• Janet Smylie, Kristen O'Brien, Emily Beaudoin, Nihaya Daoud, Cheryllee Bourgeois, Evelyn Harney George, Kerry Bebee, and Chaneesa Ryan.
• Well Living House (Smylie), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie), University of Toronto; Ontario HIV Treatment Network (O'Brien); Midwifery Education Program (Bourgeois), Ryerson University; Seventh Generations Midwives Toronto (Bourgeois), Toronto, Ont.; Department of Public Health (Daoud), Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; National Aboriginal Council of Midwives (Harney George, Bebee), BC; Native Women's Association of Canada (Ryan), Ont.; Bridlewood Medical Centre (Beaudoin), Kanata, Ont. janet.smylie@utoronto.ca.
• CMAJ. 2021 Jun 21; 193 (25): E948-E955.

BackgroundFor Indigenous Peoples in Canada, birthing on or near traditional territories in the presence of family and community is of foundational cultural and social importance. We aimed to evaluate the association between Indigenous identity and distance travelled for birth in Canada.MethodsWe obtained data from the Maternity Experiences Survey, a national population-based sample of new Canadian people aged 15 years or older who gave birth (defined as mothers) and were interviewed in 2006-2007. We compared Indigenous with non-Indigenous Canadian-born mothers and adjusted for geographic and sociodemographic factors and medical complications of pregnancy using multivariable logistic regression. We categorized the primary outcome, distance travelled for birth, as 0 to 49, 50 to 199 or 200 km or more.ResultsWe included 3100 mothers living in rural or small urban areas, weighted to represent 31 100 (1800 Indigenous and 29 300 non-Indigenous Canadian-born mothers). We found that travelling 200 km or more for birth was more common among Indigenous compared with non-Indigenous mothers (9.8% v. 2.0%, odds ratio [OR] 5.45, 95% confidence interval [CI] 3.52-8.48). In adjusted analyses, the association between Indigenous identity and travelling more than 200 km for birth was even stronger (adjusted OR 16.44, 95% CI 8.07-33.50) in rural regions; however, this was not observed in small urban regions (adjusted OR 1.04, 95% CI 0.37-2.91).InterpretationIndigenous people in Canada experience striking inequities in access to birth close to home compared with non-Indigenous people, primarily in rural areas and independently of medical complications of pregnancy. This suggests inequities are rooted in the geographic distribution of and proximal access to birthing facilities and providers for Indigenous people.© 2021 CMA Joule Inc. or its licensors.

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