Position statement on midwife provision of abortion care and reproductive justice

This position statement was approved by the AOM board of directors in April 2025, and is accompanied by the complementary statement on reproductive choice and reproductive justice endorsed by the Indigenous Midwifery Advisory Circle (IMAC).

Abortion care is an integral part of health care services for women, trans, Two-spirit, non-binary, and gender diverse people across the span of their reproductive life cycle. The AOM affirms the right for comprehensive and timely sexual and reproductive health care for all, including contraception, family planning, counselling, and abortion care. The AOM refers to abortion care in its broadest sense, including planned and unplanned pregnancies, and encompassing variations arising in pregnancy including miscarriage, medical or procedural termination of pregnancy, management of incomplete abortion, and fetal death. This care may include counselling, diagnosis, medication prescribing, abortion management, and follow up care.

The AOM respectfully acknowledges the traditional knowledge and land-based medicines that inform the practices of Indigenous midwives, including First Nations, Inuit, and Métis (FNIM) midwives, who have supported their communities in reproductive care for generations prior to settler contact. These practices were forced underground by the demonization of traditional practices and the systemic erosion of traditional knowledge transmission. The violent process of settler colonialism had a clear mandate to suppress Indigenous bodily autonomy and fertility with widely spread practices of forced sterilization, forced abortion, forced contraception, newborn and child apprehension, obstetric violence and experimentation.

Settler colonialism endures through anti-Indigenous racism in healthcare experienced at the individual level and through targeted health policies, not limited to underfunding local health units in remote regions and forced evacuation for sexual and reproductive health services, including abortion. The AOM supports the sovereignty and self-determination of Indigenous midwives, knowledge keepers and communities to reinstate ancestral practices and provide comprehensive reproductive care within their own communities.

The AOM commits to advocate for structural supports for Indigenous midwives and their practices. Reproductive health services must be delivered in a manner that respects and incorporates Indigenous cultural beliefs and practices. The IMAC has endorsed a statement on reproductive choice and reproductive justice to elaborate and further add to this AOM position statement.

The AOM acknowledges that barriers to accessing essential reproductive health services negatively impact individual and community health and wellbeing-locally, nationally, and globally. The AOM affirms the World Health Organization’s (WHO) statement that “lack of access to safe, timely, affordable and respectful abortion care is a critical public health and human rights issue”.

Despite being deemed an essential service in the Canada Health Act, many gaps have been identified in providing abortion care in a timely, culturally safe, holistic manner. Access to abortion care is restricted for many pregnant people, especially Indigenous peoples, including First Nations, Inuit and Metis communities, as well as racialized, LGBTQ+, and other equity-deserving communities, and those living in rural and remote regions.

The AOM envisions midwives as key health care providers to remedy system-wide sexual and reproductive care gaps, within Ontario and across Canada. Midwives hold a range of skills and clinical competencies well suited to abortion care and work in a multitude of settings including homes, clinics, birth centres, hospitals, and across virtual platforms. Midwives have established networks of allied supports and interprofessional teams to collaborate with or refer where necessary. The midwifery model of care prioritizes client-centred, informed choice with a known provider and on-call emergency care. Midwifery funding in Ontario covers care for uninsured residents of Ontario, reducing barriers to abortion care to undocumented and newcomer populations. Midwife-led abortion care reduces unnecessary emergency care facility visits. Midwives provide health system navigation that facilitates wraparound health and social services to meet client’s needs, including emotional support or bereavement services. These features are all hallmarks of evidence-based best practice.

The AOM’s vision is aligned with the Canadian Association of Midwives’ (CAM) National Strategy for Midwife-Led Abortion Care (PDF, 255 KB). The AOM advocates for midwives to be at the forefront of abortion care excellence. Support from the AOM can include negotiation for appropriate remuneration, advocacy for broad prescribing authority, and for the removal of barriers to midwives practicing to their fullest scope. The AOM supports its members through abortion education, on-going learning opportunities and peer mentorship programs.

The AOM recognizes the inability to untangle its goals from the broader movement towards reproductive justice and the need to acknowledge historic and ongoing harms of systemic oppressions. Entrenched racism, colonization, ableism, queer and transphobia, and classism in the health care system and society limit reproductive choice, access, and bodily autonomy. Oppressions are further compounded by the stigma associated with abortion care. Disparities in resources, decision making authority, and power affect social determinants of health (such as housing, food security, education, job security) and community wellness (such as safety from police brutality and access to clean water) which impact decision-making related to family planning and reproductive choices.

The AOM affirms its commitment to working in solidarity and collaboration across diverse communities to dismantle reproductive oppression and work towards reproductive justice. The AOM affirms its commitment to working towards midwives as essential abortion care providers to improve accessible, timely, client-centred care for people who need abortions.