The Right to Be Counted: Unmasking First Nations and Métis Population Undercounts in Winnipeg, Manitoba.

Background: Evidence of systematic under-counting of First Nations, Inuit, and Métis (FNIM) populations living in urban centres in Canada has been documented for the previous three census rounds (2012, 2016, 2021). Methods: In partnership with Aboriginal Health and Wellness Centre of Winnipeg, Inc. and the First Nations Health and Social Secretariat of Manitoba, a respondent-driven sampling survey of First Nations and Métis peoples living in Winnipeg was conducted and the population living in Winnipeg was estimated using the multiplier method in conjunction with participants' responses to census participation. Results: We estimated a population of 300,000 (95% CI 248,000 to 379,000) First Nations and Métis people living in Winnipeg, three times higher than the 2021 Census count of 90,535. Interpretation: The Canadian census continues to systematically undercount Indigenous peoples living in urban centres. Improving the accuracy and precision of Indigenous population enumeration is required for equitable health services funding and delivery. Partnerships with FNIM governing and health service organizations, addition of Indigenous identity to the short form-census participation and coverage, and improved collection methods for people living in collective dwellings or experiencing housing insecurity are recommended.