Oct. 1, 2019
British Columbia’s ban on ‘birth alerts:’ A guiding light on the road to reconciliation
Mary Malebranche, Cumming School of Medicine, writing in Conversation Canada
The Government of British Columbia has put an end to “birth alerts” — a practice that allows hospital staff to alert child welfare workers that a newborn may be at risk for harm, without informing expectant parents.
This practice, which can lead to traumatic child apprehensions soon after delivery, disproportionately impacts Indigenous women.
By ending this practice, B.C.‘s action marks progress towards delivering on the Truth and Reconciliation Commission of Canada’s Calls to Action on child welfare, and specifically the first Call to Action — to reduce the number of Indigenous children in care.
To continue making meaningful progress in this era of Truth and Reconciliation, all provinces and territories should promptly follow suit where similar practices exist.
Cycles of inter-generational trauma
The practice of birth alerts is harmful for a number of reasons. Driven by fears of having a birth alert issued, it can deter at-risk women from accessing prenatal care or, for example, from seeking treatment for a substance use disorder while pregnant.
The practice can also make it difficult for women and their partners to turn their lives around as new birth alerts can be informed by remote events. For example, if a woman had a child apprehended years earlier, she can be flagged as being high-risk in a future pregnancy even if her life has changed considerably.
In the context of Indigenous families, the practice contributes to ongoing cycles of inter-generational trauma as many women for whom birth alerts are issued were themselves apprehended at birth.
The TRC called upon federal, provincial, territorial, and Indigenous governments to commit to reducing the number of Indigenous children in care. This was written into the Final Report of the Truth and Reconciliation Commission of Canada released in December 2014, and reemphasized in the recent release of the Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls.
As a means to achieving this call to action and to ensure an end to discriminatory practices, policies and processes within all provincial jurisdictions that relate to reporting newborns at risk for harm should be thoroughly scrutinized and revised, or drafted where none exists.
Ending birth alerts is just the beginning
Though a step in the right direction, ending birth alerts alone will not be enough to create a meaningful shift in child welfare systems across the country that disproportionately impact Indigenous families.
For instance, in the province of Alberta where I work as an obstetric general internist, birth alerts are not practised. Despite this, government statistics show that in 2015-16, 12,715 initial assessments were conducted by Child and Family Services on children up to the age of three.
Of these assessments, 30 per cent (3,794) involved Indigenous families, despite their comprising only 6.5 per cent of Alberta’s population.
This highlights that even in the absence of birth alerts, other discriminatory practices remain in place that require close scrutiny to ensure less Indigenous children end up in care.
Fostering trusting relationships
In a recent statement, Katrine Conroy, B.C. Minister of Child and Family Development emphasized that the focus of all child welfare practices should shift from nontransparent “red-flagging” of expectant parents to voluntary engagement and early intervention starting at the outset of pregnancy.
This approach would foster more trusting relationships with service providers and support women and their families in planning for and safely parenting their babies if that is their goal.
A shift in culture is coming. This is exemplified by many promising initiatives underway across the country that focus on upstream prevention of child apprehensions at birth. Examples, amongst many, include:
In Calgary, a portfolio program, led by the Prenatal Outreach Support Team, was developed through collaboration between community organizations caring for at-risk pregnant women. The portfolio serves as a repository of documents compiled by women and their care providers throughout pregnancy highlighting the work a woman has done to prepare for her parenting role. Examples includes certificates of completion of parenting programs, proof of engagement with substance-use treatment programs and documentation of prenatal appointments. Serving as a form of pregnancy curriculum vitae, the portfolio aims to help women and their care providers advocate for their right to parent upon delivery of a newborn.
In B.C.’s Cowichan Valley, the Butterfly Plan, created by the Red Willow Womyn’s Society, is a three-step response to child apprehensions that focuses on keeping parent and child together. This approach is being piloted through partnership with the Cowichan branch of the Canadian Mental Health Association, operating a transitional housing project that offers wrap-around supports for at-risk parents with young children.
In Manitoba, the government has launched a two-year pilot project called Restoring the Sacred Bond, in partnership with the Southern First Nations Network of Care (SFNNC). It matches doulas with Indigenous mothers at risk of having their baby apprehended, providing them with support for up to one year post-delivery with the goal of reducing the number of Indigenous babies that end up in care in Manitoba.
All provinces and territories must follow
Examples like these fly in the face of comments made by Saskatchewan’s Social Services Minister Paul Merriman in response to B.C.’s action — that his province won’t consider ending birth alerts without a viable alternative in place.
Viable alternatives are available, but pursuing them requires political will. We must continue to apply pressure to these governments to take action.
Following the B.C. government’s clear and public statement to end the discriminatory practice of birth alerts in their province, all provinces and territories should promptly follow suit.
This should be done through a shift in culture from nontransparent, punitive measures, to one focused on prevention and early intervention, fostering trusting and collaborative relationships with at-risk expectant parents.
Only then will we make meaningful progress in achieving calls to action related to keeping Indigenous children with their families in this era of Truth and Reconciliation in our country.
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