Indigenous Peoples' responses to evacuation for birth in Ontario: conceptualizing risk through an Indigenous midwifery-led approach.

Background: Currently, pregnant Indigenous Peoples living in remote, rural, and northern Indigenous communities in Canada are subjected to evacuation birth policy, whereby they are evacuated out of their community to large, urban hospitals to give birth. Evacuation for birth is assumed to decrease biomedical risk because people are birthing in hospitals. In Canadian health systems, evaluating and mitigating biomedical risk has become a standard in health decision-making but this framework disregards Indigenous ontologies and epistemologies that guide Indigenous people in their evaluation of health risk. In this study, we sought to understand how pregnant Indigenous people in Ontario conceptualise health and risk.

Methods: We collected data through semi-structured interviews with 43 participants who have been evacuated for birth or are kin of an evacuee who live in Ontario, Canada.

Results: Risks associated with evacuation for birth were conceptualised by participants in a wholistic manner based on principles of self-determination. Participants identified multiple risks that shaped their overall assessment of health risk when facing evacuation for birth including the risk of being separated from kin, confronting a lack of health services, and experiencing discrimination. As participants spoke about risk, they reimagined perinatal care to mitigate these risks, which requires bringing birth back to Indigenous communities through Indigenous midwifery.

Conclusions: We outline actions to limit the practice of evacuation for birth, support the return of birth to Indigenous communities, and expand understandings of risk within policy and clinical practice.