health
FAIR CARE Canada’s reproductive health care system needs an overhaul, and midwives are the professionals for the job Written by CARLA CICCONE Illustrations by SÉBASTIEN THIBAULT
REPRODUCTIVE JUSTICE
A HOTEL BY THE airport might not be a typical setting for a prenatal checkup, but thanks to Manavi Handa, care often comes to those who need it, wherever that is. Since November 2021, the Toronto-based midwife has been providing full physical exams; routine visits; pre-, peri- and postnatal care; and more at a GTA hotel that acts as temporary housing for recently arrived Afghan refugees. Now, she’s preparing to provide similar services to Ukrainian refugees as they arrive in Canada. Handa, who is also an associate professor in Ryerson University’s midwifery program, isn’t new to this set-up. She launched clinics to provide care out of hotels when the first group of Syrian refugees arrived in Canada in 2015. The first baby born to a Syrian refugee in Canada was delivered by a midwife from her Toronto practice, West End Midwives, which provides perinatal care to expectant parents who are newcomers, refugees or without Ontario health insurance. “It shows how important it is to have us in the community,” she says. Her work exemplifies the midwifery model, which is centred around trust and relationship building. This is reflected in the pre- and postnatal hotel visits Handa does in between teaching and working from West End Midwives, and the always-on-call hours of delivering babies. Handa has wellearned insight into the lives of the people she cares for—and many tell her about their gynecological needs outside of pregnancy. She knows, for instance, that most people fleeing danger don’t have access to routine health checks or contraception. “I quickly realized many of the women want IUDs, so I trained on how to insert them,” she says. But she can’t always provide this care: “There’s a clause that says I can’t take care of people unless they’re within eight weeks postpartum without a medical directive from a physician.” Handa is used to providing gynecological care under medical directives from doctors she works with, but sometimes, like when the physician she normally collaborates with goes on maternity leave, attaining them can be a challenge. “IUD insertion is still one of the biggest reasons people come to see me,” she says, adding that she’s in the process of ensuring the directive she gets is ongoing. Handa’s experience positions her to provide all of these procedures at any time. But like midwives in most places across Canada, there are hard limits on what she can do.
MAY/JUNE 2022 • CHATELAINE
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