Academic journal article Canadian Journal of Public Health

Equity and Dignity in Maternity Care Provision in Canada, Finland and Iceland

Academic journal article Canadian Journal of Public Health

Equity and Dignity in Maternity Care Provision in Canada, Finland and Iceland

Article excerpt


Objective: In recent decades, governments around the globe have been under pressure to create more efficient and effective health care systems. Research shows, particularly in middle- and low-income countries, that many of these neo-liberal policies that have been enacted have had a largely negative effect with regard to equitable health services for lower-income populations and dignified working conditions for health providers. In this paper we highlight recent reforms in health care in Canada, focusing on formal care during pregnancy and childbirth, and compare these to parallel developments in two Nordic countries - Finland and Iceland.

Method: We draw upon secondary data sources and primary research findings.

Results: Our comparative analysis pays close attention to barriers in access to primary care services across the childbearing period for lower-income women in the three countries, as well as the factors that create poor working conditions for the predominantly female maternity care labour force.

Discussion: As Canada struggles to deal with the crisis in its maternity care system, it could learn from developments in Finland and Iceland that promote teamwork among primary health care professionals and high-quality care for lower-income populations.

Key words: Health care reform; equity; dignity; maternity care; lower-income populations

Mots clés : réforme des soins de santé; équité; dignité; soins de maternité; populations à faible revenu

Recent international economic policy has been focused on boosting exports and free trade, deregulating domestic economies, liberalizing capital markets and promoting market-based pricing. These macro-economic "neo-liberal" reforms have typically been accompanied by policies to reduce public expenditure, including public outlay for health. Evidence mounting from low- and middleincome countries points to increasing inequality, as the affluent few can afford to overuse health care, paying for the consumed services out of pocket, while the bulk of the population face a "medical poverty trap", unable to access health care for even basic conditions.1,2

A question remains as to the impact of neo-liberal economic reforms on more developed welfare states with universal public health care systems. While some scholars have argued that neo-liberal reforms have enhanced the efficiency and effectiveness of public health care systems,3 other researchers maintain that the reforms have largely been negative, resulting in poorer working conditions for health providers,4,5 especially those delivering primary care services,6-8 a decline in the quality of health care available for lower-income populations9 and, of special relevance to maternity care, the medicalization of normal life events.10,11

The first section of the paper focuses on Canada, highlighting the consequences of neo-liberal reforms for the organization of maternity care. The paper then examines recent changes in the maternity care systems of Finland and Iceland. We argue that a comparative study of maternity care organization that includes Canada, Finland and Iceland can contribute valuable knowledge about the variable impact of health care reforms on equitable health services for lower-income populations and on dignified working conditions for health providers. The contrastive comparison of cases that are new to the literature helps the analysis to reach beyond partly outdated welfare state models. In particular, as noted by Benoit and Hallgrímsdóttir in the opening paper, rather than treating the Nordic model as unitary, by focusing on the diversity and difference across the Nordic welfare regimes we can draw more comparative insights helpful to understanding the Canadian case.12-14

Health care reform in Canada

While inequities in access to physician and hospital services in Canada had risen to the political agenda by the 1950s, universal health insurance did not arrive until the passage of the Medical Care Act of 1968 (implemented in 1972). …

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