The maternity care workforce is a critical to the delivery of comprehensive primary care, and to the fulfillment of sexual and reproductive health and rights. This workforce figures prominently in both domestic and international efforts to achieve the UN’s Sustainable Development Goals on gender equity and good health and wellbeing. The key maternity care workforce issues to be addressed by this CHWN group range from access to and equity of choice of maternity care provider by birthing people to the factors associated with establishing and sustaining team-based and person-centered maternity care across jurisdictions.
Understanding the Individual, Organizational, and System-Level Factors Shaping Pregnant People’s Experiences Choosing and Accessing a Maternity Care Provider in Ontario’s Champlain Region
Doctoral Candidate: Caroline Chamberland-Rowe
Thesis Supervisor: Dr. Ivy Lynn Bourgeault
In theory, pregnant people in Ontario can choose to seek maternity care from a midwife, a family physician, or an obstetrician. Supporting “a system of care that provides women and their families with equitable choice in birth environment and provider” (PCMCH & MOHLTC, 2017, p.33) has been identified as one of the central objectives of the Provincial Council for Maternal and Child Health’s Low Risk Maternal Newborn Strategy. However, in practice, pregnant people’s opportunity to choose a maternity care provider remains constrained.
This project aimed to determine whether or not provincial policies had translated into the levels of access, awareness, and resourcing required to afford pregnant people the opportunity to exercise autonomous choice of provider within the local maternity care system in Ontario’s Champlain Region. To achieve these objectives, this project - which was conducted in partnership with the Champlain Maternal Newborn Regional Program - adopted a mixed-methods approach encompassing two complementary components: (1) quantitative geospatial mapping to assess pregnant people’s access to the full range of maternity care providers across the Region, and (2) a series of focus group and individual interviews with parents, providers and policy-makers to explore the individual, organizational, and system-level factors that are enabling or restricting access and autonomy within the local maternity care system.
Using a systems approach to the investigation of this locally-identified issue, this project demonstrated that pregnant people within the Champlain Region have inequitable opportunities to exercise autonomous choice of maternity care provider due to (1) system and organizational-level factors that are creating imbalances in the supply, distribution and mix of maternity care provider options, and (2) pregnant people’s differential access to the enabling information and resources required to exercise autonomous choice of provider and to navigate access to their services.
Health Workforce Research in Progress:
Welcoming the 'Sacred Spirit' (child): Connecting Indigenous and Western 'ways of knowing' to inform future policy partnerships to optimize maternal child health service delivery initiatives in remote Canadian regions