Economic Costs of Travel for Birth - Reclaiming Indigenous Birth

Research Question

What is the evidence about the costs of travel for birth for First Nation, Métis, Inuit and/or Indigenous birthing persons in Canada and globally?

The Economics of Obstetric Evacuation

Our study further contributes to the literature by systematically reviewing the evidence related to obstetric evacuation costs and presenting the findings through a cost analysis framework.

By reporting the direct, indirect, and intangible costs associated with evacuation, we present a quantitative and qualitative summary of the costs associated with obstetric evacuation across Canada.

Objective

For First Nations people and Inuit who live on reserves or in rural and remote areas, a guideline requires their travel to urban centres once their pregnancy reaches 36–38 weeks gestation age to await labour and birth. While not encoded in Canadian legislation, this guideline—and invisible policy—is reinforced by the lack of alternatives. Research has repeatedly demonstrated the harm of obstetric evacuation, causing emotional, physical, and financial stress for pregnant and postpartum Indigenous women and people. Our objective was to describe the costs of obstetric evacuation, as reported in the literature.

Methods

We conducted a systematic review using online searches of electronic databases (Ovid EMBASE, CINAHL, Ovid Healthstar, PubMed, ScienceDirect, PROSPERO, and Cochrane Database of Systematic Reviews) and identified studies that reported costs related to medical evacuation or transportation in rural and remote Indigenous communities. We performed critical appraisal of relevant studies.

Synthesis

We identified 19 studies that met the inclusion criteria. The studies reported various types of cost, including direct, indirect, and intangible costs. Medical evacuation costs ranged from CAD $7714 to CAD $31,794. Indirect and intangible costs were identified, including lost income and lack of respect for cultural practices.

Conclusion

Costs associated with obstetric evacuation are high, with medical evacuation as the most expensive direct cost identified. Although we were able to identify a range of costs, information on financing and funding flows was unclear. Across Canada, additional research is required to understand the direct costs of obstetric evacuation to Indigenous Peoples and communities.

Keywords: Indigenous · First Nations · Inuit · Midwifery · Obstetric evacuation · Cost