I would like to thank Dr. Janet Smylie and Wanda Phillips-Beck for their thoughtful commentary in CMAJ.1 I agree with them that the low uptake of prenatal care among mothers who had a child placed in care goes well beyond what we discussed in our study, including ongoing colonialism, anti-Indigenous racism and gaps in cultural safety competencies, and that there are Indigenous community–led models of maternity care that are addressing these issues. As Smylie and Phillips-Beck point out, an Indigenous-specific analysis of this research question would lead to a better understanding of the drivers of inadequate prenatal care among mothers who had a child placed in out-of-home care.
Smylie and Phillips-Beck identified ethical concerns about this research, primarily around the absence of Indigenous engagement and input on a study in which the affected group was composed primarily of Indigenous mothers. Our study was conducted using data from families involved with child protection services in Manitoba, and although we did not include an Indigenous identifier, it is known that during the study years, between 80% and 87% of children in care in Manitoba were Indigenous.2,3 I take Smylie and Phillips-Beck’s concerns seriously and acknowledge that the exclusion of Indigenous involvement in this study was an oversight on my part. I apologize for my role in the harms this causes and will work to ensure that Indigenous representation and engagement is present in relevant research using routinely collected data.
Footnotes
Competing interests: None declared.