Actually, Canada along with Australia, I think, are really leading the way in terms of evidence, looking at rural midwifery practice. What we haven't seen are the investments that follow the evidence.
We know that midwives are more likely to go to rural areas; they're more likely to stay in rural remote areas. In terms of the percentage of people they can keep close to home for birth, midwives can maximize the percentage of people who can stay in their home community without having to travel, in comparison to other health care providers.
The evidence is there, and Canada and Australia lead in this evidence. You can look up the rural birthing index work by Jude Kornelsen.
What we need to see are investments that follow that evidence. In particular, this is going to look at salaried models of care and expanded scope, which are going to be essential to this.
These areas have care that's low volume, but that doesn't necessarily mean it's low input. You can spend an incredible amount of time, particularly when the midwife is replacing the role of several health care providers. The midwife in a rural remote community may also be serving as an ultrasonographer. They may also be the lab tech, drawing blood samples. They might be the infant hearing screener, the lactation consultant.
They're providing an enormous value. But we need to be investing. We need to look at alternate models of care. As well, as I mentioned, we need to be getting that Treasury Board distinction that would facilitate midwives working in federal jurisdictions, because several of these rural and remote areas, such as on reserve, fall under federal jurisdiction.