The Association of Ontario Midwives

The Association of Ontario Midwives

Report calls for an end to discrimination: reinstate pay equity for midwives

Ontario midwives have been underpaid for almost two decades. Midwives had suspected the Ministry of Health and Long-Term Care undervalued their services, but in the fall of 2010, they received confirmation in the form of an independent, third-party report commissioned by the Ministry: the Courtyard Report.

The 54-page report examines the issue of compensation from a number of angles, including the evolution of midwifery funding, midwives’ level of education and scope of practice, and how Ontario midwives are compensated compared with other health care providers.

The report notes that, despite requests from the AOM to maintain pay equity, midwives experienced an 11-year stretch (1994-2005) when they received no pay increases, and that increases in 2005 and 2008 had not been sufficient to make up the significant wage gap midwives experienced.

The Courtyard Report recommended a significant one-time wage equity adjustment for all Ontario midwives, effective April 1, 2011.

For Katrina Kilroy, President of the AOM from 2008-2012, and head of the AOM negotiations committee during the time the Courtyard Report was written, that recommendation was very welcome. But more important than the specific figure was the recognition that midwives were not being fairly recognized for the value they provide to the Ontario health care system.

“That was what Courtyard did: it said that midwives were valuable and we were being underpaid,” says Kilroy. “We gave an independent, third-party the facts, and this was their conclusion. We were validated.”

No government response

The report was not binding, but Kilroy was initially optimistic that the government would have to consider such a strong recommendation from a report that they had commissioned and funded. But months dragged on with no response. Three years later, the government has yet to implement any of the report’s recommendations.

“Midwives feel devalued, because they are devalued,” explains Kilroy. “We are an all-female profession providing care to women, and inherent in the Ministry’s refusal to compensate midwives appropriately is the devaluation of both midwives as health care providers and women’s health care.”

Today’s AOM Negotiations Committee, now led by current board president Lisa M. Weston, RM, continues to call for a response to the report. She says it’s a waste for the government to commission a report then ignore the recommendations.

“Government needs to take action on this issue immediately,” she says.

It has not always been this way. When pay levels were set in 1994 at the initial regulation of midwifery, the model of compensation was informed by the Ontario Pay Equity Act, which went into effect in 1988. The NDP government of the day did not want to create a pay equity gap for a new female-dominated profession.

The Morton Report, published in 1993, compared a midwife’s job description, including scope and responsibilities, to other health care providers: a primary care nurse and a salaried physician working at a community health centre. This analysis and comparison was part of how pay equity was incorporated into midwives’ funding agreement. However, while the report’s recommendations were accepted and acted upon by government, this comparison was never maintained and there exists no current method to ensure pay equity for midwives.

Midwives are contractors paid by government. They do not fall under the Pay Equity Act. In fact, midwives do not receive the protection of labour laws, because the model of care they provide to clients requires continuity of care. 

Continuity of care demands flexible work hours and taxing on-call schedules for midwives. Midwives and women set up midwifery care in Ontario to function this way, where a woman’s right to excellent care was at the forefront and it remains there today.

And so midwives find themselves without access to the same laws as public sector workers, for instance. However, they do not give up access to their human right not to be discriminated against as women.

The government of Ontario delivers the midwifery program to families. Government determines a budget for delivering midwifery services to women and newborns in the province and stipulates compensation levels for front-line health care workers. The government essentially controls every financial aspect of midwifery.

In the two decades since the Morton report, midwives have become better integrated in the health care system and their scope has significantly increased. Midwives bring savings to the overall health care system through low rates of interventions, such as c-sections, and short hospital stays, for example.

Pay detached from rationale

“But midwives’ compensation has become increasingly detached from any kind of clear, principled rationale which accurately reflects our role, leaving midwives vulnerable to discrimination,” says Kilroy. “The purpose of Courtyard was to formally consider these principles and create a fair framework to determine fair compensation for work of value to Ontario.”

The Courtyard Report’s true legacy may turn out to be midwives’ certainty that they are subject to systemic, gender-based discrimination. 

“We’re not claiming that individuals at the Ministry of Health are discriminatory, but it’s clear that the government has a pattern of discrimination,” says Kilroy. “We’re up against barriers we can’t even see.”

Kilroy has seen that despite the discrimination they have experienced from government, midwives have always put clients first.

“Midwives feel compelled to accept being underpaid for our work, which is so profoundly unjust, because we are driven to make personal sacrifice to provide the best care possible to women,” she says. “Providing woman-centred care, providing continuity of care and care which includes informed choice, is the best care for women and their families. Midwives have subsumed their own needs again and again to provide the care that is right for women.”

Weston and Kilroy say government must stop taking advantage of midwives’ commitment to women’s health and reinstate a pay equity mechanism for determining compensation for midwives. And they know women and families will be standing alongside their midwives as they demand fairness and an end to discrimination.

Katrina Kilroy, RM, speaks out for pay equity at a 2011 rally at Queen’s Park