Long-distance travel for birthing among Indigenous and non-Indigenous pregnant people in Canada.

Autor:	Smylie J; 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., O'Brien K; 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., Beaudoin E; 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., Daoud N; 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., Bourgeois C; 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., George EH; 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., Bebee K; 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., Ryan C; 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.
Jazyk:	angličtina
Zdroj:	CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne [CMAJ] 2021 Jun 21; Vol. 193 (25), pp. E948-E955.
DOI:	10.1503/cmaj.201903
Abstrakt:	Background: For 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. Methods: We 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. Results: We 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). Interpretation: Indigenous 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. Competing Interests: Competing interests: Cheryllee Bourgeois is a midwife with Seventh Generations Midwives Toronto. Evelyn Harney George is a past Co-Chair and currently a Community Engagement Lead for the National Aboriginal Council of Midwives. No other competing interests were declared. (© 2021 CMA Joule Inc. or its licensors.)
Databáze:	MEDLINE
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