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

This exploratory study in Women's Health Reports (SAGE, 2026) is among the first to examine domestic violence (DV) and probable brain injury (BI) in Canadian South Asian women, using an online survey delivered in English, Punjabi, and Hindi. The study applied the 14-item South Asian Violence Screen (SAVS) to assess physical, sexual, emotional, and in-law abuse; a modified Brain Injury Severity Assessment (BISA) tool for self-reported BI symptoms; and the GAD-7, PHQ-9, and International Trauma Questionnaire for psychosocial health outcomes.

The findings document the co-occurrence of DV, probable brain injury, and psychosocial burden in this population — evidence directly relevant to Health Canada's gender-based violence priorities and PHAC's mandate for culturally safe programming, and to CIHR's equity-focused research agenda where brain injury in racialized immigrant women remains a critical understudied gap.

Dhaliwal, Adhikari, Malhotra, and van Donkelaar (2026) provide the first characterization of domestic violence and probable brain injury in Canadian South Asian women using culturally adapted, multilingual instruments, establishing a foundation for equity-informed brain injury screening in immigrant and racialized women's health services in Canada.

Cite: Dhaliwal, J. K., Adhikari, S. P., Malhotra, N., & van Donkelaar, P. (2026). Characterizing domestic violence and probable brain injury in Canadian South Asian women: An exploratory survey. Women's Health Reports, 7. https://doi.org/10.1177/26884844261434508

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 study in Birth (Wiley, 2022) examines racial and ethnic disparities in experiences of coercion and non-consent during perinatal care in the United States, using the Giving Voice to Mothers (GVtM-US) study — a community-led national survey — with multivariable logistic regression across 2,490 participants.

Overall, 31% of respondents were pressured to accept perinatal procedures, 41% received non-consented procedures, and 10% were pressured to have a caesarean. Black respondents experienced non-consented procedures 89% more frequently than white respondents during perinatal care, and 87% more frequently during vaginal births. Critically, Black and white childbearing people declined care at equal rates — yet providers were significantly more likely to proceed without consent when the person who declined identified as Black. Midwife-led care, out-of-hospital birth, and care continuity reduced coercion, though racial disparities persisted after adjustment.

The findings establish that obstetric coercion and non-consent are racially patterned and constitute a measurable driver of reproductive health inequity — with direct relevance to WHO's respectful maternity care framework and SDG 3, and to policy reform efforts in high-income countries addressing structural racism in health systems.

Logan, McLemore, Julian, Stoll, Malhotra, et al. (2022) find that Black childbearing people in the United States experience non-consented perinatal procedures 89% more frequently than white counterparts, and that providers are significantly more likely to disregard refusal of care when the person identifies as Black, establishing quantitative evidence that obstetric coercion is racially patterned and independent of care-seeking behaviour.

Cite: Logan, R. G., McLemore, M. R., Julian, Z., Stoll, K., Malhotra, N., GVtM Steering Council, & Vedam, S. (2022). Coercion and non-consent during birth and newborn care in the United States. Birth, 49(4), 749–762. https://doi.org/10.1111/birt.12641

This study in the Journal of Tropical Pediatrics (Oxford University Press, 2014) examines the role of maternal diet and iron-folic acid (IFA) supplementation in determining low birth weight (LBW) in Indian infants, using the National Family Health Survey (NFHS-3, 2005–06) and multivariate regression analysis on a nationally representative sample.

Infants of mothers who consumed milk and curd daily had significantly higher odds of avoiding LBW (OR 1.17; 95% CI 1.06–1.29). Daily fruit consumption was also protective (OR 1.20; 95% CI 1.07–1.36), as was weekly fruit consumption (OR 1.13; 95% CI 1.02–1.24). IFA supplementation independently increased birth weight by 6.46 grams per month of supplementation — a finding directly relevant to WHO and UNICEF recommendations on antenatal micronutrient supplementation in LMICs. Both dietary diversity and IFA compliance emerged as distinct, independently significant predictors of birth weight, positioning LBW prevention as a dual challenge of food access and supplementation uptake.

The findings support integrated antenatal nutrition interventions combining dietary counselling and IFA supplementation across LMICs, where LBW rates remain among the highest in the world and one in three infants in India is born underweight.

ite: Malhotra, N., Upadhyay, R. P., Bhilwar, M., Choy, N., & Green, T. (2014). The role of maternal diet and iron-folic acid supplements in influencing birth weight: Evidence from India's National Family Health Survey. Journal of Tropical Pediatrics, 60(6), 454–460. https://doi.org/10.1093/tropej/fmu051

This study in the Canadian Journal of Economics (Wiley, 2011) develops a non-cooperative game-theoretic model of household resource allocation in developing countries in which domestic violence functions as a bargaining tool, and tests its empirical implications using the National Family Health Survey (NFHS, 1998–99) of India, with instrumental variable estimation to address the endogeneity of domestic violence.

The theoretical model yields a counterintuitive result: the extent of domestic violence a woman faces is not necessarily declining in her reservation utility, nor necessarily increasing in her spouse's, meaning that standard economic logic suggesting women's outside options protect them from violence does not straightforwardly apply. Empirically, the paper isolates the causal effect of domestic violence on female autonomy using appropriate instruments, finding that domestic violence significantly reduces women's autonomy within the household. Additional evidence supports the evolutionary theory of domestic violence — that spousal violence stems partly from jealousy rooted in paternity uncertainty — a finding relevant to gender economics research and World Bank and UN Women frameworks for understanding intimate partner violence in LMICs.

The findings challenge the dominant policy assumption that improving women's labour market access is sufficient to reduce spousal violence, with implications for gender-based violence programming across South Asia and other LMICs.

Eswaran and Malhotra (2011) demonstrate theoretically and empirically that domestic violence significantly reduces female autonomy in India, and that women's reservation utilities do not straightforwardly protect them from spousal violence — establishing that effective policy responses to intimate partner violence in LMICs must go beyond improving women's employment options.

Cite: Eswaran, M., & Malhotra, N. (2011). Domestic violence and women's autonomy in developing countries: Theory and evidence. Canadian Journal of Economics/Revue canadienne d'économique, 44(4), 1222–1263. https://doi.org/10.1111/j.1540-5982.2011.01673.