Long-distance travel for birthing among Indigenous and non-Indigenous pregnant people in Canada

Understanding the experiences of young, urban, Indigenous mothers-to-be in British Columbia, Canada

BACKGROUND

Indigenous Peoples comprise the youngest and fastest growing demographic in Canada, with many living in urban-suburban areas. Given higher fertility rates, younger overall ages and higher adolescent pregnancy rates, perinatal research is needed-to inform policymaking and programming throughout pregnancy and childhood. Yet such data remain scarce in British Columbia (BC), Canada. This study therefore aimed to describe the experiences of young, urban, Indigenous mothers-to-be who enrolled in a larger BC early prevention trial designed to reach families experiencing socioeconomic disadvantage.

METHODS

This descriptive study utilized baseline data from a trial that enrolled first-time mothers-to-be who met indicators of socioeconomic disadvantage and who were residing in select urban-suburban areas. These indicators included being young (19 years or younger) or having limited income, low access to education, and being single (aged 20-24 years). We described and compared survey data on girls (n = 109; aged 14-19 years) and young women (n = 91; aged 20-24 years) using Chi-square or Student's t-tests.

RESULTS

Of the 739 trial participants, 200 or 27% identified as Indigenous and met trial eligibility criteria: limited income (92.9%), limited access to education (67.0%), and/or being single (90.9%). Beyond this, participants reported associated adversities including: unstable housing (63.3%), psychological distress (29.3%), severe anxiety or depression (48.5%), experiences of childhood maltreatment (59.4%) and intimate partner violence (39.5%). Compared to girls, young women reported higher income and educational attainment (p < 0.001), more unstable housing (p = 0.02) and more childhood maltreatment (p = 0.014). Many had recently received primary healthcare (75%), but few had received income assistance (34%). Most (80.5%) reported experiencing four or more adversities.

CONCLUSIONS

We present data illustrating that a high proportion of pregnant Indigenous girls and young women engaged with public health and consented to long-term research participation-despite experiencing cumulative adversities. The trial socioeconomic screening criteria were successful in reaching this population. Girls and young women reported relatively similar experiences-beyond expected developmental differences in income and education-suggesting that adolescent maternal age may not necessarily infer risk. Our findings underscore the need for Indigenous community-led services that address avoidable adversities starting in early pregnancy.

Unpacking access barriers through the health providers' lens among the Arab Bedouin population in Israel

The Arab Bedouin ethnic minority is considered one of the most vulnerable populations in Israel due to socio-cultural factors that affect their healthcare utilization patterns. By adopting the intersectionality perspective, this research aims to identify gaps and barriers to Bedouins' healthcare services (HCS) utilization, as perceived by healthcare professionals (HCP) serving this community. A qualitative study was conducted from June 2019 to January 2022, involving in-depth semi-structured interviews with thirty-two HPCs working in hospitals and community health centers/clinics in Bedouin villages and towns in Southern Israel. Reflective Thematic Analysis (RTA) was used to analyze the collected data, and trustworthiness was ensured through audit, reflexivity, and peer debriefing. Findings revealed that healthcare professionals noted gaps that hinder HCS accessibility and utilization. This study found that the intersection of physical, financial, language, health literacy, and gender barriers with issues of trust, stigma, and deep-rooted socio-cultural norms and beliefs affect Bedouin healthcare accessibility. Additionally, Bedouin women are particularly vulnerable subgroups who were impacted differently by these barriers. In conclusion, our research highlights the necessity of targeted interventions to improve healthcare access for Bedouin minority populations, particularly tailoring HCS to the women subgroup within the Bedouin community. Suggested interventions include health literacy-enhancing educational initiatives, addressing medication affordability, and approaches to mitigate cultural and gendered hindrances to HCS. These insights have broader relevance for shaping health policies and strategies that bridge healthcare disparities among global minority populations.

Anishininew infant feeding experiences in Sandy Lake, Canada: a story of Waabeequanee

Global public health recommendations for optimal infant nutrition include exclusive breastfeeding for the first 6 months of life. Breastfeeding has several benefits; however, breastfeeding initiation rates and duration remain below recommendations in Northwestern Ontario, Canada. Sandy Lake First Nation is particularly interested in understanding infant feeding experiences of community members to support increased breastfeeding initiation and duration. Therefore, this project aims to understand Indigenous caregiver infant feeding experiences using qualitative and Indigenous methodologies. As part of the Sandy Lake Health and Diabetes Project, a community-based participatory project focused on the prevention of type 2 diabetes mellitus, qualitative semi-structured interviews were conducted with 32 Anishininew caregivers living in Sandy Lake, Ontario. These interviews were tape recorded and transcribed verbatim. The Anishininew medicine wheel and situational analysis were used to inform our methods throughout this work. We recruited 32 co-creators, ages 18-57 years, who contributed knowledge through 26 individual and group interviews that occurred between August and October 2019. Two overarching themes, community context and caregiver identities, were identified that encompass six and eight specific themes, respectively, representing infant feeding experiences in Sandy Lake. Community members provided a variety of recommendations to help support infant nutrition in Sandy Lake, including a focus on structural needs like higher income and water security. This work highlights the need for birthing supports within remote Indigenous communities, and the inclusion of local and Indigenous knowledge in programming.

Keeping birth at home: Community and service provider visions for perinatal wellness and continued Inuit childbirth in Nunavik

PROBLEM

Childbirth on traditional territories is unattainable for many Indigenous peoples living in remote communities in Canada.

BACKGROUND

In Nunavik, Inuit territory in northern Quebec, rapid population growth risks exceeding local midwifery capacity. This poses challenges to community-based childbirth in a region recognized for reclaiming Inuit midwifery and local birthing.

AIM

To explore community views on protective factors of maternal and family perinatal wellness and continued local birthing.

METHODS

In ten communities, Inuit families and perinatal service providers created a total of 54 fuzzy cognitive maps on protective factors for (1) birth in a good way in Nunavik, (2) maternal and family perinatal wellness, and (3) community-based birthing in Nunavik. We used fuzzy transitive closure to examine direct and indirect connections and collated individual factors into categories using inductive thematic analysis.

FINDINGS

Well-equipped local medical facilities and services, community birthing centres run by Inuit midwives, and Inuit perinatal traditions had the strongest influence on experiencing birth in a good way in Nunavik. Inuit youth perspectives featured instrumental and emotional support for mothers and families, along with health and self-care in pregnancy as the most influential factors on maternal and family perinatal wellness. Prominent protective factors for community birth in Nunavik included maternal-infant health and wellness, local Inuit midwifery services, and well-resourced medical facilities.

DISCUSSION

Fuzzy cognitive mapping was helpful in informing community visioning of local childbirth and maternal and family perinatal wellness in Nunavik.

CONCLUSION

Inuit-led midwifery services are essential to continued local childbirth in the region.

Perceived Access to Healthcare of Indigenous Peoples in Canada With Rheumatoid Arthritis and Their First-Degree Relatives

OBJECTIVE

There are complex and interrelated factors that lead to inequitable healthcare delivery in Canada. Many of the factors that underlie these inequities for Canada's geographically dispersed Indigenous peoples remain underexamined.

METHODS

A cohort of 831 First Nations (FN) individuals from urban and remote communities were recruited into a longitudinal study of rheumatoid arthritis (RA) risk from 2005 to 2017. Data from each participant's initial enrollment visit were assessed using a survey that captured concerns with healthcare access.

RESULTS

We found that remote participants with RA reported poor access compared to remote first-degree relatives (FDRs; P < 0.001); this difference was not observed for urban participants with RA. We observed substantial differences based on sex; female participants perceived access to care to be more difficult than male participants in both urban and remote cohorts (P < 0.001). We also observed that male participants with RA reported poor access to care compared to male FDRs. Importantly, access to care in remote communities appeared to improve over the duration of the study (P = 0.01). In a logistic regression analysis, female sex, remote location, and older age were independent predictors of poor access to care. Predictors of poor access in participants with RA also included female sex, remote location, and older age.

CONCLUSION

FN peoples living in remote communities, particularly those with an established RA diagnosis, report more problems accessing health care. Sex-based inequities exist, with FN female individuals reporting greater difficulties in accessing appropriate health care, regardless of RA diagnosis. Addressing these sex-based inequities should be a high priority for improving healthcare delivery.

Indigenous maternal and infant outcomes and women's experiences of midwifery care: A mixed-methods systematic review

BACKGROUND

The impact of midwifery, and especially Indigenous midwifery, care for Indigenous women and communities has not been comprehensively reviewed. To address this knowledge gap, we conducted a mixed-methods systematic review to understand Indigenous maternal and infant outcomes and women's' experiences with midwifery care.

METHODS

We searched nine databases to identify primary studies reporting on midwifery and Indigenous maternal and infant birth outcomes and experiences, published in English since 2000. We synthesized quantitative and qualitative outcome data using a convergent segregated mixed-methods approach and used a mixed-methods appraisal tool (MMAT) to assess the methodological quality of included studies. The Aboriginal and Torres Strait Islander Quality Appraisal Tool (ATSI QAT) was used to appraise the inclusion of Indigenous perspectives in the evidence.

RESULTS

Out of 3044 records, we included 35 individual studies with 55% (19 studies) reporting on maternal and infant health outcomes. Comparative studies (n = 13) showed no significant differences in mortality rates but identified reduced preterm births, earlier prenatal care, and an increased number of prenatal visits for Indigenous women receiving midwifery care. Quality of care studies indicated a preference for midwifery care among Indigenous women. Sixteen qualitative studies highlighted three key findings - culturally safe care, holistic care, and improved access to care. The majority of studies were of high methodological quality (91% met ≥80% criteria), while only 14% of studies were considered to have appropriately included Indigenous perspectives.

CONCLUSION

This review demonstrates the value of midwifery care for Indigenous women, providing evidence to support policy recommendations promoting midwifery care as a physically and culturally safe model for Indigenous women and families.

Perinatal Outcomes at Rural Hospitals That Participated in the Rural Surgical and Obstetrical Networks (RSON) of British Columbia (2016-2021)

BACKGROUND

The goal of the Rural Surgical and Obstetrical Networks (RSON) of British Columbia was to support safe and appropriate surgery, operative birth, and perinatal care closer to home for rural communities. Family physicians with enhanced obstetrical and/or surgical skills provide cesarean delivery and family practice anesthetists manage anesthesia for labour pain and operative births at RSON-supported hospitals, with the involvement of a local specialist at one site.

OBJECTIVES

The objectives of the study were to: (1) compare perinatal outcomes at hospitals participating in the RSON initiative with outcomes at referral hospitals and (2) examine temporal changes in the proportion of childbearing people who resided in RSON communities and gave birth locally.

METHODS

Poisson regression analysis was used to model the effect of hospital type (RSON vs. referral) on perinatal outcomes. We restricted the analysis to singleton births and controlled for differences in maternal characteristics, obstetric history, and pregnancy complications.

RESULTS

Childbearing people who gave birth at RSON-supported hospitals (n = 3498) had a 10% lower incidence of adverse maternal-newborn outcomes compared to those who gave birth at referral hospitals (n = 14 772), after controlling for referral bias. We found a small increase (3.2 %) in the proportion of local births over the study period.

CONCLUSION

Findings provide evidence that childbearing people can safely give birth at smaller rural hospitals in British Columbia and that investments in rural hospitals contribute to service stability. Stabilizing local birth services in rural communities benefits the whole region because it reduces surgical overload in regional referral centres.

Mixed-methods study exploring health service access and social support linkage to the mental well-being of Canadian Indigenous pregnant persons during the COVID-19 pandemic

OBJECTIVES

This study aimed to explore how the unprecedented stressors associated with the COVID-19 pandemic may have contributed to heightened levels of depression and anxiety among pregnant Indigenous persons, and identify protective individual-level factors.

DESIGN

The current study used a mixed-methods design including standardised questionnaires and open-ended response questions. Using hierarchical regression models, we examined the extent to which COVID-19-related factors of service disruption (ie, changes to prenatal care, changes to birth plans and social support) were associated with mental well-being. Further, through qualitative analyses of open-ended questions, we examined the coping strategies used by pregnant Indigenous persons in response to the pandemic.

SETTING

Participants responded to an online questionnaire consisting of standardised measures from 2020 to 2021.

PARTICIPANTS

The study included 336 self-identifying Indigenous pregnant persons in Canada.

RESULTS

Descriptive results revealed elevated rates of clinically relevant depression (52.7%) and anxiety (62.5%) symptoms among this population. 76.8% of participants reported prenatal care service disruptions, including appointment cancellations. Thematic analyses identified coping themes of staying informed, social and/or cultural connections and activities, and internal mental well-being strategies. Disruptions to services and decreased quality of prenatal care negatively impacted mental well-being of Indigenous pregnant persons during the COVID-19 pandemic.

CONCLUSIONS

Given the potential for mental well-being challenges to persist and long-term effects of perinatal distress, it is important to examine the quality of care that pregnant individuals receive. Service providers should advance policies and practices that promote relationship quality and health system engagement as key factors linked to well-being during the perinatal period for Indigenous persons.

Structural racism and violence: Routine healthcare access in a cohort of marginalized Indigenous women and Two-Spirit Peoples during the COVID-19 Pandemic

Objectives

Historical and ongoing colonial violence, racism, discrimination, criminalization, and intergenerational trauma continues to impact the health of Indigenous women (cisgender and transgender) and Two-Spirit Peoples. Previous and ongoing work clearly articulate the deeply harmful roles of colonialism and racism in continuing to systemically exclude Indigenous Peoples from accessing equitable and culturally safe healthcare. While the COVID-19 pandemic has amplified structural inequities, little attention has been paid to how the pandemic impacts healthcare access for Indigenous women and Two-Spirit Peoples living in urban settings. The aim of this study was to evaluate factors associated with experiencing difficulty accessing routine healthcare in a cohort of marginalized urban Indigenous women and Two-Spirit Peoples on the ancestral, occupied territories of the Musqueam, Squamish and Tsleil-Waututh Nations in what is now referred to as Metro Vancouver, Canada during the COVID-19 pandemic.

Methods

Data were drawn from AMPLIFY, a study of Indigenous cis and trans women and Two-Spirit Peoples in Metro Vancouver. Analyses drew on baseline and semi-annual questionnaire data collected with sex workers and women living with HIV from October 2020-August 2021. We used bivariate and multivariable logistic regression with generalized estimating equations (GEE) to model correlates of experiencing difficulty accessing a family doctor, nurse, or clinic for routine healthcare during the COVID-19 pandemic in the last 6-months.

Results

Amongst 142 marginalized Indigenous women and Two-Spirit Peoples (199 observations), 27.5% reported difficulty accessing routine healthcare. In multivariable GEE logistic regression, participants who had ever been pregnant (AOR:4.71, 95% CI:1.33-16.66) experienced negative changes in psychological and emotional well-being (AOR: 3.99, 95% CI: 1.33-11.98), lacked access to culturally safe health services (AOR:4.67, 95% CI:1.43-15.25), and had concerns regarding safety or violence in their community (AOR:2.72, 95% CI:1.06-6.94) had higher odds of experiencing recent difficulty accessing routine healthcare.

Discussion

Findings are in line with the BC Commissioned In Plain Sight report which recommends the need for accessible, culturally safe, anti-racist, and trauma-informed routine healthcare for marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples during the current and future pandemics. More community-based research is needed to understand access needs for culturally safe routine healthcare amongst marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples.

The pandemic experiences of Ontario perinatal providers: a qualitative study

BACKGROUND

The COVID-19 pandemic has produced widespread disruptions for healthcare systems across Canada. Perinatal care in Ontario, Canada was subject to province-wide public health restrictions, reallocation of hospital beds and human health resources. To better understand the impacts of the pandemic on Ontario perinatal care, this study explored the perspectives of perinatal care providers about their clinical COVID-19 pandemic experiences.

METHODS

Semi-structured key informant virtual interviews were conducted between August 2021 and January 2022 with 15 Ontario-based perinatal care providers. Recorded interviews were transcribed, and thematic content analysis used to identify major themes and subthemes.

RESULTS

Participants were mainly women, practicing in Eastern and Central Ontario as health providers (obstetricians, nurses, midwives), allied regulated health professionals (social worker, massage therapist), and perinatal support workers (doula, lactation consultant). Major themes and subthemes were identified inductively as follows: (1) Impacts of COVID-19 on providers (psychosocial stress, healthcare system barriers, healthcare system opportunities); (2) Perceived impacts of COVID-19 on pregnant people (psychosocial stress, amplification of existing healthcare barriers, influences on reproductive decision making; minor theme- social and emotional support roles); (3) Vaccine discourse (provider empathy, vaccines and patient family dynamics, minor themes- patient vaccine hesitancy, COVID-19 misinformation); and (4) Virtual pregnancy care (benefits, disadvantages, adaptation of standard care practices).

CONCLUSIONS

Perinatal care providers reported significant stress and uncertainty caused by the COVID-19 pandemic and evolving hospital protocols. Providers perceived that their patients were distressed by both the pandemic and related reductions in pregnancy healthcare services including hospital limits to support companion(s). Although virtual pregnancy care impaired patient-provider rapport, most providers believed that the workflow efficiencies and patient convenience of virtual care is beneficial to perinatal healthcare.

COVID-19 and indigenous youth wellbeing: A review

Indigenous youth in Canada and the United States of America (USA) have been disproportionately affected by the COVID-19 pandemic due to the compounding of increased illness risk and legacies of colonization. This article reports the findings of a Cochrane rapid review of 23 studies that examined mental wellbeing outcomes for Indigenous youth from March 2020 to April 2023 in Canada and the USA. Reported pandemic-related mental wellbeing impacts included changes in alcohol and substance use, anxiety, depression, sleep, and suicidality. Protective factors emerged including cultural and community connection. Results suggest that mental wellbeing worsened for many Indigenous youth during COVID-19. Clinical implications are discussed alongside guidance for service provision improvements to support Indigenous youth wellbeing, from a lens of self-determination.

Disparities in primary and emergency health care among "off-reserve" Indigenous females compared with non-Indigenous females aged 15-55 years in Canada

BACKGROUND

Access to primary care protects the reproductive and non-reproductive health of females. We aimed to quantify health care disparities among "off-reserve" First Nations, Métis and Inuit females, compared with non-Indigenous females of reproductive age.

METHODS

We used population-based data from cross-sectional cycles of the Canadian Community Health Survey (2015-2020), including 4 months during the COVID-19 pandemic. We included all females aged 15-55 years. We measured health care access, use and unmet needs, and quantified disparities through weighted and age-standardized absolute prevalence differences compared with non-Indigenous females.

RESULTS

We included 2902 First Nations, 2345 Métis, 742 Inuit and 74 760 non-Indigenous females of reproductive age, weighted to represent 9.7 million people. Compared with non-Indigenous females, Indigenous females reported poorer health and higher morbidity, yet 4.2% (95% confidence interval [CI] 1.8% to 6.6%) fewer First Nations females and 40.7% (95% CI 34.3% to 47.1%) fewer Inuit females had access to a regular health care provider. Indigenous females waited longer for primary care, more used hospital services for nonurgent care, and fewer had consultations with dental professionals. Accordingly, 3.2% (95% CI 0.3% to 6.1%) more First Nations females and 4.0% (95% CI 0.7% to 7.3%) more Métis females reported unmet needs, especially for mental health (data for Inuit females not reported owing to high variability).

INTERPRETATION

During reproductive age, Indigenous females in Canada face many disparities in health care access, use and unmet needs. Solutions aimed at increasing access to primary care are urgently needed to advance health care reconciliation.

Surgery in the western Canadian Arctic: The relative impact of family physicians with enhanced surgical skills working collaboratively with specialist surgeons

Introduction

Little is known about the surgical needs of rural, remote or circumpolar populations in Canada; these same regions are also home to half of all Indigenous people in the country. In the present study, we sought to understand the relative impact of family physicians with enhanced surgical skills (FP-ESS) and Specialist Surgeons in the surgical care of a mostly Indigenous rural and remote community in the western Canadian Arctic.

Methods

A descriptive and retrospective quantitative study was conducted to determine the number and range of procedures performed for the defined catchment population of the Beaufort Delta Region of the Northwest Territories, as well as the type of surgical provider and location of that service, over the 5 years from 1 April, 2014, to 31 March, 2019.

Results

FP-ESS physicians in Inuvik performed 79% of all endoscopic and 22% of all surgical procedures, which accounted for nearly half of the total procedures performed. Over 50% of all procedures were performed locally (47.7% by FP-ESS and 5.6% by visiting specialist surgeons). For surgical cases alone, nearly one-third were performed locally, one-third in Yellowknife and the remaining one-third out-of-territory.

Conclusions

This networked model reduces the overall demand on surgical specialists, who can better focus their efforts on surgical care that is beyond the scope of FP-ESS. With nearly half of the procedural needs of this population being met locally by FP-ESS, there are decreased health-care costs, better access and more surgical care closer to home.

Enhancing health and wellness by, for and with Indigenous youth in Canada: a scoping review

BACKGROUND

Indigenous youth in Canada face profound health inequities which are shaped by the rippling effects of intergenerational trauma, caused by the historical and contemporary colonial policies that reinforce negative stereotypes regarding them. Moreover, wellness promotion strategies for these youth are replete with individualistic Western concepts that excludes avenues for them to access holistic practices grounded in their culture. Our scoping review explored strategies, approaches, and ways health and wellness can be enhanced by, for, and with Indigenous youth in Canada by identifying barriers/roadblocks and facilitators/strengths to enhancing wellness among Indigenous youth in Canada.

METHODS

We applied a systematic approach to searching and critically reviewing peer-reviewed literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews [PRISMA-ScR] as a reporting guideline. Our search strategy focused on specific keywords and MeSH terms for three major areas: Indigenous youth, health, and Canada. We used these keywords, to systematically search the following electronic databases published in English between January 01, 2017, to May 22, 2021: Medline [Ovid], PubMed, ERIC, Web of Science, Scopus, and iportal. We also used hand-searching and snowballing methods to identify relevant articles. Data collected were analysed for contents and themes.

RESULTS

From an initial 1695 articles collated, 20 articles met inclusion criteria for this review. Key facilitators/strengths to enhancing health and wellness by, for, and with Indigenous youth that emerged from our review included: promoting culturally appropriate interventions to engage Indigenous youth; using strength-based approaches; reliance on the wisdom of community Elders; taking responsibility; and providing access to wellness supports. Key barriers/roadblocks included: lack of community support for wellness promotion activities among Indigenous youth; structural/organizational issues within Indigenous communities; discrimination and social exclusion; cultural illiteracy among youth; cultural discordance with mainstream health systems and services; and addictions and risky behaviours.

CONCLUSION

This scoping review extracted 20 relevant articles about ways to engage Indigenous youth in health and wellness enhancement. Our findings demonstrate the importance of promoting health by, and with Indigenous youth, by engaging them in activities reflexive of their cultural norms, rather than imposing control measures that are incompatible with their value systems.

Public health perinatal promotion during COVID-19 pandemic: a social media analysis

Background

Canadian public health agencies, both municipal/regional and provincial/territorial, are responsible for promoting population health during pregnancy and the early postnatal period. This study examines how these agencies use web-based and Facebook channels to communicate perinatal health promotion during the emergence of the COVID-19 pandemic.

Methods

Perinatal health promotion content of websites and Facebook posts from a multijurisdictional and geographically diverse sample of government and non-governmental organizations (NGO) were evaluated using thematic content analysis in 2020.

Results

Major Facebook perinatal health promotion themes included breastfeeding, infant care, labor/delivery, parenting support and healthy pregnancy. Facebook COVID-19-themed perinatal health promotion peaked in the second quarter of 2020. Websites emphasized COVID-19 transmission routes, disease severity and need for infection control during pregnancy/infant care, whereas Facebook posts focussed on changes to local health services including visitor restrictions. NGO perinatal health promotion reflected organizations’ individual mandates.

Conclusions

Canadian government use of Facebook to disseminate perinatal health promotion during the COVID-19 pandemic varied in terms of breadth of topics and frequency of posts. There were missed opportunities to nuance transmission/severity risks during pregnancy, thereby proactively countering the spread of misinformation.

Impact of Maternal Health Behaviours and Social Conditions on Infant Diet at Age 1-Year: Results from a Prospective Indigenous Birth Cohort in Ontario, Canada

Background: Understanding the impact of maternal health behaviours and social conditions on childhood nutrition is important to inform strategies to promote health during childhood. Objective: To describe how maternal health sociodemographic factors (e.g., socioeconomic status, education), health behaviours (e.g., diet), and traditional health care use during pregnancy impact infant diet at age 1-year. Methods: Data were collected from the Indigenous Birth Cohort (ABC) study, a prospective birth cohort formed in partnership with an Indigenous community-based Birthing Centre in southwestern Ontario, Canada. 110 mother-infant dyads are included in the study and were enrolled between 2012 and 2017. Multiple linear regression analyses were performed to understand factors associated with infant diet scores at age 1-year, with a higher score indicating a diet with more healthy foods. Results: The mean age of women enrolled during pregnancy was 27.3 (5.9) years. Eighty percent of mothers had low or moderate social disadvantage, 47.3% completed more than high school education, and 70% were cared for by a midwife during their pregnancy. The pre-pregnancy body mass index (BMI) was <25 in 34.5% of women, 15.5% of mothers smoked during pregnancy, and 14.5% of mothers had gestational diabetes. Being cared for by an Indigenous midwife was associated with a 0.9-point higher infant diet score (p = 0.001) at age 1-year, and lower maternal social disadvantage was associated with a 0.17-point higher infant diet quality score (p = 0.04). Conclusion: This study highlights the positive impact of health care provision by Indigenous midwives and confirms that higher maternal social advantage has a positive impact on child nutrition.