Ministry of Health releases summary of GBA+ assessment

December 1, 2021


As part of the Remedial Orders, the Human Rights Tribunal of Ontario (HRTO) ordered the Ministry of Health (MOH) to work with an expert to conduct a Gender Based Analysis (GBA) to reform and align its compensation policies and practices in accordance with the Ontario Human Rights Code (Code). The GBA+ Assessment was intended to assess the policies and practices of the MOH, to better understand the gender-based barriers, systemic inequities and gaps perpetuated by the MOH, with regards to compensation of midwives as independent contractors.

In December 2020, the ministry retained Canada Equality Consulting (CEC) to conduct the GBA+. Since January 2021, the AOM has been working with CEC consultants to make recommendations and provide analysis to inform the GBA+.

Specifically, the AOM took the following actions:

  • Actively advocated for midwives at the Implementation Steering Committee (ISC)
  • Advocated for an intersectional lens that captured more than just gender, but also other protected grounds such as disability, race, indigeneity, family status (GBA+)
  • Provided over 30 issue notes, documents, resources and communications with CEC to inform the GBA+ analysis and address intersectional adverse impacts for midwives

On Nov. 18, 2021, the ministry finally released a three-page summary of the GBA+ report (login rquired; PDF, 140 KB) to the AOM after almost two months’ delay.

GBA+ report summary

Key findings of the GBA+ Assessment include:

  • Power, privilege and oppression dynamics in the negotiation and compensation system between government and midwives;
  • Lack of intersectional gendered lens applied to policies, practices and decision-making; and
  • Lack of clarity and defined compensation priorities in the provincial maternal and newborn care sector

Based on the findings, the GBA+ report summary indicates the following recommendations:

  1. Development of a gender equality action plan for midwives in Ontario
  2. Development of an Ontario maternal and newborn care sector strategy
  3. Development and application of an intersectional gender lens/tool
  4. Adoption of gender budgeting
  5. Adoption of gender impact assessments
  6. Increase of accessibility and transparency of midwifery compensation policies
  7. Integration of an intersectional gender lens into the Joint Compensation Study (JCS)

AOM notes that the summary of the GBA+ report includes some findings and recommendations that were provided to the CEC by the AOM (e.g. development of a gender equality plan, deployment of gender-based budgeting, impact assessments of decision and policy making).

AOM response to GBA+ report summary and process

The AOM has expressed its ongoing frustration with the government throughout the ISC process. It is evident that the government has neglected to use the opportunity provided by the GBA+ to change its policies and practices, instead carrying on with business as usual. As long as government compensation policies do not use a gender lens, midwives continue to experience adverse outcomes and work under discriminatory practices.

AOM’s criticisms of the GBA+ report and process include:

  • Inadequate summary of the GBA+ report, disappointment at the inexplicable delay of receiving the GBA+ report summary (over two months), and lack of clarity surrounding timeline of when the report was received from CEC
  • Continued refusal by the ministry to release the full GBA+ report with detailed findings and recommendations to the AOM
  • Lack of ministry actions to reform compensation policies and practices, despite being formally advised of Code violations in 2018, and refusal to produce current compensation policies and practices
  • Ministry’s continued refusal to acknowledge or investigate AOM’s allegation of discrimination since 2014
  • Restriction of CEC mandate to exclude “implementation” of the GBA+, and focus on simply producing a report
  • Ministry’s exclusion of the AOM from meaningful participation in implementing the GBA remedy; engagement with CEC occurred only due to direct communication by AOM with CEC
  • GBA+ summary lacks specificity surrounding MOH compensation policies and practices and their gender impacts
  • Failure of CEC to meaningfully engage with the Indigenous Midwifery team and Indigenous Midwifery Advisory Circle in a respectful way
    • The AOM insists that the MOH work to remediate adverse impacts experienced by Indigenous midwives
  • Failure of CEC to explicitly name racism/anti-racism in the use of the intersectional GBA+ lens
  • CEC’s continued use of language of “equality” over “equity” in pursued outcomes
  • Lack of detail regarding any GBA+ implementation plans and transformative actions, while midwives continue to work daily under discriminatory conditions 

Next steps

The AOM continues to demand a copy of the full GBA+ report, which articulates all findings and recommendations in detail. The ministry persists in its refusal to release the report, highlighting the ongoing discriminatory oppression and power dynamics of the government with midwives. The AOM is filing a Freedom of Information (FOI) request to obtain the report.

The AOM Board of Directors, as advised by the AOM legal team, is considering next steps to protect the rights of midwives who continue to experience systemic discrimination by the MOH.

Update March 2022: Full GBA+ report released to the AOM

As a result of ongoing advocacy and the filing of an FOI by the AOM, the MOH has now released the full GBA+ report to the AOM. Members and Applicants can read the report online (login required; PDF, 4.4 GB).