Canada’s evacuation policy for First Nations women living on reserves in rural and remote regions is currently understood to be founded on concerns of First Nations’ health and wellbeing. Archival documents held at Library and Archives Canada, however, provide evidence of a very different beginning for the evacuation policy. The founding goals related not to good health, but to attempts to assimilate and civilize First Nations. Our research shows that the evacuation policy began in 1892, significantly earlier than previously thought. Further, we identified two strategies the federal government employed to propel the evacuation policy forward: the marginalization of First Nations pregnancy and birthing practices and the use of coercive pressures on First Nations to adopt the Euro-Canadian biomedical model. With this knowledge, the evacuation policy can be evaluated to determine if policy alternatives should be generated as First Nations work towards self-governance and self-determination in health care.