The Association of Ontario Midwives

The Association of Ontario Midwives

Pay Equity Frequently Asked Questions

Q: Is midwives’ fight for pay equity a gender issue?

Yes. Female-dominated professions face a historical lack of pay equity. In recent years, much has been done to try to resolve gender-related pay equity disputes. But midwifery, a profession almost entirely comprised of women, has fallen through the cracks. Together, this has resulted in a gender penalty for midwives: a deep discount in their pay. The work midwives do has not been valued appropriately compared to other health-care professionals with similar levels of skills and responsibility. To devalue midwifery services is to devalue the people to whom midwives provide services: clients and families.

Q: Didn’t government make an investment in midwifery, including growing the number of registered midwives and opening birth centres?

Yes. But there is a difference between an investment in midwifery and an investment in midwives. The government has invested in expanding the midwifery program in Ontario and it’s important for them to continue to do so, as currently four in 10 clients who want a midwife are unable to access one. Because of this high demand, Ontario needs to retain every Ontario-trained midwife to ensure demand is met. This means investing in both the infrastructure that supports the Ontario midwifery program, as well as midwives themselves. This parallel effort is the only way to recruit and retain midwives and ensure that the profession grows in the future. Ontario cannot grow the size of the midwifery profession on the backs of midwives.

Q: How did the pay gap between midwives and comparable health-care providers happen?

Midwives have been providing excellent, cost-effective care since 1994 — that’s over 20 years now. But for 11 of those years (1994–2005), they received no pay increase. As a result, midwives’ earnings were systematically eroded compared to that of other health-care providers. In 2013, pay equity expert Paul Durber performed a full pay equity analysis. Durber’s detailed report evaluated health professions, including midwifery, in relation to skills, effort, responsibility and working conditions and found that midwives were being paid only 52% of what their work is worth. In 2010 a third-party, government-commissioned compensation report (the Courtyard report) found that midwives’ work was undervalued by at least 20%.

Q: These are tough economic times. Why should midwives get an increase when many public sector workers haven’t gotten a raise?

A pay equity increase is not a raise — it is an adjustment that recognizes a historical inequity. Midwives are asking for a pay equity adjustment so that they are paid appropriately compared to other health-care professionals with similar levels of responsibility and skill. What midwives are asking for is not a wage increase. Midwives are asking to be paid fairly for what their work is worth.

Q: Does midwifery cost the health-care system a lot of money?

No. In fact, midwifery saves the health-care system money. Midwives provide incredible value to the maternity care system in Ontario. In 2014-2015, midwives delivered more than 19,000 newborns and provided primary care to their birthing parents. Midwives create savings for the system by providing care in the community and reducing intervention rates. They have the highest satisfaction rate of any maternal health-care provider in Ontario.

Q: What value do midwives bring to the health-care system?

We know that midwifery care results in better outcomes for clients and newborns, with fewer interventions. Not only does this produce high client satisfaction rates, but it provides measurable savings to the health-care system. Midwives provide care for healthy, low-risk pregnancies, allowing obstetricians to be more available to clients who need high-risk care. Eighty percent of pregnancies are healthy and low-risk. But if Ontario is to continue receiving the benefits of midwifery care, several issues need to be addressed, including pay equity.

Q: How is pay equity linked to the sustainability of midwifery?

The sustainability of any profession depends on fair compensation for the work performed. Midwifery is growing very quickly; the midwives graduating from the Midwifery Education Program have pushed the number of midwives in Ontario to 800 — up from 500 in 2010. But without a salary that is equitable with other health-care providers in Ontario, these graduates may leave Ontario to practice elsewhere, in places where they are fairly valued and compensated. We’ve seen this happen with physicians and nurses. It is critical that the next government close the pay equity gap for midwives to avoid future issues with recruitment and retention of midwives in Ontario. Because four out of 10 women seeking midwifery care are unable to obtain it, Ontario needs to retain every Ontario-trained midwife in order to ensure demand is met.