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Birth Justice NL’s Response to Health Accord for Newfoundland and Labrador’s Final Report

Dear Dr. Patrick Parfey, Elizabeth Davis, and Health Accord NL Task Force Members,

On behalf of Birth Justice NL, a non-profit organisation in Newfoundland and Labrador seeking to remove obstacles to adequate reproductive health care, we would like to thank you for the important work Health Accord NL has done to investigate and address the many issues to our province’s approach to health care provision.

We commend the task force for viewing this multifaceted and broad-ranging issue through the lense of quality, inclusion, and integration. The impact of social, economic, and environmental factors on health are significant, and we are glad to see these issues acknowledged in the Final Report. However, to our disappointment, there is very little mention of reproductive wellness nor was there strategy to improve perinatal and reproductive health services, despite our formal submission to Health Accord NL outlining our suggestions. While the report did highlight a significant decrease in the population of Newfoundland and Labradorians aged 15 years and younger, there was no acknowledgement of the barriers families face when deciding to expand and care for their families. Families across our province deserve to be supported by family-friendly policies and reproductive health care that is easily accessible, evidence-based, and empowering. We believe an outline for how this can be achieved should have been included in the Final Report.

Our first recommendation to the task force was to implement sustainable and accessible midwifery services throughout the province. Birth Justice NL believes that midwives are an essential component of a comprehensive health care system and that the option of midwifery care is a right for all birthing people and newborns in this province. The midwifery profession is currently in its sixth year of regulation in the province; Midwives Regulations under the Health Professions Act came into effect in 2016. However, access to midwifery care is still not available. The one site providing midwife-led care is no longer fully operational due to an obstetrical diversion, leaving parents in the province without the option of midwifery care. The benefits of midwifery care are evidence-based, well-documented, and outlined in the report we submitted to Health Accord NL previously.

As primary health care providers, midwives make significant positive and long-lasting impacts on growing families, and to health systems at large. Midwives, including Indigenous midwives, allow for parents to birth closer to home, especially in rural and remote communities, improve birth outcomes, all while providing community-based continuity of care, two issues Health Accord NL seems to be interested in.

The underinvestment in midwifery care in our province is unprecedented throughout the country, and an issue that our organisation has continued to raise for decades. Our organisation, formed under the name ‘Friends of Midwifery of Newfoundland and Labrador’ in 1994, has advocated for regulated and publicly-funded midwifery care access since its inception. It is disappointing after long-standing silence from Minister Haggie regarding our requests to meet with him, to see this significant issue omitted from the Health Accord NL Final Report, especially while the province’s only midwifery program is not receiving adequate support to provide birth services, and the Provincial Chief Midwife position has been vacant for over a year.

Our second recommendation, as detailed in our submission, is the need to improve access to safe and timely sexual and reproductive care by increasing services and training for care providers. There are numerous calls to action included in the Final Report that we feel have a strong potential to support this goal. The immediate creation of a provincial Pathway for Inclusion has the potential to improve health care for many groups. We hope that The Blueprint and the Pathway for Inclusion addresses specific actions that will be taken to improve care for racialized and migrant individuals and communities; rural and remote communities; rural and urban Indigenous peoples; members of the 2SLGBTQIA+ community; sex workers; people facing incarceration; and other groups facing specific barriers to safe and timely health care. While we were heartened to see inclusion listed as a priority, it is of crucial importance that the implementation of specific anti-oppressive strategies, including gender-affirming care and anti-racist practices, is done in consultation with the impacted groups in order to create a truly safe and inclusive health care system.

As community teams are established, we strongly believe that community-based sexual and reproductive health must be included in this initiative. The recommendation to support all provider groups in working to their highest scope of practice is a great strategy that could enable Registered Midwives, Nurse Practioners, and other health professionals to fill gaps in sexual and reproductive health care provision. As hospital service delivery is rebalanced, we feel it is essential that reproductive services are carefully considered in these decisions as well.

One particularly time-sensitive issue is birth. Many parents must travel several hours before or during labour in order to give birth safely, which can be stressful, dangerous, and traumatising, as well as logistically challenging for those with other children to care for. We believe that all communities should have access to birthing services close to home. Bringing birth closer to home can reduce significant social and financial strain faced by families who are forced to travel in order to give birth, as well as reduce the associated cost to the health care system. We urge the task force to use creative approaches, including midwifery-led units, to keep birthing services available in as many communities as possible. Breastfeeding support, fertility treatments, and medication and surgical abortions are other services that we feel must be made easily and freely accessible across the province.

One call to action that is of particular concern is the recommendation to incorporate Women’s Health into the Janeway Hospital Children’s Health & Rehabilitation Centre, a facility designed to provide health care to children and youth. Women are not children, and Women’s Health encompasses far more than perinatal health care. While this may not be the intention, this action essentializes women and other people with uteruses to their ability to bear children. We feel that it is entirely inappropriate to bring Women’s Health under the umbrella of a children’s hospital and we urge the task force to revoke this call to action.

We understand that the Final Report serves as a general guide for a reimagined provincial health care system and that many of the specific details of the plan will be included in The Blueprint. As we await The Blueprint, we wish to remind the task force of the importance of improving sexual and reproductive health in our province. Sexual and reproductive health is an integral part of the health and wellness of individuals and communities. Reproductive health matters, not only because those with reproductive capacity are able to help increase the population of our province, but because people deserve safe, dignified, and accessible care throughout their lives. Sexual and reproductive health and wellness matters because all individuals, including people with uteruses, require access to care, support, and resources in order to live full and happy lives.

It is our sincere hope that a reimagined provincial health system will include systemic improvements and specific supports to improve the reproductive wellness, fulfilment, and autonomy for all peoples who call this region their home.


Birth Justice NL Board of Directors

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