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Understanding Canada's Birth Evacuation Policy

Updated: Jun 7, 2023

January 28, 2022 - By Michaela Parenteau

Michaela Parenteau is an Indigenous Registered Nurse currently completing her Masters in Public Health. She works for Indigenous Services Canada providing reproductive and perinatal care to members of her community. She is currently fulfulling her practicum placement with the Northern Birthwork Collective.

This is the view out of the windows of Stanton Territorial Hospital’s Obstetrical unit that most expectant pregnant people in the NWT are not witnessing this winter.

With the ongoing reduction of services at Stanton Territorial Hospital’s Obstetrics unit (only some services are resuming next month), and birthing people continuing to face medical evacuation to Edmonton to have their babies, we wanted to shed light on a policy that has been impacting remote Indigenous communities for over 100 years.

What is it?

In 1892, the federal government of Canada established the Evacuation Policy. This mandate requires Indigenous child bearers who live on reserves or in remote communities to leave their community, families, support, culture and traditions to evacuate to urban medical centres for the birth of their child. Health care workers arrange for the transfer of the pregnant person to hospital between 36-38 weeks gestational age or sooner to await the birth of their child, medically referred to as ‘confinement’ period. The birthing person must navigate this process, often alone in an unfamiliar city.

Despite ongoing medical breakthroughs and noteworthy improvements in the realms of health and best practice, Canada follows the historic recommendation to remove, separate and confine Indigenous birthing persons in urban centres. The use of language such as the word ‘confinement’ itself is violent, inhumane and reflects a Policy rooted in colonialism. More recently, evacuation during pregnancy has been imposed upon all parents who seek obstetrical care at the Yellowknife’s Stanton Territorial hospital.

Why was it created?

According to the government the “intended” goal of this policy was to reduce deaths of First Nation infants and decrease mortality rates of Indigenous birthing persons, however, a hidden agenda of assimilation and continued efforts at colonization are apparent. Philosophies of superior western medicine led to the creation of Health Canada’s Birth Evacuation Policy, that aims to support the colonial movement of assimilation by undermining Indigenous traditional birthing practices and epistemologies of health and instead replacing customary ways with the foreign western medical views in urban settings. The Policy was built on motives of oppression, discrimination, and the destruction of Indigenous ways of life and being.

Impacts of the Birth Evacuation policy

The effects of the Birth Evacuation Policy are everlasting, detrimental to infants, parents, family and community. Removing an expecting parent from their partner, other children, family, community and familiar home to access health care in a foreign city can be overly stressful and adds to existing intergenerational traumas. During the weeks leading up to the onset of labor, the birthing person waits in a hotel room or boarding home where they often feel isolated, have trouble navigating the healthcare system, may have difficulty communicating due to language differences, may experience a lack of access to culturally appropriate foods or enough nutritious food to eat to maintain a healthy pregnancy. Removing social, emotional, spiritual and physical support during this significant life event increases anxiety and stress, but also increases adverse birth outcomes. Birth Evacuation increases the risks of preterm labor, impacts fetal neurodevelopment, decreases rates of breast/chest feeding, and affects relationships and family bonding.

The ‘Birth Evacuation Policy’ has attempted to marginalize Indigenous birthing persons, remove their power and their rights. In Canada, Indigenous people continue to experience a loss of agency in their ability to make decisions, their right to choose and participate in their health care. This ‘Policy’ has continued to suppress Indigenous voices; however, society and policy makers must not forget the resilience of Indigenous people and new legacies of hope continue to be born.

Messages to Take Away

It is important to shed light on the impact of continued acts of colonization, perpetuated trauma and experiences of childbirth and instead foster health practices that focus on concepts of healing. Beginning discussions about the legacy of the Birth Evacuation Policy that exists in Canada are steps towards deconstructing oppressive government policy and drawing attention to inequity. Together, we need to explore health care frameworks that are centralized in ambitions of truth and reconciliation, strengthening connection to culture, empowering women, girls, and two-spirit/gender non-binary individuals, building community capacity and returning birth practices to Indigenous communities.

Canada’s Birth Evacuation Policy is built on concepts of colonialism and assimilation, and together we must advocate for change. This journey to restore traditional ways of childbirth and transition towards this return must be developed with collaboration of community voices and appropriate and respectful communication. Shifting away from the Birth Evaluation Policy and forced confinement is a step towards the healing of our country and an act of acknowledging mistakes and beginning a journey of reconciliation.

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