The Applied Policy Research Unit (APRU) is very pleased to announce the release of its latest report entitled, “System Enablers of Distributed Maternity Care for Aboriginal Communities in British Columbia: Findings from a Realist Review“. The report is an applied examination of the features that would enable high quality, culturally and clinically safe maternity services for First Nations women living in rural and remote BC.
In recent decades, clinical practice has required many First Nations women from rural areas to leave their community weeks before their expected delivery date to await labour near a tertiary centre. Under the Federally managed Non-Insured Health Benefits program, accompanied travel is not reimbursed. For anyone, the costs up-front and those not reimbursed can be challenging to manage and can include food, lost time at work, child care, long distance phone calls and more. Research findings indicate that women who must travel for birth are much less likely to have a support person present at their birth and that the experience is isolating, lonely and scary.
Further, First Nations women from rural areas face an extreme disparity in birth outcomes. Canada’s neonatal mortality hovers around 40th in the world at 3.5 per 1,000 live births. Among Canadian First Nations in rural areas, the neonatal mortality rate is 2.3 times higher at over 8 deaths per 1,000 live births.
Commissioned by the First Nations Health Authority, the newest APRU report examines evidence from around the world on returning birth to small, rural and remote Indigenous communities. Eleven enablers are considered across four models of care from over 160 sources. Considered enablers include what types of professionals should be involved, how to enable women to use their existing social supports, what kinds of clinical and political leadership are needed, as well as the most useful types of infrastructure and the legal requirements of potentially implementing new models of care driven by the needs of women from BC’s First Nations. APRU and FNHA agreed to privilege examples specific to Indigenous models of care in which cultural and social safety were components of care.
The organizing question of the review was:
“What systemically enables the decentralization of maternity services while maintaining safe birth outcomes in rural and remote communities?”
BC has a unique opportunity for radically new models of care that integrate high quality Western medical practice with community-held cultural, historical and personal knowledges and are based on international best practices.