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.