By Mata Press Service

Canada’s promises on reconciliation are being routinely violated in hospital delivery rooms, with Indigenous women facing systemic mistreatment and disrespect when giving birth, according to a new national survey

Published this summer in the journal Frontiers in Global Women’s Health, the study analyzed responses from more than 6,000 people who gave birth in Canada between 2009 and 2022, including 309 who identified as Indigenous.

Researchers found that Indigenous participants reported significantly higher rates of abuse, coercion and loss of autonomy than both white and other racialized patients, raising questions about Canada’s adherence to domestic and international human‑ rights commitments.

“These findings expose ongoing colonial violence and structural racism in Canadian perinatal care,” the authors write, arguing that what Indigenous families experience during childbirth stands in “stark contrast” to the federal government’s reconciliation rhetoric.f

The data come from the RESPCCT (Research Examining the Stories of Pregnancy and Childbearing in Canada Today) survey, a cross‑ sectional, online questionnaire developed with a community steering council representing under‑ served populations. Between mid‑ 2020 and early 2022, more than 6,000 respondents from all provinces and territories described their pregnancies and interactions with health‑ care providers.

Within that group, 6.7 per cent of participants identified as Indigenous—First Nations, Métis or Inuit—while 78.6 per cent identified as white and 14.7 per cent as Black, Asian, Middle Eastern, Hispanic/Latine or multi‑ ethnic.

Using validated indices of “mistreatment” and “disrespect,” the researchers compared how often different groups reported specific negative experiences such as being shouted at, left unattended, denied privacy or subjected to treatment without consent.

The contrast was stark. Nearly two‑ thirds (63 per cent) of Indigenous respondents reported at least one form of mistreatment during labour and birth, compared with 51.5 per cent of other racialized participants and 49.4 per cent of white participants.

Almost three‑ quarters (74.6 per cent) of Indigenous respondents reported at least one form of disrespect, versus 69.2 per cent of other racialized respondents and 58.4 per cent of white respondents.

Those headline numbers reflect a cluster of more troubling details. The study found that:

31 per cent of Indigenous respondents said health‑ care providers either withheld treatment or forced them to accept care they did not want, a significantly higher rate than among white and other racialized participants.

28 per cent reported being shouted at or scolded by providers, compared with 18 per cent of white respondents.

More than a third said they were ignored or refused help, and 37.1 per cent reported being left unattended when they needed care.

10.8 per cent reported physical abuse, including aggressive contact or denial of pain relief for procedures such as episiotomies.

19.4 per cent said their private information was shared without consent, and 7.9 per cent reported being forced to sign legal documents to authorize procedures against their will.

Perhaps most alarming, 2.2 per cent of Indigenous respondents reported undergoing surgery that left them unable to have more children, without their consent—forced sterilization—at rates significantly higher than those reported by white participants. While the absolute numbers are small, the authors describe these cases as part of an “ongoing legacy of reproductive control” over Indigenous bodies, echoing documented abuses in other parts of the health system.

The study also examined subtler forms of discrimination that can erode trust and traumatize families. Indigenous respondents were more likely than other groups to report negative comments from staff about their ethnicity, culture, sexuality or physical appearance, as well as routine failures to obtain consent for intimate procedures.

One in five Indigenous participants said health‑ care staff mocked them, and nearly 8.4 per cent reported derogatory remarks about their heritage or culture—compared to just 0.6 per cent of white respondents. More than half said they were not consistently asked for permission before students performed examinations or procedures on them, and 38.3 per cent said providers often did not ask for consent before carrying out vaginal examinations.

The burden of mistreatment was not evenly distributed. Indigenous women aged 25 or younger were significantly more likely to report abuse and disrespect than older Indigenous participants, with absolute differences of 18.4 and 17.5 percentage points respectively. Those whose partners were also Indigenous faced higher rates of mistreatment and disrespect than those whose partners were non‑ Indigenous, suggesting layered biases against visibly Indigenous families.

These findings reinforce a broader body of Canadian research showing that Indigenous women and infants experience worse health outcomes than non‑ Indigenous populations, including higher rates of preterm birth, stillbirth and infant mortality.

A 2017 national analysis by Statistics Canada found that Indigenous infants had higher rates of adverse birth outcomes than non‑ Indigenous infants, while more recent work has documented elevated maternal mortality and greater exposure to harmful conditions before and during pregnancy.statcan+3

The authors did find some protective factors that point to potential solutions. Indigenous participants attended by midwives during labour and birth reported significantly lower rates of mistreatment and disrespect than those whose intrapartum care was provided by family doctors or obstetricians.

Effect sizes were substantial, suggesting that midwifery‑ led care may offer a safer and more respectful environment for Indigenous families.

Similarly, Indigenous respondents who had at least one Indigenous provider involved in their prenatal care—“culture‑ matched care”—reported lower mistreatment than those without Indigenous providers, though the difference was not statistically significant in this sample. The authors argue that these patterns support calls to expand Indigenous midwifery and community‑ based birthing services, especially in regions where Indigenous women are still routinely evacuated from their home communities to deliver in distant urban hospitals.

Existing programs, such as the Inuulitsivik Midwifery services in Nunavik, Quebec, have previously been credited with reducing medical evacuations, improving maternal and neonatal outcomes, and restoring community control over childbirth. The new data, the authors suggest, should strengthen the case for similar models across Canada.

Beyond documenting individual experiences, the study explicitly frames its findings as evidence that Canada is failing to live up to the Truth and Reconciliation Commission’s health‑ related Calls to Action and its commitments under the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP).

The authors mapped survey responses to specific articles of UNDRIP and the Universal Declaration of Human Rights, identifying widespread violations of rights to security of the person, freedom from discrimination and access to culturally safe, trauma‑ informed care.

Nearly 40 per cent of Indigenous respondents reported neglect during childbirth, which the researchers say contravenes UNDRIP Articles 22 and 24, focused on special protections for Indigenous women and the right to the highest attainable standard of health.

“Taken together,” the paper concludes, “these results reveal an illusion of reconciliation in Indigenous perinatal care in Canada,” where policy language “obscures ongoing violations of Indigenous women’s human rights.”