I call this meeting to order.
Welcome to meeting number 36 of the House of Commons Standing Committee on the Status of Women. Today's meeting is taking place in a hybrid format, pursuant to the House order of January 25, 2021. Our committee is studying midwifery services across Canada.
Witnesses, I will recognize you by name. All your comments should be addressed through the chair. If you need interpretation, there is a button at the bottom of your screen where you can choose either your favourite language or the audio from the floor. When you're speaking, please speak slowly and clearly for the interpreters. When you're not speaking, your mike should be on mute.
Now I'd like to welcome our witnesses, who will each have five minutes for their opening remarks.
We have, from Laurentian University, Robert Haché, president and vice-chancellor, and Marie-Josée Berger, provost and vice-president, academic. From the Association of Ontario Midwives, we have Ellen Blais, director, indigenous midwifery.
We'll begin with Robert for five minutes.
Thank you very much, Madam Chair.
Good morning, everyone. Aaniin.
Good morning, I'd like to thank the committee for inviting me to participate today. The committee's work in examining critical issues such as women's health, support and care for certain groups of women, women's labour issues and challenges faced by women living in rural communities, for example, is essential.
I am pleased to speak to you today from Laurentian University in Sudbury, in Northeastern Ontario, located on the 1850 Robinson-Huron Treaty territory and on the traditional lands of the Atikameksheng Anishnawbek and Wahnapitae First Nations.
Earlier this year, Laurentian University faced a devastating choice: close the university's doors or declare insolvency and set down the path of the Companies' Creditors Arrangement Act to ensure the university's survival. It was an extremely difficult choice and the consequences were significant. We were at an impasse where decisions had to be made to ensure our long-term future, and one of those decisions was the termination of our midwifery program.
Although midwifery and sage-femme programs have been a point of pride for Laurentian University and indeed an area of need for the province, it has been a very expensive program to deliver relative to other programs. Indeed, it has actually been two programs, one in French and one in English, with a total of 30 students across both programs, and with faculty and support duplicated for each program.
With revenues capped well below the cost of the delivery of the programs, in a situation in which decisions needed to be made to restore the financial viability of the university, it was no longer possible for Laurentian to continue to offer these programs. To accommodate midwifery students, Laurentian has been working with the other programs in the province and is communicating options to help students make informed decisions about their academic future to ensure that they complete their degree. Further, the total number of midwifery training positions in the province will not change, as the Laurentian slots are being redistributed across the other programs in the province.
Laurentian's efforts are firmly trained on the future: on what comes next, on rebuilding and on excelling in our mandate of educating the future leaders of our global communities. We remain deeply committed to our bilingual and tricultural mandate, offering strong programs in French and English and with indigenous content and program options across faculties.
Laurentian University will continue to provide post-secondary pathways for our North's first-generation learners, for francophone and Indigenous students, for those located in remote areas or impacted by societal challenges, to the children and grandchildren of our nearly 70,000 alumni and to all those discerning individuals who choose to pursue higher education.
I would like to thank the committee again for the invitation to appear before you this morning and applaud the important work that you are doing for the people of Canada.
Thank you. Merci. Meegwetch.
Thank you. Shekoli
. Good morning.
I'm speaking to you today from Wasauksing First Nation near Parry Sound.
Thank you, committee members, and thank you, Madam Chair. I am honoured to have the opportunity to have a few minutes to share with you some words about the value of indigenous midwifery to the health and wellness of indigenous communities.
My name is Ellen Blais, and I hold the position of director of indigenous midwifery at the Association of Ontario Midwives. I am a graduate of the midwifery education program at Ryerson University, and I am from the Oneida Nation of the Thames.
I would like to share the name I was given that connects me to my spirit. In the Oneida language my name is Kanika Tsi Tsa, which means Little Flower. I was born through the waters of Many Flowers, who was born through the waters of She Who Carries Flowers, my maternal grandmother. My identity comes from a place of dislocation from the moment I was born, being taken away at birth by child welfare from my culture and my roots. The story of indigenous midwives is inherently related to dislocation as well, up to and including the closure of the Laurentian University midwifery education program.
Sadly, my story is shared by many. Although indigenous people make up about 4%-5% of the population of Canada, in many jurisdictions well above 60% of our population are in the care of the state. Since indigenous midwives are often present at the birth of indigenous babies, they work hard every day to intervene in these destructive practices and are providing excellent clinical care to every indigenous family they are working with. However, there are far too few of us to sustain this kind of work into the future.
I have three recommendations that I will now share, and then provide you with real-life contexts of why these recommendations are relevant.
First, we need a commitment from the federal government to build capacity for indigenous midwifery programs and services by developing a funding strategy to ensure indigenous midwifery is core funded.
Second, we need a commitment from the federal government to provide a mechanism to hire midwives and to provide housing and infrastructure for midwives in first nation and indigenous communities.
Third, we need a commitment from the federal government to provide funding for indigenous midwifery education, so that individual communities can support broader initiatives or create their own midwifery education programs that are relevant to the community, self-governed and community-responsive.
To connect the theme of dislocation, the history speaks for itself. The colonization of indigenous lands and resources also involved the forced removal of our children by the state to be placed in residential schools, now replaced by the current child welfare system. The medicalization of childbirth, along with policies embedded in the Indian Act, pushed indigenous midwives to the side and extinguished their work.
Without these overwhelming forces, midwives would have stood strong to keep birth in our communities. Midwives would have held our babies close and would never have allowed infants and children to be taken out of their mothers' arms. The anti-indigenous racism that is so prevalent in our health systems would not have been allowed to develop exponentially, to the point where indigenous people die from lack of culturally safe care.
In addition, the closure of Laurentian University has left a huge gap in providing midwifery education in the north, and with that, access for midwifery education for indigenous students and the growth of indigenous midwifery in northern communities.
Allow me one moment to ask you a few questions to illustrate my story.
If you have had children, imagine yourself when you were preparing for childbirth, or maybe even preparing for the birth of your grandchild. What were your hopes and dreams for your birth? Where were you going to have your baby? Most likely, you were thinking about your home, your family and your community.
Now replace your thoughts with these. Imagine yourself getting on a plane alone about four weeks before your baby is due. You wave goodbye to your family and hope that they will be okay. You arrive in a small rural or remote community thousands of kilometres away, where you know no one. You live in an unfamiliar place and you wait four lonely weeks until your baby is born. At birth, there is no family, no home and no community. You get back on a plane and you go home all alone with your baby in your arms, with no support.
This is what indigenous people have had to do for generations. It is a harmful and hurtful practice. Where is the sound of the newborn baby's cry? We have only silence. What does that mean for the health and wellness of your community? What has been lost?
In conclusion, access to indigenous midwives is imperative for the health outcomes of indigenous communities. Please consider these recommendations. We are tired of holding this up on our own. We know that to bring back birth is to bring back life. We know how to do this. We are strong, we know what we need, and we are brilliant.
I will conclude with a final ask by sharing a quote from the Women Deliver Indigenous Women's Pre-Conference.
We ask the government of Canada to measure the health and wellness of Indigenous women, girls and gender diverse people as an indicator of the health and wellness of the entire nation.
Thank you. Yaw?’kó
Thank you, Madam Chair.
I thank the witnesses very much for coming here today to discuss a very important topic for our community. I am a graduate of Laurentian University, as are my father and daughter, and the news on April 12 when the court proceedings ended shook the community to its core. I myself was extremely disappointed and frustrated at programs being terminated at Laurentian University, which also saw its image become tarnished. I am still very proud of the university, but I'm having trouble accepting the process.
I know I don't have a lot of time, Mr. Haché, but we need to regain the community's trust. Today in committee we are specifically looking at the midwifery program.
Mr. Haché, we've heard repeatedly that there's an urgency to keep the midwifery program in northern Ontario. It's been our pride for the last 28 to 30 years because it's rural focused and it's in northern Ontario, with strong partnerships with Laurentian and Lakehead and a focus on indigenous studies, and it's the only bilingual program in Canada. Can you confirm today what efforts are being made to support this program to stay in northern Ontario?
Thank you for the question.
Students have been redistributed throughout the province of Ontario, which has a total of 90 spots for training midwives. Previously, these spots were distributed across the three institutions offering the program.
The 30 positions assigned to Laurentian University have been redistributed to McMaster University and Ryerson University. This leaves the total of 90 training spots intact.
It is an excellent program for people who want to study in the field. We always have many more applications for the training than we have spots available. The province determines how many graduates we will have and students we will take in each year. It is managed by the province, which ensures that the right number of midwives are active in the system. That number has not changed for several years.
In the future, we will continue to offer 90 spots throughout the province. The challenge will continue to be to offer the program in French, as Ryerson's and McMaster's long-term programs are offered in English. At Laurentian University, five or six people were studying in French each year, which meant about twenty people were enrolled in the program over the four years of training. This is a large number, but it reflects the challenge of offering a fairly expensive program to a very small number of students.
Thank you for the question.
I'd like to add something to what Mr. Haché said. Students who are currently completing their fourth year of the program are staying at Laurentian University. We will ensure that they complete their placements until the end of December, and they will graduate from Laurentian University.
Those in their third year will have letters of permission, but their placements will continue in Sudbury and Northern Ontario. This transition is confirmed.
Those in first and second year will transfer to McMaster University and Ryerson University to complete their studies. As Mr. Haché mentioned, the consortium receives funds from the Ministry of Health and the Ministry of Colleges and Universities. All of this is being coordinated by the consortium.
When you look at the number of students enrolled, the programs that need to be offered, and the quality that needs to be provided—which is really important for a midwifery program like the one the consortium is implementing—one thing becomes clear: even though we're working together to implement the program and the educational curriculum, the fact remains that the revenue doesn't really match the costs.
Thank you, Madam Chair.
Thank you, Madam Blais, for being here. I would love to speak with you about midwifery, particularly in the north in communities like Fort Albany, Attawapiskat and Moose Factory, and I hope we can speak at another time. Today I'm going to have to focus on the situation at Laurentian.
Mr. Haché, the bankruptcy protection act has been around since 1933 and, according to the experts I've spoken with, it has never been used on a public institution, and certainly not a university. One of the tools it's used for is to give breathing room to be able to restructure.
I'm interested in the decision that was made to fire 100 professors, cancel 58 undergrad courses and kill 11 postgraduate courses in the midst of the final week of classes. Why did you sign off on that date? Why did you not give the students a chance to finish their year?
Thank you, Madame Chair; and thank you to all the witnesses.
I'm really sorry to hear of the closure of this very important program. As a former faculty member as well, and then later on becoming the administrator, I know the challenges on both sides of the table whenever you talk about funding.
However, I have several questions.
First of all, regarding the impact of COVID-19, I understand that because of COVID-19, many programs are not fully attended by students. Therefore, fees as revenue and other programs that are generating revenues might have been impacted.
As Laurentian administrator, can you comment on that to explain your decision?
Indeed, the campus has been functioning virtually since the middle of March of last year, when COVID fully arrived. At that point, Laurentian was actually the first university to transition from face-to-face to virtual programming. We did it virtually overnight. All students completed their term. We ran a spring term.
Enrolments have not been significantly impacted by COVID per se, but students are not on campus. We are actually looking forward to a return to campus this September, but for the past year, students have been working virtually. They have been advancing in their studies and the programming continues to be offered.
A significant portion of revenue at the university happens through activities that occur on campus. The loss of so-called ancillary revenue and residences that are not being used and so on do provide financial challenges to the university. Also, a number of additional expenses were incurred because some activity needs to continue on campus, such as research, so there were increased safety protocols and cleaning and all the rest of it.
COVID has had an impact, but it was not the only impact on Laurentian. There were a number of issues that Laurentian has faced over the past decade that ultimately led us to where we were at the end of January.
First, let me agree with you that Laurentian truly does have a picturesque campus. That is a really important feature of the university.
We have been in conversation with the province continuously for many, many months about the situation that Laurentian is in, how we're progressing now through the CCAA process, and what will be needed, as we come out of the process, to have a university that will be sustainable into the future. Those conversations are happening with great regularity with the province, more than once a week at the present time. We are working with them to develop the package of supports that will help the university be sustainable going forward as it transitions out of the CCAA process.
At the same time, we are doing an audit of space at the university. It is important that we be able to ensure that we have the infrastructure we need to support the students going forward and to support the university going forward. That's the other aspect of it. We must ensure on the one hand that we have the campus and we have the buildings and facilities that will support the educational mandate of the university going forward. At the same time, should we identify some infrastructure that is truly surplus to the university, that is costing money to have at the university and that is not needed, there is a duty to look at how we can realize something from those assets that otherwise would be a cost to the university.
Note that I'm not talking about the lands of the university, necessarily; I'm really focused on physical infrastructure in terms of buildings and structures that might have other purposes that could benefit the university going forward.
Thank you for the opportunity to address your question.
I think it's very important right now.... To think that indigenous people will feel okay, with what I've heard, it's not okay to have them necessarily go down south for the remainder of their education.
The accessibility of a northern program is absolutely important for all indigenous communities in the north. The north of Ontario is the size of France. We have 160 first nations in Ontario, many in the north, and we've heard that many communities are very interested in developing midwifery programming in their communities. For indigenous people to have to go down south is not acceptable. They need programming in the north, and this is something that's very important to them. We need indigenous content in our programming, which northern Ontario can certainly deliver, instead of adding in any indigenous content as an afterthought. Relocating to communities like Toronto or Hamilton for university-level midwifery programming is out of the reach of many indigenous students. Gaining tuition funding is not always easy, and some of the timelines that are required, according to some of the loan institutions, to finish our degrees do not work for our communities.
There are many things to think about in terms of the closure in the north. I've heard from many indigenous students that the north is where they want to remain.
Prior to that, though, when you knew you were getting into deeper and deeper trouble, did you go to Minister Romano or to the federal government to try to get some breathing room? This is about finding breathing room to work with your creditors. Did Minister Romano or the federal government tell you that you were on your own? Why were you not able to get that breathing room?
We're talking about an institution that is unique for francophones, for indigenous, for working-class northern Ontario. People come from all over the world to this university. I can't imagine they all just said, “Hey, well, whatever, we'll just see it all torn down.”
To get that breathing space, were you turned down by the province, and did you talk to the feds?
That's a really good question. Thank you.
When I think about midwives being in community, certainly in the urban and some of the more rural areas, I believe there has been quite a bit of continuity of care. Midwifery services have continued programming. There were some initial issues around obtaining PPE for communities, but services have continued. There has been the same level of home births and hospital births that there were.
Going into a home for a birth, of course, requires that the families themselves don their own gear. However, it has been relatively stable. The issues have been with the ones who have to fly out for the births, which I mentioned earlier.
With some of the issues that have happened, I have heard that there has been difficulty finding housing or hotels when you have to fly south and to find places to stay when you're discharged from the hospital. Family members have not been allowed to come with you. There have been issues with blood products and things like that, which have not been able to stay stabilized when you have to travel thousands of kilometres away.
Some communities, I've heard as well, have not had any health care services in the first nations because of COVID and lack of human resources during that time.
I call the meeting back to order.
Welcome to our study on midwifery services in Canada.
I'm very pleased to welcome our witnesses today. Each will have five minutes for their opening remarks.
From the Canadian Midwifery Regulators Council, we have Tracy Murphy, the executive director, and Louise Aerts, the chair.
From the National Aboriginal Council of Midwives, we have Claire Dion Fletcher, an indigenous registered midwife and the co-chair, and Brenda Epoo, also an aboriginal registered midwife and another co-chair.
From Regroupement Les sages-femmes du Québec, we have Josyane Giroux, president and midwife.
We will have all, eventually. We'll start with our guests from the Canadian Midwifery Regulators Council.
Louise, you can begin. You have five minutes.
Thank you, Madam Chair and members of the committee. My name is Louise Aerts and I am the board chair of the Canadian Midwifery Regulators Council.
I am speaking to you today from the unceded Coast Salish territory, represented by the Musqueam, Squamish and Tsleil-Waututh Nations.
I am pleased to have this opportunity to appear before the committee regarding your study on midwifery services in Canada.
The Canadian Midwifery Regulators Council is a network of provincial and territorial midwifery regulatory authorities. Collectively, we regulate the profession of midwifery in Canada. As is the case with many other health professionals, each jurisdiction has its own midwifery regulatory authority or college, which works to ensure public safety by setting registration requirements, setting and enforcing standards for safe and ethical care, and responding to complaints from the public about midwifery services. Midwives must register with the college in their province or territory in order to practise.
Midwifery is currently regulated in all jurisdictions in Canada except Prince Edward Island. Ontario was the first jurisdiction to regulate in 1993, followed by B.C. in 1998. Yukon is our newest jurisdiction to be regulated. This took effect in April of this year. The CMRC is now supporting P.E.I. as it works to regulate midwifery.
There are fewer than 1,700 practising midwives in Canada. Ontario has the most, with around 800 practising midwives. The next-largest jurisdiction is B.C., with 325. At the other end of the spectrum, there are 10 midwives in the Northwest Territories, six in New Brunswick and six in Newfoundland and Labrador.
I'd like to speak about indigenous midwifery from a regulatory point of view.
Indigenous students may take any of the recognized midwifery education programs in Canada and are eligible for registration in their jurisdiction through the regular channels. Further, Ontario and Quebec have laws that provide exemptions from registration for indigenous midwives working in their communities. In Ontario, the exemption clause has been enacted, but it has not yet been enacted in Quebec.
In B.C., the Midwives Regulation includes the ability to regulate a class of indigenous midwife. This also has not been enacted.
The CMRC's mission is to encourage excellence among Canadian midwifery regulatory authorities through collaboration, harmonization and best practice. Some of these recent efforts have included revised entry-to-practice midwifery competencies, common registration requirements, and a shared letter of standing and professional conduct. We are also working to harmonize self-assessment by midwives, indigenous midwife self-identification, labour mobility and emergency skills training certification.
The CMRC owns and administers the Canadian midwifery registration exam, the CMRE. All midwifery regulatory authorities except Quebec require applicants to successfully complete this exam prior to registration. Each year, 110 to 150 midwifery candidates write the CMRE. These individuals are from our Canadian baccalaureate midwifery education programs or bridging programs for internationally educated midwives.
As evidenced by these numbers, midwifery is a small professional group and is limited in terms of growth by the numbers of graduates entering the profession each year—i.e., under 150 across the country.
The CMRC was disappointed to learn of the closing of Laurentian University's midwifery program. This leaves only six baccalaureate midwifery education programs in the country, and only in the provinces of B.C., Alberta, Manitoba, Ontario and Quebec. The CMRC hopes that the Laurentian University midwifery program will be relocated to a new university that, like Laurentian, can provide instruction in English and French and serve the needs of indigenous students and communities.
Midwifery regulators in Canada are ready to assist in the creation of indigenous-led pathways for regulation or exemption. We ask that the committee consider ways to expand investment in indigenous midwifery, which includes creating diverse pathways to education.
Midwives play a vital role in the provision of equitable, accessible, culturally safe and high-quality health care. In some jurisdictions, temporary emergency registration has allowed eligible midwives to register quickly, on a short-term basis, to assist with the COVID-19 pandemic efforts. Further, some jurisdictions have issued public health orders that have expanded midwives' scope of practice to fill needs brought about by the pandemic.
Thank you for your time and consideration. I hope these remarks have helped you to understand the regulation of midwifery in Canada. I am happy to take any questions you may have.
Thank you, Madam Chair and members of the committee.
Greetings from the many communities of indigenous midwives that make up and contribute to the National Aboriginal Council of Midwives.
I would like to start by acknowledging the land we gather upon today. It is the land that brings us health, wisdom and opportunity for renewal.
My name is Claire Dion Fletcher, and I am a Lenape-Potawatomi and mixed settler midwife.
Indigenous midwives have been the backbone of our communities from time immemorial. Colonization, including the medicalization of birth, sought to erase our pivotal role in our communities, our indigenous knowledges and our governance systems, drastically contributing to the poor health outcomes we see today.
Anti-indigenous racism is a problem in this country. It exists in all of our systems: judicial, health, education and beyond. Indigenous midwives provide a protective force against racism—not only in our role as indigenous health care providers, not only in our role as advocates for our clients and not only in being a witness to how our people are treated, but also by providing care in a way that promotes the sovereignty of indigenous people, so that our babies, from the moment of birth, are surrounded by indigenous knowledge and teachings and grow up with us as a part of their community to help them understand their bodies and their rights.
Indigenous midwives are culturally safe care for our communities. We are not the same as mainstream midwives. Yes, there are many similarities, but there is no replacement for indigenous midwives in our communities. Growing and sustaining indigenous midwifery is a direct commitment to addressing anti-indigenous racism and gender inequality that all levels of government can make today.
The following are our three recommendations.
Recommendation one is a reinvestment in indigenous midwifery by the federal government. We must acknowledge that substantive equity starts at birth. The Government of Canada made a historic first five-year investment in indigenous midwifery in 2017. We urge the federal government to renew and substantially increase this funding in 2022 and beyond.
We have numerous reports that highlight the inequities in health outcomes for indigenous people. How many more reports do we need before we take real action? The health of indigenous women, girls and gender-diverse people is an indicator of the health and wellness of the entire nation, and we are failing. The recently released report on the state of the world's midwifery indicates that investing in midwives directly improves health outcomes. A substantial and long-term commitment to indigenous-led midwifery increases equitable access to sexual and reproductive health, works toward addressing gender-based violence and promotes the empowerment of all members of our communities, particularly women, girls and gender-diverse people.
Recommendation two is the addition of midwifery to the job classification system of the Treasury Board of Canada. At present, there is no federal recognition for the profession of midwifery, which creates barriers for communities wanting to hire midwives. Midwives are essential primary health care providers. The lack of recognition by Treasury Board is a key barrier to establishing and sustaining midwifery services for indigenous communities. The cost of non-indigenous-led primary health care to the health system and to indigenous communities is unjustifiable.
Recommendation three is an investment in indigenous-led midwifery education. As indigenous midwives, we know that education programs need to be close to home. We need to train and retain more students within our communities. The closure of the Laurentian midwifery education program is devastating for rural, northern, francophone and indigenous midwifery.
However, we need to also be clear about the limitations of the current university-based education program for indigenous midwifery students. These programs have rigid structures that do not acknowledge the family and community roles of indigenous students and are based in colonial systems that fail to recognize the importance of indigenous knowledge and ways of being. The recognition of indigenous knowledge is a skill in midwifery, and it is crucial for meeting the health needs of our communities.
Our current system is failing prospective indigenous midwives and urgently needs to be reimagined. Indigenous midwives in communities across the country are working to diversify pathways to education for indigenous midwifery students. It's time for the government and the university system to catch up and invest seriously in indigenous-led midwifery education. This is a commitment the government can make as part of its work in addressing anti-indigenous racism.
Anti-indigenous racism is the root of inequity in Canada. Our colonial legacy has been uniquely borne out by indigenous women, girls and gender-diverse peoples, which affects all of our families. Indigenous midwives return to indigenous communities the respect, autonomy and reverence for all of our life-givers.
Anushiik. Thank you.
Thank you, Madam Chair.
Good afternoon, everyone.
I thank the committee for having me here today.
I am Josyane Giroux, a midwife and president of the Regroupement les Sages-femmes du Québec, or RSFQ.
The RSFQ is the professional association that represents more than 240 midwives working in the profession throughout the province. It works to develop the profession and its specificity within Quebec's health care system. In collaboration with the authorities and citizen groups, the RSFQ is committed to supporting access to midwifery services that meet the needs of the population.
The RSFQ also defends the free choice birthplace for women or people who give birth, in accordance with the standards of practice of the profession, as well as its philosophy of practice. The RSFQ is recognized by Quebec's department of health and social services as a spokesperson for midwives, and it negotiates their working conditions.
In Quebec, midwifery has been legally recognized since 1999. At the time, there were already six birth centres where 50 midwives worked. In 2008, the Quebec government published its perinatal policy, in which it pledged that, by 2018, midwifery services would be available in all regions of Quebec, that 10% of women and birth attendants could access services and that there would be a total of 20 birthing centres across the province.
According to 2019-20 data, only 4% of maternity follow-ups are carried out by midwives. Many regions still don't have access to services, and all the birthing centres have very long waiting lists, sometimes representing 30% of the number of annual follow-ups that can be offered by the teams.
We think there are three main reasons for this slow-motion development. First, the lack of recognition of the profession in general and its crucial role in reproductive and sexual health is a major issue. The midwifery model of practice, based on relational continuity, confidence in autonomy and respect for the physiological process of pregnancy and childbirth, is not recognized and valued.
In Quebec, the lack of knowledge of the profession heightens tensions and still leads to refusals of collaboration by medical teams. Ultimately, this remains an obstacle in the development of interdisciplinary services or projects that meet the needs of communities. The government has failed in its crucial role of demystifying and valuing the midwifery profession and its importance to the health system. On a day-to-day basis, it is midwives and families who are experiencing this pressure and are still fighting against misperceptions about their practice by clinical teams and the public.
The second major deficiency is the lack of workforce planning and workforce monitoring consistent with the objectives presented. Despite numerous representations in this regard by the RSFQ and other organizations, the warnings were not heard by the Quebec department of health social services. Midwives and families are the main victims of this lack of political leadership, as labour shortages are now affecting all midwives and forcing them to reduce services to the population. At this very moment, more than 20 contracts are unfilled in the province, and the opening of at least two birthing homes has been delayed.
In Quebec, the Université du Québec à Trois-Rivières is the only educational institution for the midwifery profession. It has a capacity of 24 students per year since the program opened in 1999, but is struggling to fill these places due to the lack of midwives to accompany trainees. It is essential that national consultation work involving the groups and community-based organizations directly involved, including citizen groups, be undertaken in order to find solutions and establish a clear plan.
The third very important element to consider in the analysis of the development of midwifery services and its slowness is the gender discrimination that midwives experience. The midwifery model, developed to meet the needs of women and pregnant persons and whose services are mainly aimed at women, is the source of indecent working conditions. Quebec midwives, at the end of their careers, earn 20% less than their comparable pay equity jobs. In Quebec, in 2019-20, the government paid only a total of $23,561,343 for midwifery services, including all operating costs. These working conditions, in addition to the context described above, lead to many early departures from the profession, exacerbating the shortage of human resources.
At the same time, the RSFQ operates solely based on membership dues, as the government does not recognize the importance of a strong professional association for supporting the development of the profession. Our association therefore struggles to meet all the needs, both those of its members in a global way and the support in the strategic work more than necessary.
Finally, it is with humility that I would like to add that the elements I've described are an exacerbated reality for women, pregnant people, and midwives from indigenous communities.
To date, there is no clear plan to provide families in these communities with access to midwifery services. Collaboration is at its starting point between governmental and legal organizations, communities, universities, and associations.
Our NACM colleagues and indigenous midwives will certainly be able to explain the issues in detail, but we believe it is crucial that the committee look at these matters.
In short, the RSFQ asks the provincial, territorial and federal governments to set up a campaign to demystify, promote and recognize the midwifery profession; invest in the establishment of a working committee for workforce and development planning in line with community needs; provide funding to professional midwifery associations, essential in supporting practice at all levels; recognize gender discrimination faced by midwives and adjust working conditions to end it; and prioritize work for the training, accessibility and development of midwifery services in indigenous communities.
Thank you, committee members, for your attention.
I will be happy to answer any questions you may have.
Thank you, Madam Chair and members of the committee, for allowing me to speak on behalf of Brenda. It's unfortunate that she's not able to connect, as she brings a very unique perspective to this committee.
I'm now going to read her statement for you, as follows.
My name is Brenda Epoo and I'm an Inuk midwife from Inukjuak, a small village in the remote Arctic region of Nunavik, Quebec. I am part of a team of indigenous midwives that serves seven villages on the Hudson coast, using modern and traditional Inuit midwifery skills.
The month of May celebrates midwives and nurses globally. To acknowledge this, the World Health Organization and partners launched “The State of the World's Midwifery 2021” report, which tells the story of the COVID-19 pandemic and how midwives serve their communities in a time of crisis.
A key finding of the report is that during the crisis there has been an increase in violence and reduced access to essential reproductive and sexual health services, and that, critically, midwives play a crucial role in providing support and guidance and access to these important health services.
Across the world, including here in Canada, women and gender-diverse pregnant people are struggling, which has led to increases in maternal mortality, unintended pregnancies, unsafe abortions and infant mortality. While Canada has an established public health care system, it is highly inequitable.
At home in the Arctic, midwives are the leaders of the maternity. We protect our communities and help lessen the impacts of COVID-19 on families. Our Inuit-led model of midwifery is culturally appropriate, with excellent clinical outcomes, including 86% of births taking place in Nunavik between 2000 and 2015. Our model leads the world in linking traditional and medical ways of knowing, and yet we remain largely unrecognized and unseen.
The significant contributions we make day in and day out are not known to most Canadians and policy-makers. Systemic racism is rampant in the health care system, especially against indigenous people. We need a more compassionate and thoughtful system that recognizes the important role that indigenous medical professionals play as clinicians, educators and mentors.
The National Aboriginal Council of Midwives believes that investments in indigenous-led community-based education strategies are critically needed. This investment will create meaningful opportunities for indigenous training, apprenticeships and, ultimately, increased culturally relevant service capacity.
NACM has already developed a sophisticated indigenous midwifery core competency framework that allows communities to customize opportunities to maximize local benefit. We are ready to partner on expanding this initiative to create a more inclusive, responsive and equitable health care system, especially for indigenous people living in rural and remote communities.
Here in the north, we do more than catch babies and do postpartum care. We provide an opportunity for children to be born on our land, in our communities, with a sense of place and pride. It's all about our families, communities and creating future generations of healthy people.
Sure. I'll start with the positive. I think the COVID-19 pandemic has forced us, across the board, to think outside the box, and in some ways jurisdictions have looked to midwives to solve some of the issues that have come forward. In some cases, they have expanded the scope of midwives. Midwifery is quite unique in that it is defined in terms of the restricted activities as services provided to a pregnant person or someone in the postpartum period. Midwives have lots of skills, knowledge, education and judgment that fall outside that period as well.
One example is being able to test for COVID. Midwives within the regulation could do that for their pregnant clients but not for the general public, so health orders were expanding those services. Similarly, for administering the vaccines, midwives could do so for their clients but not necessarily for the full public. Therefore, midwives were looked to and scope was expanded through temporary orders to allow midwives to fill those gaps. Because they are in rural and remote areas and they have that knowledge, skill and judgment already, it was a natural extension, which has been positive.
On the negative side, and very much in terms of the burnout piece, some of the existing structures that were in place for others around personal protective equipment didn't fall into place for midwives right away, especially in the home birth setting. Everyone knows there was very limited PPE available across the country, but what there was, was in the hospital setting. Midwives weren't able to immediately access PPE for home birth, and they really had to again think outside the box to be able to provide care in a safe way.
I think there is a general burnout. We have seen increases in home births through the pandemic, as people looked to avoid being in the hospital setting. There was a lot on midwives to manage. Often there are very few midwives available in small communities, so to have someone need to isolate or come into contact with COVID-19 was very impactful on those communities.
Thank you for the question.
As I said earlier, the reasons are quite varied. The main reason there hasn't been a clear plan is that there is no recognition of the profession. Midwives aren't recognized for their work or their importance in the health care system as front-line professionals.
There is a significant lack of awareness of our work among the public and government bodies. There is still a lot of work to be done in this respect. There has never been a campaign or project to address this issue. Every time new services are introduced in the regions, everything has to be redone. This simple awareness work, which must be done on a daily basis, requires a great deal of time and energy from professional midwives.
All of this obviously has consequences and slows down, among other things, the development of the profession. There are a number of things that come into play, but I think essentially, as I mentioned, this is the one thing that needs to be improved.
Thank you very much, Madam Chair.
I'd like to thank the witnesses, Ms. Dion Fletcher, Ms. Aerts, Ms. Murphy and Ms. Giroux, for being with us today. It's always interesting to hear the reality of midwives on the ground.
I'd like to start by going back to what Ms. Aerts said, which is that the pandemic revealed that this profession had experienced a certain lack of resources, including a lack of personal protective equipment, or PPE.
It's important to work on the recognition of the profession, but it's also important to give it more resources, whether by facilitating access to PPE or by giving it more financial resources. Better funding could help put in place more projects that focus, for instance, on training midwives and even on recognizing midwives.
So I'd like to know more about this lack of resources. Ms. Aerts, one of the things you talked about was PPE.
Ms. Giroux, I'd also like to hear your comments about this lack of resources.
Thank you for the question.
In fact, the pandemic has exacerbated the problems we have, including the lack of midwives, which I mentioned. In the short term, these are things we couldn't necessarily address. However, the lack of resources for our professional association, among others, was particularly noticeable. During the pandemic, considerable effort has been made to support members with all the new developments, from all the new clinical guidelines to implementing the measures and obtaining protective equipment. Having worked with all the professional associations across the country, I can confirm that we were all in the same situation, and it would have helped us tremendously at that time to have additional resources.
Obviously, I'm talking about financial resources that would allow us to have people working with us.
The challenges facing midwifery fall to few people. As we move forward, that's one of the important things to look at in terms of the development of the profession.
Very good. That is the end of our time for today.
I thank our witnesses for your service to women in Canada, and also for your testimony today and helping us with our report.
For committee members, you will have received the second draft of the unpaid work study. Is it okay to request that all of your supplemental or dissenting reports be submitted by June 1, which is next Tuesday, in order that we stay on schedule to be able to table that report? Is that okay? Yes? That's good. All right.
I would remind you that our meeting on Thursday is from 6:30 to 8:30 in the evening, Eastern Standard Time, and we will be finishing up the women's unpaid work study and then moving on to the report on sexual misconduct in the military.
Is it the pleasure of the committee to adjourn? Seeing that it is, we shall see you on Thursday night.
Thanks again. Have a great day.
The meeting is adjourned.