Infertility in Northern Remote Communities: Expanding Care Through the Ethical Use of AI

Objective: To investigate the prevalence and contributing factors of infertility among Indigenous populations in Canada, including First Nations, Métis, and Inuit communities; to assess healthcare access disparities affecting fertility care; and to explore the potential role of artificial intelligence (AI) as an equitable tool to improve reproductive health outcomes. Comparative insights from Aboriginal and Māori populations in Australia and New Zealand are included to contextualize Indigenous reproductive health disparities globally. Design: A mixed-methods approach combining quantitative analysis of national health survey data with qualitative semi-structured interviews of Indigenous individuals and healthcare providers. A health systems innovation framework examines the potential of AI tools, including predictive algorithms and automated triage systems, appraised by software development experts, to deliver culturally safe and equitable fertility care. Materials and Methods: Quantitative analysis will utilize data from the 2009–2010 Canadian Community Health Survey, focusing on women aged 18–44 who self-report infertility. Logistic regression will evaluate associations between infertility and demographic or health access variables. Qualitative data will be gathered through semi-structured interviews with Indigenous individuals and healthcare providers in Manitoba and Ontario, exploring perceptions of infertility and barriers to care. Thematic analysis will be performed using NVivo software. A narrative review of AI interventions in fertility care, including Indigenous-specific case studies from Aboriginal and Māori populations, will be conducted in parallel. Results: Preliminary findings indicate that Indigenous women in Canada face significantly higher barriers to infertility care compared to non-Indigenous populations, including geographic isolation, systemic racism, and cultural discordance in care delivery. Healthcare providers report challenges offering culturally appropriate services, citing community mistrust and limited Indigenous-led fertility programs. Similar themes emerge in Aboriginal and Māori populations. AI-based platforms demonstrate potential to mitigate access gaps when developed with Indigenous co-leadership and data governance principles. Conclusions: Infertility remains a significant yet underrecognized concern in Indigenous populations in Canada, mirroring disparities in comparable populations internationally. Structural inequities and historical injustices perpetuate poor access to care. Community-driven, responsible deployment of AI holds promise to reduce disparities but must align with cultural safety, Indigenous data sovereignty, and equitable innovation. Investment in Indigenous-led fertility programs and culturally adapted technological solutions is urgently needed to advance reproductive justice.