Locating Invisible Policies: Health Canada’s Evacuation Policy as a Case Study


  • Karen M Lawford University of Ottawa National Aboriginal Council of Midwives


First Nations Health, Invisible Policy, Policy Tool


I describe an initial tool for revealing invisible policies. Invisible policies are made apparent by three criteria: allocation of resources, material impacts, and reactions. Allocation of resources can be economic, human, or otherwise. Material impacts are those that are tangible and can be described as having a physical impact in some manner. Finally, the reactions of those impacted by the policy, like agencies and scholars, provide a third lens through which these policies can be understood and identified. Using the three criteria, I reveal the long-standing “evacuation policy” as a genuine and authentic policy, which is currently applied to those First Nations populations falling under federal jurisdiction. My contribution to policy analysis is to provide another tool to close a gap in the literature with respect to the analysis of invisible policies.

This paper won the Women’s and Gender Studies et Recherches Féministes (WGSRF) Graduate Essay Prize in 2014.

Je décris un outil initial pour révéler les politiques invisibles. Les politiques invisibles sont mises en évidence par trois critères : allocation des ressources, impacts matériels et réactions. L’allocation des ressources peut concerner les ressources économiques, humaines ou autres. Les impacts matériels sont ceux qui sont tangibles et peuvent être décrits comme ayant un impact physique quelconque. Enfin, les réactions de ceux qui sont touchés par la politique, comme les organismes et les chercheurs, fournissent une troisième perspective selon laquelle ces politiques peuvent être comprises et cernées. À l’aide de ces trois critères, je révèle la « politique d’évacuation » de longue date comme une politique véritable et authentique, qui est actuellement appliquée aux populations des Premières Nations relevant de la compétence fédérale. Ma contribution à l’analyse des politiques est de fournir un autre outil pour combler une lacune dans la littérature en ce qui concerne l’analyse des politiques invisibles.

Cet article a remporté le Prix de l’essai (cycles supérieurs) de l’association Women’s and Gender Studies et Recherches Féministes (EGFRF) en 2014.


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Author Biography

Karen M Lawford, University of Ottawa National Aboriginal Council of Midwives

Karen Lawford is a Ph.D. candidate at the University of Ottawa. An ongoing exploration of the power of Canada’s constitution and the Indian Act frame her policy research. Karen is also a registered midwife (Ontario) and an Aboriginal midwife (on education leave) from Lac Seul First Nation, Treaty 3.


Abele, Frances, Robert Lapointe, David J. Leech, and Michael McCrossan. 2011. “Aboriginal People and Public Policy in Four Ontario Cities.” In Aboriginal Policy Making in Canadian Municipalities, edited by Evelyn J. Peters, 87-126. Montreal, QC and Kingston, ON: McGill-Queen’s University Press.

Baskett, Thomas, F. 1978. “Obstetric Care in the Central Canadian Arctic.” British Medical Journal 2: 1001-1004.

Bessant, Judith. 2008. “The Sociology of Policy-Making in the Modern State.” Journal of Sociology 44 (3): 283-300. doi:10.1177/1440783308092885.

Bierman, Arlene S. 2009. “Crossing the Chasms: Research, Policy, and Advocacy.” In Women’s Health: Intersections of Policy, Research, and Practice, edited by Pat Armstrong and Jennifer Deadman, 235-250. Toronto, ON: Women’s Press.

Blackstock, Cindy. 2008. “Jordan’s Principle: Editorial Update.” Paediatric Child Health 13 (7): 589-590.

____. 2012. “Jordan’s Principle: Canada’s Broken Promise to First Nations Children?” Paediatric Child Health 17 (7): 368-370.

Braën, André. 2002. Health and the Distributive Powers in Canada: Discussion Paper No. 2. Ottawa, ON: Commission on the Future of Health Care in Canada.

Brennan, Marie, and Sue Willis. 2008. “Sites of Contestation Over Teacher Education in Australia.” Teachers and Teaching: Theory and Practice 14 (4): 295-306. doi:10.1080/13540600802037702.

Canada Health Act, R.S.C., 1985, c. C-6.

Canada. Health Canada. 2012a. “Canada’s Health Care System.” Ottawa, ON: Health Canada. http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2011-hcs-sss/index-eng.php#a6.

____. 2012b. Chapter 12 – Obstetrics. Ottawa, ON: Health Canada. http://www.hc-sc.gc.ca/fniah-spnia/services/nurs-infirm/clini/adult/obstet-eng.php.

____. 2012c. Clinical Practice Guidelines for Nurses in Primary Care. Ottawa, ON: Health Canada. http://www.hc-sc.gc.ca/fniah-spnia/services/nurs-infirm/clini/index-eng.php.

____. 2012d. The First Nations and Inuit Health Branch Strategic Plan: A Shared Path to Improved Health. Ottawa, ON: Health Canada. http://www.hc-sc.gc.ca/fniah-spnia/pubs/strat-plan-2012/index-eng.php.

____. 2013. First Nations and Inuit Health. Ottawa, ON: Health Canada. http://www.hc-sc.gc.ca/fniah-spnia/index-eng.php.

____. 2014. Audit of the Non-Insured Health Benefits Medical Supplies and Equipment, Vision Care and Mental Health. Ottawa, ON: Health Canada. http://www.hc-sc.gc.ca/ahc-asc/alt_formats/pdf/pubs/audit-verif/2014-03_nihb-ssna/2014-03_nihb-ssna-eng.pdf.

Canada. Privy Council Office. 2010. Difference Between Canadian Provinces and Territories. Ottawa, ON: Privy Council Office. http://www.pco-bcp.gc.ca/aia/index.asp?lang=eng&page=provterr&doc=difference-eng.htm.

Canada. Public Health Agency of Canada. 2009. What Mothers Say: The Canadian Maternity Experiences Survey. Ottawa, ON: Public Health Agency of Canada.


Canada. Treasury Board of Canada Secretariat. 2006. Table of Concordance. Ottawa, ON: Treasury Board of Canada Secretariat. http://www.tbs-sct.gc.ca/cla/conc-eng.asp#sh.

Canadian Health Services Research Foundation. 2011. Harkness Canadian Health Policy Briefing Tour. Ottawa, ON.

Canadian Midwifery Regulators Consortium. 2010. “Legal Status of Midwifery in Canada.” Winnipeg, MB. http://cmrc-ccosf.ca/node/19.

CBC News. 2012. “Sioux Lookout Hospital Births Almost Double.” CBC Online, January 4. Accessed January 14, 2015. http://www.cbc.ca/news/canada/thunder-bay/sioux-lookout-hospital-births-almost-double-1.1145690.

Clarke, Sarah. 2007. “Ending Discrimination and Protecting Equality: A Challenge to the INAC Funding Formula of First Nations Child and Family Service Agencies.” Indigenous Law Journal 6 (1): 79-100.

Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c 11. http://www.laws-lois.justice.gc.ca/eng/const/page-4.html#h-17.

Couchie, Carol, and Sheila Sanderson. 2007. “A Report on Best Practices for Returning Birth to Rural and Remote Aboriginal Communities.” Journal of Obstetrics and Gynaecology of Canada 29 (3): 250-254.

Dawson, Jennifer M. 1993. “Native Childbirth in the Canadian North: Are Midwives the Answer?” Nexus: The Canadian Student Journal of Anthropology 11: 15–26.

Dukelow, Daphne A. 2006. Pocket Dictionary of Canadian Law. 4th Edition. Toronto, ON: Thomson Carswell.

Dye, Thomas R. 1978. Understanding Public Policy. 3rd Edition. Englewood Cliffs, NJ: Prentice-Hall.

First Nations Child and Family Caring Society of Canada. 2011. Jordan’s Principle Advocacy Needed Soon. Ottawa, ON. http://www.fncaringsociety.com/sites/default/files/Jordan’s%20Principle%20Advocacy%20Info%20Sheet.pdf

Gibson, Dale. 1996. “The Canada Health Act and the Constitution.” Health Law Journal 4 (1): 1-33.

Giri, Ram A. 2011. “Languages and Language Politics: How Invisible Language Politics Produces Visible Results in Nepal.” Language Problems & Language Planning 35 (3): 197-221. doi: 10.1075/lplp.35.3.01gir.

Government of Manitoba. 2011. Maternal and Child Health Care Services Provincial Perinatal Referral Process. Winnipeg, MB. http://www.gov.mb.ca/health/primarycare/mach/pdf/referral_process.pdf

Grzybowski, Stefan, and Jude Kornelsen. 2009. Providing a Birth Support Program for Women of the North Island, Vancouver Island: An Aboriginal Midwifery Demonstration Project. Vancouver, BC: Centre for Rural Health Research.

Hunt, Sarah. 2014. “Ontologies of Indigeneity: The Politics of Embodying a Concept.” Cultural Geographies 21 (1): 27-32.

Indian Act, S.C. 1876, c. 18.

Jasen, Patricia. 1997. “Race, culture, and the colonization of childbirth in Northern Canada.” The Society for the Social History of Medicine 10 (3): 383-400.

Kornelsen, Jude, and Stefan Grzybowski. 2005. “The Costs of Separation: The Birth Experiences of Women in Isolated and Remote Communities in British Columbia.” Canadian Women Studies 24 (1): 75-80.

Kornelsen, Jude, Andrew Kotaska, Pauline Waterfall, Louisa Willie, and Dawn Wilson. 2010. “The Geography of Belonging: The Experience of Birthing at Home for First Nations Women.” Health & Place 16 (4): 638-645. doi.org/10.1016/j.healthplace.2010.02.001.

Lasswell, Harold D. 1936. Politics: Who Gets What, When, How. New York, NY: Whitlesey House.

Lawford, Karen, and Audrey R. Giles. 2012a. “Marginalization and Coercion: Canada’s Evacuation Policy for Pregnant First Nations Women Who Live On Reserves in Rural and Remote Regions.” Pimatisiwin 10 (3): 327-40.

____. 2012b. “An Analysis of the Evacuation Policy for Pregnant First Nations Women in Canada.” AlterNative 8 (3): 329-342.

Lawrence, Bonita, and Kim Anderson. 2005. “Introduction to ‘Indigenous women: The State of Our Nations.’” Atlantis 29 (2): 1-8.

Lea, Tess, Helen Thompson, Eva McRae-Williams, and Aggie Wegner. 2011. “Policy Fuzz and Fuzzy Logic: Researching Contemporary Indigenous Education and Parent-School Engagement in North Australia.” Journal of Education Policy 26 (3): 321-339. doi: 10.1080/02680939.2010.509813.

Lett, Dan. 2008. “Jordan’s Principle Remains in Limbo.” Canadian Medical Association Journal 179 (12): 1256.

Lewis, Steven, Cam Donaldson, Craig Mitton, and Gillian Currie. 2001. “The Future of Health Care in Canada.” British Medical Journal 323: 926-929.

Lux, Maureen. 2010. “Care for the ‘Racially Careless’: Indian Hospitals in the Canadian West, 1920-1950s.” The Canadian Historical Review 91 (3): 407-434.

Mettler, Suzanne. 2011. The Submerged State: How Invisible Government Policies Undermine American Democracy. Chicago, IL: The University of Chicago Press.

Miljan, Lydia. 2008. Public Policy in Canada: An Introduction. 5th Edition. Toronto, ON: Oxford University Press.

Murray, Karen B. 2011. “The Silence of Urban Aboriginal Policy in New Brunswick.” In Urban Aboriginal Policy Making in Canadian Municipalities, edited by Evelyn J. Peters, 53-86. Montreal, QC and Kingston, ON: McGill-Queen’s University Press.

National Aboriginal Health Association. 2006. Exploring Models for Quality Maternity Care in First Nations and Inuit Communities: A Preliminary Needs Assessment. Ottawa, ON.

Native Women’s Association of Canada. 2009. Journey for Two: A Guidebook for When You’re Away From Your Community to Give Birth. Ottawa, ON. https://www.nwac.ca/wp-content/uploads/2015/05/2009-NWAC-Journey-for-Two-A-Guidebook-For-When-Your-Away-From-Your-Community-to-Give-Birth.pdf

Paulette, Lesley. 1990. “The Family Centred Maternity Care Project.” In Gossip: A Spoken History of Women in the North, edited by Mary Crnkovich, 71–87. Ottawa, ON: M.O.M. Printing.

Robinson, Sarah. 2008. “Trusting the Method: An Ethnographic Search for Policy in Practice in an Australian Primary School.” Ethnography and Education 3 (3): 243-252. doi:10.1080/17457820802305477.

Romanow, Roy J. 2002. Building on Values: The Future of Health Care in Canada – Final Report. Ottawa, ON: Commission on the Future of Health Care in Canada. http://www.cbc.ca/healthcare/final_report.pdf

Schneider v. The Queen, [1982] 2 S.C.R. 112 http://scc-csc.lexum.com/scc-csc/scc-csc/en/2449/1/document.do

Seiter, Richard P., and Karen R. Kadela. 2003. “Prisoner Re-entry: What Works, What Does Not, and What is Promising.” Crime & Delinquency 49 (3): 360-388. doi: 10.1177/0011128703253761.

Simpson, Leanne R. 2004. “Anticolonial Strategies for the Recovery and Maintenance of Indigenous Knowledge.” American Indian Quarterly 28 (3/4): 373-384.

Society of Obstetricians and Gynaecologists of Canada. 2010. “SOGC Policy Statement: Returning Birth to Aboriginal, Rural, and Remote Communities.” Journal of Obstetrics and Gynaecology Canada 32 (12): 1186-1188.

Struthers, Ashley, Shannon Winters, Colleen Metge, and Darlene Girard. 2015. “Traveling for Birth: An Occupational Perspective.” Poster presentation at the annual Canadian Association of Occupational Therapists. Winnipeg, MB, May 27-30. http://www.caot.ca/conference/2015/presentations/f5.pdf.

Theimer, Sarah. 2012. “What Language Death and Language Planning Tell us About MARC and RDA.” Journal of Library Metadata 12: 279-93. doi:10.1080/19386389.2012.700604.

Waldram, James B., Ann D. Herring, and Kue T. Young. 2006. Aboriginal Health in Canada: Historical, Cultural, and Epidemiological Perspectives. Toronto, ON: University of Toronto Press.

Women and Health Care Reform. 2007. Maternity Matters: Why Should We be Concerned About the State of Maternity Care? Winnipeg, MB: Women and Health Care Reform. http://www.nnewh.org/images/upload/attach/6610maternity%20matters%20women%20and%20health%20care%20reform%20ENG.pdf.

Yadava, Yogendra P. 2007. “Linguistic Diversity in Nepal: Perspective on Language Policy.” Paper presented at International Seminar on Constitutionalism and Diversity in Nepal. Kathmandu: CNAS, Tribhuvan University, August 22-24.