The Community as Provider: Collaboration and Community Ownership in Northern Maternity Care

Across Canada, researchers and maternity care leaders have identified a crisis in maternity care due to a shortage of skilled providers (obstetricians, family physicians, midwives). For the remote Inuit communities of Nunavut this crisis is about a lack of local maternity care and childbirth brought about by the erosion of local capacity and participation in planning and provision. These communities face difficulties recruiting, training and retaining skilled providers. They also experience a lack of consistency in providers and services within and across Aboriginal communities in Canada, and system dependence on the evacuation of women in remote communities for childbirth. System dependence on evacuation for childbirth has effectively removed childbirth from Nunavut families and communities. Across Nunavut, efforts to return childbirth to communities have been challenged by a lack of mobilization of providers and communities, concerns about safety, and relationships between communities, providers, decision-makers, and various levels of government. From November 2002 to December 2004, through a qualitative consultative methodology we examined current maternity care across ten Nunavut communities and their visions for change. We found that a return of childbirth to communities is thus, not simply about hiring more providers and developing local training. This return will require a rethinking of relationships between and collaboration among communities, providers, and levels of government to determine, plan and implement sustainable maternity care for remote, Inuit communities. While collaboration is crucial to providing sustainable maternity care in remote, Inuit settings, we argue that multidisciplinary collaboration needs to be reframed to include the community. Moreover, we find that collaboration becomes all the more complex in the context of community ownership and historical relationships between traditional and non-traditional providers.