Midwifery Shouldn't Be "User Pay"

During Question Period in the PEI Legislative Assembly on Friday came this exchange between the Leader of the Opposition, Peter Bevan-Baker, and the Minister of Health and Wellness, Hon. James Aylward:

Leader of the Opposition: Although the official opposition has stated vigorously and repeatedly that we are disappointed in the amount of money pledged in the budget to the priorities that we have brought to government, one item I personally was glad to see receive some funding was for midwifery. Many people have been advocating for the establishment of midwifery services on PEI for decades, and I believe that this is actually the first time that dedicated funding has found its way into a budget. For that, I am indeed grateful. According to the budget, this year’s allocation of $150,000 is and I quote: “to allow these services to be appropriately established consistent with current and anticipated demand.” A question to the Minister of Health and Wellness: Could you tell the House exactly what that statement means?

Mr. Aylward: Thank you very much, Mr. Speaker. As I’ve spoken several times during this session with regards to midwifery services and in the past when I was in opposition, I’m certainly looking forward to having this service provided here on Prince Edward Island. There is a process that needs to be followed. We need to ensure that when midwifery is fully operational and introduced here on Prince Edward Island that it’s just not done haphazardly. There’s consultation to be taken with, obviously, the college of physicians, the PEI Medical Society, we have to determine how it’s going to be introduced, if there’s going to be employees of Health PEI, if it’s going to be user pay. So there’s many issues around the introduction of midwifery here on Prince Edward Island. But as the Minister of Health and Wellness, I’m extremely proud that I’m going to be the minister that will finally be able to make this happen here on Prince Edward Island.

A satisfying answer. Until you get to the “if it’s going to be user pay” tucked in at the end.

The Leader of the Opposition noticed this too, and returned to address it at the end of several more questions about the details of the plans for the introduction of midwifery:

Leader of the Opposition: One of the statements made, again, in the answer I loved so much, I’m starting to love it a little bit less now – was you mentioned user-pay, could you elaborate a little bit on what you might mean by that? A user-pay for midwifery services seems like an odd statement for a health minister to say.

Mr. Aylward: Thank you very much, Mr. Speaker. Once again, as I said, we have to still go through this whole consultation process with our current health care providers. Currently on Prince Edward Island there is approximately 1,400 births annually here on Prince Edward Island and currently, as well, our compliment of health care professionals, OBGYN’s etc cetera, are more than capable of handling that number of births. Yes there is a request to have midwifery here on PEI, I’m extremely supportive of this service, I always have been and I will continue to be. But until we have all the details around how midwifery will be introduced, integrated in our health care system, it’s impossible for me to answer specifically, precisely today on how that will be rolled out. It’s a process and we’re working through that.

Leader of the Opposition: Thank you. Can I just get a confirmation though from the minister that when he used the word user-pay he’s not suggesting that for Island women to access midwifery services that they will themselves have to actually pay for that?

Mr. Aylward: Thank you very much, Mr. Speaker. Again, as I’ve said, we are working through a process currently right now and until we have all the details and we’ve had all the consultation with all the health care providers here on Prince Edward Island in, addition to the midwifery association, I can’t specifically answer that question. Thank you very much, Mr. Speaker.

Leader of the Opposition: Wow.

Wow indeed.

Later in the day the CBC reported about the exchange, under the headline P.E.I. targets early 2020 for midwifery, but Islanders may have to pay out of pocket, in part:

Among the considerations, Aylward said, is whether the services would be “user-pay” — something Bevan-Baker said he was “a little horrified” to hear.

“We have a public health service and midwifery is absolutely, in all other jurisdictions, a part of the public health service,” Bevan-Baker said.

“So even the suggestion that this would become a user-pay system where … families out-of-pocket, would have to pay for this, is quite an extraordinary thing.”

I share Bevan-Baker’s shock at the suggestion that midwifery would be even considered as a “user pay” service, both for the fact itself, and for what this suggests about how midwifery is conceived of by the government.

Midwifery is not an upgrade to business class, it’s basic health care.

There is no rationale whatsoever for classifying it as anything other than this, and to fly a trial balloon that positions it otherwise is an insult to those who have worked so tirelessly for so long to reintroduce a practice that was standard and accepted during our grandparents’ day.

I trust that the opposition will continue to make this point clear to government.