Using Data to Help Understand the Unique Needs of the North

Northern Maternal Child Network

Connecting the North, Improving Health: the tagline for the Northern Maternal Child Network (NMCN) is simple, but its work is anything but. The Northern Ontario region – a massive 858,000 square kilometer area (roughly the size of France and Germany combined) – currently relies on 15 hospitals to provide routine obstetrical care.

Although the North comprises 80% of Ontario’s land mass, it’s home to only 5% of the population (with large proportions of Indigenous, Francophone, rural and remote populations). Travelling long distances for healthcare, harsh weather conditions, a lack of health-care providers, and a host of socio-economic challenges can make life in the North difficult.

Part of NMCN’s mission is to identify and understand service gaps in the North, including barriers to underserved populations. To do this, NMCN needs high-quality data. In 2022-23 BORN provided data to NMCN to inform 21 maternal and 13 infant health indicators. Information about distance travelled to access obstetrical care was also shared. NMCN hopes to use this information for benchmarking, priority setting, and quality improvement.

Distance Travelled

Given the geographic remoteness and low population density of the North, the NMCN knew people were travelling for care, but they wanted data to understand exactly how many people were travelling and how far.

Analysis of BORN data from 2017-2022 showed that 15.3% of pregnant individuals in the North travelled at least 100 km to reach a hospital that provided obstetrical care, 10% travelled more than 200 km, and 3% more than 400 km (based on the straight-line distance between home and hospital, which is probably an underestimation of actual distance travelled).

Rates in some areas are even higher. During this same time (2017-2022), 60% of pregnant individuals who lived in the Kenora Census Division travelled over 100 km to receive the majority of their perinatal care. Sixteen percent of birthing patients at Sioux Lookout Meno Ya Win Health Centre and 10% at the Timmins District Hospital traveled more than 400 km for care.

Staffing shortages are a contributing factor, forcing local services to close and requiring patients to travel further to access care. This is the case in Moose Factory. Dr. Elaine Innes, Chief of Staff at the Weeneebayko Area Health Authority (WAHA) and a member of the Maternal-Newborn Committee within the NMCN, says a physician shortage forced the closure of the obstetrics program at the Weeneebayko General Hospital in Moose Factory in 2018.

Dr. Innes says they need at least 5 physicians who can do obstetrics to be able to run their obstetrics department. Currently they have two, and attempts to recruit new physicians have been unsuccessful. Patients were being referred to Timmins, but now, because of staffing shortages in Timmins as well, all their obstetrical patients are referred to Kingston – over 800km away. What does this mean for a pregnant individual living in a northern Ontario coastal community?

Dr. Innes offers an example of pregnant individuals living in Peawanuck, an isolated Northern Cree community located near Hudson Bay. They need to leave their community at 38 weeks gestation for evacuation (also called confinement). Their journey to Kingston begins with a two-hour commercial flight to Moosonee from Peawanuck (only available on Tuesdays and Thursdays). Once in Moosonee, they then travel to Kingston via another two-hour flight. What if an individual goes into labour and it’s not Tuesday or Thursday? Dr. Innes says patients are then flown via emergency services to Kingston (or sometimes Timmins depending if it is an obstetrical emergency). This is just one of many examples of barriers to accessing necessary care.

Does distance travelled matter?

According to a British Columbia study, it does. Researchers found that pregnant individuals who needed to travel for more than one hour for obstetrical care were seven times more likely to experience moderate or severe stress when compared to individuals who had local access to obstetrical services.

A 2022 Norwegian systematic review found that traveling more than one hour to a hospital might increase the risk of eclampsia/Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) Syndrome, induction of labour for logistic reasons, and unplanned delivery outside a hospital.

The authors, however, say more research is needed as evidence linking distance from a hospital and increased morbidity was uncertain for most of the complications examined in the review.

Data analysis is needed to understand which (if any) perinatal health outcomes are affected by long travel times to hospitals in the Northern context.

Looking Ahead

Despite being a relatively new network, NMCN has established an impressive number of collaborative relationships and projects. The team is already using data to document health conditions in the North, identify service gaps, and advocate for increased funding to address inequities. 

BORN looks forward to supporting NMCN by providing the high-quality information it needs to improve health in the North. For more information on the NMCN, please contact Crystal Lawrence, the Regional Coordinator for the NMCN.