knowledge about First Nations health and culture amongst providers. I share anti-oppressive practices implemented by care providers, health organizations, and systems which supported the return of birth back to First Nations communities.

Discussion: Ending mandatory evacuation for birth is dependent on the growth of Indigenous midwifery in communities where evacuation for birth policy is implemented. I call upon and provide recommendations to health systems to redress structural oppression by uplifting Indigenous midwifery and creating anti-oppressive perinatal care cultures across Turtle Island.