Birthing injustice: unmasking structural racism and the illusion of reconciliation in indigenous perinatal care in Canada, insights from the RESPCCT study.

Indigenous people in Canada continue to experience systemic racism, disrespect, and loss of autonomy within the healthcare system, particularly in the context of pregnancy and childbirth. Despite national commitments to reconciliation and the recognition of Indigenous rights through frameworks such as the Truth and Reconciliation Commission (TRC) and the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), the realities of maternity care for Indigenous people are shameful. This study draws on data from a national survey examining respect, mistreatment and autonomy in pregnancy and childbirth care across Canada, with focused analysis of the experiences of Indigenous respondents. The findings reveal persistent racism, lack of culturally safe care, and widespread violations of their rights, particularly informed consent and bodily autonomy. Mistreatment and disrespect were more common among Indigenous participants, participants who had an Indigenous partner, and those aged 25 and younger (p < 0.001, Bonferroni-corrected). Through an Indigenous-led lens, this analysis challenges the performative nature of reconciliation in Canadian healthcare system and calls for transformative change rooted in accountability, Indigenous knowledge systems, and in the restoration of birthing sovereignty. These results underscore the urgent need to center Indigenous voices and leadership in reorienting perinatal care policy, practice, and education.