This study in Birth (Wiley, 2026) makes two contributions to Canadian perinatal care research: it introduces the Compassionate Disclosure of Loss (CDL) index, a new validated psychometric instrument measuring the quality of provider communication at the time of pregnancy loss, and documents significant racial inequities in care experiences among people who experienced pregnancy loss in Canada.

Using the RESPCCT (Research Examining Stories of Pregnancy and Childbearing in Canada Today) cross-sectional survey (July 2020–February 2022) among 172 individuals who experienced early or late perinatal loss, the study applies the Mothers' Autonomy in Decision Making (MADM) scale, the Mothers on Respect Index (MORi), the CDL index, and a single item measuring whether providers listened to pregnancy concerns, patient-reported experience measures (PREMs) relevant to CIHI's pan-Canadian health system performance reporting.

Racialized people (including Indigenous Peoples in Canada, Black, and People of Colour) were 2.61 times more likely to report that providers did not listen to their pregnancy-related concerns prior to the loss (AOR 2.61**), and had significantly lower odds of autonomy (AOR 0.31***) and respectful care (AOR 0.34**). These findings speak to Health Canada's work to address anti-Indigenous racism and improve equitable access to care, as well as to PHAC's mandate for inclusive, equity-informed perinatal care. Those experiencing early pregnancy loss reported significantly lower CDL scores than those experiencing late loss — pointing to miscarriage as a neglected gap in Canadian perinatal bereavement care.

Cite: Hall, W. A., Malhotra, N., Clark, E., Hodge, K., Griffith, G., & Vedam, S. (2026). Inequities in care during pregnancy loss: empirical insights from experiences with Canadian perinatal care. Birth, 53, 215–223. https://doi.org/10.1111/birt.70020

   [Link to the Paper ]    [Summary & Policy Brief] 

This study in BMC Pregnancy and Childbirth (Springer Nature, 2024) provides the first large-scale quantitative examination of weight-based disparities in respectful perinatal care across Canada, using the RESPCCT (Research Examining Stories of Pregnancy and Childbearing in Canada Today) pan-Canadian cross-sectional survey among 3,280 childbearing people with a BMI ≥18.5, measuring autonomy, respect, and mistreatment with three validated patient-reported experience measures (PREMs) directly relevant to CIHI's mandate for pan-Canadian health system performance reporting.

As BMI increased, so did the odds of reduced autonomy, disrespect, and mistreatment. Childbearing people with BMI ≥35 had 45% higher adjusted odds of reduced autonomy (AOR 1.45), declining respect scores across BMI categories (ORs 1.34, 1.51, 2.04; p<.01), and mistreatment (AOR 1.95). All significant after controlling for race, income, and education.

Indigenous Peoples in Canada and racialized childbearing people faced independently elevated mistreatment odds (AOR 2.26 and 1.33, respectively), evidence that directly informs Health Canada's 2024–25 priority of addressing anti-Indigenous racism in health systems. For CAHSPR  and CIHR agendas, these findings provide patient-oriented, pan-Canadian evidence that weight stigma, racism experienced by racialized non-Indigenous people and Indigenous Peoples in Canada, each independently contribute to measurable deficits in respectful maternity care.

Malhotra, Jevitt, et al. (2024) provide the first pan-Canadian quantitative evidence that BMI, Indigenous identity, and racialized identity independently influence mistreatment and reduced autonomy in perinatal care, even after adjusting for each other and for income and education. Specifically, Indigenous Peoples in Canada face 2.26 times higher odds of mistreatment, non-Indigenous racialized childbearing people 1.33 times higher odds, and those with BMI ≥35 an adjusted odds ratio of 1.95. All effects are mutually adjusted, demonstrating that weight stigma, anti-Indigenous racism, and racial discrimination operate as distinct barriers to respectful perinatal care in Canada.

Cite: Malhotra, N., Jevitt, C. M., Stoll, K., Phillips-Beck, W., Vedam, S., & the RESPCCT Study Team. (2024). Weight-based disparities in perinatal care: quantitative findings of respect, autonomy, mistreatment, and body mass index in a national Canadian survey. BMC Pregnancy and Childbirth, 24, 737. https://doi.org/10.1186/s12884-024-06928-8

Birth setting shapes the quality of midwifery care itself — and hospital structures may undermine person-centred practice even when midwives are the providers.

This study in Reproductive Health (BioMed Central/Springer Nature, 2023) uses the Giving Voice to Mothers US (GVtM) cross-sectional national survey among 1,771 childbearing people to measure decision-making autonomy (Mothers' Autonomy in Decision Making [MADM] scale), respectful care (Mothers on Respect [MOR] Index), mistreatment (Mistreatment Index [MIST]), and adequate visit time across three provider-setting combinations — midwife in community birth settings, midwife in hospital, and physician in hospital.

Compared to physician-attended hospital births, those receiving midwifery care in community settings had more than five times the adjusted odds of high autonomy (aOR = 5.22) and high respectful care (aOR = 5.39), over fourteen times the odds of adequate visit time (aOR = 14.65), and significantly lower odds of mistreatment (aOR = 0.16). Midwifery care in hospital settings yielded only partial gains — higher autonomy (aOR = 1.70) and more time (aOR = 1.95) compared to physician care, but no significant improvements in respectful care or mistreatment — confirming that institutional environment, not provider philosophy alone, constrains person-centred care. These findings directly inform Health Canada's priority of equitable access to culturally safe care and PHAC's mandate for stigma-free perinatal environments by identifying structural determinants of mistreatment beyond individual provider behaviour. For CIHR and CAHSPR, the results support health system reform that enables autonomous midwifery practice across all birth settings under the Quadruple Aim and SPOR frameworks.

Niles et al. (2023) found that childbearing people receiving midwifery care in community settings had more than five times the adjusted odds of high autonomy (aOR = 5.22) and respectful care (aOR = 5.39), and significantly lower odds of mistreatment (aOR = 0.16) compared to physician-attended hospital births, with midwifery care in hospital settings producing only partial gains — demonstrating that birth setting, independent of provider type, is a significant structural determinant of experiential outcomes in maternity care.

Cite: Niles, P. M., Baumont, M., Malhotra, N., Stoll, K., Strauss, N., Lyndon, A., & Vedam, S. (2023). Examining respect, autonomy, and mistreatment in childbirth in the US: do provider type and place of birth matter? Reproductive Health, 20, Article 67. https://doi.org/10.1186/s12978-023-01584-1

📌 Full text: https://link.springer.com/article/10.1186/s12978-023-01584-1

This paper sets out a simple non-cooperative model of resource allocation within the household in developing countries that incorporates domestic violence as an instrument for enhancing bargaining power. We demonstrate that the extent of domestic violence faced by women is not necessarily declining in their reservation utilities, nor necessarily increasing in their spouses’. Using the National Family Health Survey data of India for 1998-99, we isolate the e¤ect of domestic violence on female autonomy, taking into account the possible two-way causality through the choice of appropriate instruments. We provide some evidence for the evolutionary theory of domestic violence, which argues that such violence stems from the jealousy caused by paternity uncertainty in our evolutionary past. The findings have strong policy implications, suggesting that it will take more than an improvement in women's employment options to address the problem of spousal violence.[go to paper]

This paper sets out a simple non-cooperative model of resource allocation within the household in developing countries that incorporates domestic violence as an instrument for enhancing bargaining power. We demonstrate that the extent of domestic violence faced by women is not necessarily declining in their reservation utilities, nor necessarily increasing in their spouses’. Using the National Family Health Survey data of India for 1998-99, we isolate the e¤ect of domestic violence on female autonomy, taking into account the possible two-way causality through the choice of appropriate instruments. We provide some evidence for the evolutionary theory of domestic violence, which argues that such violence stems from the jealousy caused by paternity uncertainty in our evolutionary past. The findings have strong policy implications, suggesting that it will take more than an improvement in women's employment options to address the problem of spousal violence.[go to paper]

The RESPCCT study highlights significant disparities in perinatal care experiences related to body mass index (BMI) among Canadian participants. The cross-sectional survey, which included 3,280 respondents with a BMI of ≥18.5, revealed that individuals with higher BMIs (≥35) experienced notably reduced autonomy and increased mistreatment in healthcare settings. Specifically, the study found an unadjusted odds ratio of 1.62 and an adjusted odds ratio of 1.45 for reduced autonomy among those with a BMI ≥35 compared to normal-weight individuals. Furthermore, the likelihood of falling into the lower tercile of respect scores increased with BMI, with odds ratios of 1.34, 1.51, and 2.04 for BMI categories of 25–25.9, 30–34.9, and ≥35, respectively (p < .01). These findings underscore the pervasive nature of weight stigma in perinatal care, indicating that implicit and explicit biases among healthcare providers contribute to the disrespectful treatment of individuals with higher BMIs. Addressing these biases is essential for improving the quality of care provided to this population. [go to text"]