Thesis Format

Integrated Article

Assessing the economic costs of obstetric evacuation in rural and remote First Nation and Inuit communities in Canada

Author

Majd Radhaa, Western UniversityFollow

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

John-Baptiste, Ava

2nd Supervisor

Leason, Jennifer

Abstract

First Nations and Inuit Health Branch guidelines require First Nations and Inuit birthing persons residing on reserve or in rural and remote areas in Canada to travel to urban centres at 36–38 weeks gestational age, to await labour and birth. We sought to determine the costs of obstetric evacuation.

Our first study was a systematic review identifying obstetric evacuation costs in Canada. Medical evacuation costs, direct and indirect, ranged from $7,714 to $31,794 Canadian dollars. Our second study was a model-based analysis of the cost for fly-in First Nation communities in Ontario. The estimated average cost of obstetric evacuation was $38,551.72 Canadian dollars, comprised of $14,237.44, $8,540.28, $6,564.11, $5,973.01, $2,195.20, $647.92, and $393.76 representing lost productivity, escort, travel, hospitalization, accommodation, meals, and dependents, respectively.

Future research could expand our model-based framework to estimate population-level obstetric evacuation costs and conduct economic evaluations of culturally appropriate obstetric services, such as Indigenous midwifery.

Summary for Lay Audience

First Nation and Inuit Health Branch (FNIHB) guidelines have specific requirements for First Nations and Inuit birthing persons who live on reserve or in rural areas. Once they reach the final weeks of their pregnancy, they are required to travel to cities to give birth. This is referred to as obstetric evacuation. This requirement of travel to give birth has harmful impacts on First Nations people and Inuit. The cost of obstetric evacuation remains unclear. Our goal was to identify the costs documented in published literature. We also developed a model-based approach to estimate costs of obstetric evacuation for fly-in (no road access) First Nations in Ontario.

Our first study was a systematic review. We identified the medical evacuation costs documented in published literature within Canada. Medical evacuation costs ranged from $7,714 to $31,794 2022 Canadian dollars. Some of these costs were direct costs, such as accommodation cost. Other costs were indirect, such as lost wages due to missing work. We also noted intangible costs which are not assigned a monetary value, such as lack of respect for cultural practices. Our second study was a model-based analysis of obstetric evacuation cost. The focus was on fly-in First Nation communities in Ontario. The estimated average cost of obstetric evacuation was $38,551.72 2020 Canadian dollars, comprised of $14,237.44, $8,540.28, $6,564.11, $5,973.01, $2,195.20, $647.92, and $393.76 representing lost productivity, escort, travel, hospitalization, accommodation, meals, and dependents, respectively.

Future research could expand our framework to estimate obstetric evacuation costs. Understanding the costs could inform economic evaluations of culturally appropriate obstetric services, such as Indigenous midwifery.

Recommended Citation

Radhaa, Majd, "Assessing the economic costs of obstetric evacuation in rural and remote First Nation and Inuit communities in Canada" (2023). Electronic Thesis and Dissertation Repository. 9973.
https://ir.lib.uwo.ca/etd/9973

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.