Keywords: maternal health, perinatal care, respectful maternity care, patient-reported experience measures (PREMs), health inequities, pregnancy loss, CIHR
Maternal and Perinatal Health and Health Inequities: Research on respectful maternity care, pregnancy loss, and patient-reported experience measures (PREMs), using survey and administrative data to examine autonomy, quality of care, and inequities across populations.
Evidence from U.S. and Canadian studies shows that respectful maternity care and autonomy vary systematically by race, BMI, and social position, with patient-reported measures revealing inequities not captured in administrative data and with implications for health system performance (Hall et al., 2026; Malhotra et al., 2024; Niles et al., 2023; Logan et al., 2022).
Key findings:
Autonomy and respectful maternity care vary systematically by BMI, race, and social position
Individuals experiencing pregnancy loss report significantly lower respect and support in care
Patient-reported measures identify inequities not captured in routine health system data
Keywords: infant and young child feeding (IYCF), child malnutrition, behaviour change communication, health literacy, early childhood health, Nutrition International
Research on infant and young child feeding (IYCF), maternal behaviour, and early childhood health outcomes in low- and middle-income countries, using nationally representative survey data.
Key findings:
Nutritional information strongly predicts feeding practices across all wealth groups
Behaviour change communication improves child nutrition outcomes
Early childhood health outcomes are shaped by maternal behaviour, environment, and access to information
Keywords: trade policy, antidumping, export restraints, preferential trade agreements, trade diversion, NAFTA, Softwood Lumber Agreement, Canada–Chile FTA, WTO
Research on trade remedies and liberalization, including antidumping measures, export tax, and preferential trade agreements, using product- and industry-level data to examine how these instruments shape trade flows, market competition, and welfare. The effect of export tax can be ambiguous if accompanied by an increase in efficiency in export production, as was the case of the Sofwood Lumber industry in Canada. Research on preferential agreements, including the Canada–Chile Free Trade Agreement, shows that tariff reductions expand trade but produce uneven, sector-specific gains shaped by initial trade structures and industry composition (Malhotra & Rus, 2009; Malhotra et al., 2005; Malhotra & Malhotra, 2008).
Key Findings:
Export restraint agreements can stabilize trade flows while possibly constraining exporters' market access, but only when they involve quantity restrictions.
Trade policy instruments operate through second-best mechanisms, where intended protections or expansions are offset by firm and market responses.
Trade liberalization requires complementary domestic policies to address uneven sectoral adjustment
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