Paper page · Canadian perinatal health equity
Perinatal Care Inequities in Canada
Results from Malhotra and colleagues show that inequitable care experiences are associated with Indigenous identity, racialized identity, socioeconomic status and BMI. The weight-based disparities are part of a broader pattern of intersecting inequities in Canadian maternity care.
Which populations report greater inequities in perinatal care?
Results from research conducted by Malhotra and colleagues provide evidence of an association between inequitable care experiences and racialized identity, Indigenous identity and socioeconomic status. The findings therefore place weight-based disparities within a broader pattern of intersecting inequities in Canadian maternity care.
Higher reported mistreatment
Indigenous participants had higher adjusted odds of reporting mistreatment in the published MIST model.
Experience of care matters
Racialized participants also reported poorer experiences, reinforcing that maternity-care quality is relational, not only clinical.
Intersecting inequities
Higher BMI and income insufficiency remained associated with poorer reported care experiences after adjustment.
Why patient-reported measures matter
The broader health equity programme argues that health-system performance cannot be assessed only through clinical outcomes, service use or availability of care. Communication, compassion, autonomy, respectful care and timely access are also measurable dimensions of healthcare quality.
- Autonomy (MADM): whether providers explained options, supported involvement in decisions and respected choices.
- Respect (MOR): whether people felt comfortable asking questions, accepting or declining care, and having personal or cultural preferences respected.
- Mistreatment (MIST): whether people experienced being ignored, mocked, coerced, exposed without consent, neglected or subjected to negative comments.
Inequities in reported mistreatment
In the adjusted mistreatment model, Indigenous identity, racialized identity, higher BMI and income insufficiency were associated with higher odds of high mistreatment. This positions weight-based disparities alongside racism, Indigenous-specific inequities and socioeconomic inequities in maternity-care experience.
How to read this finding
This comparison is not a hierarchy of harm. It shows that several dimensions of inequity are measurable in the same national survey framework.
The policy relevance is that respectful care, autonomy and mistreatment can be tracked as health-system quality indicators, not treated as isolated interpersonal events.
Weight-based disparities remain central
The paper also shows a consistent BMI gradient across patient-reported care experience: lower autonomy, lower respect and higher mistreatment. The point is to place these results within the broader equity pattern, not to minimize the weight-stigma finding.
These figures are cropped from the published open-access article. Keep the DOI link visible near the figures or citation.
Contribution of the paper
The study translates experiences of autonomy, respect and mistreatment into measurable outcomes. That makes it possible to ask which populations are more likely to report poorer care and whether disparities persist after adjustment for other social and demographic factors.
- Clear search identity: perinatal care inequities, BMI, Indigenous identity, racialized identity, mistreatment, Canada.
- Clear measurement identity: RESPCCT, PREMs, MADM, MOR and MIST.
- Clear policy identity: respectful maternity care, health equity, informed consent and patient-reported quality.
Downloadable summary
One-page research summary
This PDF frames the paper around the broader message: perinatal care experiences vary by Indigenous identity, racialized identity, socioeconomic status and BMI.
Suggested citation
Questions this page answers
Which populations report greater inequities in perinatal care?
The results provide evidence of associations between inequitable care experiences and Indigenous identity, racialized identity, socioeconomic status and BMI.
Is this only a paper about BMI?
No. The paper highlights weight-based disparities, but the stronger health-equity framing places those disparities within a broader pattern of intersecting inequities in Canadian maternity care.
Why use patient-reported experience measures?
Clinical records may document procedures and outcomes without showing whether people felt heard, respected or involved in decisions. PREMs make these aspects of quality visible.
What should policy or clinical audiences take from the paper?
Respectful care should be monitored as a quality indicator. Training and accountability should address implicit and explicit weight bias, racism, informed consent, body autonomy and the social determinants of health.