Polyamorous families face stigma during pregnancy and birth because of attitudes and policies in health care that are built around monogamy, Ontario researchers say.

The Canadian Medical Association Journal published a study Tuesday based on interviews with 24 polyamorous Canadians -- 11 who had given birth in the previous five years and 13 partners -- recruited through ads posted on social media groups.

The researchers with McMaster University's midwifery program say their inquiry was motivated in part by some team members' personal involvement in the polyamory community and a shared interest in inclusive health care.

Co-authors Erika Arseneau and Samantha Landry say their findings suggest that while participants reported both positive and negative health-care experiences, all faced some form of marginalization rooted in "mono-normativity," the assumption that romantic relationships are limited to two partners.

"There's a lot of people that are engaging in polyamory and a lot of them are having children, contrary to popular belief, and their experience is very similar to monogamous families in a lot of ways," said Arseneau.

"In other ways, it's enhanced by the fact that they have multiple relationships and multiple support people in their lives."

While there's no universally accepted definition, polyamory is typically characterized by engaging in multiple intimate relationships with the consent of all parties involved.

Statistics on the prevalence of polyamory are hard to come by, but there are numbers to suggest that non-monogamous relationships may be on the rise in Canada.

According to a study of more than 2,000 Canadians published in the Journal of Sex Research last April, four per cent of Canadians who are romantically attached reported being in an open relationship, and 20 per cent said they had previously engaged in the practice.

In 2016, the executive director of the Calgary-based Canadian Research Institute for Law and the Family used social media to ask polyamorous Canadians to take part in an online survey. Of the 500 people who responded, more than 40 per cent said there were children living in their homes full- or part-time.

It appears the law is slowly catching up to this evolution of Canadian families. Last year, a court in Newfoundland and Labrador recognized three unmarried adults as the legal parents of a child born within their "polyamorous" family.

Arseneau and Landry say their study -- dubbed the "Polybabes" project -- is unique in that it investigates what it's like for polyamorous parents to navigate the health-care system.

They found that while participants expressed that having multiple partners provided more support during the childbearing process, these relationships often went unacknowledged by the health-care system.

Due to fears of discrimination, many participants opted not to disclose their polyamorous status unless it was medically relevant, said Landry.

Those who revealed they were polyamorous encountered an assortment of interpersonal and administrative challenges.

For example, some health-care providers would refer to a third partner as an "uncle" or "aunt" rather than their preferred title as a parent, said Landry.

"A lot of the time, health-care providers... would kind of validate the people who were biologically related to the child, rather than kind of opening up the focus to everyone and giving everyone the same treatment.

Arseneau noted that intake forms often only provide spaces for two parents, which can restrict a partner's access to the delivery room and involvement in medical decisions.

She said some barriers could be as small as the fact that identification bracelets linking a child to their parents come in sets of threes. As one participant told researchers: "It's become this huge ordeal about who is getting bracelets. It's like 'The Bachelor,' I think. Who gets a rose?"

Arseneau said these slights can add up to put a damper on what should be a joyous occasion -- the addition of a new family member.

She said she hopes the study helps health-care providers educate themselves about polyamory so they can acknowledge and accommodate the full spectrum of family structures.

"If you're creating a respectful, inclusive and accessible space for conversations to take place, whether it's about health care or social ideas, then that allows more room for difference and acceptance," said Landry.

This report was published by The Canadian Press on Oct. 15, 2019.