Returning childbirth to Inuit communities in the Canadian Arctic

Abstract

While Inuit living in Nunavut have been advocating for decades for the return of birthing to their own communities, over two-third of births continue to occur outside of the territory. We conducted a literature review to answer the question, why has birthplace choice not been given back to Inuit yet. Based on our review we identified a number of factors impacting birthplace choice, including the organisation of the Nunavut medical system that is focused on primary health care and that cannot easily accommodate the potential clinical risks Western health care associates with birthing, often in isolation from socio-cultural risks; staffing vacancies and turn over in Nunavut, which creates challenges in continuity of care and in maintaining trust; and trends in Canada towards the medicalisation of birthing, which resulted in the displacement of traditional midwifery, and lately in the professionalisation of midwifery with training centres mostly located outside of Nunavut. We recognise that providing more options to birth in the north is complex. While birthing in the north as an option is a given objective, operationalising this objective in a consistent manner is likely going to be a challenge for years to come.

Kivalliq Inuit women travelling to Manitoba for birthing: findings from the Qanuinngitsiarutiksait study

“…In the Kivalliq region, this became policy in 1982, further undermining Inuit midwifery knowledge transmission and naming practices at birth (bestowed by grandparents and the midwife or ikajurti) [5,[17][18][19][20]. This policy is also linked to family stresses as women travel, until recently without their partner [21], to a southern locale at 36 weeks of gestation, to await their delivery.…”

“…The notion of risk, to the mother and baby, can explain in part the push for women to deliver in tertiary care centres. Predominantly biomedical constructs of risk, and associated legal risks to the provider and employer, are reductionists, and ignore cultural, social and personal risks to Inuit families [6], and Inuit's own conceptualizations of risk [21,25,26]. Further, it is unclear how evacuating women to urban locales might mitigate risks associated with food insecurity [27], crowded housing [28], poverty and other systemic risk factors resulting from colonial encroachment on Inuit lives.…”

Giving birth in rural Arctic Greenland results from an Eastern Greenlandic birth cohort

“…The social aspect of pregnancy and childbirth is of pivotal importance for remote communities [ 5 , 9 ] as being born where the family lives is essential to the survival of remote communities [ 10 ]. An example of this is in the remote area in Nunavik in Northern Canada, where the community has decided to support women to give birth in their own remote community and increase prevention in relation to public health and social services [ 5 , 11 , 12 ].…”