By Touka Shamkhi, Contributor
It’s 5:30 a.m. and I allow myself to enjoy a few moments of pre-dawn peace before I get up to confront the day ahead of me. As I scramble to get ready, I take a mental note of my plans for the day: placement, work and then tutorial prep. Why work, you may ask? Well, although midwifery students receive reimbursements from the program, it takes a long time to process and it hardly covers the amount that needs to be spent on paying for a car (a program requirement), gas, car maintenance, travel and relocation fees, hospital/placement-related parking and course materials.
Prior to entry, the midwifery education program cautions us that we will not be able to work for the majority of our time in this four-year program due to its intensive nature. But what about those of us who do not have a choice? I can’t help but think about how many people don’t make it through the gates because of these barriers. And for those of us who were able to claw our way through the gates, we have to fight everyday to stay here because financial planning can only get you so far when your institution is not set up to support you.
“How’s your break year going?” a well-intentioned but entirely out of touch older woman asks me. The third year of the midwifery education program is considered to be a “break” year of more regular and predictable hours, and I imagine it would be a break year for those who have the luxury of a financial safety net. As a third year student, I am lucky to even be able to entertain the thought of working, but when I make it to my fourth year, the clinical hours and on-call schedule will make it virtually impossible to work outside of the program and cover the cost of living.
As students in clinical placements, we are a part of the healthcare team. We are simultaneously learners and team members, which is a very special and valuable role to have, but it can be stressful when we do not have another source of income. Financial compensation of some sort would relieve this stress and allow us to focus on our learning and growth as budding healthcare providers. This is especially important for senior (fourth year) midwifery students, who have much more responsibility compared to midwifery students in previous levels. Senior midwifery students eventually start to take on the role of backup midwives under supervision. In simplified terms, when senior students get called up as backup midwives instead of registered midwives they are, in most circumstances, functionally taking on the role of a midwife. Similar to medical residents that relieve some of the workload of their unit, senior midwifery students lessen the workload of other midwives at the clinic. Despite the added responsibility and workload that senior midwifery students have, they do not get paid. On the other hand, first year medical residents, for example, rightfully get paid approximately $60,000 in Ontario to offset living costs, as they do not have time to work outside of school. Unlike first year medical residents, senior midwifery students do not receive income related to the work they do while on placement. This forces senior midwifery students to rely on savings, loans and family support, because the intensity of fourth year and the unpredictable hours of midwives’ on-call schedule makes it impossible to work outside of placement. This calls into question which students this institution is setting up for success — it isn’t the students who rely on inadequate funding from OSAP and it isn’t students without a financial safety net.
Midwifery students’ financial precarity was exacerbated in 2017 when the only professional line of credit offered by a major Canadian bank, the Royal Bank of Canada, no longer allowed midwifery students to apply for a line of credit, whereas students from other healthcare disciplines were offered higher lending limits without cosigners. This decision by RBC launched a student-led campaign to address the financially precarious situation midwifery students have to navigate. The Fair Financing for Midwifery Students campaign emphasizes that “this precarity disproportionately affects students who already face barriers to higher education including people of colour, Indigenous students, single parents and those from rural areas.”
Midwifery as a profession is undervalued within the healthcare system and by our provincial government. The Association of Ontario Midwives filed a complaint with the Ontario Human Rights Tribunal alleging that the Ontario Ministry of Health discriminated against midwives on the basis of gender. In September 2018, the Human Rights Tribunal of Ontario ruled in favour of the Association of Ontario Midwives and the midwifery association is now putting pressure on the provincial government to honour that ruling and close the pay gap. It isn’t difficult, then, to understand that midwifery students are also undervalued and unsupported. The financial barriers that midwifery students experience is more than just an oversight. Rather, it is symptomatic of an unaccommodating institution and a system that doesn’t value the work of gendered helping professionals.
I am tired. And for those of us who are de-centered within dominant, white upper-middle class midwifery culture, I am exhausted. For my friends at the margins of the margins, who are undervalued and unsupported from outside and within this program and profession, I share your exhaustion.
I remember going to Guelph University to see Angela Davis speak in the winter of 2019, an evening which I will always cherish. Of the many things that stuck with me from that evening was Angela Davis’ critique of Hillary Clinton-esque feminism that is invested in “breaking the glass ceiling” which entirely neglects those under which the ground is threatening to collapse. And on that note, best of luck to those who are at the top and whose only barrier is the glass ceiling, but I am interested in those of us who have to fight to stay above ground.