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

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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"]

Traditional assessments of perinatal care quality often focus solely on clinical markers, overlooking the experiential outcomes that are vital to women's childbirth experiences. This study highlights the necessity of understanding how the model of care and, importantly, the birth setting influence experiences of respect, autonomy, and decision-making to provide a comprehensive evaluation of care quality. Using validated patient-centered measures, the study assessed four domains: decision-making autonomy, respect, mistreatment, and time spent during visits. Participants were grouped into three categories based on provider type and birth setting: midwives at community births, midwives at hospital births, and physicians at hospital births. Adjusted multivariate logistic regression revealed significant differences influenced by birth setting.

Compared to hospital settings, those who gave birth in community settings reported substantially higher levels of autonomy and respect and fewer instances of mistreatment. Notably, even when midwives provided care, outcomes were better in community settings than in hospitals. This suggests that hospital environments may hinder the full realization of person-centered care due to structural and cultural constraints. The study underscores the critical impact of birth setting on childbirth experiences and calls for systemic changes to promote compassionate, individualized care across all settings.
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Aim: To examine the role of maternal diet in determining the low birth weight (LBW) in Indian infants.Methods: Data from the National Family Health Survey (2005–06) were used. Multivariate regression analysis was used to analyze the effect of maternal diet on infant birth weight.

Results: Infants whose mothers consumed milk and curd daily [odds ratio (OR), 1.17; 95% confidence interval (CI), 1.06–1.29]; fruits daily (OR, 1.20; 95% CI, 1.07–1.36) or weekly (OR, 1.13; 95% CI, 1.02–1.24) had higher odds of not having a low birth weight baby. The daily consumption of pulses and beans (OR, 1.18; 95% CI, 1.02–1.36) increased the odds while weekly consumption of fish (OR, 0.79; 95% CI, 0.70–0.89) decreased the odds of not having an LBW infant. Intake of iron-folic acid supplements during pregnancy increased birth weight by 6.46 g per month.

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In this paper we examine the barriers and the facilitating factors for seeking treatment for childhood diarrhoea, and determine the main causes for delay in seeking treatment. Data from Indian Demographic and Health Survey 2005-06 (NFHS-III) were used. Mothers were asked whether i) their children (<5-years) had suffered from diarrhoea during the 2 weeks preceding the survey, ii) if treatment was sought, and iii) the number of days waited to seek treatment after the diarrhoea had started. Multivariate logistic regression analysis was performed to find the determinants of seeking treatment at the health facility and the factors responsible for the 'delay' in seeking advice/treatment.

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This study in Public Health Nutrition (Cambridge, 2013) examines whether inadequate infant and young child feeding (IYCF) practices in India are driven by information constraints or household economic capacity, using the National Family Health Survey (NFHS-3) and logistic regression across 9,241 children aged 6–18 months. Nutritional counselling by frontline community health workers is a strong, consistent predictor of WHO-compliant feeding practices across all wealth quintiles. For infants aged 6–8 months, household wealth is not statistically significant; early feeding behaviour is shaped more by knowledge than income. Yet compliance remains low even among higher-income households, and mass media exposure independently improves outcomes, reinforcing behaviour change communication (BCC) as a scalable intervention. The findings position child malnutrition not only as a resource problem but as a health literacy and behaviour change challenge with direct implications for IYCF program design across LMICs.

Malhotra (2013) finds that nutritional counselling by frontline community health workers predicts WHO-compliant IYCF practices across all wealth quintiles in India, with household wealth not significant for infants aged 6–8 months, positioning child malnutrition as much a health literacy challenge as an affordability problem.

Cite: Malhotra, N. (2013). Inadequate feeding of infant and young children in India: lack of nutritional information or food affordability? Public Health Nutrition, 16(10), 1723–1731. https://doi.org/10.1017/S1368980012004065 

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The objective of this paper is to identify demographic, social and behavioural risk factors for HIV infection among men in Zambia. In particular, the role of alcohol, condom use, and the number of sex partners is highlighted as being significant in the prevalence of HIV.

The survey included socio-economic variables and HIV serostatus for consenting men (N = 4,434). The risk for HIV was positively related to wealth status. Men who considered themselves to be at high risk for HIV-positive were most likely to be HIV-positive. Respondents who, along with their sexual partner, were drunk during the last three times they had sexual intercourse, were more likely to be HIV-positive (Adjusted odds ratio (AOR): 1.60; 95% confidence interval (CI): 1.00-2.56). Men with more than two sexual life partners and inconsistent condom use had a higher risk for being HIV-positive (OR: 1.89; 95% CI: 1.45-2.46 and OR: 1.49; 95% CI: 1.10-2.02, respectively). HIV prevention programs in Zambia should focus even more on these behavioural risk factors. [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]

In order to develop effective policies and programs that reduce the number of smokers a necessary first step is to understand the determinants of starting to smoke. In this paper, we present a split-sample duration model of the decision to start smoking. We use data from the 2002 Canadian tobacco use monitoring survey. The hazard rate of starting smoking peaks sharply at age 15 and quickly declines thereafter. Our parametric estimates provide evidence that gender, education, marital status, and household size are important determinants of smoking habit. We also find that higher cigarette prices have an impact on picking up the habit, but not on the initiation age. Thus, the results highlight the importance of cigarette taxes in influencing the likelihood of smoking. [go to paper]

In this article, we analyze whether the Softwood Lumber Agreement between the United States and Canada imposed significant economic costs on industries that use softwood lumber in the United States. To ascertain this impact, we use an event study. Our event study analyzes variations in the stock prices of lumber-using firms listed at the major stock markets in the United States. We find that the news of events leading to the Softwood Lumber Agreement had significant negative impacts on the stock prices of industries using softwood lumber. The average reduction of stock prices for our sample of firms was approximately 5.42% over all the events considered. Article first published online: 20 OCT 2009 [go to paper]

The main aim is to question why we don't see more firms petitioning for import relief. It is well accepted that petitioning itself can restrain imports, lead to higher prices and hence higher profits (in the short run). What prevents more firms from filing for protection? It may be that petitioning reflects cost inefficiency on the part of the petitioning firm, and concerns about revealing this information might act as a deterrent for firms to come forward with their complaints. However, in a declining industry where a large number of firms are contemplating an exit, petitioning could be a signal that the firm expects to remain in the market for the near future. The signalling hypothesis is tested by comparing the stock market response of an antidumping petition for petitioning firms and non-petitioning firms producing the same product. link to paper unavailable.

In this article we highlight the anticompetitive nature of antidumping (AD) legislation. Antidumping legislation was set up to protect domestic firms from predatory pricing by foreign firms. We argue that protecting highly concentrated industries drastically reduces competition at home. In cases where the industry consists only of one or two firms, import restriction may breed monopolies at the expense of domestic consumers. This article looks at cases filed by the agriculture sector, and at the market concentration of industries in this sector, to illustrate the above possibility. We study the case of fresh tomatoes in detail to further demonstrate the anticompetitive nature of AD legislation. We show the effect of AD legislation on imports, as well as the change in the Lerner index in the fresh tomato industry. [go to paper]

In this paper we analyze whether U.S. Anti-Dumping (AD) duties in the agricultural sector are effective in restricting trade. More specifically, does the imposition of an antidumping duty restrict imports of the named commodity or is there a diversion in the supply of imports from countries named in the petition to countries not named in the antidumping petition? We find that AD duties have had a significant impact on the imports of agricultural commodities from the countries named in the petition. However, our results also indicate that, unlike the manufacturing sector in the US, there was little trade diversion towards countries not named in the AD petition. Our results indicate that AD is a plausible protectionist policy in the Agriculture sector.[go to paper]

We estimate the degree of trade diversion from provinces named under the Softwood Lumber Agreement(SLA) to provinces not named. Our regression results indicate that the SLA had a significant impact on the exports of non-named SLA provinces. Controlling for other factors, the SLA would have increased exports from these provinces four times. The corresponding effect for the provinces named in the SLA is estimated at minus 5 percent. This decrease is not, however, statistically significant.[go to paper]

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In this paper, we compare the use of antidumping (AD) measures in the agriculture sector by Canada and the United States, the two major users of antidumping procedures.1 We consider both the direct and indirect effects of the AD measure and consider what factors make an AD measure more or less successful at impeding trade and when it is more likely to cause trade diversion. Specifically, we ask when the imposition of an antidumping duty restricts imports of the targeted commodity and when is there a deflection in the supply of imports from countries named in the petition to countries not named in the antidumping petition? We compare these results for that of the US and draw conclusions about the determinants of such differences, like the exchange rate, GDP and distance to partner countries. We use a modified version of the gravity model, as used in the earlier literature (Prusa (2001)) for our analysis. We find that affirmative AD cases caused trade diversion from non-named countries for agricultural products in general, but that trade diversion was particularly strong for perishable products. We also find that the more concentrated the imports, the more restrictive the AD duties.[go to paper]

Why does child malnutrition persist in India? This column argues that the reason is not limited to poverty or inadequate access to food; but that a lack of knowledge about healthy nutrition plays a vital role.

Nutrition advice on feeding infants and children provided by health professionals is shown to be strongly correlated with improved feeding practices across all age groups. If information about feeding children is the key obstacle to improving nutrition, then there is hope; it will be easier to resolve the problem of scarce information than to resolve the problem of acute poverty. [go to text]

Vancouver, BC. Poster Presentation: Evidence of Disparities in Respectful Maternity Care in Canada – The RESPCCT Study. (N. Malhotra, S. Vedam et al.)

Presentation: Implementation of the Undisturbed Labour and Birth Index

Co-Host & Scientific Committe Member:  Served as a Scientific Committee Member and Co-Host, contributing to research evaluation, event organization, and advisory roles within the academic community.