A midwife.
A midwife. Credit: Midwifery Regulatory Council of Nova Scotia Credit: Midwifery Regulatory Council of Nova Scotia

Midwives, like other women-centred professions, have been attacked by Liberal and Conservative provincial governments for decades. 

Ontario enacted the Pay Equity Act (PEA) in 1987, a proactive law designed to redress systemic gender discrimination in compensation. 

In 1994, when midwifery became a regulated profession, using the pay equity principles outlined in the PEA, compensation was set in proportion to the male comparator, Community Health Centre (CHC) physicians. These salaried doctors are the lowest paid physicians in the healthcare system.

But it turned out, the PEA did not apply to midwives because they are considered self-employed, independent contractors and the PEA only applies to employees. 

Wage gap: a human rights violation

Over decades, the wage gap for midwives has widened far beyond the standards set out in the PEA. That forced midwives to file a complaint with the Human Rights Tribunal of Ontario. 

In 2025, the Association of Ontario Midwives (AOM) was negotiating a new contract specifically requesting binding arbitration. Instead, Health Minister Sylvia Jones invoked non-binding mediation.

The January 6, 2026 report and recommendations issued by mediator Beverly Mathers stated unequivocally that Ontario is in the midst of a crisis in retention and recruitment of midwives. Mathers also stated that midwives are entitled to a compensation catch up from the years they were restricted to one per cent by Bill 124 from 2019 to 2023. 

It’s important to remember that three of those years fall squarely within the COVID pandemic and that the imposed one per cent increase lasted one year longer for midwives.

Ultimately, Jones rejected the report and essentially all of the mediator’s recommendations. The existing contract was allowed to expire in March 2026. 

Midwives say the current negotiations framework is fundamentally unbalanced as the current round of negotiations revealed. The broader impacts of these negotiations have undeniably affected midwifery recruitment, retention and ultimately, the sustainability of maternity care in Ontario.

A main issue remains the absence of a fair dispute resolution mechanism for midwives. Unlike many other professionals, midwives are unable to take strike action without jeopardizing the health and safety of their clients. 

During previous round of negotiations, the Ministry of Health agreed to include mediation in the process if the parties reached an impasse in negotiations. However, this round demonstrated that non-binding mediation is ineffective when the government can simply disregard the mediator’s recommendations without consequence.

Midwives continue to advocate for access to binding arbitration as a fair and balanced mechanism that would help address the significant power imbalance.

The midwifery gender trifecta

Midwifery is a non-authoritarian method of delivering client-centred cooperative care that falls outside of the male-centric hospital birth experience. Midwifery is predisposed to the gender trifecta: it’s a female dominated field; the job involves caring for women and trans folks; and it’s a healthcare experience. 

Foundationally it is grounded in the care economy and the government of Ontario Premier Doug Ford that has shown that it has no intention of remedying systemic gender discrimination. 

According to Elizabeth Brandeis, a Registered Midwife and the Director of Government, Labour & Public Relations at the Association of Ontario Midwives (AOM): “The midwifery model relies on 24/7 on-call care and that is not compliant with employment labour laws and their autonomy and continuity of care could be impacted by employment standards. So, that was the stumbling block.”

Brandeis added, “The original principle of the funding model is that the funding should follow the model of care rather than the other way around.”

Ultimately, this meant that midwives were not covered by Ontario legislation including the PEA, Employment Standards Act and Ontario Labour Relations Act. This has left midwives vulnerable to pay discrimination.

Midwives are classified as independent contractors, but as a profession, are funded and managed by the Ontario government who sets compensation as well as the funding structure of bargaining. However, the provincial government also manages the volume of clients which means there’s a conflict of interest.

Effectively, midwives are not independent in the true sense of the word and should more correctly be classified as dependent contractors. 

 While originally being paid the same as CHC physicians, the Ministry of Health abandoned that designation over the years leaving midwives without a benchmark or male comparator. 

During those decades, the pay gap widened and successive provincial governments ignored the concerns of midwives. That motivated midwives to file a complaint with the Human Rights Tribunal in 2013 to fight for fair pay based on gender rights discrimination.

Brandeis played a key role in the landmark tribunal victory for midwives that was meant to remedy systemic gender discrimination regarding compensation. 

“That was a bold move because midwives are a small group of female-dominated workers and fighting government is expensive,” Brandeis told rabble.ca.

“But it was really important to midwives that they take action that not only would impact their own pay and valuing of their own work, but would set legal precedent for other female dominated healthcare providers and care providers more generally for the principle of equal pay for equal value,” Brandeis added.

The extremely lengthy process is ongoing because all recommendations set out by the tribunal have either not been implemented or only minimally implemented.

The bargaining structures and processes midwives had access to had limitations that prevented the restoration of benchmarks and paying midwives fairly for equal work. 

Province appeals tribunal decision

The Human Rights Tribunal found the provincial government liable for gender discrimination against midwives, ordering the Ministry of Health to remedy both the compensation and the practices to prevent a further widening of pay gaps.

Following the tribunal’s decision, the Ford government launched two unsuccessful appeals which upheld the tribunal’s decision. The provincial government dropped their final appeal to the Supreme Court of Canada so the tribunal’s original decision still stands. 

Midwives are currently in the process of implementing the last outstanding measure ordered in 2020: a joint compensation designed to address the pay gap back to 2014. In addition to redressing those 12 years of discriminatory pay, a 2021 remedial order recommended midwives be given a 20 per cent pay increase retroactive to 2011.

There were also remedial orders to adjust the compensation setting practices to include a review using a gender-based analysis of how the provincial government sets midwifery compensation. 

Although the Ministry of Health complied with the order to conduct a review, the findings and recommendations of the external consultant have either not been implemented or not implemented in full. 

The joint compensation study is expected to be released by the end of this year. 

“Then, our work will be to hold government accountable to implement the recommendations from that study as well,” Brandeis said.

Midwives were to receive substantial remedial compensation at the onset of COVID. Instead, the Ford government declared the money would not be paid because those funds were being re-directed to help cover the cost of the emergency.

During the pandemic, midwives, who are not public employees, were deemed by the government to fall under the umbrella of Bill 124 and limited to one per cent annual salary increases during unprecedented inflation. However, once Bill 124 was found to be unconstitutional, midwives were denied a reopener clause by the provincial government that would have allowed them to re-bargain their contracts for those years like teachers and public service workers did. Midwives were also prevented from seeking redress the way physicians were able to. 

Midwives left without recourse

Despite Mathers recommending a 6.5 per cent increase to compensate midwives for lost increases during those four years, the Ford government completely rejected the recommendation leaving midwives without recourse. 

Yet, the Ford government found the funds to give MPPs a 35 per cent salary increase in 2025. This political choice of who deserves financial compensation lays bare the fact that Conservatives do not value care work nor care workers. 

As part of the AOM’s senior staff leadership team, Brandeis oversees the association’s contract negotiations with the Ministry of Health and the ongoing implementation of the remedial orders from the Human Rights Tribunal decision.

Contract negotiations wrapped up this summer. These negotiations mark the first time midwives had access to a mediation process – although it was non-binding. Prior to that, midwives had no access to dispute resolutions within their bargaining structure despite requesting binding arbitration for over a decade. Unfortunately, Health Minister Sylvia Jones dismissed the third-party report and all recommendations.

Access to a fair and impartial third-party during contract negotiations is a Charter Right. The role of that third-party is to determine how best to move forward from a bargaining impasse. Midwives have been denied access to binding arbitration as well as the right to have any of the recommendations of the current arbiter fully implemented due to Jones invoking non-binding mediation.

At the end of the day, even Mathers recommendation of a decent cost-of-living increase was toned down in the provincial government’s final offer. Negotiations moved ahead with the government’s final offer providing the bare minimum. 

It’s time to not only make family planning and prenatal, birth and postnatal care a priority, but to properly fund midwifery, all female dominated healthcare providers, as well as care providers more generally. Otherwise, the principle of equal pay for equal value is just another Trojan horse.

Doreen Nicoll

Doreen Nicoll is weary of the perpetual misinformation and skewed facts that continue to concentrate wealth, power and decision making in the hands of a few to the detriment of the many. As a freelance...