New data from a first-of-its-kind nationwide maternity study led by University of British Columbia researchers has found that three-quarters of Indigenous women surveyed report some form of mistreatment or disrespect from care providers during pregnancy and childbirth.
UBC Prof. Saraswathi Vedam said the study is “not just about being nice to people” — mistreatment leads to poor outcomes.
“When people don’t trust the health care system, when they’re mistreated, they don’t come in for care if that’s what they need to do,” Vedam said. “If you delay your response, you don’t believe someone, they say they’re bleeding — you can then end up with a very bad outcome.”
The Research Examining the Stories of Pregnancy and Childbearing in Canada Today (RESPCCT) study surveyed 6,096 people across Canada between 2020 and 2022 who had been pregnant or given birth within the past decade. Among the 309 Indigenous participants, 63 per cent reported mistreatment and nearly 75 per cent reported disrespect.
Vedam called the findings “shocking.”
In 31 cases, women even reported forced sterilization. This included five Indigenous women, 10 racialized women and 16 white women, which translates to 2.2 per cent of racialized and Indigenous respondents who answered that question compared to 0.6 per cent of white respondents.
The researchers weren’t even going to measure this because they didn’t think it still happened in Canada.
“It should be zero,” Vedam said.
Indigenous participants reported a wide array of harmful experiences, including 39.6 per cent reporting neglect, 37.1 per cent saying they were keft unattended when they needed help, 34.8 per cent reporting they were ignored or refused care, 31 per cent saying treatment was withheld or impsed without consent, 28 per cent saying they were scolded or shouted at and 8.4 per cent saying they recieved negative comments about their culture or ethnicity.
Advocates in B.C. say they often hear about this type of mistreatment.
Gena Edwards, president of the B.C. Native Women’s Association and St’át’imc Nation member, shared the story of an 18-year-old woman in the Interior Health region who, in 2023, was turned away from the hospital because providers did not believe she was in active labour.
“They kept dismissing her, and she ended up having her baby in her car on her way back to the hospital,” Edwards told Black Press Media.
Edwards says that, as the study shows, Indigenous women often feel neglected or are left unattended when they seek care.
“These findings are accurate in today’s time and today’s society,” she said. “And it’s really unfortunate that Indigenous women and teenagers are still being mistreated during childbirth.”
This was the first Canada-wide survey of its kind, conducted by a research team of academic, clinical and community partners, and led by Vedam, a midwifery professor. University of Manitoba Prof. Wanda Phillips-Beck supervised the analysis of Indigenous experiences, which was published on June 30 in the journal Frontiers in Global Women’s Health.
Vedam and her team began developing the survey that informs this research in 2018, creating a questionnaire to get to the heart of what it means to receive proper treatment during childbirth.
Through community and practitioner engagement, they developed a scale that included complex concepts such as autonomy, along with more basic types of mistreatment such as verbal abuse.
This is especially important for pregnant women who can be faced with many difficult choices before, during and after childbirth. These can range from choosing a midwife or obstetrician to deciding if and when to induce labour, or whether to have a C-section.
“You can’t just say, ‘Oh well, did you have autonomy or not?’” Vedam said. “You have to say, ‘What does that look like?” Did someone tell you how to make a decision? Did they explain your options for care? Did they explain the risks and benefits? Did you have enough time to consider your options? Did someone respect your choice?”
Using these measures, researchers found that people who are racialized, disabled, gender marginalized or have an incarceration history experienced a significantly greater loss of autonomy than the general population.
They also found that access to midwifery care leads to less mistreatment and better outcomes.
Vedam and her team say the research demonstrates that health authorities must do more to incorporate both Indigenous practitioners and culturally appropriate care into the care system.
Edwards agrees, saying that provincial health authorities must do more for Indigenous mothers, and providers need to be made more aware of traditional cultural practices and needs.
This makes it especially important because childbirth is a sacred time in many communities.
“The hospitals and the institutions — they need to understand the emotional stress that leaving communities causes for women who are going to have a child,” Edwards said.
Vedam says the federal government is already funding some changes to improve care for Indigenous women. And she is told the RESPCCT survey will help inform how that money is spent.
It is also being used as the basis for several similar studies coming out soon, each of which will focus on a unique subpopulation.