Racism a barrier to prenatal health care, midwives say

Systemic racism is putting the health of expectant mothers and their babies at risk, according to the Canadian Association of Midwives.

Indigenous women, newcomers to Canada and people of colour face barriers in accessing the benefits of prenatal care due to a lack of resources, as well as discrimination and mistrust, it said.

Prenatal care is credited with safer outcomes for mother and baby by reducing the risks of pregnancy complications and infant mortality. There are also long-term benefits that contribute to the ongoing health of the child.

The association is holding its annual convention in Gatineau, Que., this week.

"Health equity is a problem," said Karline Wilson-Mitchell, director of midwifery at Ryerson University. "It's due to unequal access to care, structural racism and systemic discrimination."

Wilson-Mitchell said refugees often face "unconscious bias" and suspicion in Canada's health-care system. She has heard of pregnant women being interrogated by staff and denied care because of missing paperwork.

"Someone who is a newly arrived immigrant and has been waiting for their OHIP card for three months is not an abuser of the system, but they may be treated like one."

She said more hard data is needed to help remedy the situation.

"We need to get over the embarrassment of asking about identity," Wilson-Mitchell said. "We need to know race, ethnicity, language, sexual orientation, gender ... to help identify needs."

Stress and isolation

A lack of community health facilities force many pregnant Indigenous women to deliver their babies in distant hospitals, far from their loved ones, said Nathalie Pambrun, a Métis midwife from Manitoba who is also president-elect of the Canadian Association of Midwives.

"This is supposed to be a joyous moment in someone's life, but you're creating stress and isolation instead of joy," Pambrun said.

With the rate of infant mortality in the Indigenous community two to four times higher than other parts of Canada, Pambrun said it's crucial that solutions are found.

The dark legacy of residential schools created mistrust in Canada's medical system among Indigenous people, and also eroded traditional knowledge and family lore, she said.

Solutions should be be community driven, Pambrun added, but midwives have an important role to play as they partner with local health centres and work one-on-one with women to help them to access health care.