Governing birth in a pandemic: A policy analysis of maternity hospital restrictionsin Ontario during the COVID-19 pandemic

At the beginning of the COVID-19 pandemic, hospitals around the world modified policies for many services, including maternity care, to limit viral transmission. While early decisions were made under significant uncertainty, it is not clear how much consistency there was across jurisdictions, or whether some of these policies inadvertently and disproportionately impacted maternal and infant health for marginalized populations. Using a digital archive database, this study examines how maternity policies evolved during the COVID-19 pandemic across Ontario hospitals, assesses equity implications for marginalized communities, and evaluates the extent to which policy changes aligned with data-driven public health risk assessments. A thematic content analysis of obstetric policy documents on 13 Ontario hospital websites between 2020 and 2023 explores three policy areas with equity implications for maternal care: visitor access, support partner restrictions, and doula care limitations. Using a health equity perspective, findings show a high degree of variability in how the Ontario Ministry of Health policies were implemented both within and across hospitals and raise concerns about equity for marginalized populations, social justice in health, and evidence-informed policy alignment.