Ministry of Health: New policy to pay for a support person to travel with Indigenous women giving birth away from their community

Photo Credit: Unsplash User

Photo Credit: Unsplash User

Health Minister Jane Philpott announced this April that Ottawa will pay travel costs for a companion for Indigenous women who need to leave their communities to give birth.  In an interview with The Canadian Press, April 9, 2017, Philpott said, "It is a major policy change for us.  It requires significant resources in order to be able to do that, but it is absolutely a wise investment."

Indigenous women without proof of a medical need to have someone escort them have been forced to have their children alone, far from their communities.  [Note: The article “Pre and Postnatal Support with the Family Ties Healthy Babies Group” in the Keeping in Touch CPNP Special Edition of April 2016 touched on some of the practical issues and realities this creates for mothers and their families when women have to leave their home community to give birth.]

Philpott said northern Manitoba doctors had told her of women who were so terrified to travel alone that they would hide to avoid having their pregnancy discovered, only to present themselves at the last minute in communities ill-prepared for deliveries.

The Minister also noted the need to transform the delivery of health in communities, saying a number of indicators clearly show considerable gaps between health outcomes of Indigenous and non-Indigenous people, citing findings from the Truth and Reconciliation Commission’s findings that decades of now-questioned government policies have had significant impact on issues around indigenous health.

Doctors and maternal health experts, including the Society of Obstetricians and Gynecologists of Canada, had called for Health Canada to make this policy change.  Dr. Michael Kirlew, a family physician in Sioux Lookout, Ontario, and Wapekeka First Nation, notes that having a support person in pregnancy is associated with a number of positive health outcomes, and would like to see the policy extended to Indigenous people needing to leave communities for end-of-life care.  Speaking in an interview for the Sioux Lookout Bulletin, Dr. Kirlew expanded, saying, “This, for me, isn’t really starting something good. This is really stopping a policy that was extremely adverse to women.”

“We’ve had 45 years of solid medical evidence that shows having a support person during pregnancy is actually associated with far better health outcomes. This has been the standard of care in Canada for at least the past 40 years, to not restrict birth partners or people in the delivery room. In fact, it goes so far as a caesarian section is one of the few surgical procedures that we allow somebody actually in the OR, because we recognize that for partners or support people to be present with women during delivery is such an important thing,” he explained. “This is not a lone effort. A number of individuals at the hospital, a number of my physician colleagues, have been advocating for this for a very long period of time. I work with a wonderful group of colleagues at the northern practice as well as the Hugh Allen Clinic, that have been pushing for this change for a number of years so it’s great to see this change has been made.”

Conflict arose immediately, however, on which level of government would pay for the program.  Speaking to the Winnipeg Free Press in an article by Nick Martin on April 12, Maryse Durette, senior media relations supervisor with Health Canada, said that Ottawa had not projected the likely costs for women in Manitoba flying to Winnipeg, but based on prenatal travel costs, companion coverage could run about $22 million a year in Canada.  Manitoba Health Minister Kelvin Goertzen welcomed the new federal plan to pay for companions to accompany pregnant Indigenous women flying to Winnipeg to give birth, but said that his understanding is that it would not be paid for by the Manitoba health system.  Manitoba is currently engaged in a dispute with the federal government over $37 million the province has paid for First Nations transportation that the federal government has refused to reimburse.

In an interview with Michael Robinson, for the Toronto Star, Lillian Slipperjack, a mother of seven, from Fort Hope, a small fly-in reserve beyond Thunder Bay, surrounded by forest, said she never felt more isolated than when she had to travel to the nearest city to give birth.  “I was scared and wishing someone was with me.  I would have brought my mom.  She would have talked me through the birth.”

In January 2014, the Winnipeg Regional Health Authority published a study to understand the experiences of the roughly 1,200 women who travel there for births each year. Patients from Ontario's most northern communities, such as Fort Severn First Nation, will sometimes be flown to the Manitoban capital because it's closer.

Researchers noted "the biggest need identified by women and health care practitioners is to have the support of their partner, mother, or someone else who knows them during labour and birth" and recommended the health authority develop a better understanding of NIHB's escort policies "in order to understand why the policy seems inconsistent."

The article notes, women themselves wish obstetric evacuations were not necessary at all. "I remember telling my nurses that I really wanted to just have my baby at home, that I didn't want to leave," said Tara Rae from Deer Lake First Nation, a small Oji-Cree community of 1,200 people.

In February of this year, Ontario announced $2 million dollars in funding to support Aboriginal midwives in six communities across the province.