Radhaa Majd, Leason Jennifer, Twalibu Aisha, Davis Erin, Fletcher Claire Dion, Lawford Karen, Darling Elizabeth, Wylie Lloy, Couchie Carol, Simon Diane, John-Baptiste Ava
Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
Department of Anthropology and Archaeology, University of Calgary, Calgary, AB, Canada.
Can J Public Health. 2025 Feb;116(1):5-25. doi: 10.17269/s41997-024-00945-y. Epub 2024 Oct 11.
For First Nations people and Inuit who live on reserves or in rural and remote areas, a guideline requires their travel to urban centres once their pregnancy reaches 36-38 weeks gestation age to await labour and birth. While not encoded in Canadian legislation, this guideline-and invisible policy-is reinforced by the lack of alternatives. Research has repeatedly demonstrated the harm of obstetric evacuation, causing emotional, physical, and financial stress for pregnant and postpartum Indigenous women and people. Our objective was to describe the costs of obstetric evacuation, as reported in the literature.
We conducted a systematic review using online searches of electronic databases (Ovid EMBASE, CINAHL, Ovid Healthstar, PubMed, ScienceDirect, PROSPERO, and Cochrane Database of Systematic Reviews) and identified studies that reported costs related to medical evacuation or transportation in rural and remote Indigenous communities. We performed critical appraisal of relevant studies.
We identified 19 studies that met the inclusion criteria. The studies reported various types of cost, including direct, indirect, and intangible costs. Medical evacuation costs ranged from CAD $7714 to CAD $31,794. Indirect and intangible costs were identified, including lost income and lack of respect for cultural practices.
Costs associated with obstetric evacuation are high, with medical evacuation as the most expensive direct cost identified. Although we were able to identify a range of costs, information on financing and funding flows was unclear. Across Canada, additional research is required to understand the direct costs of obstetric evacuation to Indigenous Peoples and communities.
对于居住在保留地或农村及偏远地区的原住民和因纽特人，一项指导方针要求他们在怀孕达到36至38周胎龄时前往城市中心等待分娩。虽然这一指导方针——一项无形的政策——并未编入加拿大法律，但由于缺乏替代方案而得到强化。研究反复表明产科后送的危害，给怀孕和产后的原住民妇女及人群带来情感、身体和经济压力。我们的目的是描述文献中报道的产科后送成本。
我们通过在线搜索电子数据库（Ovid EMBASE、CINAHL、Ovid Healthstar、PubMed、ScienceDirect、PROSPERO和Cochrane系统评价数据库）进行了系统综述，并确定了报告农村和偏远原住民社区医疗后送或运输相关成本的研究。我们对相关研究进行了严格评估。
我们确定了19项符合纳入标准的研究。这些研究报告了各种类型的成本，包括直接成本、间接成本和无形成本。医疗后送成本从7714加元到31794加元不等。确定了间接和无形的成本，包括收入损失和对文化习俗的不尊重。
产科后送相关成本很高，医疗后送是已确定的最昂贵的直接成本。尽管我们能够确定一系列成本，但关于融资和资金流的信息尚不清楚。在加拿大全国范围内，需要进行更多研究以了解产科后送对原住民和社区的直接成本。
