The Ontario government will fight a human-rights challenge by the province's midwives, who argue they are victims of gender discrimination and that their salaries should nearly double.
More expectant women in the province are choosing to have midwives deliver their babies, rather than doctors, whose pay has risen at a greater rate than that of midwives. Ontario has the largest number of midwives in Canada, and three universities that graduate about 90 new midwives each year.
Yet four of every 10 women who request care from a midwife are turned away due to lack of practitioners, the Association of Ontario Midwives says.
The association filed a pay equity complaint with the province's Human Rights Tribunal on Wednesday, arguing that midwives are discriminated against because of gender and that their salaries should nearly double, to a maximum of $197,300 from the current $102,500.
"Midwives experience the perfect trifecta of discrimination: Midwives are primarily women, they are providing care to women, and they're providing care that is exclusively a women's health experience," said Lisa Weston, the association's president. "The fact that midwifery is about women providing care to women does not justify a gender penalty."
If the pay for the province's 682 midwives was nearly doubled, it would cost the Ontario government up to $56-million annually.
Health Minister Deb Matthews said she was "puzzled" by the midwives' approach, noting that the provincial Liberals have increased pay by 25 per cent in the past 10 years. (However, her press secretary later said that midwives' average pay had gone up by 33 per cent since the Liberals took office in 2003.)
"They're asking for a doubling," Ms. Matthews told reporters. "There is no considering doubling compensation to midwives."
However, the association noted that midwives' pay has increased by one-third since 1993 while the salaries of family physicians at community health centres have gone up by 76 per cent.
The midwives' association is basing its demand on a report it commissioned that found that midwives should receive 91 per cent of the pay of health-centre general practitioners.
The report by Paul Durber, a former pay equity director at the Canadian Human Rights Commission, compared the skills, efforts, responsibility and working conditions of midwives and general practitioners.
"The basic question was not just whether they were equitably paid with respect to the physician in a community health centre, but whether there was an issue of sex discrimination," Mr. Durber said. "That really meant figuring out whether the kinds of things that women do generally, and midwives in particular, were classically women's work. Well, frankly, not much could be more classically women's work than midwives, and the family physician has traditionally been a male job."
Ms. Weston said the human rights complaint comes after years attempts to persuade the government to raise midwives' salaries.
"We've run out of patience," she said as several newborns cooed after a press conference.
The midwives' human rights application also asks for "compensation for injury to dignity, feelings and self-respect," said Mary Cornish, the association's lawyer. The group is also asking for retroactive compensation.
"I've worked on a lot of cases with respect to pay equity, and I've never seen a case as dramatic as this in terms of this gap," she said. "The gender penalty here is absurd."
Ontario's Human Rights Code requires the government to provide equal treatment in employment on the basis of sex, and bans sex-based discrimination in employment contracts. But it has not been determined whether the principle of pay equity – the obligation of employers to compensate jobs traditionally performed by women at the same rate as comparable jobs traditionally held by men – applies to independent contractors such as midwives.
However, Ms. Cornish said there are "clear precedents" for covering independent contractors by the Human Rights Code.
Midwifery is female-dominated: only one in the province is male. Midwives and family practitioners each perform approximately 12 per cent of deliveries in Ontario. Obstetricians perform the rest.
Qualification as a midwife requires a four-year specialized university degree plus a one-year residency. Many midwives have additional degrees in public health or science.
Midwives offer primary care to low-risk pregnant women and newborns from early pregnancy through labour, birth and up to six weeks postpartum.
Since they follow patients through the entire process, they must be available around the clock.
"Midwives have the skill and judgment to do everything necessary for the vast majority of births," said Kelly Dobbin, registrar of the College of Midwives of Ontario. If patients develop complications that fall outside their scope, midwives are required to consult doctors and possibly transfer them to obstetricians.
While the number of midwives has increased to 1,300 from 500 across Canada since 2006, waiting lists are common in the seven provinces where the industry is regulated.
In British Columbia, for example, midwife-assisted deliveries increased to 14 per cent from 12.8 per cent between 2011 and 2012. The province has seen a steady rise in recent years, said Ganga Jolicoeur, executive director of the Midwives Association of British Columbia.
"Women are becoming more and more familiar with this choice," Ms. Jolicoeur said. Still, most midwifery practices have full caseloads, and some communities have no access to maternity care at all.
While training is similar at all schools, compensation is negotiated separately in each province. Some provinces pay salary and benefits. Ontario provides a grant to cover some overhead and benefit costs. Outside Ontario, midwife pay scales are pegged to occupations other than family practice.
Editor's Note: An earlier version of this story incorrectly said Ontario categorizes midwives as independent contractors who cover their own benefits and overhead. In fact, an Ontario government spokeswoman said, the province provides a grant to cover some overhead and benefit costs.