Tag Archive for: health policy

Ensuring Medical Research Accounts for Sex and Gender: The MESSAGE Project

Authors: Marina Politis, The George Institute for Global Health UK and Newcastle University; Alice Witt, The George Institute for Global Health UK; Kate Womersley, The George Institute for Global Health UK, Imperial College London and NHS Lothian | Editors: Romina Garcia de leon, Janielle Richards (Blog Co-Coordinators) | Expert Reviewer: Dr. Liisa Galea

Published: December 13th, 2024

From the girl who doesn’t receive an ADHD diagnosis, but instead is labelled an anxious daydreamer, to the trans woman who faces dire outcomes following a heart attack and is not counted by clinical trials, to the man with depression who is less likely to reach out for help, neglecting sex and gender negatively harms us all. 

Why Sex and Gender Matter in Research

What springs to mind when asked about the factors influencing our health? Socioeconomic status, lifestyle factors such as smoking or alcohol use, and genetic risk are all variables that are ingrained in the public’s, clinicians’ and researchers’ consciousness as crucial considerations. Sex and gender, despite being fundamental to us all, remain neglected across medical research, with over five times more male than female cells and animals used in preclinical research and only 20% of participants being women in phase I clinical trials.

The MESSAGE Project 

Enter the MESSAGE (Medical Science Sex & Gender Equity) project, a UK initiative aiming to ensure that biomedical and healthcare researchers incorporate sex and gender considerations at every stage of their research project. Unlike sex and gender policies that have been designed and implemented by individual funders in the US and Canada, MESSAGE brings together the wider UK research sector – from government organizations to charitable funders to ensure change doesn’t happen in silos. 

As a sector, MESSAGE stakeholders have created a policy framework, designed as a template, that can be adopted as is or adapted based on the individual needs of research funders to enable tangible action across the research pipeline. Adoption of policies based on this framework will mean that any researcher applying for funding will need to state in their application how they plan to account for sex and gender dimensions.  This would bring sex and gender dimensions to the forefront of researchers’ thinking right from the outset of the study design. 

The Policy Lab Process

The MESSAGE project has been structured around four Policy Labs and consists of collaborative workshops which bring together diverse stakeholders to tackle the specific challenges related to integrating sex and gender considerations into research. The first Policy Lab focused on: articulating a vision for sex and gender policy change, emphasizing a lack of awareness about the relevance of sex and gender in medical research, recruitment challenges and the challenges surrounding inflammatory public and political discourse, for example inappropriately essentializing sex. Subsequent labs focused on refining the policy framework, implementation strategies and developing a five-year roadmap for sector-wide change.

The MESSAGE Policy Framework

The MESSAGE policy framework requires researchers to justify four key aspects to account for sex and gender: sex and/or gender characteristics, target distribution of participants in terms of sex/gender, strategies for recruitment and retention and the sex and/or gender distribution in secondary data from original datasets. Researchers must also detail any planned sex/gender disaggregated analyses or justify their absence. Researchers are not expected to have sample sizes powered for statistically significant results for each sex or gender group, but they should consider how sex and gender may impact study outcomes and report on these dimensions transparently. 

The policy also aims to address gaps in medical evidence regarding trans, non-binary, and intersex individuals, encouraging their inclusion and outlining recruitment strategies. Reporting data, even in small numbers, can facilitate meta-analyses and novel conclusions. 

International Collaboration & Global Standards

MESSAGE is not working in isolation, and is informed by a precedent of robust sex and gender policies set by other nations, notably the Canadian Institutes for Health Research (CIHR) (2010), the National Institute for Health (NIH) in the United States (2016) and countries in the European Union under Horizon (2016). 

These policies are not merely documents resigned to paper as recent evaluations demonstrate that sex and gender policies are a critical first step to enacting change. A 10-year evaluation of the effect of the CIHR policy on proposed studies for research funding found a four-fold increase in the number of studies accounting for sex, and a three-fold increase in studies accounting for gender. Even here, it is important to highlight that when analysis moved beyond mandatory boxes, which is where we may see tokenism, to published abstracts, only a small 2% mention sex or gender, with no huge increase in reporting of sex or gender in Canadian funded research and the same is true of NIH funding. Evidently, more work is needed in this space.

A Call to Action

All of us, whatever role we have in the research pipeline – bench scientist, trialist, statistician, person with lived experience, participant, clinician – can change the norms surrounding sex and gender considerations in our work. From funders, who can update funding application systems to reflect sex and gender principles to leaders in higher education who can reflect on the research culture they create and  embed sex and gender principles into curricula. Researchers can also critically review literature, interpret the research they read and incorporate sex and gender considerations into their own projects from initial methodology to final reporting.

As MESSAGE concludes its first project, the resulting policy framework sets a new standard for medical research, ensuring that sex and gender considerations are no longer an afterthought but a core component of scientific inquiry.

Empowering Change: Celebrating the International Day of Action for Women’s Health

Authors: Tanvi Puri, PhD Candidate, University of British Columbia & Bonnie Lee, PhD Candidate, University of British Columbia/CAMH | Editor: Romina Garcia de leon (blog coordinator)

Published: May 28th, 2024

The International Day of Action for Women is celebrated annually on May 28, and is dedicated to raising awareness of and advocating for women’s health and rights. This day was first observed in 1987, and aims to advocate for women’s reproductive rights, highlight healthcare disparities faced by women, raise awareness about gender-based violence, and promote sexual health and rights. 

One of our key missions at the WHRC is to advocate for the improvement of women+’s health research and policy. Members of the WHRC have dedicated their time and expertise to advocating for women’s health by testifying before the Canadian Parliament (more details linked below). Several Cluster members were invited by the House of Commons’ Standing Committee on Health to appear as part of a panel of witnesses in view of its study of women’s health, with a focus on mental health. Dr. Liisa Galea highlighted the importance of recognizing the importance of studying female-specific factors affecting health, and recognizing sex differences in medical research to ensure tailored and effective healthcare treatments. Dr. Catriona Hippman called for increased awareness and access to genetic screening and counseling services, particularly for individuals with a family history or disease risk. Dr. Tina Montreuil spoke about the urgent need to increase support and resources for perinatal mental health services, and the significant impact of mood disorders and anxiety during pregnancy and the postpartum period. Their testimonies emphasize the breadth and urgency of critical issues facing women’s health. You can view the meeting details and video recordings here for April 11 (Dr. Liisa Galea) and here April 8 (Drs. Catriona Hippman and Tina Montreuil).

One of our Senior Cluster Leads, Dr. Liisa Galea, and Cluster members Dr. Laura Gravelsins and Tallinn Splinter, also submitted a policy brief to the House of Commons highlighting the chronic underfunding and undervaluation of women’s health research on behalf of the WHRC and Centre for Addiction and Mental Health. They note that although women live longer than men, they do so with more chronic diseases and mental health conditions, and points out that the lack of effective research on women’s health variables leads to delayed diagnoses and suboptimal treatments for women. They call for dedicated funding, specialized peer review committee, and mandatory training in sex and gender-based analysis to bridge the knowledge gap and improve health outcomes for everyone. In addition to advocating for women’s health research to parliament, the WHRC supports and showcases the publication of scientific peer reviewed articles as well as other knowledge mobilization initiatives. A recently published article about the disparity in women’s health research funding can be found here and Dr. Liisa Galea’s op-ed in the Toronto Star can be found here. 

Dr. Wendy Norman, another member of the WHRC, has contributed extensively to sexual and reproductive health research and policy. She plays an important role in leading public health initiatives and using evidence-based practices that work to enhance access to contraceptives and abortion, and development of reproductive rights, particularly in underserved and rural communities. Dr. Norman is also involved with the education and training of healthcare providers, and her research findings have informed healthcare practices worldwide. Initiatives like those led by Dr. Norman have informed policy decisions and paved the way for the recent momentous decision for the federal  government to make contraceptives free across Canada in 2024.

Small individual actions by community members can snowball and make a significant impact! Here are a few things you could do to make a meaningful contribution to advancing women’s health: 

  • Advocate for policy change by signing local petitions, writing to your MLA, or vote in support of research funding, improved maternal and fetal healthcare, and increased access to reproductive health services. 
  • Volunteer to participate in research studies, or share calls that others might be able to participate in that you don’t qualify for. 
  • Share information about women’s health issues on social media, or participate in community events and awareness campaigns.
  • Support and donate to women’s health organizations such as the Women’s Health Research Institute, Planned Parenthood, or local women’s clinics.

There is a desperate need to grow the discipline of women’s health research to overcome the concerning gaps in knowledge that jeopardize women’s health. Please donate today to catalyze women’s health research worldwide. Your gift will support:  

  • Publications, education and academic opportunities that will enable groundbreaking knowledge translation to help transform women’s health on a global scale
  • Vital advocacy efforts to change the policies and practices that are impeding women’s health research

Happy International Day of Action for Women’s Health 2024

May 28 is International Day of Action for Womens’ Health. This day was first observed in 1987, and aims to advocate for women’s reproductive rights, highlight healthcare disparities faced by women, raise awareness about gender-based violence, and promote sexual health and rights. 

The Women’s Health Research Cluster is committed to empowering and advancing women’s health research. To honor the International Day of Action for Women’s Health, we are celebrating the strides the Cluster and its members have taken to advocate for the funding, prioritization, and advancement of women’s health research. Small actions together can make a significant difference by raising awareness and driving policy changes, and we encourage individuals from all walks of life to make their own meaningful contributions to this movement! 

Learn more about our advocacy work and find ideas on how you can get involved in our blog post.

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.

Behind the Science with Eunice Bawafaa

Authors: Arrthy Thayaparan and Alex Lukey (Blog Coordinators) Interviewing: Eunice Bawafaa, RN, MSTTI, MScN, Phd Student, UBC

Published: May 7th, 2021

Our next installment of the Behind the Science features Eunice Bawafaa. Not only is Eunice a talented PhD student, but she is also a registered nurse passionate about improving the health of women in Sub-Saharan Africa.

Eunice “sat down” with Alex over zoom from her home in Ghana to talk about her research journey.

How did you become interested in the work you’re currently doing?

I have worked for the past twelve years as a registered nurse in Ghana. In my capacity as an RN, I have worked in several health facilities in different units and also at a policy implementation level at the municipal health directorate as the PMTCT/ HIV, pregnancy school and health promotion coordinator in the La-Nkwantanang Madina Municipal Health Directorate in Accra, Ghana.

So I have been working with women at different stages of their health in materially under-resourced facilities in Ghana. Working in materially under-resourced health facilities in Ghana, I have witnessed firsthand, the devastating effect of poverty in women’s health. Poverty, race and gender affect the ways in which particular groups of women are constructed and treated in the healthcare sector.  Generally, however, women’s knowledge and experiences of and with maternity and child-care in Sub-Saharan Africa are usually discounted in the face of western biomedical practices and knowledge. As a practicing nurse, I have been struck and dismayed at the lack of acknowledgement or recognition of women’s own knowledge with regards to maternity and childcare but such knowledge, in the context of Ghana is considered ‘traditional and backward’.I have been particularly interested in understanding how gendered and racialized constructions of women and particularly rural and poor women, impact the quality of their interaction with healthcare personnel and probably the type of treatment they receive. So these questions, I felt would be better answered through research. There is an impact to be made on the health of these women by giving them a voice because working with them, one thing I’ve noticed is that they actually don’t have a voice in their own health.

So you’re doing your PhD right now?

Yes, I’m in my second year in the health equity stream. I am currently looking at the perception of reproductive health access for rural Ghanian women. My mentor and supervisor is Dr. Suzanne H. Campbell. Her work centers around transformational leadership in simulation and lactation, and she also happens to be a member of the Women’s Health Research Cluster here in UBC. She introduced me to this cluster and the lactation lab, which have both enhanced my research. I think there’s a lot that we can do for women if we try to solve health problems with evidence from research. We can make a lot of positive changes on what is impacting women’s health.

How would you explain your research in simple terms?

My area of research has to do with rural women who are at an age when they might be starting a family. During these ages, these women have the ability to decide when and how they choose to go to the hospital for services to help them achieve this goal. Sometimes, the society they live in makes it difficult for them to make this important decision. They may even have the money to go to the hospital for the services, but there might be pressure from their community that might change this decision. So in my research, I want to know about this moment when they want to access these services. I want to know about the possible challenges that they are facing in getting these services concerning childbirth and their well-being. Therefore, the purpose of this research is to contribute to finding solutions to problems that women face when going to the hospital for services that can help them choose when and if they want to have children. This will help make the rural women healthier and happier.

What makes you excited about the future of women’s health research? 

What makes me excited is working with top researchers, including my supervisors, Dr. Suzanne H. Campbell and Dr. Alison Phinney who are both changing lives with the wonderful works that they are doing. They are both excellent role models and they are contributing significantly and  impacting health outcomes for women, their families and the larger society. There are also a number of excellent role models in the Women’s Health Research Cluster here at UBC who are making a very significant impact in changing policies and impacting health outcomes for women. As the years go by, more research is being conducted and sponsored for women’s health and that tells us the future is promising for women’s health. Clusters such as the women health research institute here in UBC is training and mentoring more researchers in women’s health and that is one of the many steps that the cluster has taken in ensuring that issues of women’s health are made known to the rest of the world and that something is done about it. There are also a number of good grants that specifically sponsor research for women’s health and that shows that other stakeholders in health are coming to the negotiating table on women’s health. In the end, there will be enough evidence from these researches to change or amend or implement policies that will improve upon the health of women globally. There’s a light at the end of the tunnel and it is so exciting; for instance, in my case, I came to Canada (UBC) from Ghana and I am working in partnership with other health stakeholders so that I could make an impact back home in Ghana. I feel excited because I think we are making progress and I am happy to be a part of this progress in health research.

Looking back on your journey, are there things you wish you would have known when you were just starting as a women’s health researcher?

Yes! From my own experience, people to mentor you is very important. Also, getting involved in organizations like the Women’s Health Cluster are all helpful ways of staying tuned and abreast with issues around us. When I actually started my academic career, I was always more interested in the practical side rather than the other aspects, that is, teaching, administration and research. But then, as I became more grounded in the principles and theories behind my practice that I love so much, I realized that without research, the practice setting would not be improved and we cannot explain or substantiate what we do in the practical field. Research may look tedious, but that is actually how we find solutions to bigger problems. I would encourage anyone who has the love for research to go for it and never look back.

Any last thoughts that you would like to leave us with?

Women are the bedrock of society. Because of this, the health of women is actually the health of society and more attention should be paid on issues of women’s health.