The Injustices Surrounding Prenatal Care in Canada
by Ciana Hamilton
Reproductive Justice isn’t a term that many people understand. And maybe that’s the first part of the problem. In contrast, abortion rights seem to be interpreted more easily; does a woman in Canada have the right to terminate her pregnancy? Yes. Does this mean Canada gets an A on reproductive justice? Not really.
Canada is one of the countries where abortion is legal; a woman who decides to abort her pregnancy in Canada has no legal restrictions. However, accessibility to abortion clinics can vary from province to province. If a woman chooses to abort her pregnancy but is unable to access an abortion clinic where does that leave her? Reproductive justice is the framework that gives an individual choice over their reproductive health, but puts the responsibility on governments to provide accessible care to accommodate those choices.
In 1994 a group of black women from Chicago recognized that there were other important reproductive issues, besides abortion, that were affecting women in their community. This group of women created the term Reproductive Justice. They called themselves the Women of African Descent for Reproductive Justice and their goal was to give black women a voice and a platform outside of the mainly white, middle class, women’s rights movement. Almost twenty-five years later the term is known worldwide and represents Indigenous Women, Women of Colour and Trans People.
Today many people of marginalized communities face reproductive injustice and oppression. Access to safe, compassionate prenatal care where both medical and cultural needs are met, doesn’t always happen. Women and families are not being given access to resources and information in order to make informed choices; community services are not accessible and their voices are not being heard. In Canada, Aboriginal women face the most significant inequality around maternal care, especially those in remote communities. Women of colour, women living at or below the poverty line, teen mothers, LGBTQ families and HIV positive women also face the reality of reproductive inequality when seeking care. There appears to be two crucial factors when discussing reproductive justice: inaccessible midwives and a lack of representation in the healthcare system.
For many women, the first time their reproductive health is spotlighted is when they become pregnant. This was true for me, being pregnant for the first time at 23. I did not even know that I had reproductive rights. As a young, black, woman from a low-income home, I felt the system was stacked against me from the beginning. I did not have a family doctor and was nearing my second trimester without receiving any regular prenatal check-ups. I remember initially wanting a midwife but was unable to access one in the city I was in. I remember going to a walk-in clinic and practically begging the doctor to refer me to anyone who could provide prenatal care for my baby and me. She did not. Eventually, with some family help, I got in with a team of obstetricians. I was initially relieved, but quickly realized the type of care I would receive was nothing like I imagined. I got basic treatment; none of the doctors cared to know my name. None of the doctors asked if I had a birth plan. I was not given options or choices. I was handed requisitions for tests and sent on my way. I didn’t know who would deliver my baby until the day of delivery. Reflecting on my experience with my first child, what sticks out for me was my desire to have a midwife and being unable to access one. I didn’t know much about midwifery but I felt like a midwife would be the obvious choice for compassionate, trustworthy and respectful care.
Midwifery has gained traction over the years, going from a misunderstood hippie alternative to the more natural, inclusive option. In fact, more parents are continuing to seek out care from midwives. According to the Better Outcome Registry Network or BORN, in Ontario between 2014-2015, midwives cared for 15% of all births in the province. It also helps that midwifery services are covered by OHIP. And, although there has been an increase in the amount of midwives providing care, there still seems to be a lack of midwifery services in the communities that need it the most. If given the choice, I strongly believe most women, specifically marginalized women, would choose to be cared for by a midwife. However, if midwifery services are inaccessible in their community, then there is no choice.
In early December I sat down with Martha Aitkin, a registered midwife in Guelph who has been practicing for 21 years. She believes there are some key differences between care from a doctor and care from a midwife. “The way we organize and the way we give care gives us a lot more time. Time with women and their families to get to know who they are and what is important to them. Time to answer their questions and share information to allow them to make their own decisions about their care.” Aitkin adds, “if a person has a midwife then they have a known care provider, someone they have had a chance to develop a relationship with – someone that they trust. That enhances the safety of their care.”
Pictured above from top to bottom: Martha Aitkin and Nicole Barrette
The midwifery model of care is beautifully simple. Give women choice. Give women a safe space to ask questions, review options and be vulnerable. Give people who identify as LGBTQ+ an inclusive space that is accepting and easily adaptable to non-binary lifestyles. Provide access to materials that can educate and inform families about choices around parenting.
Midwives also provide in home, postpartum care up to six weeks following the birth. For women in the far north, such as Nunavut, extended postpartum care within their own community could be extremely supportive. These women could potentially receive extra support around breastfeeding, diagnosis and treatment of postpartum depression, as well as incorporating traditional medicines for physical healing. Martha spoke about her experience providing care for Inuit women in Nunavut, one of the places that still suffers the most reproductive injustice in Canada. “Most women in Nunavut have to go far away, separate from their families to other cities – Edmonton, Winnipeg, Yellowknife to have their babies. They could be gone for a month to six weeks separated from their other children and the rest of their community. That’s an injustice as far as I’m concerned and the solution as far as I can see is the growth of midwifery services provided by Inuit people for Inuit people.” Martha is right; one possible solution for many Indigenous women living in remote communities across Canada is the growth of midwives in their communities. Imagine the possibilities, women would have access to a midwife close to their home, receive regular prenatal care and be able to deliver their babies in an environment where they feel safe.
When I became pregnant with my second child, I knew I wanted my experience to be different. I wanted to exercise my reproductive rights to the fullest. I wanted to be cared for by a midwife. I wanted an un-medicated homebirth. I wanted to breastfeed. Luckily, I was able to access and get what I had hoped for. I was cared for by two midwives in Guelph, I had a completely non-medicated home birth and I have proudly breastfed my daughter for more than a year. My second experience completely changed my views on reproductive care and reproductive choice. My voice was heard and my choices were respected. Instead of being told to take certain tests, I was asked. I felt empowered and valued as a parent. A part of this empowerment came from the quality of care I received by other women. My midwives were women who respected the autonomy of pregnancy and parenthood. We worked as a team to strategize the safest maternal care and delivery for me. They ensured that I always felt comfortable with any procedure or test that needed to take place. Ultimately, the connection between my midwives and I grew much deeper than I could have anticipated. And as a result, I felt safe.
If we are looking at ending reproductive injustice than we need to look at equal representation amongst care providers. Midwives provide a piece of that representation; they represent the power and beauty that is a woman birthing a child. They represent the diversity in methods of care. They represent open spaces for different family dynamics. However, midwives are in high demand and in short supply. Not having equal representation in the healthcare system for a marginalized person creates an automatic distrust and assumption that those providing care – the doctors, the nurses – don’t understand the issues that a vulnerable person might face. Representation doesn’t begin and end with healthcare professionals; doulas, childbirth educators, lactation consultants and patient advocates also need to be included to represent the diversity of the people receiving care.
Two years ago I began volunteering for Women Everywhere Breastfeed (WEB), a volunteer run program out of the Guelph Community Health Centre. The cafe offered by WEB is held weekly and is aimed at anyone in the community who may be facing challenges around breastfeeding and who is looking for accessible support from their peers. The program is coordinated by Nicole Barrette, an advocate for reproductive justice, who is deeply invested in ensuring that her work remains inclusive of all people who are needing support during their parenting journey. Nicole is also a birth and postpartum doula and has been for 11 years. She has first-hand experience with the layers of stigma that marginalized women and families face from health care providers when receiving reproductive care. One group we talked about were parents who identify as LGBTQ+, specifically Trans people. “There’s a lack of gender diversity acknowledgment – not everybody who has a baby is identifying as a woman. We talk about breastfeeding/chestfeeding at the WE Breastfeed program.
Chestfeeding, the term Nicole mentioned, is an example of how interchangeable language can be used to make a program more representative of all parents who may choose to attend. Chestfeeding is a term that could be used by a Trans masculine or gender-non-conforming parent. It simply takes out the word breast for a parent who is using the milk from their body to feed their child, but because they do not identify as a woman, the term breast [may?] conflict with their gender identity. Most hospitals and doctors’ offices have information promoting breastfeeding, and the term breastfeeding is almost always used. WEB is one of the only places I’ve seen that includes terminology that would be representative of Trans parents.
If we are looking for ways to end reproductive injustice, then we must allow communities to represent themselves in the healthcare system. Reproductive justice starts at the grassroots level- people with diverse backgrounds and experiences need to be at hospitals, clinics or community centres offering advocacy services and providing basic resources to educate people.
Collective efforts need to be put forth to educate, empower and equip those who are victimized by Canada’s accessible, but oppressive health care system. The Women of African Descent created the term and set the stage for an open and honest discussion around reproductive injustices faced by marginalized women. It is up to us to demand a change from a system that needs to be held accountable.
Ciana Hamilton is a freelance writer based out of Guelph,Ontario. She respectfully honours Turtle Island as sacred Indigenous lands. Her work leans towards creative non-fiction and she enjoys writing about issues surrounding advocacy, justice, feminism and cultural ancestry.