Catastrophic disaster represents a vital issue in emergency management for many countries in the European Union (EU) and around the world. Given the damage to human lives that different hazards represent, evacuation operations can be the only option available to emergency managers to mitigate the loss of life from catastrophic disaster. However, due to the amount of time needed to effectively evacuate a large area, the decision to evacuate must occur when there is a relatively low probability of the event. An explicit understanding of the evacuation decision can lead to better organisational preparedness in advance of catastrophic disaster events. This research represents work performed with 159 emergency experts and professionals across ten countries. The goal of this research was to create decision-making aids for evacuations in advance of a variety of catastrophic disaster scenarios. Traditional Decision Theory (DT) provides a rational approach to decision-making that emphasizes the optimization of subjective preferences combined with uncertainty. Within evacuation decision-making, DT and its respective outputs are appealing; however the analytical process can be difficult due to the lack of observed data to support quantitative assessments from catastrophic events and relative infrequency of evacuation operations. This research explored the traditional use of DT applied to catastrophic evacuation scenarios. Theoretical contributions to DT and emergency management include: 1) identification of evacuation decision criteria, 2) inter-model analysis between decision structures called Influence Diagrams (IDs), 3) complete application of quantitative decision analysis to support evacuation decision-making and 4) multi-criteria analysis for evacuation vulnerability using spatial data. Important contributions from this work include:1) An analysis of evacuation criteria for a variety of catastrophic disaster scenarios2) Inter-model analysis of evacuation scenarios (flooding, nuclear dispersion and terrorist attack) to identify common probabilistic structures to support multi-hazard strategy planning3) Quantitative decision models to support evacuation strategies, identify key uncertainties and policy analysis 4) Process to use spatial data to support multi-criteria evacuation vulnerability analysis 5) Organisational self-assessment for evacuation decision-making and spatial data use based on findings across all participating countries.

Pregnant First Nations women who live on reserves in rural and remote regions of Canada are routinely evacuated to urban cities to await labour and birth; this is commonly referred to as Health Canada’s evacuation policy. I produced two stand alone papers to investigate this policy. In the first, I investigated the development and implementation of the Canadian government’s evacuation policy. Archival research showed that the evacuation policy began to take shape in 1892 and was founded on Canada’s goals to assimilate and civilize First Nations. My second paper employed First Nations feminist theory to understand why the evacuation policy does not result in good health, especially for First Nations women. Because the evacuation policy is incongruent with First Nations’ epistemologies, it compromises First Nations’ health. I offer policy recommendations to promote First Nations health in a way that is consistent with First Nations’ epistemologies and goals towards self-determination and self-governance.

Pregnant First Nations women who live on reserves in rural and remote regions of Canada are routinely evacuated to urban cities to await labour and birth; this is commonly referred to as Health Canada’s evacuation policy. I produced two stand alone papers to investigate this policy. In the first, I investigated the development and implementation of the Canadian government’s evacuation policy. Archival research showed that the evacuation policy began to take shape in 1892 and was founded on Canada’s goals to assimilate and civilize First Nations. My second paper employed First Nations feminist theory to understand why the evacuation policy does not result in good health, especially for First Nations women. Because the evacuation policy is incongruent with First Nations’ epistemologies, it compromises First Nations’ health. I offer policy recommendations to promote First Nations health in a way that is consistent with First Nations’ epistemologies and goals towards self-determination and self-governance.

This paper reports on a qualitative exploratory study focusing on the childbirth experiences of women and their families from a northern isolated community in Manitoba - who had to leave or were about to leave home to give birth. Perspectives from critical medical anthropology, cultural relativism and human ecological theory provided the theoretical foundation for this study. This study utilized ethnographic approaches to explore the perspectives of the women, their families and “significant others” and how they have been affected by policies, practices and structures at all levels of their environment in an attempt to gain a better understanding of the type of support and services that could potentially improve this experience. Presently, women from northern, rural and/or isolated communities leave home from a period of a few days up to 10 weeks to deliver their babies in an urban tertiary centre. They stay in boarding homes with others who have left home to obtain medical care, or with family and friends. During this period of time the women often do not access prenatal support or services within the regional health authority, other than medical care from a primary care provider (whom they may not have seen prior in their pregnancy) or to receive specialized medical intervention and monitoring. The boarding homes where they often stay do not offer any prenatal support or outreach services and are not conducive to housing women so close to delivering a baby. The women spoke of their experiences of giving birth marred by memories of fear, anger, frustration, tears and longing for family. They also spoke of a renewed sense of hope and excitement at the opportunity to share their ideas about possible ways that their experience could be improved. This paper breathed life into their thoughts and brought their ideas together to develop a new vision towards a system of supportive childbirth care for First Nation women in Manitoba, and more specifically, for women who are medically evacuated from the north to deliver their babies in urban Manitoba. For the Faculty of Medicine, it is a Master’s thesis, but for me and the many women and residents of Berens River, it is an opportunity for First Nation women to participate in shaping policy and influencing the direction for care and services that is created for them. It is important to acknowledge that evacuation and temporary relocation for birth is not an issue unique to First Nation women, it impacts hundreds of other northern and rural Métis and non-First Nation women every year. However, their experience is not included in this study. This paper suggests immediate and interim solutions for women who must leave home to give birth, albeit, the ultimate aim is to return birthing services closer to home.

This paper reports on a qualitative exploratory study focusing on the childbirth experiences of women and their families from a northern isolated community in Manitoba - who had to leave or were about to leave home to give birth. Perspectives from critical medical anthropology, cultural relativism and human ecological theory provided the theoretical foundation for this study. This study utilized ethnographic approaches to explore the perspectives of the women, their families and “significant others” and how they have been affected by policies, practices and structures at all levels of their environment in an attempt to gain a better understanding of the type of support and services that could potentially improve this experience. Presently, women from northern, rural and/or isolated communities leave home from a period of a few days up to 10 weeks to deliver their babies in an urban tertiary centre. They stay in boarding homes with others who have left home to obtain medical care, or with family and friends. During this period of time the women often do not access prenatal support or services within the regional health authority, other than medical care from a primary care provider (whom they may not have seen prior in their pregnancy) or to receive specialized medical intervention and monitoring. The boarding homes where they often stay do not offer any prenatal support or outreach services and are not conducive to housing women so close to delivering a baby. The women spoke of their experiences of giving birth marred by memories of fear, anger, frustration, tears and longing for family. They also spoke of a renewed sense of hope and excitement at the opportunity to share their ideas about possible ways that their experience could be improved. This paper breathed life into their thoughts and brought their ideas together to develop a new vision towards a system of supportive childbirth care for First Nation women in Manitoba, and more specifically, for women who are medically evacuated from the north to deliver their babies in urban Manitoba. For the Faculty of Medicine, it is a Master’s thesis, but for me and the many women and residents of Berens River, it is an opportunity for First Nation women to participate in shaping policy and influencing the direction for care and services that is created for them. It is important to acknowledge that evacuation and temporary relocation for birth is not an issue unique to First Nation women, it impacts hundreds of other northern and rural Métis and non-First Nation women every year. However, their experience is not included in this study. This paper suggests immediate and interim solutions for women who must leave home to give birth, albeit, the ultimate aim is to return birthing services closer to home.

Pregnant First Nations women who live on reserves in rural and remote regions of Canada are routinely evacuated to urban cities to await labour and birth; this is commonly referred to as Health Canada’s evacuation policy. I produced two stand alone papers to investigate this policy. In the first, I investigated the development and implementation of the Canadian government’s evacuation policy. Archival research showed that the evacuation policy began to take shape in 1892 and was founded on Canada’s goals to assimilate and civilize First Nations. My second paper employed First Nations feminist theory to understand why the evacuation policy does not result in good health, especially for First Nations women. Because the evacuation policy is incongruent with First Nations’ epistemologies, it compromises First Nations’ health. I offer policy recommendations to promote First Nations health in a way that is consistent with First Nations’ epistemologies and goals towards self-determination and self-governance.

Pregnant First Nations women who live on reserves in rural and remote regions of Canada are routinely evacuated to urban cities to await labour and birth; this is commonly referred to as Health Canada’s evacuation policy. I produced two stand alone papers to investigate this policy. In the first, I investigated the development and implementation of the Canadian government’s evacuation policy. Archival research showed that the evacuation policy began to take shape in 1892 and was founded on Canada’s goals to assimilate and civilize First Nations. My second paper employed First Nations feminist theory to understand why the evacuation policy does not result in good health, especially for First Nations women. Because the evacuation policy is incongruent with First Nations’ epistemologies, it compromises First Nations’ health. I offer policy recommendations to promote First Nations health in a way that is consistent with First Nations’ epistemologies and goals towards self-determination and self-governance.

First Nations women who live on reserves receive maternity care from a variety of government health care systems: Federal, provincial, and municipal. At first glance, this seems like an abundant amount of health care; however, the lack of coordination has led to poorer outcomes as demonstrated for example by the twofold IMR for First Nations on reserves compared to that of non-Aboriginal populations. To inform discussions and changes to health care policy and programming for maternity care for First Nations on reserves, my dissertation focuses on Health Canada’s evacuation policy within the province of Manitoba. It describes how First Nations women journey among these three health care systems in the provision of that care. This federal policy instructs federally employed nurses to arrange for the transfer of pregnant First Nations women who live on rural and remote reserves to an urban – and usually southern – location so that the women can receive labour and birthing services. Women are evacuated out of their home communities between 36 and 38 weeks gestational age and wait in the city, often alone, for labour to start. While there is a general understanding of how different elements of this federal policy work, there is no literature that describes its execution in detail nor in full. To address this critical knowledge gap, my dissertation consists of three stand-alone papers. For the first paper, “‘This Policy Sucks and It’s Stupid:’ Mapping Maternity Care for First Nations Women on Reserves in Manitoba,” I used intersectionality, institutional ethnography, and semi-structured interviews to produce a descriptive and visual map of the evacuation policy. Using intersectionality and a case study approach, the second paper, “Health Canada’s Evacuation Policy for Pregnant First Nations Women in Manitoba: Resignation, Resilience, and Resistance,” semi-structured interview data are analyzed through a thematic analysis to understand the experiences and perspectives of First Nations women, family, and community members. I argue for the development of a specific theoretical framework that makes explicit the specific legal and policy influences particular to First Nations women who live on reserves in the third paper, “The Legal Categorization of First Nations Women in Health: The Need for a First Nations Feminist Theory.” Taken as a whole, these three papers address some of the knowledge gaps related to maternity care services for First Nations women once they are evacuated. They also situate these gaps within the legal context of health care for First Nations women so that tangible improvements can be made.