Dr. Naana Jumah, an Obstetrician-Gynaecologist, pictured at her office in Thunder Bay, Ont., on April 22, says her said her patients go through a lot to leave their communities and give birth.David Jackson/The Globe and Mail
Naana Jumah aims to make her patients feel safe and cared for after they arrive in Thunder Bay to deliver their babies, a journey that takes them many hundreds of kilometres away from their families, culture and communities.
They have travelled by plane or road from First Nations in northwestern Ontario that lack health care services. Typically, patients leave home by around 36 weeks pregnant (air travel is not recommended beyond that point) and stay in Thunder Bay until after they deliver.
Dr. Jumah, a Harvard-educated obstetrician-gynecologist who immigrated to the city at age six from Ghana, said her patients go through a lot to leave their communities, such as Fort Hope First Nation, for the birthing process.
But she is honoured when they request that she care for them in a subsequent pregnancy.
“It’s just incredibly rewarding just to give someone the opportunity to have dignity in their birth,” she said at her clinic in Thunder Bay this week.
The Midwife Clinic at Dilico Anishinabek Family Care in Thunder Bay.David Jackson/The Globe and Mail
Health care, including access to maternity services, has not played a prominent role in the federal election campaign, which has largely focused on the economy and responding to U.S. President Donald Trump’s tariff and annexation threats. Ahead of Monday’s vote, all major parties have pledged to take steps to add more health care workers amid concerns among millions of Canadians about access to primary care.
Indigenous patients are acutely aware of enormous barriers to care. Advocates say patients face both physical and emotional risks because they cannot access timely medical supports.
Limited health services in Indigenous communities, such as not being able to see doctors and trained midwives, contributes to why pregnant patients often spend several weeks in motels and hotels in cities such as Thunder Bay waiting to deliver their babies. Routine ultrasounds in pregnancy also involve travel because the technology tends to not be available in remote communities.
There are many other scenarios where patients must also travel far distances for treatment for other health issues, such as cancer and at the end-of-life.
Midwife Lisa Bishop sees mothers in their prenatal and postpartum periods at at Dilico Anishinabek Family Care and often travels to see patients in communities that are accessible by road.David Jackson/The Globe and Mail
Ottawa shapes health care received by Indigenous patients. The federal government says Indigenous Services Canada funds or directly provides health services for First Nations and Inuit through what is known as the non-insured health benefits program.
This program is designed to cover medically necessary health services not covered by provincial or territorial health plans or other private insurance.
For First Nations people, barriers to access health care services infringes on their right to access timely medical treatments, said Deputy Grand Chief of Nishnawbe Aski Nation Anna Betty Achneepineskum. NAN is a political organization that represents 49 northern Ontario First Nations.
She said the federal government needs to take an honest look at whether it is fulfilling its obligation to provide health care services, including to expectant mothers who must travel to deliver.
“There’s very little support for them,” she said. “They’re pretty well alone.”
A 2021 study published in the Canadian Medical Association Journal said Indigenous people in Canada “experience striking inequities in access to birth close to home compared with non-Indigenous people, primarily in rural areas and independently of medical complications of pregnancy.”
Researchers found prior to a federal policy change in 2017, Indigenous pregnant people often travelled and birthed alone because travel companions were not deemed medically necessary. That changed under the Liberal government, allowing one person to accompany them.
Still, the National Council of Indigenous Midwives says the experience of having to travel out of community to deliver (what it refers to as forced birth evacuations) is cruel. In its 2025 federal budget submission, the council recommended $422-million over five years and $113-million continuing annually starting in 2030 to grow Indigenous midwifery.
Despite the federal policy change permitting travel companions, expectant mothers may have to leave family at home to give birth, said Alisha Julien Reid, the co-chair for the national council who is a trained midwife. This may happen because the birthing individual’s partner must care for other children at home.
“Often, lifegivers are no longer having access to their culture that they would normally have in community with a circle of grandmothers, aunties, uncles, family members who would naturally be there for them, creating that support circle,” she said. “That will also then result in poor health outcomes.”
Facilitating travel and accommodations for deliveries also involves navigating a considerable amount of red tape.
Once patients arrive in Thunder Bay, Dr. Jumah typically sees them once a week. After each appointment, she said she has to write a letter to the non-insured health benefits program to confirm she has seen the patient, confirm that a follow-up appointment has been booked and to indicate they must remain in the city, along with a birth escort if one is there with them.
Even though the government is aware they are in the city to give birth, patients are discharged from accommodations on the morning of the appointments and then efforts to co-ordinate new arrangements ensue, she said.
Lisa Bishop, a midwife in Thunder Bay, also works with expectant Indigenous mothers in the city. She works for an organization called Dilico Anishinabek Family Care with two other midwives. They see mothers in their prenatal and postpartum periods and often travel to see patients in communities that are accessible by road.
Ms. Bishop’s work hinges on building trust. She tries to build connections by chatting with people about where she is from. She tells them she is an Indigenous midwife who lives in Thunder Bay and that she is from Manitoulin Island. And then, she said, she makes lots of jokes.
Ms. Bishop said the midwives are on-call to answer questions from patients, including when they are still in their communities and need help navigating challenges, such as if there is a snowstorm and they cannot get to Thunder Bay.
“They just have somebody that they can reach out to,” she said.
She said coming to the city is often dangerous for patients from remote communities because of vulnerabilities they face, such as with substance use.
Ms. Bishop said there is a high prevalence of drugs in the city and patients from the north can be pulled into gangs and trafficking while here. Some go missing, she said, and later show up at the hospital in labour.
Ms. Bishop said there should be a place better suited to house and support patients ahead of deliveries rather than having them stay in hotels.
Dr. Jumah agrees. She said the system should ultimately be changed so patients don’t have to travel far to give birth but this would require a major system overhaul. She believes the new federal government should give attention to rural and remote maternity care.
Twenty years ago, she said, smaller hospitals in the region had birthing services, such as in the Northern Ontario community of Geraldton, which is about a three-hour drive northeast from Thunder Bay. Dr. Jumah said fewer people have the skills and knowledge to care for pregnant people in rural and remote communities, putting patients at risk.
For now, Dr. Jumah would like to see a facility created in Thunder Bay to offer housing for Indigenous patients and their families, where they can stay before and after delivery and receive prenatal and breastfeeding supports.
“That would be my absolute dream.”
