Status of Women Committee on May 10th, 2021

[The Chair, Conservative, Marilyn Gladu]

Sorry, could you please raise your microphone?

[Andréanne Larouche, Bloc, Shefford, QC]

Of course.

I was about to say that, in Quebec, health and education programs are the responsibility of the province, as they come under provincial jurisdiction. So how can you work in collaboration with the federal government?

Ms. Bourret, you talked about the Consortium national de formation en santé. Can you tell us about potential collaboration with the federal government to ensure a better service and monitoring of midwives?

[Kirsty Bourret]

Thank you.

Once I answer your question, I will yield the floor to Susan James, who has much more experience than I do with the CNFS. She will be able to tell you in more detail about a potential collaboration.

In my experience, the CNFS is a very important program for health care providers. It provides subsidies and allows for collaboration among universities at the provincial level. It is intended for all health care providers.

I would not go as far as to say that we have been discriminated against at Laurentian University, but we initially had to re-explain to the federal government what a midwife is, what the profession consists in and what our needs are. In the beginning, it was a bit difficult for us to collaborate properly with the federal government. That is why we have discussed the possibility of raising awareness, either through the CNFS or by creating programs specifically aimed at increasing the number of francophone midwives.

The CNFS is used not only to increase the number of health care providers, but also to increase the capacity of the francophone profession, namely by subsidizing research on midwifery. As Dr. James said earlier, we don't have the capacity needed to do research on our own profession.

How can we explain the benefits of our work when we cannot measure them? The CNFS's programs are really important, as they support research. We assume that good collaboration would be possible, especially for midwifery and for francophone midwives.

I now yield the floor to Ms. James, so that she can explain to you in more detail how that collaboration works.

Thank you.

[Dr. Susan James]

I believe one of the ways that we have worked very effectively with CNFS as a federal organization and the university as a provincially funded organization is through wonderful communication and looking at where the sources of funding are for a particular request. For example, if it were a student who was really struggling with something about a placement—and this comes up all the time, because they have to move and find a place to live and buy food and travel around, etc.—we do get provincial money to help with some of that. However, sometimes a student will have additional needs, and, if they are a francophone student, they could ask CNFS if they have funding available to support them. CNFS will first ask what they have already done, what they have already looked at. Then, if that student still needs to have additional support, CNFS will look at what is in their budget that can help.

We've seen that for financial support of students. We've seen that in the program. For example, recently we were looking for more textbooks in French. The challenge for professions right around the world is that most things get written in English, and we want students to have the opportunity to learn by reading the required materials in their first language.

We were able to get some funding and additional support from CNFS. Not only did they give us the money to make it happen, but they also found the right people to do the translation. This was an electronic book, so we also needed really good IT support. We needed people who did that IT support who were francophone and who could understand what it was that we really needed for the francophone students to use that textbook well.

[The Chair, Conservative, Marilyn Gladu]

That's our time on that question.

Now we'll go to Ms. Mathyssen for six minutes.

[Lindsay Mathyssen, NDP, London—Fanshawe, ON]

Thank you, Madam Chair.

One of the things that we've seen over the recent period of time is that there was, for a long stretch, quite a lot of support, at least in Ontario, for midwives from the Association of Ontario Midwives. There was stable funding. That has been, as I understand it, cut, and you can correct me if I'm wrong, but in addition to that, midwives worked extremely hard to win a historic landmark within the Human Rights Tribunal of Ontario for pay equity. That is now being appealed. Could you talk about the impacts that has on your members, both financially and professionally, and how that impacts your members?

[Jasmin Tecson]

I would say that the impact has been extremely discouraging for midwives. Midwifery has been legislated in Ontario for 27 years, and for 17 of those 27 years, midwifery compensation was frozen even for the cost of living. To have a midwife with the clinical and emergency skills that we have who are available on call 24-7 for our clients the disrespect is incredibly disheartening.

To have that recognized by the Human Rights Tribunal of Ontario and the Divisional Court of Ontario was affirming, and yet it is deeply frustrating to have the provincial government challenge that, especially in light of the work midwives have put in on the front lines bridging care in the community so that families that are at a very vulnerable point in time can reduce their exposures during the pandemic.

To work as essential workers and yet not be recognized has led to burnout. It frustrates midwives that their compensation levels have led to them taking on higher caseloads than might be healthy, with that leading in turn to levels of mental and physical disability, which are a penalty for the entire profession.

Thank you for your question, because I feel this is an equity issue, where the health of birthing people and the health of those care providers, particularly those who are marginalized, is threatened because of the undermining of this female-predominant profession that serves them.

[Lindsay Mathyssen, NDP, London—Fanshawe, ON]

Thank you.

In this committee at the same time we're multi-functioning, doing a study on unpaid work and the additional work that women take on just naturally within the care professions as women and the imbalance or unfairness we see in the pay in those care professions. It seems as though midwives are no exception, unfortunately, to that.

You mentioned the additional stress because of COVID as well, and it's my understanding that because you were not recognized as essential services, midwives were neither provided with the pandemic pay nor PPE. Can you talk about the impacts on your profession that way, as well?

[Jasmin Tecson]

Yes, that's correct.

The federal government was good enough to provide funding for our province for pandemic pay. Unfortunately, in the divvying up of that pandemic pay, despite midwives meeting all of the criteria for essential workers who are eligible, they were not paid out, because within the gender bias of policy-setting, midwives were not included as an eligible category. Midwives are consistently treated as afterthoughts within the health care system.

The impact on midwifery practices was that they had to pay for additional staff, for changes to their facilities, and for personal protective equipment for themselves and their students out of their own operational budgets. For some practices, community members got together and sewed midwives' masks and made them gowns out of bedsheets.

To have that happen to a health care profession that has gone above and beyond and pivoted to meet the needs of the community is incredibly disheartening, and midwives definitely felt the insult. It definitely added to the stress and burden of the pandemic personally and professionally.

I just want to say that as far as sustaining and growing midwifery is concerned, midwifery cannot grow if it's stunted from the beginning by underfunding, or outright cutting of its educational programs. Further, it can't grow if it's starved by policies and compensation practices that don't value its workers. Their treatment around pandemic pay is entirely consistent with that.

[Lindsay Mathyssen, NDP, London—Fanshawe, ON]

You are, obviously, highly educated. Many of the students I spoke to were very concerned that they couldn't continue their education if they were to switch to the other two universities, because they would be put onto a pass-fail type of situation. How does that also impact your profession when you're stunted—and a bachelor's is incredible—when it stops there?

[The Chair, Conservative, Marilyn Gladu]

Please provide a quick answer, in 20 seconds.

[Jasmin Tecson]

I would say that the cutting of the program—which was a success by all measures—is an example of what happens when decisions are made without consideration of the subtle impacts of gender bias. Ultimately, this slows the growth of a profession that already is growing slowly and is behind demand.

[The Chair, Conservative, Marilyn Gladu]

That's very good.

Now we'll go to Ms. Shin, for five minutes.

[Nelly Shin, Conservative, Port Moody—Coquitlam, BC]

Thank you, Chair, and thank you to all the witnesses today for providing us with some wonderful insights about midwifery, especially in northern Ontario.

I wonder if you could speak to midwifery and how it relates to indigenous communities. Access to health care services may be challenging for many indigenous communities, which may force indigenous people to seek this care outside their communities. They have reported experiences of racism and violence while seeking health care, including sexual and reproductive health care outside their communities.

According to the National Aboriginal Council of Midwives, “Indigenous Midwifery care is a pathway that supports the regeneration of strong Indigenous families by bringing birth closer to home.”

Could you describe the role that indigenous midwifery plays in the health and well-being of indigenous peoples and communities?

That question is for anyone.

[Jasmin Tecson]

I suppose I can start.

Susan and Kirsty, perhaps you can chime in, from working most directly with indigenous students.

My practice in downtown Toronto, even though I live in Scarborough, Ontario, is Seventh Generation Midwives. We work with an urban indigenous population, but we work with a model that grounds care fundamentally within a family unit and centres that within the bigger community.

For indigenous families, to receive care from an indigenous midwife who shares their world view and shares their understanding of what is essential in consideration of their whole personhood, their health and their location within their community makes a huge difference and minimizes the trauma that can be reenacted in their interactions within the health care system. It's affirming for the indigenous midwives practising, and definitely for the families, and resets the harm that has been caused generationally thanks to residential schools.

Perhaps Kirsty or Susan would like to add more.

[Dr. Susan James]

In the midwifery program at all three sites, right from the beginning in 1993, we have felt that it was important to ensure that indigenous applicants had an opportunity to have a space within the program.

At Laurentian, we have generally had a cohort of indigenous students in every year of the intake of our program. We attempt to not only support what it is that they feel they need from us to prepare them for practice in their communities, but we also want the other students who will be practising in northern Ontario, likely with at least some indigenous clients, and some practices will have high proportions of indigenous clients, to have an understanding so that each client doesn't have to try to interpret what it means to be indigenous to every midwife that she encounters in her health care.

Ideally, of course, we would like for our indigenous students to have an opportunity to have all their placements in indigenous practices and we do have procedures set up in our placement process to at least give them the first opportunity to get those placements when they are available.

We also know that the times are changing and it is time for there to be indigenous schools of midwifery. We know there is federal funding being put in place through FNIHB for the students to be able to create a school that is indigenous.

One of the things that may happen with a new northern school of midwifery is that instead of just re-creating the northern site of the consortium, perhaps we may have a new consortium that's something similar to what we have, but our partners might be maybe two or three indigenous schools of midwifery in northern Ontario. Maybe our partners will be with other places where francophone students want to study.

I'm getting off the indigenous topic here.

[The Chair, Conservative, Marilyn Gladu]

Mr. Serré, you now have the floor for five minutes.

[Marc Serré, Liberal, Nickel Belt, ON]

Thank you, Madam Chair.

I thank the three witnesses for their testimony.

I would like to put a quick question to the three witnesses, who will understand why I am bringing up this issue.

Lisa Morgan, who was a witness at the last meeting, said she was part of the tri-council.

Dr. James, were you part of the tri-council? We heard from Lisa Morgan. She participated in meetings at the tri-council.

I just want to know—yes or no—whether you were you part of that. I will tell you why afterwards.

[Dr. Susan James]

If you were talking about the tri-council with McMaster and Ryerson, yes. I was the director for 20 years. I've participated in many meetings of that consortium.

[Marc Serré, Liberal, Nickel Belt, ON]

Excellent.

Ms. Tecson, are you part of that tri-council?

[Jasmin Tecson]

I am not a member of the consortium. However, I was a member of the advisory council of the consortium when I was a student.

The consortium members are leaders within the midwifery education program not the professional—

[Marc Serré, Liberal, Nickel Belt, ON]

Excellent.

Madame Bourret, were you part of the tri-council?

[Kirsty Bourret]

Yes, I have been part of it since 2007 because I have been a professor at Laurentian University since then.

[Marc Serré, Liberal, Nickel Belt, ON]

Are McMaster University graduates sent across Canada? Laurentian University sends students to Nunavut and New Brunswick.

Does McMaster University send students across Canada or only to Ontario?

[Kirsty Bourret]

I cannot give you exact statistics. I can only talk about our graduates and the places they move to. I can say that the majority of graduates are Franco–Manitobans, Albertans or New Brunswickers.