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Background: In circumpolar countries such as Canada,northern regions represent a unique geographical entity climatically, socioeconomically and environmentally.There is a lack of comparative data on birth outcomes among Indigenous and non-Indigenous subpopulations within northern regions and compared with southern regions.Methods: A cohort study of all births by maternal mother tongue to residents of northern (2616 First Nations(North American Indians), 2388 Inuit and 5006 non-Indigenous) and southern (2563 First Nations, 810 643non-Indigenous) Quebec, 1991-2000.Results: Compared with births to southern non-Indigenous mother tongue women, births to northern women of all three mother tongue groups were at substantially elevated risks of infant death (adjusted OR (aOR) 1.7-2.9), especially post neonatal death (aOR2.2-4.4) after controlling for maternal education, age,marital status and parity. The risk elevation in perinatal death was greater for southern First Nations (aOR 1.6)than for northern First Nations (aOR 1.2). Infant macrosomia was highly prevalent among First Nations in Quebec, especially in the north (31% vs 24% in the south). Within northern regions, Inuit births were at highest risk of preterm delivery (aOR 1.4) and infant death (aOR 1.6).Conclusion: All northern infants (First Nations, Inuit or non-Indigenous) were at substantially elevated risk of infant death in Quebec, despite a universal health insurance system. Southern First Nations newborns have not benefited from the more advanced perinatal care facilities in southern regions. Environmental influences may partly account for the very high prevalence of macrosomia among First Nations in northern Quebec. [ABSTRACT FROM AUTHOR]