Informed Decision Making: The Interaction Between Sustainable Maternity Care Services and Community Sustainability

Principal Investigator: 
Award Type: 


  • Michael Klein, MD
    University of British Columbia
  • Cathy Ulrich
    Northern Health
  • Christina Miewald, PhD
    Simon Fraser University

To examine the role of maternity care in the sustainability of rural and remote communities, with the goal of assisting decision-makers in understanding the implications for the community and to provide them with a framework for making challenging decisions involving changes to the provision of these and other health services.

Research Summary

Many rural and remote communities have reduced or are reducing maternity care services. When this occurs, women and families have to travel to receive care which increases their financial costs while reducing their personal and family supports. There is also evidence that medical restructuring of this nature also affects the economy of communities, as lack of such services makes it more difficult for businesses to recruit employees.

This research project represents the first time that the role of maternity care in the viability and sustainability of a community is being examined as a critical element for decision-making involving provision of health services. The team’s goal is to incorporate relevant elements about the sustainability of maternity care and the sustainability of communities into the design of a decision support framework and decision-aiding tools that can be used by health authority decision-makers to aid them in making difficult decisions about how to maintain safe and effective maternity services. The availability of the framework and tools may also help decision-makers to better communicate these decisions, and help stakeholders to better understand the challenge and complexity of the choices decision-makers face. The ultimate goal of supporting better decision-making and communication is to support better outcomes for mothers, families and the communities.

Research Results

Data collection consisted of key informant interviews, focus groups and observational data. Interviewees included physicians, nurses and other maternity support services providers, First Nations, local business leaders and economic development officials, local elected officials, community groups, as well as pregnant women and those who had recently given birth. The key result of the research was the creation of a decision-support framework, which outlines a step-by-step process to assist with making optimal decisions about the delivery of rural maternity care services. The steps of the framework focus on developing viable actions and a strategy for addressing the complex issues associated with providing high standards of care in a variety of rural situations.

The research has the potential to improve and aid in the quality of decisions around maternity care. There is also potential for improving relations between health authorities and the communities they serve by providing a structured, objective and transparent approach to decision-making. The framework is transferable and applicable to other health authorities and there is the potential for adapting it to other areas of health service delivery.

Research Pillar: 
Host Institution: 
University of British Columbia
Research Location: 
Children's & Women's Health Centre of British Columbia