Awaiting A Landmark Decision

Midwives Worldwide Await Ontario’s Pay Equity Decision

It will be a landmark decision and a precedent-setting case that may change how workers in female-dominated professions worldwide are compensated.

In 2013, midwives in Ontario Canada filed an application with the Human Rights Tribunal of Ontario. They allege midwives in Ontario have faced a gender penalty in their pay from the Ontario government for almost two decades.

“I work extremely hard to provide excellent care to my clients,” explains Jacqueline Whitehead in her affidavit submitted to the court. She’s a registered midwife with 10 years experience who runs a practice in Canada’s capital city, Ottawa. 

“Being a midwife is not just a job. It is my primary identity,” says Jacqueline, “And so when I am underpaid, it is just not my ‘work’ identity that the inequitable pay affects. It is my whole identity.”

Ontario midwives are primary health-care providers who are specialists in providing around-the-clock, on-call care for clients throughout normal pregnancy, birth and the first six weeks after birth.

Midwives in Ontario face a pay equity gap of at least 48%, according to the Association of Ontario Midwives (Durber Report, 2013). Policy makers, governments, academics, activists, and workers in vulnerable professions dominated by women are eagerly awaiting the outcome of the case.

Rooted in Social Justice 

Midwives working in the province of Ontario are perfectly situated to take on the pay equity fight. With the largest membership in Canada and a strong history of social activism, they are fighting for all female-dominated professions. 

Katrina Kilroy, President of the Canadian Association of Midwives

Katrina Kilroy has worked as a midwife in urban and rural settings since 1991. She is the president of the Canadian Association of Midwives and has been involved in the fight for pay equity for midwives since the beginning. For her, the fight is about so much more than money. It’s about valuing the lives and the experiences of people who are having babies.

“When I started as a midwife,” explains Katrina, “the delivery room in one of the local hospitals still had restraints on the tables which were routinely used in prior years. There were doctors who did episiotomies and forceps delivery with every baby. That’s how babies came out. That’s what happened.“

Ontario has the most midwives of any province or territory in Canada, more than half of all midwives in the country. In 1994, it was the first province to become regulated by the government. Prince Edward Island, Newfoundland and the Yukon don’t yet employ any midwives, while New Brunswick hired its first few in 2018.

“I think there is a lot of misunderstanding about what midwives are, what they do, and what their responsibilities are,” says Katrina.

“There’s a common misconception that midwives are asking to be paid the same as physicians, which we are not. We want to be paid fairly relative to the intensity, responsibility, and the nature of the work we do and what it does for society. Midwives are providing a very valuable service and we should be paid fairly to do that service.“

Katrina Kilroy, President, Canadian Association of Midwives

Midwives Voices, Midwives Realities

Midwives around the world are undervalued and underpaid. In 2016, the World Health Organization released a report investigating the work conditions for midwives. It was the first study of its kind.

The report documents the voices and experiences of 2,470 midwives from 93 countries. Their universal complaint is their lack of voice and exclusion from decision-making.

“Midwives should be given as much respect for their expertise in pregnancy and normal birth as the obstetric doctors are given for their expertise in abnormality of pregnancy and birth,” explains a midwife from the United Kingdom.

The report also documents the economic struggles of midwives. One-fifth of respondents say their salary isn’t enough to live on. Most feel they are not paid fairly compared to professionals in similar positions. 

Between 20–30% of all midwives in the study say they are treated badly because of discrimination against women and gender inequality. Many, especially in Africa, voice concerns about facing harassment, as well as physical and sexual violence while on the job.

The World Health Organization points to the “vital role” midwives play in improving healthcare and reducing maternal and newborn deaths. The report highlights that midwives are not properly recognized for their important work and funding for midwifery is not sufficient. It also highlights the vulnerability of the profession as a whole because it is a female-dominated field.

New Zealand’s Fight

One country where midwives have successfully fought for proper recognition is New Zealand. Midwives there face similar challenges to midwives in Canada. Those who are self-employed are also paid by the government, and much like Ontario’s midwives, they have taken their fight for pay equity to the courts.

“We are hearing an increasing number of stories from around the country of severe shortages as midwives continue to leave the profession,” says Karen Guilliland, Chief Executive of the New Zealand College of Midwives. “We can now see a pattern confirming that this is a service in crisis.”

A compensation review shows that rural midwives in New Zealand earn about $6.76 CAD an hour (after tax and expenses). That’s less than half the minimum wage there. There’s also no compensation allowance for career experience. A newly qualified midwife earns the same as a midwife with decades of experience delivering babies.

"I think that is a really serious place to be in,” says Karen. “I've been in midwifery for 40 years. I've never seen such levels of despair and outrage. The outrage is one thing but the despair is quite another thing altogether."

New Zealand Midwives Protesting

Photo Courtesy: Don Row, The Spinoff

In May 2018, midwives in New Zealand withdrew their court action against the government. They settled their fight for pay equity after they were promised a 6 percent pay increase and more control over their contract negotiations. They’re still waiting to see if the government follows through on its promises. 

“What we want is a commitment that we will end up with pay equity,” explains Karen. “I'm not sure whether we've got that, but I am reasonably sure that we will get enough for midwives to feel like they can carry on.”

Hope for Change

Ontario Midwives Pay Equity

Photo Courtesy: Ashley Eve Photography

In Canada, midwives everywhere are eagerly awaiting the Human Rights Tribunal of Ontario’s decision. 

“Midwives across the country face the same conditions that affect midwives in Ontario in terms of gender bias,” explains the Canadian Association of Midwives president, Katrina Kilroy.

“I think it’s actually important to the whole society that we pay people fairly in these highly female-dominated professions," says Katrina. "What does it mean to us as a society if we decide that this profession of women for women doesn’t deserve to be paid as equitably as other professions? What’s that say about us as a society?”

Human rights lawyer, Mary Cornish, has fought and won fair pay for hundreds of thousands of female workers in Canada. Now she’s representing Ontario’s midwives. She believes their case will set a precedent not just for other midwives, but for all workers in female-dominated professions in general.

"Some of the issues that will be decided by this case involve the use of a gender lens and gender-based budgeting in terms of governments," says Mary. "I think that will set its own precedent in general about the requirements of government to use a human rights lens when they’re deciding policy matters which affect disadvantaged groups."

The Individual Struggle 

Woman in Labour with her Midwife at the Toronto Birth Centre, Photo by Heather Bays

Photo Courtesy: Heather Bays Photogra

During the past two decades, despite increases in responsibility and workload, the Ontario government’s neglect of the gendered nature of midwifery care has led to a significant pay equity gap.

“Since I began in midwifery, I have had my scope expanded significantly,” explains Ontario midwife, Jacqueline Whitehead. “I have been able to prescribe new and more varied prescriptions. I am now able to intubate newborns. I now run a practice, manage staff, adhere to rules and regulations of public health, health privacy laws, city by-laws, and labour laws. The expectations for me now are so much higher, and yet the pay has barely changed since I graduated."

"Promoting choice in women's healthcare was also one of the reasons why I became a midwife myself. I remember not being listened to, and my thoughts and feelings being dismissed. I want to ensure that women do not have the experiences that I had [in my birth]. I want to make sure that they have informed choice. This is why I continue in this profession despite the lack of equitable pay. This is the caring dilemma.” 

Jacqueline Whitehead, Registered Ontario Midwife

A decision from the Human Rights Tribunal of Ontario is expected soon.