Chela Rafferty
March 7, 2024
For many Indigenous communities, pregnancy and birth are emphasized as sacred times, with familial involvement and cultural practices that mark the arrival of a new baby [1]. However, for many isolated Indigenous communities, Ontario’s mandatory evacuation policy at 36 weeks of pregnancy disrupts cultural and familial care, leading to adverse consequences for infant, maternal, and community health. [2]
According to the Assembly of First Nations, “The effects of this evacuation policy has had
devastating consequences on First Nations infant and maternal mortality rates, mental health, infant attachment and bonding, child apprehension rates, and forced and coerced sterilization of vulnerable First Nations women left virtually alone due to these policies.” [3]
The National Council of Indigenous Midwives (NCIM) is a fierce advocate for the return of birth to Indigenous communities and the end of forced birth evacuation policies. Today, the NCIM has around 120 members, consisting of both Indigenous midwives and students. [4] The goal of the NCIM is to promote culturally safe sexual and reproductive health and restore community-based Indigenous midwifery education and practice.
In Ontario, Indigenous midwives can work under an exception clause in the Midwifery Act, 1991, with the title of Aboriginal Midwife. [5] The exception clause in the Act allows for a community to formally recognize those who hold the skills and knowledge to provide midwifery care as legal midwives. Ontario is the only province with an exemption clause built into the midwifery legislation. [4] Aboriginal Midwives are equipped with comprehensive skills to deliver culturally safe, holistic perinatal care which resonates with the values and traditions embedded in the Indigenous community they serve.
Despite the crucial role of Aboriginal Midwives in their communities, many have faced
significant barriers to providing comprehensive perinatal care. Midwives working under the
exception clause often face limited integration into the broader medical system and they may not be compensated under the same funding models as Registered Midwives. As a result, Indigenous midwifery practices have been chronically underfunded, requiring Indigenous midwives to develop innovative models for compensation and for acquiring supplies and medicines. [6]
While there are some Indigenous midwifery practices with funding across Canada, they are
generally funded and regulated as individual clinics with specific agreements. These agreements often fluctuate and may be unsustainable due to shifts in available funding or local clientele.
In a groundbreaking move, in 2016, the Ontario government announced an application call for community-based Aboriginal Midwifery Programs. [7] Recognizing the unique impact of
Indigenous midwives on the health and well-being of their clients, this program represents a
significant step toward fostering culturally safe perinatal care and expansion of Indigenous
midwifery. The Aboriginal Midwifery Program presents a formal pathway for regulation,
sustainable funding, and establishment of Indigenous midwifery practices in Ontario.
The Aboriginal Midwifery Programs are based within Indigenous communities and many are
staffed by Aboriginal Midwives and community appointed caregivers. The application process requires that applicants provide information about their community needs, as well as their proposed caregivers, governance of the program, and yearly budget. [7] The application process allows for communities to establish Indigenous midwifery in their community which is based on their unique perinatal needs and values.
Since 2016, there have been two waves of applications. In the first wave of applications, five
programs were established across Ontario. [8] These programs provided sustainable funding to many Aboriginal Midwives who were already working in their communities. This funding has enabled Aboriginal Midwives to establish midwifery clinics, provided appropriate compensation, and ensured that midwives can acquire necessary equipment and medicines.
The Kenhtè:ke Midwives, who are located on the Tyendinaga Mohawk Territory, were one of the first approved programs. [9] The practice was established in 2012 by midwives who were practicing under the Aboriginal Midwife exemption clause in an unfunded model. In 2017, the Kenhtè:ke Midwives were approved as an Aboriginal Midwifery Programs and are now fully funded through provincial transfer payments. They also provide a community based apprenticeship program for Onkwehón:ew Midwives who will practice as Aboriginal Midwives. The funding provided through the program has allowed the Kenhtè:ke Midwives to establish a clinic and grow into a greater network of care within the community.
The Aboriginal Midwifery Program provides sustainability through funding and allows for
Indigenous communities to establish Indigenous midwifery through their own governance
models and traditions. The program is an excellent first step towards sustainable resurgence of Indigenous midwifery. The importance of the Aboriginal Midwifery Programs is best reflected in the work it enables Indigenous midwives to do. In the words of the Kenhtè:ke Midwives, “We aim to provide culturally appropriate care that sustains our way of life by birthing our children in the hands of our own people, on our land, using our language traditions, culture, and traditional medicines whenever possible.” [9]
References
[1] National Collaborating Centre for Aboriginal Health. (2012). The Sacred Space of
Womanhood - Mothering Across the Generations.
[2] Adams, E., McDonald, S., Henry, B., & Smith, D. B. (2021). Sacred and Strong: Upholding
our Matriarchal Roles. First Nations Health Authority.
[3] Johnston, C. E., & Spence, C. W. (2019). Support for a Greater Investment into the
Reclamation of Childbirth. Assembly of First Nations.
[4] National Council of Indigenous Midwives. (2023, March 30). History & Strategic Plan.
[5] Midwifery Act 1991, S.O. 1991, c31. s8(3)
[6] National Council of Indigenous Midwives. (2018). Landscape of Midwifery Care for
Aboriginal Communities in Canada. NCIM.
5/NACM_LandscapeReport_2016_REV_July18_LOW.pdf
[7] Department of Health and Social Services. (2012). Midwifery Program Review and
Expansion Analysis. Government of the Northwest Territories.
[7] Ministry of Health and Long-Term Care. (2020). Guide to completing an Aboriginal
Midwifery Program Application Form. Government of Ontario.
e_en.pdf
[8] MUSKRAT Magazine. (2017). Ontario improving access to aboriginal midwifery care.
Muskrat Magazine.
[9] Kenhtè:ke Midwives. (n.d.). Home. Kenhtè:ke Midwives.