I'm going ahead here.
I wanted to tell you that we are the accrediting agency for midwifery education, and one of our goals is to maintain the standards of curriculum and scholarship as well as supporting continuing development of midwifery faculty and programs. Currently, we are also exploring the ways in which we can support the indigenous midwifery education programs that currently exist and are being developed.
Before Laurentian’s closure last month, Canada had seven baccalaureate midwifery education programs in five provinces. Combined, they admitted just over 150 individuals into a highly competitive stream each year, where approximately 10% of all applicants are given an offer of admission. Upon graduation, these new midwives will have spent over 2,500 hours in supervised clinical practice and exit the education program ready to provide primary care, meeting the sexual and reproductive health care needs of women, trans and non-binary people.
Midwifery is the international standard supported by the World Health Organization for primary maternity care. Professional midwifery is the most cost-effective primary maternity care for health care payers, and 85% of pregnant people can complete their pregnancy and birth safely with only midwifery care. We have an obstetrical primary care provider crisis in many communities across Canada, and midwives see themselves well prepared to fill this need.
As you may know, I think you probably heard that midwives attend about 20% of births in Ontario per year and 26% of births in British Columbia. Those are the two largest midwifery-represented provinces. The loss of a program threatens the production of enough midwives to replace midwifery retirement or those promoted into leadership work. Ontario also educates midwives for the provinces and territories without sufficient midwives in practice to have their own educational programs such as Atlantic Canada and the far north. That need, combined with educating midwives for Ontario, cannot be managed by two midwifery programs in the south.
We must also highlight that we lack sufficient midwifery providers who represent the diversity of our communities across the country. Birth is a psychosocial health event that proceeds most normally when the culture of the primary provider matches that of the birthing family. Therefore, diverse provider backgrounds, including indigenous and French-speaking midwives, are essential to culturally safe care.
Students should be able to study midwifery close to their home communities. Having students move south to large urban centres for midwifery education places an unnecessary burden on families when they plan to live and work in the north. Students may learn and perform less well when separated from their community supports, and program attrition is linked to such barriers and stressors.
As a collective, the midwifery education program has recognized the urgent need to address inequities and facilitate diversity within our programs to support a safe and inclusive environment for indigenous, Black and people of colour within the student cohorts. We also know that the populations that suffer Canada’s highest perinatal morbidity and mortality are found in our northern, indigenous and racialized communities.
When there are insufficient maternity community obstetrical services, the birthing units close. Pregnant people must travel, sometime significant distances, to receive care. This intersects with multiple social determinants of health. Researchers from the University of British Columbia have reported the negative impact on birth outcomes when obstetrical services close and people must travel from their communities to give birth. Several universities are instituting processes to remove barriers for indigenous applicants and others to join midwifery education programs.
Education programs that reduce barriers to enable inclusivity of folk, who, due to racism and colonization, have experienced systemic trauma, violence and oppression, is essential to support equity underserved populations. Closing Laurentian University's midwifery program, a program that helped meet those gaps, imperils those communities.
I also need to stress that midwives continue to struggle for recognition, and it is exhausting to continue to have to do so. At the federal level, there are barriers to midwives. Notwithstanding the long indigenous and settler history of midwives' roles in Canadian history, the first new midwifery wasn't regulated in Ontario until 1994. Now, 27 years later, midwifery is regulated or is in the process of being regulated in all provinces and territories in Canada.
In the current health care climate, there is a pressing need to support capacity building. Midwives should have pathways in leadership and service at the federal level. Unfortunately, there's lack of access to research awards and representation at the table where policy is forged.
Many midwives will graduate from a four-year degree with a debt burden of $90,000 to $100,000. However, if they work in rural and remote communities, they do not benefit from the federal education loan forgiveness programs that their colleagues in nursing and medicine enjoy.
Midwifery is a gendered profession, and we serve a gendered population. Laurentian provided education to future midwives who serve indigenous, francophone and northern and remote communities.
It has been said by others that you can assess the health of a nation by how it treats its indigenous peoples. Limiting the education of health professionals who can ably serve these communities does not reflect very well on us.
Thank you very much for the time to allow me to speak to you today.