Skip to main content
I would like to thank Smylie and Phillips-Beck for their thoughtful commentary.1 I agree with the authors that the low uptake of prenatal care among mothers who had a child placed in care goes well beyond what we discussed in our study, including ongoing colonialism, anti-Indigenous racism and gaps in cultural safety competencies, and that there are Indigenous community-led models of maternity care that are addressing these issues. As the authors point out, an Indigenous-specific analysis of this research question would lead to a better understanding the drivers of inadequate prenatal care among mothers who had a child place in out-of-home care.
Smylie and Phillips-Beck identify ethical concerns regarding this research, primarily around the absence of Indigenous engagement and input on a study where the affected group primarily comprised of Indigenous mothers. Our study was conducted using data from families involved with child protection services in Manitoba, and although we did not include an Indigenous identifier, it is known that during the study years, between 80 and 87% of children in care in Manitoba were Indigenous.2,3 I take Smylie and Phillips-Beck’s concerns seriously and acknowledge that the exclusion of Indigenous involvement in this study was an oversight on my part; I apologize for my role in the harms this causes and will work to ensure that Indigenous representation and engagement is present in relevant research using routinely collected data.
References
1. Smylie J, Phillips-Beck W. Truth, respect and recognition: addressing barriers to Indigenous maternity care. CMAJ. 2019;191:E207-E208.
2. Brownell M, Chartier M, Au W, et al. The Educational Outcomes of Children in Care in Manitoba. Winnipeg, MB; 2015. http://mchp-appserv.cpe.umanitoba.ca/reference/CIC_report_web.pdf.
3. Wall-Wieler E, Kenny K, Lee J, Thiessen K, Morris M, Roos L. Prenatal care among mothers involved with child protection services in Manitoba: a retrospective cohort study. CMAJ. 2019;191:E209-E215.