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Childbirth evacuation among rural and remote Indigenous communities in Canada: A scoping review

  • Hilah Silver
    Correspondence
    Corresponding author.
    Affiliations
    CIET-PRAM, Department of Family Medicine, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, Quebec, H3S 1Z1, Canada
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  • Ivan Sarmiento
    Affiliations
    CIET-PRAM, Department of Family Medicine, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, Quebec, H3S 1Z1, Canada

    Grupo de Estudios en Sistemas Tradicionales de Salud, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogota, Colombia
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  • Juan-Pablo Pimentel
    Affiliations
    CIET-PRAM, Department of Family Medicine, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, Quebec, H3S 1Z1, Canada

    Grupo de Estudios en Sistemas Tradicionales de Salud, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogota, Colombia

    Departamento de Medicina Familiar y Salud Pública, Facultad de Medicina, Universidad de La Sabana, Chia, Colombia
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  • Richard Budgell
    Affiliations
    CIET-PRAM, Department of Family Medicine, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, Quebec, H3S 1Z1, Canada
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  • Anne Cockcroft
    Affiliations
    CIET-PRAM, Department of Family Medicine, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, Quebec, H3S 1Z1, Canada
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  • Zoua M. Vang
    Affiliations
    Department of Sociology, McGill University, Montreal, Canada

    Department of Obstetrics and Gynaecology, McGill University, Montreal, Canada

    Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, Canada

    Institute of Health and Social Policy, McGill University, Montreal, Canada
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  • Neil Andersson
    Affiliations
    CIET-PRAM, Department of Family Medicine, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, Quebec, H3S 1Z1, Canada

    Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Mexico
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      Abstract

      Problem

      Routine evacuation of pregnant Indigenous women from remote regions to urban centres for childbirth is a central strategy for addressing maternal health disparities in Canada. Maternal evacuation continues despite mounting evidence of its negative impacts on Indigenous women and families.

      Background

      Since the 1960s, pregnant Indigenous women living in remote regions in Canada have been transferred to urban hospitals for childbirth. In the following decades, evidence emerged linking maternal evacuation with negative impacts on Indigenous women, their families, and communities. In some communities, resistance to evacuation and the creation of local birthing facilities has resulted in highly diverse experiences of childbirth and evacuation.

      Aim

      A scoping review mapped the evidence on maternal evacuation of Indigenous women in Canada and its associated factors and outcomes from 1978 to 2019.

      Methods

      We searched MEDLINE, Embase, and CINAHL, and grey literature from governmental and Indigenous organizations. We collated the evidence on maternal evacuation into 12 themes.

      Results

      Factors related to evacuation include (a) evacuation policies (b) institutional coercion (c) remoteness and (d) maternal-fetal health status. Evacuation-related outcomes include (e) maternal-child health impacts (f) women’s experience of evacuation (g) financial hardships (h) family disruption (i) cultural continuity and community wellness (ij) engagement with health services (k) self-determination, and (l) quality of health services.

      Discussion

      Numerous emotional, social and cultural harms are associated with evacuation of Indigenous women in Canada. Little is known about the long-term impacts of evacuation on Indigenous maternal-infant health. Evidence on evacuation from remote Métis communities remains a critical knowledge gap.

      Keywords

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