Does Living On-Reserve Versus Off-Reserve Make a Difference in First Nations Birth Outcomes in Manitoba, Canada?

Objective: First Nations people in Canada often migrate between living “on-reserve” and “off-reserve.” The purpose of this study was to determine if there was any difference in birth outcomes among First Nations women living on-reserve versus off-reserve in Manitoba. Study Design: This population-based birth cohort study was conducted using Statistics Canada’s linked vital data for Manitoba, 1991-2000. A total of 26,176 First Nation births were identified (14,165 on-reserve, 12,011 off-reserve), based on self reporting by the mother or father. A mother was considered to be living on-reserve if her residential postal code (or municipal code) was among those used for First Nations bands or communities. Results: The crude rates of preterm (7.5% versus 9.7%) and small-for-gestational-age (7.3% versus 8.1%) births were significantly lower among First Nations women living on-reserve compared to off-reserve, while rates of neonatal death (4.1 versus 4.1 per 1,000) and postneonatal death (6.6 versus 5.6 per 1,000) were not significantly different. After adjusting for maternal characteristics and rural versus urban residence, the lower risks of preterm birth (adjusted odds ratio [aOR] 0.82 [95% confidence interval [CI] 0.75-0.90]) and small-for-gestational-age (aOR 0.89 [0.81-0.98]) on-reserve remained, but a higher risk of infant death was observed (aOR 1.29, 95% CI 1.00-1.67) mostly due to higher risk of postneonatal death. Conclusion: Living off-reserve is associated with higher rates of preterm and small-for-gestational-age births, suggesting the need to improve prenatal care. Living on-reserve is associated with higher rates of infant death, suggesting the need to improve infant care and socioeconomic conditions.