Lack of pay equity leads to labour pains for midwives

Posted on April 15, 2014 in Equality Debates – Opinion/Commentary – Why are midwives paid so much less than the doctors that provide largely the same service? Perhaps because midwives are mostly women, caring for women.
Apr 15 2014.   By: Mary Ann Leslie

I’ve been a midwife for 28 years. In that time, I’ve had the privilege of providing care to more than 2,000 mothers and newborns. I’m nearing retirement now and when I look back, I’m troubled by the fact that I have spent most of my career undervalued — reflected in a gender penalty on my compensation.

A gender penalty means I’m paid less for the work I do simply because the work I do is performed mostly by women. Midwifery, as the most female-dominated profession, has been systemically and routinely undervalued and underpaid.

Midwifery has been susceptible to being undervalued not only because we are a profession made up of women, but also because we care for women, during the physiologically female experience of birth.

Many people I speak to are surprised that, in this day and age, women still experience discrimination around their compensation because they are women. But according to the Equal Pay Coalition of Ontario, women in this province still earn, on average, 31 per cent less than men. The pay gap affects women of all ages and education levels. That’s why Equal Pay Day Wednesday is so important.

pay gap means that women in female-dominated sectors are paid less than male-dominated work, even when the work is rated equivalent (or proportional) in skill, effort, responsibility and working conditions.

That is not what I wanted for my daughter, who is also a midwife, or any of the other midwives in this province who are on call for women, day and night, as we respond to an event that doesn’t happen on a schedule — birth.

As a midwife, I love what I do. That’s what’s kept me providing care to families for decades. On a typical day, I see pregnant women in my clinic, make house calls to clients with newborns, respond to pages from clients, and potentially go to a birth. To provide the continuity and woman-centred care that is essential to our great outcomes, I am on call a lot. Being on call means I drop whatever I am doing, day or night, to attend to women in labour or look after urgent concerns. Being on call means sometimes my own plans and family have to come second. That’s not a complaint; it’s simply a reality.

Close to 700 midwives provide care in urban, rural and remote communities throughout the province; we attend more than 12 per cent of Ontario’s 140,000 births per year and that percentage is increasing every year. Midwives provide care in clinics, hospitals, birth centres and client homes.

Paul Durber, a pay equity expert who analyzed and reported on midwifery work in Ontario, found the work I do every day as a midwife is proportionately comparable to about 90 per cent of the work done by the traditionally male-dominated medical profession. But we’re not valued that way.

Durber’s report finds that midwives are paid only half of what our work is truly worth. He says it is “clear that the compensation of the midwife is not fair and equitable … Sex bias is operating in the unequal compensation being received by midwives.”

Salaried doctors at Community Health Clinics were the comparator group used by the Ministry of Health to determine midwifery compensation when midwives were first introduced into the health care system 20 years ago. With normal pay increases they are now paid $215,000 a year (top level). However, midwives have not received increases at any similar rate and now earn $100,000 (also for the top level).

If a pay equity process had been established and maintained by the Ministry of Health, pay equity principles and law would dictate that midwifery work should be valued at nearly double the current compensation.

It’s not right that as women front-line workers, we continue to subsidize health care by discounting our labour.

The neglect and devaluing of midwives and of women’s health has continued literally for generations. It isn’t fair. It’s not right.

For well over two decades now, midwives have built an exemplary model of midwifery care for Ontarians. We have excellent health outcomes and are in such high demand that we still turn away about 40 per cent of women who seek our care. For 20 years, we have tried to fight for our right to be fairly compensated for our work. We have worked with government and we have been patient, but to no avail.

Finally, on Nov. 27, 2013, I and hundreds of my colleagues filed an application with the Human Rights Tribunal of Ontario. We’re asking the tribunal to close our pay gap by ordering government to follow its own laws and ensure that our compensation is fair and equitable.

Pay equity is a human right. And it’s a value I hold dear. We can no longer allow the compensation of midwives to be discounted simply because we are women, caring for women.

Mary Ann Leslie is a midwife practising in the Toronto area.

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