Tag Archive for: health equity

Addressing Stigma and Inequities in Postpartum Urinary Incontinence Research

Interviewee: Jordyn Cox, Masters Student, University of Alberta | Authors/Editors: Romina Garcia de leon, Janielle Richards (Blog Co-coordinators)

Published: January 24th, 2025

 

Can you tell us a bit about your research? 

Currently, I am focusing on stigma and the lived experiences associated with postpartum urinary incontinence (PUI), and how it impacts health-seeking behaviors, such as seeking healthcare provider support, physical activity, and accessing social support. PUI is the unintentional leaking of urine that can happen after giving birth due to weakened pelvic floor muscles or other changes from pregnancy and childbirth. This condition affects approximately 33% of postpartum women, but it remains highly stigmatized and is rarely discussed, leading to many mothers feeling isolated and ashamed which leads to a lack of accessing care. Despite its prevalence, PUI has a significant impact on mental health and quality of life, yet research addressing its stigma and the barriers it creates—especially for racially diverse populations—remains limited. A key focus of my work is exploring whether racially diverse individuals face unique barriers or experiences compared to their White counterparts. By documenting the lived experiences of diverse populations through interviews, my research seeks to generate actionable, person-informed recommendations for healthcare professionals to mitigate stigma, improve patient-provider relationships, and enhance access to supportive care for all postpartum individuals in Canada.

 

How do you conduct these qualitative measures in your work? 

I have partnered with a local hospital with a group of urogynecologists there to gain feedback throughout the studies process, and through recruitment, I’ve been working with them to target marginalized populations. I also work with a local Edmonton group called the Multicultural Health Brokers which caters their services to immigrant populations and marginalized voices in the community. I’ve been doing a lot of my recruitment through those avenues to try and increase the population to not just be the typical White middle-class-educated groups we see in most research. I have finished recruitment for this study and was able to have my sample come from six different racial backgrounds and a majority identifying as non-White which was a big win for me in terms of the objectives of this study.

 

How did you get interested in your research? 

My interest in women’s health began when I was a child and watched the TV show A Baby Story on TLC which followed mothers throughout their pregnancies and then documented the labour and deliveries of their babies. This show sparked my interest in pregnancy and childbirth. This early interest evolved into a passion as I pursued academic opportunities in pregnancy research during my undergraduate studies, and it has grown from there. As a Black woman, I’ve also witnessed the privilege I hold in accessing certain spaces, and I feel a responsibility to amplify the voices of marginalized individuals who face additional barriers. Women’s health conditions often carry significant stigma, and I feel driven to address these inequities, particularly by examining the experiences of those who are underrepresented in research. Through my work, I hope to shed light on these issues and contribute to creating more equitable healthcare practices.

 

What is the impact you hope to see with your work? 

I hope I can contribute to breaking the stigma surrounding PUI specifically, and making sure it becomes a normalized topic of discussion in healthcare and society. I want to address the stigma-related barriers that prevent people from accessing care, also by highlighting the unique experiences of racially diverse individuals. I wish to inform inclusive healthcare practices across different populations. Ultimately, my goal is to empower women with the knowledge and resources they need, ensuring no one feels shame due to conditions like PUI. In the future, I plan to collaborate with hospitals in my community to build connections between clinical work and research.

I’m starting my PhD soon, where I plan to shift my focus to weight stigma during pregnancy. Specifically, I aim to explore how weight stigma and its internalization affect stress and behavioral outcomes like physical activity during pregnancy. This work will also investigate how these experiences change throughout pregnancy and how factors such as migration status, socioeconomic background, and minority gender identities intersect with weight stigma. Given the significant role of maternal stress and behavior in pregnancy outcomes, this research is a natural extension of my commitment to addressing stigma in women’s health.

 

Where can people learn more about your work?

Learning From Experiences, Adherence, (preconception) Pregnancy (postpartum), Stigma Lab Website (Jordyn’s lab) 

Lab Instagram: @leappps

X account: @jordynncox

Linkedin

A Look Into RE-IMAGYN BC: Improving How We Measure Gender and Relationship Equity

Authors: Yas Botelho (they/them) Youth Research Associate, Faculty of Health Sciences Simon Fraser University and Harman Grewal (she/her), Research Assistant, Faculty of Health Sciences Simon Fraser University | Editors: Romina Garcia de leon, Janielle Richards  (Blog Coordinators) | Expert Reviewer: Lindsey Thurston 

Published: August 16th, 2024

Our intimate relationships are meaningful social determinants of health. Lack of gender equity in relationships can lead to intimate partner violence, exposure to sexually transmitted infections, and unwanted pregnancies. Because of these potential health outcomes, it’s important to: a) measure relationship equity effectively and b) ensure that our measurements encompass diverse relationship structures and populations. However, the scales currently used to measure gender-based power dynamics within intimate relationships were designed solely with cisgender, heterosexual, white, and monogamous married women in mind.

The failure of these measurements to represent the needs of youth became evident in Dr. Kalysha Closson’s work evaluating the effectiveness of the Sexual Relationship and Power Scale (SRPS) with young people in South Africa. The SRPS measures controlling behaviour and decision-making dominance of male partners in intimate relationships. In the study, it was revealed that participants had challenges with comprehension of the SRPS questions resulting in multiple interpretations of questions and overall, a lack of applicability to young people’s lives. These findings demonstrate a need for a more inclusive and contemporary measurement of gender and relationship equity.  

Intimate partner violence occurs in all settings and socio-economic backgrounds, yet research has shown that certain groups of people are at greater risk of intimate partner violence including: young women, young disabled women, Indigenous women, non-binary youth, and lesbian, gay, and bisexual people. Therefore, there is a great need for more accurate measurements of relationship equity to best support programming for those at risk.   

That’s where our study comes in: the Relationship Equity and Intersectional Measurement Among Gender-inclusive YouNg people in British Columbia (RE-IMAGYN BC) is looking to create a more inclusive and comprehensive gender and relationship equity measurement scale through a youth-led and community-based approach that is “informed by the lived and living experiences of queer and trans youth”. 

In practice, this means putting together a team of youth who belong to the study population of interest (queer, trans, gender diverse, and non-monogamous youth between the ages of 16 and 29 years in BC) to co-lead every aspect of the study as Youth Research Associates (YRAs) or through our Youth Advisory Committee (YAC). 

The YRAs are embedded in RE-IMAGYN’s day-to-day research activities as they check in with one another, as well as the other study members on a bi-weekly basis. Additionally, they support the facilitation of the YAC, collect data, and assist with data analysis and knowledge mobilization activities. They are compensated $50 for every cognitive interview they complete and $25/hour for all other study-related activities. 

In comparison to the YRAs, the YAC plays an overarching advisory role. They participate in discussions about study methods, data analysis, and knowledge mobilization in 2-hour meetings that take place every 4 to 6 weeks. When new youths join the YAC, they are compensated $50 for reviewing various onboarding materials and then $50 for every meeting they attend and complete the associated pre-work for.  

Central to our youth-engaged approach is allowing the youth to show up in this work in the best way that works for them. Some examples of this are: offering tailored research training so that the youth feel empowered to lead the study, and using methods of communication that are more accessible to the youth, such as Discord and text as opposed to email.  

The success of RE-IMAGYN is contingent upon the relationships we have with these youths, as well as our community collaborators. We encourage the youth to bring their whole selves, meaning their identities, experiences, stories, and worldviews, to everything that we do. The goal is to collectively ground our work in relationality to disrupt power imbalances that exist between researchers and community, making room for shared decision-making that makes for more equitable and, in turn, better research.  

To stay up-to-date with our study, please follow us on Instagram @reimagyn.

 

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: Maternal Health in Ethiopia

Interviewee: Abera Kenay Tura, PhD, Assistant Professor of Maternal and Child Health at Haramaya University, Ethiopia; Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: September 29, 2023

Could you tell us more about your research?

I’m leading a research team working on surveillance of severe maternal morbidity and deaths. We recently established a research platform called the Ethiopian Obstetric Surveillance System (EthOSS), where we are registering cases of women having complications like hemorrhage, hypertensive disorders of pregnancy, and severe anemia as well as sepsis. These are the major conditions that lead to deaths of women in Ethiopia and we are not only registering these conditions but also establishing a Confidential Enquiry into Maternal Deaths Committee in collaboration with the University of Oxford that will review cases of women who died from complications in pregnancy and childbirth. These committee members, trained by experts from the University of Oxford and EthOSS investigators will review thoroughly the cases of women to identify why a woman died and then make recommendations for improving care of women. As part of this work, we are also collaborating with countries with similar systems, including Canada. You might be aware that there is a Canadian Obstetric Surveillance System where they are also registering maternal mortality and severe maternal morbidity cases. 

What led you to this field of research and what made you want to study maternal health outcomes?

As someone who is from a low-income country, it’s common to hear about deaths of women or women having severe complications during pregnancy, childbirth, or the postpartum period. Pregnancy and childbirth are normal physiologic processes and it’s a period of joy and celebration for many, but for women who are living in low-resource countries, like ours, it is a period of worry and concern. For example, the risk of death would be high for pregnant women in countries like ours. In order to at least contribute some to this problem, I want to have studies like this. And of course, this was started when I applied for my PhD study on maternal health programs. As a country, it makes sense to study this so that lessons can be learned for improving care of women so that pregnancy and childbirth would be a time of joy and celebration as many others have elsewhere.

Are there any interesting findings from your research that you’d like to share?

We know why women are dying. In many low-resource countries, we say that women are dying from bleeding, hypertensive disorders of pregnancy, or severe infections/sepsis. But what we learned from our confidential inquiry into maternal death is beyond this. It’s true that women who died had bleeding for example or she might have had hypertensive disorders of pregnancy, but the main underlying cause, as has been indicated by the review of the committee, is our health systems’ failure in responding to women who have such complications. If the health system was ready to respond to women’s needs, we could have saved many women. In 9 out of 10 deaths that we have reviewed, there have been delays in helping the women get the appropriate care on time. These delays could happen at what we call “delay one”, which is the delay in recognizing that the woman is in danger, or “delay two” which is the failure of women to reach appropriate facilities on time. And “delay three” is delay in getting the appropriate care after reaching facilities. In many of the cases, even women who reached facilities didn’t get the appropriate care as compared to the national guidelines or the international best practices. We learned that almost all deaths were preventable if the health system was ready to respond to the women’s complications on time.

We have seen, for example, problems with triaging, meaning when transferring women from lower to higher facilities, there are delays in making decisions. Facilities should know what they can do and what they can’t do so that a woman can be transferred to the appropriate facilities where she can get care. But at the same time, we also learned that there are screening issues for women with medical problems who didn’t know that they are pregnant or didn’t know that they have these underlying medical complications, which might make the pregnancy more prone to complications. 

What impact do you hope to see with your work?

We are working with a network of other countries under the auspices of the International Network of Obstetric Survey Systems (INOSS), where I’m the vice chair for Africa, that have already shown that it’s possible to reduce maternal mortality, especially through using this system of obstetric surveillance and confidential enquiry of maternal deaths. From our piloting so far in eastern Ethiopia, we learned that it’s possible to change the system in responding to the tragic loss of women. I want to scale up this to a national program and want to see that our intervention would save more lives in the future like it’s doing in other countries, including yours.

You can find out more about Abra’s work at: 

Pub Med, Linkedin, Researchgate, or contact him by e-mail: daberaf@gmail.com

Behind the Science: Stroke and Health Inequities in Women

Interviewee: Ismália De Sousa, PhD Candidate, Registered Nurse, University of British Columbia, School of Nursing. Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: August 4th, 2023

Could you tell us more about your research?

My Ph.D. research is a two-phase project. The first part is a literature review of health inequities in stroke care. The second phase is a qualitative study exploring the experiences of young women with stroke history in British Columbia, with an equity-oriented lens. In particular, I am interested in how intersecting systems of structured inequity (e.g., racism, sexism, and other isms) influence their experiences accessing healthcare. 

What drove you to study the experience of stroke in young women?

I’ve been a registered nurse for 14 years. In my career as a registered nurse, I specialized in stroke care. For this reason, I have developed a clear understanding of the complexities of the care of stroke survivors. There have been significant advances in stroke care but in the last 20 years, the focus has been on the acute stroke phase (those immediate hours to days after the stroke) and not so much on the rehabilitation and recovery phase. This poses a gap in stroke research. Another component is that people often think strokes occur only in older people, but this is not true. Stroke rates are increasing among younger people. Moreover, there are sex and gender differences in the incidence of stroke and stroke outcomes. For example, pregnancy and menopause confer a higher risk of stroke and women have greater disability and poorer health-related quality of life. And all of this can be exacerbated by health inequities, the unjust, unfair, and avoidable health differences. So we really need to know better the experiences of young women who have had a stroke, how these health inequities manifest in their experiences during stroke rehabilitation and recovery, access to healthcare, and so forth.

What impact do you hope to see with this work? 

I really hope that my findings can influence health policy or can inform health policy and clinical practices and the development of equitable practices in stroke care in British Columbia. I also think that this work can inform national strategies and resource allocation for neurorehabilitation. The Heart and Stroke Foundation of Canada has a big emphasis on women’s health and the invisible and inequitable effects on women (and I would recommend reading their recent report). And the World Health Organization (WHO) recently released a position paper asking countries to prioritize brain health and reduce the stigma, impact, and burden of neurological disorders, since strokes are a neurological condition with significant burden for stroke survivors, their families, and caregivers.

Are there other projects you are currently working on? 

Another project I worked on looks at the History of Black nurses in British Columbia, between 1845 and 1910. This is important because we need to reflect on the invisibility of Blackness and Black nurses in British Columbia but also to understand how some of our current-day issues, such as the lack of representation of Black nurses in senior leadership positions, can be linked to historical events such as colonialism and chattel slavery and the ideas and thinking that shaped that period in our history. This work is about what has happened in the past, and how it has a trickle-down effect on where we are today. The specific time that I looked at, an important historical juncture for nursing, was the beginning of the professionalization of nursing, with the development of nursing schools. This meant that to be a nurse you needed to be trained within a nursing school, but not everyone could be a nurse. Because of the ideas that were prevalent during chattel slavery and colonialism, Black people were continuously stereotyped as less intelligent and lazy, and I think this then has a trickle effect in preventing Black nurses from being accepted into nursing schools.

I’ve also recently conducted research looking at student nurses’ perceptions of educational strategies that promote critical awareness and engagement with social justice. Promoting health equity is a professional mandate in nursing, but how do we enact a social justice pedagogy in the classrooms? Together with faculty in the UBC School of Nursing, I interviewed nursing students to understand how they see social justice and what educational strategies should be used or have been used that promote critical awareness and engagement with social justice and positively influence their professional practice as registered nurses. We are yet to publish the findings of this work.

Where can people learn more about your work? 

Find more about what I do on my website where you can see my publications and other projects I’m working on. Find Ismália on Twitter at @Ismalia_S.

An Honest Look into Sex & Gender Health Research in Canada

Authors: Tori N.Stranges, MPK, B.Kin, PhD Student | Editors: Romina Garcia de leon, Shayda Swann  (Blog Coordinators) 

Published: May 19th, 2023

It is well understood that sex and gender impacts individual and population health across the lifespan. It is also well understood that marginalized and systemically oppressed groups including women—particularly women of color, Indigenous women, disabled women, and immigrant women, as well as members of the Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, and Asexual (2S/LGBTQIA+) community—face health disparities when accessing health care in Canada. Differences exist in disease manifestation, diagnosis time, misdiagnosis, treatment efficacy, and progression of disease resulting in devastating health effects in these populations.

These disparities can be partially attributed to the lack of funding for women’s and 2S/LGBTQIA+ specific health. Studying sex and gender influences is only one step in understanding why health disparities exist across sex or gender. Gender identity and sexual orientation are also key considerations for health research from a health equity lens. The large knowledge gaps in the health of these populations has prompted the Canadian Institutes of Health Research (CIHR) to mandate the incorporation of sex and gender into research. First by recommending the inclusion of Sex and Gender-based Analysis (SGBA) in project proposals in 2010 and then by mandating the incorporation of SGBA into grant proposals in 2019.

A group of recent grads and current grad students (including Tori Stranges, Amanda Namchuk & Tallinn Splinter) were curious how these changes in SGBA resulted in increased mention of sex or gender in funded research proposals. With the leadership of Dr. Liisa Galea and the Women’s Health Research Cluster (WHRC), we searched the publicly available database of grant abstracts funded by CIHR. We analyzed the amount of funded research that mentioned sex or gender in the abstract as well as funded grant abstracts that mentioned either female-specific health research or research within the 2S/LGBTQIA+ community. 

In total, we reviewed 8,964 Project and Operating grant abstracts awarded from 2009-2020. We found that under 3% of research funded by CIHR explicitly mentioned SGBA, with 1.94% of grants mentioning sex, and 0.66% mentioning gender within their abstracts. As one of the goals of SGBA is to inform on health equity and understudied populations with respect to SGBA, we also found that 5.92% investigated female-specific outcomes, and 0.35% focused on the 2S/LGBTQIA+ community. 

So, what does this all really mean? Our findings suggest more work needs to be done to increase researcher utilization of SGBA as well as to advance health equity in research. It is important to highlight that much of the existing work in this field has unfortunately been focused on binary understandings of sex and gender. Looking beyond this narrow focus allows for a more nuanced understanding of complex issues that include multiple perspectives. Although our understanding of the need for, and recognition of, SGBA in research may be improving, it has yet to be translated into increased research focus and funding. The research community needs to acknowledge that for publications, clinical trials, and grant funding applications, SGBA has not been fully realized despite numerous attempts to support its integration.

So, where does this leave us? The hope of SGBA is that widespread adoption of its principles will result in an equitable future for health where female-specific health, 2S/LGBTQIA+ health, racialized, disabled and gendered experiences, and more are considered. Together we have the power to improve health and reduce disparities, one SGBA at a time.

 

Figure 1: An infographic depicting the change in percentage of grants and funding between 2009 and 2020 for awarded Canadian institutes of Health Research (CIHR) grants for the different categories. The change in percentage (%) of grants (A) and funding amount (B) in the years 2009 and 2020 that “omitted” mention of sex and gender in their grant abstracts or mentioned female-specific health, female-specific health not including cancer based grants, sex, gender, or 2S/LGBTQIA+ health. Reprinted with permission from Stranges et al. 2023

Key Takeaways:

  • The percentage of funded grants in which the abstracts mentioned sex or gender in health research remained largely unchanged from 2009 to 2020 with the largest increase of 1.57% for those mentioning sex.
  • Total funding amounts for grants that mentioned sex or gender in the abstract stagnated or declined from 2009 to 2020.
  • The percentage of funded grants in which the abstracts focusing on female-specific health did not change across 2009-2020, but the percentage of funding dollars increased by 3.47%.
  • The percentage of grants in which the abstracts mentioned 2S/LGBTQIA+-specific health more than tripled across 2009-2020 but remained less than 1% of all funded grants. 

 

How Can Canada Improve Access to Abortion Care?

Author: Martha Paynter, RN PhD, Assistant Professor in The Faculty of Nursing at the University of New Brunswick

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

Published: March 24, 2023

As an abortion care provider in Canada, I feel deep solidarity with colleagues south of the border and terror for their patients after the U.S. Supreme Court overturned Roe v. Wade, the 1973 ruling that the U.S. Constitution afforded protection to the right to abortion. Individual states now may ban abortion outright — and several already have.

Abortion care affirms the dignity and autonomy of patients and translates into not only physical and mental health but also opportunity for education, employment, safety from violence, and parenting wanted children.

Providers and policymakers in Canada can and must respond to U.S. abortion bans by expanding access to care here.

In Canada, abortion is completely decriminalized and, as health care, is no more governed by criminal law than knee surgery or intravenous antibiotics. There are no legal limits on gestational age,  mandatory waiting periods, or  requirements that youth seek parental consent.

Abortion in Canada is publicly funded like most medical services, with a few exceptions. And since 2017, all primary care providers, including family physicians and nurse practitioners, have been authorized (except in Québec) to prescribe mifepristone for medication abortion, which is drug-induced rather than surgical.

Because abortion case is not governed by law in Canada, politicians cannot lobby for reforms to limit access. There is no law that providers must tiptoe around to avoid prosecution.

In the past seven years, logistical access to abortion in Canada has improved significantly:

Even COVID-19 protections resulted in care expansion: as providers became more familiar with telemedicine, many felt comfortable moving to “no touch” or “low touch” medication abortion prescribing, without requiring blood work or ultrasound.

Because pandemic inter-provincial travel restrictions limited the ability to refer patients elsewhere if they were past local gestational age caps, hospitals in several provinces made the necessary infrastructural and training adjustments to extend the gestational ages to which they would provide care.

But serious limits on abortion access in Canada remain. This is a huge country, and people living in rural, remote and underserved areas face enormous travel burdens to access care.

These burdens are greatest for people facing poverty, intimate partner violence and racism from the health-care system. And access challenges may be greater if we suddenly see an influx of demand from U.S. patients.

Because health care is administered at the provincial/territorial level, access and medical practices among the provinces/territories vary widely, and unjustly. This is the case for all kinds of health care — but abortion is basic and common care, not neurosurgery.

Consider how there are 49 (surgical) abortion sites in Québec — by far the highest number of access points — but Québec has the lowest rate of uptake of abortion medication because of rigid requirements about prescribing authority. Meanwhile, although there is only one surgical abortion site in P.E.I., where more than half of abortions are through medication.

In Newfoundland, 95 per cent of (publicly funded) surgical abortion takes place at the freestanding family practice clinic, Athena. Yet New Brunswick has kept a perverse piece of legislation on the books for decades, 84-20 Schedule 2 a.1 of the Medical Services Payment Act, denying public insurance for surgical abortion outside of a hospital building.

One in three people in Canada with a uterus will have an abortion in their lifetime. The arrangements for care should not be so convoluted and unequal.

There will undoubtedly be escalating rhetoric from anti-choice politicians in the wake of the fall of Roe. Now is the time to leap forward in terms of access. Health-care providers, policymakers, activists and everyone in Canada can channel our horror into meaningful and specific actions to enthusiastically expand abortion services.

  1. We need to ensure all medical and nursing schools include robust abortion components in their curricula to increase provider knowledge, competence and confidence with abortion care and reduce geographic disparities.
  2. Nurse practitioners and midwives should be authorized not only to prescribe abortion medication but to perform aspiration (surgical) abortion. Québec must get on board with welcoming primary care providers as medication abortion prescribers.
  3. We should nurture abortion provider networks for mentorship and support, to improve confident uptake of no-touch mifepristone prescribing and availability of abortion in rural, remote and underserved communities.
  4. We must have universal coverage for contraception for everyone, and explore offering contraception and mifepristone over the counter, as we do with Plan B.
  5. We must make sure every person understands how abortion care works here, normalize it as a health service, and resist any attempt to bind it up in a law that could someday be altered or taken away.

Poverty, stigma, racism and gender violence are barriers to abortion in Canada. If we are worried about threats to access, these are what we need to fight.

This article was originally published on Impact Ethics and has been republished here with permission from the author.

Same Disease, Different Risks & Symptoms: Cardiovascular Disease in Women

Authors: Nabilah Gulamhusein: Libin Cardiovascular Institute & Cumming School of Medicine, University of Calgary; Elaha Niazi: Libin Cardiovascular Institute & Cumming School of Medicine, University of Calgary; Smriti Juriasingani: Cumming School of Medicine, University of Calgary 

Editors: Romina Garcia de leon & Shayda Swann (Blog Co-coordinators).

 

Cardiovascular disease is the leading cause of death among women worldwide, and in fact, women are more likely to die from a heart attack than men. This often surprises women and their care providers because cardiovascular disease has traditionally been considered a male-dominated disease. Deaths due to cardiovascular disease have declined in the last 50 years in men, but have risen in women, especially in younger women. It is increasingly apparent that there are both sex-based (related to biological attributes) and gender-based (related to socially constructed identities, expression, roles, and behaviors) differences in cardiovascular risk factors, as well as the development and progression of cardiovascular diseases. Though we have made great gains in improving men’s heart health, women remain under-researched, under-diagnosed, under-treated, and under-supported; consequently, many women are unaware of their cardiovascular disease risk. 

 

Though many consider cardiovascular disease only a disease of older women, it affects women at all life stages. Reproductive-aged women have been developing increasingly disadvantageous cardiovascular disease risk profiles, including obesity, physical inactivity, an unhealthy diet, and stress; these factors appear to have a larger impact on women than men. While these are certainly important considerations in cardiovascular disease risk for young women, it is time to adopt a broader understanding of female-specific risk factors.

 

In addition to traditional risk factors, female-specific and female-predominant factors contribute to cardiovascular risk. Conditions related to fertility, such as polycystic ovarian syndrome and menstrual irregularities, have been associated with an increased cardiovascular disease risk. In addition, certain pregnancy complications can increase heart disease risk, including gestational hypertension and diabetes. It is critical that women have the opportunity for informed discussions with healthcare providers to mitigate reproductive and pregnancy-related risks. There is also a multitude of medical conditions disproportionately impacting women that result in increased cardiovascular risk. These include depression, diabetes, hypertension, autoimmune diseases, and chronic kidney disease. Awareness of these important female-specific and female-predominant risk factors can empower women in making heart-healthy choices. 

 

There is no question, however, that as a woman ages, cardiovascular risk increases considerably due to changes in the heart and blood vessels. The timing of the onset of menopause, as well as perimenopause (when the transition to menopause begins, but before a final menstrual period), may influence a woman’s cardiovascular risk. Premature menopause (before age 40) and early menopause (before age 45) are significantly associated with increased cardiovascular risk. Additionally, cardiovascular disease risk commonly increases after menopause, which is attributed to changes in hormone levels (e.g., estrogens).

 

Early heart attack symptoms are missed in more than 50% of women and therefore, it is important to recognize that women may have different symptoms compared to men during a heart attack. While women experience symptoms such as sharp chest pain, they may also have aching sensations across the back and stomach, pain in the jaw, neck or arm, shortness of breath, abnormally excessive sweating, nausea, indigestion, and extreme fatigue. Unlike men, women are more likely to present with three or more symptoms in addition to chest pain when having a heart attack. Being informed and spreading the word about heart disease symptoms in women is the first step towards protecting the women in our lives. 

 

Knowing that women have unique cardiovascular risk factors and subtle symptoms can be overwhelming, however, heart disease is largely preventable. First, following Canada’s 24-hour movement guidelines, including getting 150 minutes of moderate to vigorous physical activity per week, reducing sedentary time, and getting enough good quality sleep is recommended for a healthy lifestyle. Research shows that consuming 7-10 servings of fruits and vegetables every day, while limiting processed foods, sugar and salt are key ways to reduce cardiovascular risk. It is also important for women to have regular check-ups with their healthcare providers and take their medications as prescribed. Finally, living free from commercial tobacco and vaping while reducing alcohol intake and actively managing stress can also be beneficial.  

 

To learn about women’s cardiovascular health, including risk factors, symptoms, treatment, and support, you can participate in Wear Red Canada or visit WearRedCanada.ca! Wear Red Canada is run by volunteers across the country, including healthcare providers, scientists, and people with lived experience. Wear Red Canada Day is celebrated annually on February 13th to raise awareness about women’s heart and vascular health. Each year, you are invited to attend presentations by leading experts, join the Wear Red Canada Movement Challenge, and visit local landmarks that will light up RED in support of women’s heart health. On February 13, wear RED and join us on social media to share selfies or pictures of your participation in these events with the hashtag #HerHeartMatters and tag @WearRedCanada to share this important message. By starting conversations about women’s cardiovascular health and getting informed, we can increase awareness and improve the health of the women in our lives.

 

 

 

 

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.