PURPOSE:
Ontario remains the only province in Canada with an active exemption clause that legally allows Indigenous midwives to practice outside the provincial regulatory framework. This presentation will explore the significance of this exemption as a mechanism for affirming Indigenous jurisdiction over health care and midwifery practice. We aim to deepen understanding of how the clause works, why it matters, and how it can serve as a model for self-determined, culturally rooted care in other jurisdictions.

DISCUSSION:
We will examine the unique historical context and evolution of the exemption clause under the Midwifery Act, grounded in Indigenous legal and political advocacy. Drawing from NCIM’s long-standing engagement with communities actively practicing under the exemption, we will share insights into the practical realities, community-led governance, and accountability measures that uphold the safety and legitimacy of non-registered Indigenous midwifery. Participants will be introduced to NCIM’s new policy guidance on the exemption clause, including tools co-developed with Indigenous communities seeking to assert their jurisdiction or explore exemption pathways. This includes templates, frameworks, and protocols grounded in Indigenous knowledge systems and constitutional rights. The presentation will also reflect on the challenges posed by health system structures that continue to marginalize or ignore this legal pathway, and the need for governments and health institutions to meaningfully recognize and resource Indigenous midwifery without requiring assimilation into colonial systems.

EVIDENCE WHERE RELEVANT:
N/A

KEY MESSAGE:
The exemption clause is not an exception—it is a matter of equity, sovereignty, and Indigenous rights. Recognizing and supporting Indigenous midwifery through exemption-based models affirms community control over birth and strengthens culturally safe care. It is time to fund, protect, and uphold these practices as legitimate, essential components of the health care landscape in Canada. Poster session 2 (Group A)