Thank you, Madam Chair.
The Canadian Association of Midwives and the National Aboriginal Council of Midwives are the organizations representing midwifery in Canada. Our vision is equitable access to excellent sexual, reproductive and newborn midwifery services for everyone. Our focus to achieve this is on advocacy, midwifery association strengthening in Canada and abroad, and promoting excellence in clinical care.
Midwives are involved in 11% of births in Canada and play a vital role in the provision of equitable, accessible, culturally safe and high-quality health care, when and where people need it the most. Evidence shows that midwives working in the continuity of care model decrease pre-term birth, stillbirth, epidural use and instrumental birth. Canadian midwives also decrease rates of cesarean birth, hospital admission and readmission, and shorten hospital stays. All of this saves the system money.
For birthers of low socio-economic status, midwifery has been shown to reduce the prevalence of small for gestational age and pre-term birth when compared with physician care. Similarly, Canadian evidence shows birthers who are substance using or who have mental illness also experience improved outcomes when cared for by midwives, but access to midwifery care is constrained by a lack of awareness.
We know, as Kim has mentioned, that there's an inverse relationship between perinatal outcomes and distance travelled to care. Canadian midwives, however, have a long history of providing care closer to home, particularly in Inuit, indigenous and remote communities.
The UNFPA's state of the world's midwifery report was released on May 5, the International Day of the Midwife. For the first time, it includes a Canadian report showing that our workforce of 2,000 midwives amounts to only 0.5 midwives per 10,000 individuals. This is an inverted ratio of midwives to physicians compared to most high-income countries, and indeed, most other countries in the world.
Our sexual, reproductive, maternal and newborn child health workforce theoretically may exceed need; however, in reality, many communities do not have their needs met due to inequitable distribution of providers, as well as scope of practice restrictions.
The report also points to a potentially inefficient skill mix within the workforce, which may contribute to overmedicalization of childbirth or too much too soon in urban areas, and too little too late in rural areas, each contributing to higher cost to the system and poorer outcomes for Canadians. Given the improved outcomes and cost savings, the case for increasing the proportion of midwives involved in births is sound. However, if Canada wanted to adopt a midwife-led perinatal care system, we would need to increase the number of midwives to 9,000 by 2030.
What the state of the world's midwifery report doesn't take into consideration are the factors that threaten the future of the midwifery workforce in Canada. These include, as have been mentioned by previous witnesses, a shortage of midwives to meet the demands of Canadian birthers; a failure to address the needs of indigenous midwifery and fulfill the TRC call to action number 23; gender discrimination manifesting as a scarcity of midwifery leadership in administration and governance; inequitable pay,; lack of provincial or territorial funding; and a stagnation of growth in some jurisdictions due to health system arrangements and/or a lack of professional autonomy. These factors culminate to ultimately result in significant levels of burnout for the midwifery profession.
The closure of the Laurentian University MEP, Canada's only bilingual and tri-cultural MEP, further threatens the stability, diversity and equity of our workforce.
We call upon the federal government to co-operate with provincial and territorial governments to support the relocation of the Laurentian program to a northern university that can support its bilingual and tri-cultural mandate; expand investment in indigenous midwifery and focus on creating diverse pathways to education, including community-based education for indigenous students; extend federal student loan forgiveness to midwives working in underserved, rural and remote communities; add midwifery as a primary health care provider as defined by the Treasury Board of Canada, to facilitate midwives eligibility to work in federal service jurisdictions; create senior midwifery leadership positions, including a chief midwifery officer within Health Canada; and invest in CAM's capacity-building work with Canadian midwifery associations and invest in midwifery research and advanced education and leadership training for midwives.
Thank you.