Tag Archive for: advocacy

Behind the Science: Indigenous practices at WISE Women’s College

Interviewee: Lisa Richardson | Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators)

Published: April 19th, 2023

What was the motivation to get the Centre for Wise Practises in Indigenous Health started at Women’s College? 

The initial motivation was based on observing the experiences of Indigenous peoples in the healthcare system, both those seeking care and Indigenous learners being trained as healthcare professionals. There was a desire to have a place where people would feel supported and not have to deny their Indigeneity but be in a place where that’s valued and seen. We wanted to create a place where one can have access to traditional cultural supports if needed and where they can be supported as a whole person – mind, body, spirit, and emotion in that model of care and well-being. 

Additionally, the Centre emerged at the time that it did because the Truth and Reconciliation Commission of Canada (TRC) had come up with specific health-related Calls to Action. I had been involved in writing a report around how healthcare institutions could incorporate those calls to action specifically, and so we sought to do that at Women’s College Hospital.

 

How are healthcare providers educated on Indigenous health?

We have some amazing online modules that exist for cultural safety. But there is also a need to come together in small groups and talk through some of what was heard.  We sometimes debrief provider and patient interactions.  For instance, if there was an incident where a patient felt uncomfortable, we want to ensure that the patient is supported but also consider how to make things better for next time.  This might include a specific healing session, facilitated by an Elder, where a provider and a patient come together and try to emerge from it in a restorative way. We also have speakers for important events like the Missing and Murdered Indigenous Women and Girls annual day of recognition and the National Day for Truth and Reconciliation. Through dialogue, small groups, and one-on-one conversations we try to educate healthcare providers on Indigenous health.

Since its opening in 2018, what have been the major outcomes of this initiative?  

One of the teachings that I had from an Elder on our Decision-Making Council was “Lisa, build a small fire and people will want to come.” I interpreted it as “don’t start by wanting to build this great big program. Just start by doing the work within Women’s College and eventually, people will want to participate if it’s done in a good way.” We have very strong community partnerships. We have an Elder-in-Residence who has a Traditional Medicine clinic. We have hired a Patient Relations advocate–an Indigenous peer support and a patient and relations advocate who will sit with patients to accompany them on their journey and connect them to resources both within and outside the hospital. We additionally have a team that goes into community organizations, meets with individuals and tells them about what we’re doing. I feel very strongly about recruiting and supporting the next generation of Indigenous people in health care–advocates, leaders, providers, and scientists, and so we have a lot of Indigenous learners who do their placements or work on projects with us. We have a collaboration with the medical school, which means that Indigenous medical students come and hang out in our space where they can be surrounded by Indigenous peoples, and connect with community members and Elders. We also have an amazing summer camp program for grades 9-10 Indigenous learners. Beyond the hospital, we have worked on outreach programs to help support Indigenous primary care practitioners who are working in isolation and on the reserves. We have specialists who are going out to the reserves to provide consultations as needed. 

 

When incorporating Indigenous voices, how do initiatives and foundations avoid non-meaningful engagement and prevent tokenism? 

I think building something slowly and carefully and led by Indigenous peoples has been important for us as well. This is the opposite of having a single person in a single role and on their own trying to transform a whole institution, which is generally not successful. Importantly, we have Indigenous people in senior leadership roles overseeing everything we do for accountability purposes.  I think one important structural aspect of the Centre is the dual accountability within my role. I report both to the CEO and to our Decision-Making Elders. I do my check-ins with both and thus am held accountable by leaders in our community who can advise me on what would and wouldn’t be appropriate. This is essential for me because it helps ensure that the work is grounded in the needs of our people.

 

Why the focus on women’s health? 

There’s a reason why we’re centred at Women’s College Hospital. It’s a hospital that cares for all people but understands some of the specific needs of women and gender-diverse peoples in healthcare.  At our Centre, we understand that for our communities and for the future generations to be healthy, we need women, children and families to be healthy.

Behind the Science: Women’s Health and Forced Migration

Interviewee: Dr. Shahin Kassam, RN, PhD, Postdoctoral Research Fellow, University of British Columbia School of Nursing, Capacity Research Unit

Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators)

Published: February 9th, 2024

This week we talk to Shahin Kassam who tells us about her work on forced migration, specifically how displacement (for reasons such as climate instability, political conflict, coercion and human trafficking) impacts local and international intersections where gender, race, class and migrant status converge to shape women’s health and access to health and social services.

Can you tell us a bit more about your research?

My doctoral research looked at how public health nurses located here in British Columbia support women living with refugee status while also transitioning into parenthood. This intersectionality-framed research identified fragmented pathways women have to self-navigate to access health and social systems while also living with the impacts of gender-based violence, discrimination, and fear stemming from migration policies.

This doctoral work opened up more questions for me to further understand women’s experiences of accessing systems of health and social well-being and how they are shaped by these conjoint experiences of racial discrimination, gender-based violence, and their migrant status. To specify “forced migration” in this work is important because when we talk about migration it is often in binaries, either voluntary or involuntary. Experiences of being forced can be about being categorized by policy as a refugee, or as seeking asylum. But it can also be categorizations where women are rendered dependent and socially disconnected thereby increasing their risk for gender-based violence exposure and consequential chronic and acute health problems such as post-traumatic stress disorder, depression, hypertension, diabetes, and asthma. Rather than systems deciding whether a woman migrates forcibly or not, why are we not letting women’s experiences shape the narrative?

Essentially the research I’m doing just really intentionally ensures that we place women and their experiences at the forefront of understanding forced migration.

 

What drew you to this work? 

I come from a clinical public health nursing background. My research took off from the stories and experiences that I had with varying women with different backgrounds who experienced marginalization or disadvantages such as poverty or lack of support, literacy skills, and limited education. I constantly saw the inequities that these women faced and couldn’t let go of how that deserved more attention. So I think that just really propelled me into doing more.

Can you share any findings from this work?

As a Postdoctoral Research Fellow, I’m working with my supervisor Dr. Vicky Bungay who is the Scientific Director of the Capacity Research Unit and professor at the UBC School of Nursing, to build my program of research involving the development of non-profit community partnerships with sectors that are really integral to the safe settlement of women. So the research being done is informed by community-based participatory research principles where the community drives the research process. The overarching goal is to inform the enhancement of access to health and social services with the experiences of women impacted by gender-based violence, racism, and forced migration.

Through a SSHRC Partnership Engagement Grant, our community co-lead, Diana Ospina from DIVERSEcity Community Resources Society (DCRS) and I convened a group of leaders from three additional non-profit organizations focused on settlement service delivery. Together we met often and shaped the research process. We recruited nine women who had been in Canada from 0-5 years across varying races, migrant statuses, and languages such as Spanish, Ukrainian, Dhari, and Tigrinya.

Some of the key findings that we found through these women’s stories were that women need support in their pursuit of meaningful employment and integration into the labor market sector. Loss of financial independence and dealing with poverty is very challenging. Language barriers continue and language classes are often inaccessible because of the lack of affordable childcare. Another finding is housing that is safe from forms of violence or exploitation. The need for social growth and connections is another finding. When women arrive in Canada, often their only connection is their partner or their partner’s family/friends, creating dependency.

To further understand the experiences of women impacted by forced migration, we are hoping to grow through further funding opportunities to delve deeper into this work.

 

Given the lack of attention to forced migration, and women’s health, what keeps you moving forward? 

A big part of doing this work is grit and tenacity and simply not giving up. I think that if you are passionate about something, and you’re surrounded by support, that I think those are two big key ingredients to doing the work. For me, it’s the applied experiences as a nurse that continue to just really propel me in this direction. And then I think it’s the pragmatic and inclusive pillars and the values that align my work with the Capacity Research Unit and the School of Nursing that have promoted building and weaving together this program of research.

How can people learn more about your work?

Website: Shahin Kassam’s website

Research Unit: Capacity Research Unit, Women’s Stories of Forced Migration

More information:

Funder: SSHRC Partnership Engagement Grant

Principle Investigator: Dr. Vicky Bungay, UBC School of Nursing, Capacity Research Unit

Community Co-Applicant: Ms. Diana Ospina, DIVERSEcity Community Resources Society

Academic Co-Applicant: Dr. Shahin Kassam, Postdoctoral Research Fellow

Community Collaborators:

 

 

 

 

Menopause Hormone Therapy from a Consumer’s Point-of-View

Authors: Amanda Thebe, Fitness and Nutrition Coach Editors: Romina Garcia de leon, Shayda Swann

Published: December 29, 2023

Women don’t have much agency when it comes to menopause, and that has to change. Historically, menopause has either been demonized or swept under the rug as something women should soldier on with. And this has done women a huge disservice. It has led to a massive knowledge gap that means women aren’t getting access to the help they need, either because they don’t know what is happening to them or where to turn.

We aren’t taught about menopause in school, it is hardly ever discussed in the workplace (thankfully, that is changing), and when it comes to advocating for ourselves within the medical community, women are more likely to have incorrect treatments or be completely dismissed by their GP. Why? Well, we know doctors receive very little medical training unless they opt into take it. And the result of this leaves women floundering.

Women are unfortunately at the receiving end of the WHI Study 2002, which boldly told the world that menopause hormone therapy (MHT) causes breast cancer. Even though those findings have been withdrawn, that statement caused a lot of damage. Doctors became hesitant to prescribe MHT, and that hesitancy still exists today despite the menopause societies recommending MHT as a safe treatment option for some menopause symptoms. And the people that suffer the most because of this are women with symptoms who are desperately looking for help.

Going to the doctors to advocate for yourself during menopause can be a minefield. If women simply don’t know that they’re in perimenopause, they may just present with one or two symptoms and be treated for those symptoms without the doctor looking at the full picture. Alternatively, women might go to the doctor asking for help with what they know to be perimenopause, only to be turned away empty-handed or with a referral to a specialist because the doctor feels hesitant or uninformed about providing help. This type of negative experience leaves a lasting mark on a woman, who typically has to build up quite a lot of courage to ask for the help she needs. According to the American Association of Retired Persons (AARP), 80% of medical residents in the United States did not feel competent to discuss or treat women in menopause! 

We need to help women know that MHT should be an option open for discussion so that they can see if they can be a candidate for the treatment of their symptoms. The MQ6 is a great tool that doctors can use to screen midlife women for menopause and find appropriate treatments. Many women who start taking MHT really feel the benefit and start to see improvements in their symptoms and, therefore, in their quality of life.

On the flip side of this, there is a pervasive message, especially on social media and within menopause online communities, from women who take MHT successfully to treat their menopause symptoms,  and from some “celebrity doctors” that MHT is a panacea. This can lead to many women feeling excluded from the conversation because the truth is not every woman can or should take it. MHT is a powerful drug that doesn’t suit all women, especially those with contraindications. We all have a duty to make sure that the information we share about MHT and non-hormonal alternatives stay within the medical consensus statements. 

These same platforms often talk about (peri)menopause as a disease or deficiency that must be treated with hormones and the bizarre idea that we weren’t meant to live past menopause in the past. This type of disinformation is very harmful during a vulnerable time of a woman’s life. It is essential to empower women during this time with accurate knowledge, so that they know that if they are suffering, there is help available to them, and they do not have to suffer. But that this is a life transition (for most women) which is meant to happen and that we can and do thrive in postmenopause.

From a personal perspective, I was relieved to be offered MHT by a very progressive doctor, only to have a very negative experience with it. Many years later, when I learned I had a sensitivity to hormones, it all made sense. During those 5 years, I often would flounder into deep depression or struggle with chronic cluster migraines every time I tried MHT. And I know I am not alone. Thankfully for people like me, or for others who can never take MHT,  other pharmaceuticals do exist, and women should be given this information.

In an ideal world, if a woman is one of the 75% with moderate symptoms or 25% with life-altering symptoms, and they go to their doctor for help, they should be heard. They should have an assessment to make sure they are in perimenopause and then be offered the most appropriate treatment for them – which may or may not include MHT. Ultimately, menopause is a shared experience amongst all women, but we must be treated on an individual basis for our unique circumstances.

Behind the Science: Hearing Women’s Fertility Experiences

Interviewee: Deea K Dev, Medical Student, University of British Columbia, Faculty of Medicine, Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: September 1, 2023

Can you tell us about your research?

I work in the Memory and Imagination Lab under Dr. Daniela Palombo. We wanted to explore the memory characteristics of an unsuccessful fertility treatment experience. We wanted to look into the lived experiences of people who had gone through unsuccessful in vitro fertilization (IVF) treatment and see to what extent it became an intrusive and self-defining experience. IVF is a form of assisted reproductive technology that is quite common, but unfortunately often does not result in pregnancy and the experience itself is accompanied by a lot of adverse outcomes. It’s really expensive and getting through an unsuccessful IVF treatment has larger implications for mental health or self-esteem, and even quality of relationships with a partner. We partnered with a fertility clinic and the staff there were really supportive of the research proposal and its potential implications. We administered questions about the patient’s experiences with their medical care team. The study has really important implications for instating procedures and protocols surrounding this particular patient population so that we can work toward more patient-centred care. It seems like the doctors at that fertility clinic really valued this aspect of our research as well.

Why did you want to get involved in women’s health research?

Topics like these don’t really get much attention and there is under-representation of women across research and health care. It’s more common to know that there are intrinsic biological factors like hormones and sex-specific physiology that manifest differently for women, but I think something that’s not really talked about a lot is the fact that extrinsic factors are really important to take note of when conducting women’s health research. Socio-cultural issues and the environment itself shape the way that women interact with the healthcare system. I felt that it was really important to identify and evaluate patient perspectives on their own experiences with healthcare, then that way we can work towards patient-centred care and move away from harmful practices. I remember when I was volunteering with this organization called Wish which supports women who are involved in Vancouver’s street-based sex trade, I heard a lot about very harmful practices like medical paternalism. Hearing these patient perspectives was really a motivator for me.

You mentioned that you’re doing a lot of other advocacy work right now. Could you share more about that?

In my first year of medical school, I joined the Canadian Federation of Medical Students as the Local Officer of Sexual and Reproductive Health, representing UBC. Our first event was this overview of LGBTQ+ care and gender-affirming practices by this really amazing speaker and we had medical students across Canada attend that event. Another one that’s really popular was an IUD insertion workshop to help medical students understand the experiences that women face when going through IUD placement, and also the different types of contraception available. Another position I did was with the Women’s Health Initiative committee to organize educational events for medical students about specialized healthcare needs. We did an event on reproductive justice and health equity for free prescription contraception, which, as you may know, was something that was legislated this year in British Columbia. So that was really interesting. I also volunteered at Wish and that was really an amazing experience. Wish offers amazing services like an emergency shelter and a nightly drop-in centre. They want to make sure that women have a safe place to rest and access harm-reduction supplies. I’ve learned a lot from that experience as well.

 

What impact do you hope to see with the work that you’re doing?

I hope there is emphasis placed on the importance of highlighting the specific needs of women in healthcare in our medical training. I think there’s not much coverage of very important topics that underscore reproductive and sexual health topics, but also recognize the intersectionality of patients coming from different backgrounds. I think it’s really important to educate medical students so that we can become equipped as physicians who are eventually the ones in positions of power to start filling up the unmet gaps in our healthcare system. To help medical students get those qualities like listening to patient perspectives, and moving away from harmful practices like paternalism. I hope these are some of the things that medical students graduate with so that we can change the healthcare system and the way that women interact with it.

 

Where can people find out more about the work you do?

You can find me on LinkedIn.

 

Behind the Science: Exploring the Intersection of Racial Discrimination and Sexual Pleasure

Interviewee: Charity Mudhikwa, BSc Hons, MSc Student, Simon Fraser University Faculty of Health Sciences, Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: June 9th, 2023

Could you tell us more about your research?

 My research is sort of two-pronged. Firstly, it aims to examine the prevalence of perceived everyday racial discrimination among racialized women in British Columbia. Everyday racial discrimination refers to chronic, routine and relatively minor experiences of unequal treatment such as being followed around in stores and being treated with less courtesy because of your race. These experiences have been shown to be associated with poor health outcomes! And so, the second aim of my research is to evaluate the association between everyday racial discrimination and sexual health— particularly sexual pleasure.

I’ll also be looking to see if HIV status modifies that association since my work is within the BCC3 cohort of women living with and without HIV. I think women living with HIV are generally more aware of their sexuality because of the conversations they have in healthcare settings and with their peers, so we may see differences when comparing women living with and without HIV. 

Ultimately, I’m really interested in examining everyday racial discrimination, the tools used to measure it in health research, and the associations that it may have with sexual pleasure.

What motivated you to look at the intersection between racial discrimination and sexual pleasure in women?

As a racialized woman myself, I always knew what racism was and experienced it in different ways, but I began to understand it more when I moved to Canada because I grew up in Zimbabwe, where my race was not a significant part of my identity. Usually, when we think of racism we think of structural factors, like how racialized communities have lower socioeconomic status or blatant acts like racial slurs. But we don’t think about more minor everyday experiences of racial discrimination, like not being treated well in restaurants. It seems very minute and inconsequential, but it’s cumulative and there is evidence that it does impact health. Also, racialized women are often seen as ‘deviant’ when it comes to sexual behaviour. What about looking at sexual health from a positive lens like pleasure? What about the racial discrimination that women experience? How may it affect women’s opportunities to experience pleasure? 

What are some of your findings so far?

Racialized women, particularly Black and Indigenous women, are reporting significantly higher experiences of everyday racial discrimination compared to White women. When we compare by HIV status across specific groups, for example, Black women living or not living with HIV, there are no significant differences in everyday racial discrimination scores. So, we’re seeing that even after accounting for HIV status or socio-economic factors like income, education, and sexual orientation, racialized women are still experiencing very high levels of everyday racial discrimination. So, it warrants further investigation of how these experiences may be impacting priority health areas for women. 

Who have been some of your mentors in the research field?

I’m very lucky to have had really inspirational and encouraging mentors throughout my academic journey. For my undergraduate honours project, I reached out to Dr. Bob Hogg, and he welcomed me with open arms, helped me figure out a project, and connected me with other mentors such as Dr. Kalysha Closson who has also been supportive. I was grateful to have people who believed in me and encouraged me to pursue opportunities that I otherwise would not have such as working to get my honours work published. Throughout grad school, my supervisor Dr. Angela Kaida has been very instrumental in my journey as a researcher and encourages me to explore the questions that I’m interested in. I think that’s rare, unfortunately, so having supportive people has been incredible. I don’t think I’d be where I am without those mentors. I’m very grateful for them. 

What impact do you hope to see with your research?

Firstly, especially in Canada, I would like to see the recognition that racial discrimination even exists in the first place. Going through the literature, I’ve realized just how much is lacking in a Canadian context. Some people in Canada genuinely deny the existence of racism or racial discrimination, or say ‘But it’s not as bad as it is in the US.’ There’s definitely a need for the Canadian general public to recognize that racism does exist and that it has serious implications for people’s health. And it may have impacts on women’s priority health areas such as sexual health and pleasure. So hopefully the impact that my work will have is to recognize the potential links between racial discrimination and sexual pleasure and to also inspire further research that considers the influence of everyday racial discrimination on other health outcomes.

 Where can people find out more about the great work you do?

You can find out more about it on Twitter at @CharityMudhikwa or @HIV_HEAR_me. You can also find me on the BCC3 Study website. 

 

 

 

 

 

 

 

 

Behind the Science: Investigating Maternal Nutrition and Preeclampsia in Low Income Settings

Interviewee: Maggie Woo Kinshella, PhD candidate, University of British Columbia. Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinator).

Published: December 16th, 2022 

Could you briefly explain what your research is?

My PhD research is looking at the relationship between the food that women eat during pregnancy and our risk of developing preeclampsia, which is a serious condition during pregnancy characterized by high blood pressure in the second half of gestation alongside signs of maternal organ damage, especially in the liver and kidneys. My research is particularly looking at this relationship in Sub-Saharan Africa, where there’s a disproportionate burden of maternal deaths, as well as higher prevalence of malnutrition. 

This work is within the PRECISE Network, which is a large prospective pregnancy cohort in three countries in Sub Saharan Africa, Kenya, The Gambia and Mozambique, to give us an idea of what’s happening in East Africa, West Africa, and South Africa. The overall goal is to do research on placental conditions – including preeclampsia – in Sub-Saharan Africa, as most of the research has been done in high income settings like Canada, the United States, or the UK, where pathways of risk may be different. It’s really trying to look at within these resource limited settings, whether there are different pathways, such as a higher prevalence of malnutrition.

The research uses mixed methods, which I’m super excited about. There’s a quantitative component using the PRECISE Network surveys where they asked women about their medical history and socio-demographics, as well as did a dietary diversity score, which is the number of food groups that the woman eat in the past 24 hours. I’m going to be looking at whether a woman’s dietary diversity is linked to developing pregnancy hypertension.

I also did qualitative community-based research in each of the three countries, it was really neat! I was able to go to the three countries and it was so wonderful to be able to work with the local staff. For over a month in each country, I did focused ethnography, where we did participant observation and shadowed pregnant women and recently-delivered mothers throughout the whole day to understand where they’re getting their food, how they’re cooking it. and how they’re eating it. We also did interviews with women, as well as their male relatives, other female relatives, and community leaders.

Then we did photovoice, which is a really interesting participatory research activity that involves giving cameras to women, and they took pictures of how they made the food, where they got the food from, as well as barriers and facilitators. We then printed out the photos and we had a discussion about them afterwards. 

What led you to become interested in this women’s health issue with the maternal diet and hypertension?

I’m taking a human rights approach to health in my PhD. Really early on, looking at this research, I realized there was a there was a there was a systemic neglect of women’s health within maternal diet research.

The Safe Motherhood Initiative is really momentous in getting people to think more about maternal mortality, because they realized that there was this “measurement trap”. Maternal and child interventions ended up having a bigger benefit on child health and assuming that that would spill over into women’s health. However, that wasn’t reducing maternal mortality rates, because that reducing maternal mortality rates requires explicit interventions on facility maternity care, for example. They call this a “measurement trap” because these indicators of women’s health are systematically neglected. Similarly, nutrition programs are often intervening with pregnant women, and within mothers with small children, but they’re measuring the outcome in child growth. So, you’re intervening with the women, but you’re not measuring the outcomes in women. I think  that is a very systematic neglect and an injustice.

For example, there’s a lot of research out there are multiple micronutrients, so multivitamins, and they never measure preeclampsia as an outcome. They hardly even measure maternal mortality. It’s always low birth weights and other outcomes like that, which I think is a huge missed opportunity to look at some of these maternal indicators.

Why do you think it’s important to study women’s health?

Women are often seen in the lens of reproduction, which can be a big part of identity and things like that. However, it’s looking at women as instrumental that exploits gender norms and stereotypes, rather than being empowering. I think you cannot have community empowerment if women are systematically neglected and you can’t have women’s empowerment without our health and you can’t have health without food. I think looking at food is really fundamental. 

It seems you have been involved in a lot of community work, can you tell us a bit more about what you’ve accomplished outside of academia?

I think it’s really important to ground our academic work in terms of how it’s applied or to have an idea of how things actually are on the ground. I’ve been involved in a small NGO in Western Africa that worked with household health and gender equality projects. We had a program to raise awareness and have a community resource center to prevent sex- and gender-based violence in a small community in Western Kenya. We also had a women’s health education program. With this program, we did some fundraisers that included kayaking from Vancouver up to Alaska to raise money and awareness, as well as we cycled from Vancouver all the way down to Argentina, which was really amazing.

I’ve also spent some time in Ethiopia. I was a volunteer there as a  technical adviser on reproductive, maternal and child health communications and health promotion for the Benishangul Gumuz regional Health Bureau. I was working on was helping them reinvigorate their health promotion and health education program, particularly around understanding perspectives of the major Indigenous groups in the area.

I’ve also done some work in the Downtown Eastside, as a frontline mental health worker in various housing, treatment, and detox facilities, as well as doing community-based research there. I was a freelance research consultant, working with different organizations on issues that came up during clinical work that they wanted some more clarification and understanding about.

What impact do you hope to see with your work years from now?

I’m hoping to be a part of this paradigm shift to value and measure women’s health indicators.I think this neglect is systemic. As people kind of realize that, “Oh, wow. We didn’t measure this before”, hopefully, that builds momentum with more groups measuring it, focusing on it more, and realizing different areas where there might be a systemic neglect.

Overall, I really hope that this research, depending on the findings, is able to speak to the relationships between maternal diet and maternal health and hopefully support meaningful and appropriate prevention and interventions. 

Where can people find out more about your work and what you do?

You can find me on Twitter @MaggieWooK  or on our website. You can also email me at maggie.kinshella@cw.bc.ca

 

How Oppression in Iran Impacts Women’s Health

 

Authors: Shayda Swann, MD/PhD Candidate, University of British Columbia & Bahareh Azadi, Graduate Student, University of British Columbia

Editor: Negin (Events & Communications Specialist), Romina Garcia de leon (Blog Coordinator).

Publication date: Oct 7th, 2022

In light of the recent death of Mahsa Amini, a 22-year-old Iranian woman, while detained by Iran’s “morality police”, we sought to explore and expose the impacts of oppression in Iran on women’s health. While we could consider this issue from many vantages, we focus here on how systemic oppression impacts women’s reproductive and mental health. 

Before delving into the topic, we felt it critical to declare our positionality. Shayda is an Iranian-White MD/PhD student whose research involves women’s sexual and reproductive health. Shayda has never lived in Iran but feels a deep attachment to the country where her family originated and escaped religious persecution as members of the Baha’i Faith. 

Bahareh is an Iranian graduate student and health researcher who lived in Iran until the age of 14 before immigrating with her family to Canada in pursuit of a better future. Since immigrating, Bahareh has frequently visited Iran as a young woman where she has had several encounters with the “morality police” and has experienced first-hand the consequences of the oppressive norms of the regime. 

Impact on women’s sexual and reproductive health

Sexual and reproductive health refers to upholding rights and freedoms concerning body autonomy, reproductive choice, prevention of sexually transmitted infections, menstrual hygiene, and various other aspects of women’s lives.

A 2015 report by Amnesty International points to numerous ways in which oppression in Iran limits women’s sexual/reproductive health. Before 2012, Iran’s Family and Population Planning program met several successes, including reducing the fertility rate from 6.5 to 1.6 births per woman between 1976-2012. This program was cut in 2012, accompanied by statements from high-ranking officials that contraception should only be used with consent from the husband, thus limiting women’s autonomy. These changes, unsurprisingly, were accompanied by an increase in sexually transmitted infections among women, with a 550% increase in the prevalence of HIV from 2007 to 2015. 

In 2021, women’s reproductive choices were further restricted by the “rejuvenation of the population and support of family” bill, which severely limits women’s access to contraception. The bill further mandates the creation of materials that denounce contraception and abortion, while encouraging women to have more children. Policies such as this violate women’s body autonomy and reproductive rights, put them at higher risk for unsafe pregnancy and sexually transmitted infections, and limit their educational and occupational opportunities; therefore, these policies compound the socio-structural barriers faced by Iranian women.

Menstrual education is another important aspect of women’s reproductive health. A 2018 review found “weak knowledge” about reproductive physiology and menstrual health among Iranian girls, attributing this to sociocultural and political barriers that limit reproductive health education. Importantly, one study found that only 26% of adolescent girls report receiving adequate information about puberty.

Another study emphasized how shame and anxiety shape young women’s experience of menstruation in Iran. Shockingly, a study investigating knowledge about menstrual health among girls found that less than half (41.2%) of participants considered menstruation to be a normal physiological process, and only 1.6% had “good knowledge” about menstrual hygiene. These studies underscore a concerning lack of education and understanding of menstruation, which is likely perpetuated by culturally-rooted shame and lack of political will to incorporate this into public education, thus depriving young girls of the necessary information about their bodies.

Women’s reproductive health is further threatened by the country’s marriage laws. The legal age of marriage for girls in Iran is thirteen-years-old, or younger if allowed by the court, compared to age fifteen for boys. Child marriage is not only legal in Iran, but is tacitly encouraged through government loans, with rates of child marriage rising drastically since the introduction of these loans. In the first half of 2021, more than 16,000 Iranian girls between the ages of ten and fourteen were married. This unquestionably leads to younger pregnancy ages – which increases the risk for complications, fetal illness, and maternal mortality – along with violence and reduced educational/employment opportunities. We concur with statements by the United Nations that child marriage is a human rights violation and “can lead to a lifetime of suffering”. These are but a few examples of how oppressive and discriminatory policies threaten the health of Iranian women and girls.

Impact on women’s mental health

Mental health is defined as emotional, psychological, and social well-being. State of mind affects many aspects of life, including how people think, feel, act, deal with adversity, relate to others, and make decisions. Women living in countries affected by war and political instability have a higher risk of developing mental health disorders than men. 

A 2014 study reported that more than 25% (as high as 36% in the capital, Tehran) of Iranian women suffer from mental disorders. Iranian women are particularly vulnerable to experiencing mental health disorders due to social and cultural factors, including being of lower overall social standing, having inferior rights, and being subject to strict laws that dictate their everyday lives. They are treated as ‘second-class’ citizens and live in a patriarchal society with male-dominated attitudes and discriminatory laws that impose restrictions on their rights and personal liberties, such as laws that require women to cover their body with loose-fitting clothing and cover their hair with hijab from the age of nine-years-old. 

This law is enforced by the “morality police” and authorities have long detained, fined, and jailed thousands of women for “improper hijab.” Those who resist detention are brutally beaten. Iranian women are left to constantly assess their performance against gender norms and strict laws; being subject to this constant scrutiny renders them unable to attend to more important issues that affect their lives (Figure 1). 

 

Figure 1: Persepolis by Marjane Satrapi.

Another factor that greatly contributes to the vulnerability of Iranian women to mental health disorders is related to discriminatory labor laws and regulations that limit the financial freedom of women and their participation in the job market. 

The link between financial standing and mental health comes as no surprise. Financial instability is a major cause of stress and contributes to mental health challenges. Women who experience financial instability are at a higher risk for developing mental health disorders, such as anxiety and depression. According to a report released by the Statistical Center of Iran in 2015, although women make up over 50% of university graduates, their participation in the job market is as low as 17%. 

This is a direct consequence of domestic laws that limit women’s access to employment, in addition to placing restrictions on the types of professions that women can participate in. Further, Iranian law grants men the authority to prevent their wives from obtaining employment, and some employers go as far as to require consent from a woman’s husband. Thus, it is not surprising that the chronic exposure of Iranian women to societal pressures and their continued struggle for basic rights places them at higher risk for developing mental health disorders. 

Conclusion

Here, we chose to highlight only two of the many ways that women’s health is jeopardized by oppressive social and political circumstances in Iran. As Iranian women in health research, we felt compelled to highlight these issues, with the hopes of drawing greater awareness to these inequitable and unjust circumstances. We stand in solidarity with the women of Iran as they fight for freedom.

 

Behind the Science: Racializied Women’s Physical Pain Dismissal


Interviewee: Negin Nia, B.A., M.J., University of British Columbia, Author/Editor: Romina Garcia de leon (Blog Co-coordinator).

Published: June 17th, 2022

In this week’s Behind the Science, we highlight work done by our current Blog Co-Coordinator at the Women’s Health Research Cluster (WHRC), Negin Nia. She is a recent Master’s graduate from the UBC School of Journalism who specialized in public health. Negin’s final research project in the program sought to examine the intersection between women’s physical pain, race, and treatment in North America’s hospitals and beyond.

Negin did not only complete a literature review but also released an audio documentary covering the lived experiences of racialized women. Her podcast was recently awarded the 2022 Radio Television Digital News Foundation JJ Richards Award. Read more about her project and the lived experience that drove this work. 

Can you please tell me about the work you have done during your Master of Journalism degree? 

For the last year in my program, I decided to focus my journalism specialization on health reporting. This work was driven by my lived experience but also because I believe health impacts every aspect of our lives. 

I did my final research project, which was a combination of a literature review, and an audio documentary on women’s physical pain, race and treatment. There is a lot of research that shows that women, especially racialized women, experience a heightened degree of discrimination, stigma and dismissal of their physical pain because of stereotypes and biases. This is particularly striking as women already experience more chronic pain than men. 

So, the audio documentary explores the lived experiences of many women, including my own story surrounding physical pain, race and accessing treatment across North America’s health care systems. And then the final literature review was more of a deep dive into why this is happening. It included the research in the statistics, whereas the audio documentary was more testimony with facts — they complement each other well.

What led you to pursue this work in the field of health? 

Back in 2020, I had to undergo open-heart surgery for a benign heart condition that I have had my whole life. The situation caught me by surprise because I was an outwardly healthy, 22-year-old. But I had been having a lot of heart palpitations during that year and the doctors kept telling me it was just my anxiety. 

Finally, I got referred to a cardiologist who took such great care of me and took my pain seriously. He scheduled me for an MRI, which is an uncommon test to run for my condition. Usually, it’s an echo scan. The MRI showed more than the echo scan did, that my heart condition had all of a sudden become severe with no explanation. I underwent surgery as soon as possible. 

That experience was super scary and shocking, but I have come out of it a lot stronger — it taught me so much. And just being in the hospital that week, and talking to other people who have been dealing with chronic health issues, really opened up my eyes to the disproportionate dismissal that women, people of color, and non-binary folk face in the healthcare system. 

Do you incorporate the knowledge you gained from your undergraduate degree into what you do now? 

I did my undergraduate degree at UBC in political science and law, and it taught me how to develop my writing skills. I also focused a lot on health policy during my degree. I originally wanted to become a lawyer, but after I started writing for the school newspaper, I realized that I love writing and journalism. 

That degree equipped me for a lot of what I’m doing now in my work at the WHRC, and it also gave me the skills to pursue my master’s degree and the work that has come from it. 

What are your next steps, and long-term goals? 

I’m very interested in pursuing work that’s meaningful, similar to what I did in my podcast. I enjoyed the aspect of sharing stories and highlighting the voices of marginalized and racialized groups — which is my passion. I think that it’s really important to do something you’re passionate about because it shines through your work. 

I’m also currently working at the Women’s Health Research cluster as a Blog Co-Coordinator, which has been amazing because it’s so enriching. Every week when we post blogs, there’s a new topic and I’m constantly learning about women’s health issues and people doing amazing work in the health field. 

How can people reach you and know more about your work?

My Twitter handle is @_neginnia. My podcast is titled “Let’s Talk About: Women’s Physical Pain, Race & Treatment,” and you can find it on Spotify.

Behind the Science: Helping Individuals with Eating Disorders


Interviewee: Amané Halicki-Asakawa, B.A. | Authors/Editors: Negin Nia & Arrthy Thayaparan (Blog Co-coordinators) 

Published: March 25th, 2022

Editor’s Note: This blog post discusses eating disorders. If you or someone you know is struggling, call 1-866-NEDIC-20 or visit NEDIC.

In this week’s blog series, Behind the Science, we speak to Amané Halicki-Asakawa, a graduate student in clinical psychology at the University of British Columbia Okanagan (UBCO). Amané is working in the women’s health field with the aim of helping folks with eating disorders. Read more to better understand how her project is helping to create  tangible change, and her advice for IBPOC in the field wishing to pursue research. 

Can you please tell us about your research?

I’m primarily interested in service transformation. So, how to create a tangible change for people in the community, particularly those who live in the Okanagan. 

My research is focused on eating disorders and increasing accessibility to eating disorder services, particularly using things like technology and mobile apps. My research is through the Psychopathology Lifespan and Neuropsychology (PLAN) Laboratory at UBCO. Our lab’s primary focus is on neuropsychology and clinical psychology. The research is really broad, it covers things like stroke research, hemispatial neglect, and also a lot of body image and eating disorder research. 

What are you currently working on?

My master’s thesis is focused on adapting a self-help mobile phone app for use within an eating disorder context. The goal is to provide people with eating disorders who are waitlisted for treatment  an interim service while they’re waiting. The pandemic has increased waitlist lengths dramatically, which were already really long prior to COVID, and so eating disorder treatments are very, very inaccessible for a lot of people right now. The aim of that project is to try to make sure that people have some sort of support, so  that they aren’t being forgotten in the system. 

What got you interested in this research? 

As a woman and being subjected to a lot of cultural issues surrounding thin idealization, I was drawn naturally to  eating disorders. They appear a lot in popular culture, and once you dig under the surface a little bit, you realize that there’s so much more going on that drives these disorders. There is a lot of really serious underlying stuff related to emotion, regulation, identity, all sorts of stuff. So, I think learning about the severity, complexity, and the existing treatment gaps made me realize how important they are to study. 

What impact do you hope your research will have in the women’s health field and beyond?

I really want my research to have a tangible outcome. I think that when participants are involved in your research, you’re asking them for something. They are providing their time and sharing  upsetting, really intense things that they’re going through – especially in mental health research. I just want to make sure that the participants in my studies  are able to get something back. Also, we’re in a transforming world, and technology is becoming so much more accessible and mainstream. My hope with projects like this is to show that there can be ways to access and deliver services that aren’t being used right now. I want people to know that these things can actually fill in the gaps and create a bridge so that people can access the treatments that they need.

As a IBPOC in the science field, what advice do you have for future IBPOC academics wanting to pursue a similar path?

It’s really important to find mentorship in people who look like you and who’ve shared your experiences. I think it can be really helpful to seek out mentors, even colleagues and peers. They don’t have to be the highest members of academia, they can even be grad students who are a little bit older than you are, or research assistants at labs doing research that you are interested in. Being a racialized person in academia   can be very isolating, especially as most institutions lack diversity.   Finding those supports and people who can empathize with your experiences and your specific struggles is incredibly helpful. I’ve sought out many mentors in the past who have helped me and continue to help me,  and without their support it would have been a lot harder than it needed to be.

What is the best way for people to learn more about your work?

Feel free to connect with me through Twitter (@amanekha), and check out our lab website to keep up to date with our research.

Behind the Science: How Women are Fighting the Opioid Crisis


Authors: Arrthy Thayaparan and Negin Nia, Women’s Health Blog Coordinators | Interviewee: Dr. Jade Boyd, Ph.D., University of British Columbia

Published: October 29th, 2021

News of the opioid epidemic is constant in Canada. But what’s discussed in the media rarely goes beyond the scope of updated death rates and the repeated calls for life-saving policy change. That’s why advocates and researchers, like Dr. Jade Boyd, are essential to change the mainstream discourse and view of the opioid crisis.

As a research scientist at the British Columbia Centre on Substance Use, Dr. Boyd has worked in Vancouver’s Downtown Eastside and across Canada at the heart of the opioid crisis. She has been observing, speaking to and learning from the very individuals affected by this crisis — trying to come up with a solution.

This month on Behind the Science, Dr. Boyd highlights the challenges faced by women and marginalized individuals in the opioid crisis, and what it’s like to work in the midst of an epidemic.

How did you get into this field?

Originally I was interested in dance, visual arts and media-based work, but was always interested in social justice issues and had a hard time kind of combining my art interest with social justice issues. 

From an arts background, I moved into gender studies and knew that I had a strong interest in looking at the differences that women might experience in the world in relation to men. Also, the inequities that were coming up were always important to me, particularly for marginalized women, Black, Indigenous, women of colour, poor women, and gender diverse, transgender, and non-binary people. 

During my postdoctoral studies, I was doing arts-based research with women who use drugs. There I was looking and trying to do work about resiliency, and some of the amazing things that [women] were managing to do despite all the structural barriers that they’re facing in their everyday lives. And from there, I really enjoyed working with women who use drugs, and I was really lucky to work with community groups that were led by their members.

Now I’ve moved a bit away from the arts and more into health and medicine, and that’s just because of the focus on substance use, which has become a passion of mine. It was always a topic in my family growing up and remains important to me throughout my work. 

Could you highlight some of your most important findings or highlights from your research?

I think one of the basic things that’s important or defines my research is that we want to have equitable, accessible health care and harm reduction that actually meets the needs of people. That’s always what I’m looking to help define. Communities already know what works for them, and what doesn’t. So amplifying their voices to change those policies to better meet their needs drives my research and anything that I’ve done. 

And of course, the other biggest thing is the fact that women, men and gender diverse people experience substance use and health policies quite differently and are impacted differently. Women have to deal with criminalization and stigma, and fears around child apprehension, and racialized and gendered violence in ways that are different from cis men. Even though we already know that it seems like it continues to be siloed or under-recognized. 

My work helps to maintain the importance of seeing what the needs are of those who are underserved because our health policies around harm reduction don’t always take women and gender diverse peoples’ needs into account in a fulsome way. So the work that I did look at women and gender-diverse peoples’ access to overdose prevention sites and other new overdose prevention interventions, I think are some of the highlights.

What impact do you hope to see with your work 10 years from now? And what do you hope to see from policy changes regarding the opioid crisis in the future?

I want to see the end of preventable deaths, so I would hope that 10 years from now we would not be in an overdose crisis. That people have access to the supports that they need in order to live well, and experience not top-down, but community-led efforts. 

I think that part of that is expanding more holistic approaches that are looking at poverty, systemic racism, and criminalization. Indigenous women have very high rates of overdose compared to non-Indigenous women — that are almost equal to men. They’re also over-policed and over-surveilled. So if we don’t address our prohibitionist policies and how they intersect with colonialism and misogyny, the stigma that stems from that, housing and wage inequities, or the extra surveillance of women, then we’re not going to see a lower overdose death rate. 

Ending the criminalization of drug use is key, as it has severe repercussions on the health of women who use drugs. While access to safe, non-toxic pharmaceutical-grade drugs is a step forward, it simply is not enough.

Why is it important to have research looking at both women’s health and substance use?

Substance use and the way we deal with it, and the policies around substance use, impact women’s health. Women are more likely to hide their substance use because they experience a double stigma. 

Both men and women experience stigma related to substances. But women and gender diverse people experience greater stigma because they’re not conforming to gender norms. So poor women who have children are going to experience heightened surveillance by social services, ​​especially if they are Indigenous or a woman of colour. They’re going to experience it by law enforcement and also if they’re experiencing poverty, through housing. So that affects their health in a multitude of ways, and they may be more likely to be criminalized.

If women are more likely to hide their substance use, then they’re also at heightened overdose risk, because they might be using alone without the support of someone to help them reverse an overdose. And if they’re more likely to be second on the needle, because of gendered power dynamics that already exist in our society, that means that they’re more at risk for transmissible diseases. All of those things negatively impact women’s health.

I personally don’t think using substances is a health risk, it’s the policies around it that increase risk. The way our social and structural environment impacts women who use drugs in creating negative outcomes. 

Is there anything else you want to mention? Any inspirations for your work?

Our medical norms and research tend to stem from the male perspective — that’s the kind of society that we live in. As I mentioned, we want to ensure equitable and accessible access to all forms of health care. That’s why it’s important to me to look at diverse women’s needs. Because poor women’s needs are different from middle-class women, and racialized women’s needs are different from women who benefit from white privilege and what is going on there. What are those dynamics? And if we don’t have that kind of equitable access to health care, it doesn’t work if it’s only serving one population.

I’m very influenced by the communities and women that I work with who use drugs. Many of them are engaged in activism if they’re able to, and not everybody is, as it falls on them due to government inaction. Their expertise and knowledge, their hard work, resilience, and perseverance in the context of ongoing and constant systemic, and structural barriers that they experience — it’s very inspiring. 

Early on when I was doing a project with some women who use drugs, they documented what they do in their everyday lives, and all that they were doing. Many had to travel daily to obtain their drugs, on top of all the activist work they were doing while caring for people in their community, while also navigating poisoned drug supplies and income generation. They had this added work to deal with. Doing that work on resilience has been really important to me, but at the same time, many women that I’ve worked with over the years have passed away — it’s heartbreaking. Many of these deaths were preventable because they are the result of our flawed drug policy and ongoing structural violence. And in the midst of all that, people are persevering and doing this hard work to save lives.