Rethinking Canadian perinatal surveillance: focusing on structural drivers of maternal and child health inequities

Abstract Structural racism contributes to persistent perinatal and child health inequities in Canada, with Indigenous birthing parents and children disproportionately affected. The Canadian Perinatal Surveillance System monitors perinatal outcomes using aggregated biomedical data from the Canadian Institute for Health Information. In contrast, the U.S. Pregnancy Risk Assessment Monitoring System uses population-based self-report data to quantify the effects of structural and interpersonal racism on perinatal health. However, the absence of routinely collected race-, ethnicity-, Indigenous identity-, and racism-related data limit Canada's ability to identify structural drivers of perinatal health inequities. Adapting this model, guided by Indigenous data sovereignty, ethical governance, and meaningful community partnerships, could identify perinatal health service gaps and inform antiracism interventions in Canada. We call on federal, provincial, and territorial partners to integrate measures of race, ethnicity, Indigenous identity, and racism into perinatal surveillance to strengthen evidence for equitable maternal, perinatal, and child health policy.