Advancing equity in maternal and perinatal care in Canada: Population-based investigations of racial and ethnic disparities in severe maternal morbidity and severe perinatal morbidity and mortality

Several studies conducted outside Canada have shown large differences in rates of severe complications in pregnant people and newborns based on race and ethnicity, with racialized groups experiencing higher rates of complications compared with non-racialized individuals. Many of these studies are from the USA, where race and ethnicity data is routinely collected; however, in Canada, there is little to no information on race available to shed light on the relationship between race, ethnicity, and severe pregnancy complications. Given the differences between the USA and Canada in history, politics, immigration patterns and healthcare delivery models, it is reasonable to question whether the experience in the USA is representative of the Canadian experience. This proposal aims to compare severe pregnancy complications in pregnant individuals and newborns in different groups defined by race and ethnicity in Canada and to investigate the causes of these differences by measuring various potential effects of systemic racism (e.g., different maternity care patterns or different levels of health pre-pregnancy). We propose to use an innovative linkage of high-quality, population-based datasets in Canada, including over 950,000 pregnancies between the years 2000 to 2021 to achieve the following objectives: 1. Provide the first comparisons of severe pregnancy complications by race in Canada. 2. Profile the patterns and drivers of severe pregnancy complications over time in women and their babies, by racial groups. 3. Evaluate the combined effects of race and other markers of social disadvantage (e.g. immigrant status) on severe pregnancy complications. 4. Identify factors that link race and severe pregnancy complications to inform evidence-based, clinical and health policy targets to promote health equity in maternal and neonatal health.