Analyzing birth outcomes in Ontario
Better Outcomes Registry and Network (BORN) is a perinatal registry with data about all births in Ontario, including those that happen outside of hospitals. This is important for our research because we want to understand how to create conditions for the best health outcomes for moms and babies.
For the first time, researchers have linked data from BORN with the Indian Register to analyze birth outcomes for status First Nations individuals in Ontario. Here’s how we did it.
We initially engaged the Chiefs of Ontario, based on the health research roadmap, to apply for permissions to access First Nations BORN data. Given the complexity of community permissions, we then used a community-engaged process through the leadership of Ellen Blais, Co-CEO and former Director of the Ontario Association of Midwives’ Indigenous Midwifery Program. Diane Simon engaged band councils of 177 First Nations in Ontario. Of these, 50 communities passed Band Council Resolutions (BCRs) to authorize our use of the data. Approvals were made possible thanks to Ellen Blais, Diane Simon, and the Indigenous midwives who had relationships in these communities.
Once access to data had been approved, we developed a data creation plan that defined the variables we wanted to analyze. The Institute of Clinical Evaluative Sciences (ICES) conducted the analysis on our behalf. They provided us with anonymized data to ensure the privacy of the individuals represented by the data.
In 2026, four years after we began this project, ICES shared the first aggregated First Nations perinatal health data. As we continue to review the data, we are sharing our findings first with those it concerns, before reporting and publishing on broader trends that could inform policy changes and investments.
This process fundamentally reframed our research assumptions. Instead of answering the question “How do we obtain access?” we changed the question to “Who has the authority to grant access?” That led us to partner with communities directly.
We learned another important lesson here. Traditional research funding cycles do not align with the time it takes to navigate and respect Indigenous governance.
Research Questions
These are the questions we seek to answer through this quantitative analysis:
- What are the maternal-newborn health outcomes for status First Nations people who give birth in Ontario?
- What is the frequency of and distance travelled for medical transportation for birth (prenatal, labour/birth and postpartum travel) for status First Nations people who give birth in Ontario?
- What health services are used by status First Nations people who give birth in Ontario?
- How is geography associated with maternal-newborn health outcomes for status First Nations people who give birth in Ontario?
- How is geography associated with maternal-newborn health service use for status First Nations people who give birth in Ontario?
- How is geography associated with the cost of health service use for status First Nations people who give birth in Ontario?
Linked Data
The Institute of Clinical Evaluative Sciences (ICES) is an independent and not-for-profit research institute that holds Ontario’s health-related data. Key sources that enabled our research come from BORN perinatal health registry, which we linked to the Indian Register to create a data set specific to status First Nations individuals who live in Ontario. The charts below list data sets that make this a rich and comprehensive source for our research.
