Tag Archive for: women’s health

Beyond the Focal Points of Endometriosis and Chronic Pelvic Pain

Author: Danielle Perro, BMSc, PhD | Editors: Romina Garcia de leon, Shayda Swann (Blog Coordinators) 

Published: September 15th, 2023

*This article represents Danielle Perro’s views and not necessarily those of her employer.

Endometriosis is a chronic inflammatory condition characterized by the growth of tissue similar to the lining of the uterus found elsewhere within the body. Though typically such tissue is found within the pelvis, it has been found in many extra-pelvic sites. It is known to impact as many as one in ten women worldwide, and though data on the experience of endometriosis in transgender men, gender diverse and non-binary folks are more limited, they too experience the condition—this represents a hugely important area of ongoing/future research. 

Similar to endometriosis, chronic pelvic pain (CPP) is highly prevalent in women, affecting as many as one in four women of reproductive age. Furthermore, females living with either endometriosis or CPP experience similarly significant physical and mental health symptoms which impact their ability to go about their day-day life. According to the Royal College of Obstetricians and Gynaecologists, CPP is defined as ‘intermittent or constant pain in the lower abdomen or pelvis of a woman of at least 6 months in duration, not occurring exclusively with menstruation or intercourse, and not associated with pregnancy’. Endometriosis and CPP share many similarities, not only in their burden and commonality, but also in how they are managed. Unfortunately, in both cases, the treatments which are targeted at the pelvis or primary disease site are often ineffective or require a lot of trial and error to arrive at a suitable option. Examining years of work into endometriosis, CPP and other localised pain conditions (like migraine and low back pain), it’s important to shift the way we think about endometriosis and CPP by looking a step beyond the pelvis at whole body pain symptoms and their implications. Similar to the MaPP research group’s work on CPP, women with CPP and endometriosis have been shown to commonly experience pain outside of the pelvis, and with an increased number of regions affected by pain, there is a strong association with worse mental health and quality of life.  

Shifting the dial away from the pelvis

Endometriosis has long been described as a gynaecological condition, given that many do experience symptoms related to the pelvis and reproduction. In addition to CPP, people with endometriosis experience pain associated with their periods and/or pain during or after sex, as well as infertility. However, a recent genetic study has demonstrated that endometriosis-related symptoms are far more complex than being just a pelvic-condition. This study showed that endometriosis is genetically linked to inflammatory conditions like asthma, as well as body-wide pain symptoms, like migraine, back pain, and multi-site chronic pain (pain all over the body). Endometriosis is associated with systemic symptoms, so why do we still ascribe a gynaecological label, rather than calling it a systemic condition? Leaders in the field have put forward a strong case for considering endometriosis as a systemic disease. More work remains to be done to understand what the public health implications, and impact on individual care, of doing so would be. 

Reconsidering our current understanding of endometriosis

Earlier this year, I attended and contributed to the Reframing Endometriosis: Power, Politics and Potential Futures conference in Birmingham, UK. This conference was the first to truly bridge the biomedical and social science research divides, whilst creating a platform for people with lived experience of endometriosis and pain to equally contribute to the panels their own experiences with the condition. Similar questions to the ones above were raised, about why we still consider endometriosis to be a ‘gynaecological condition’, when so many experience system-wide symptoms. Everyone in attendance, myself included, was confronted with moments of discomfort, as our current understandings of endometriosis were challenged. It’s become clear that in order to move the endometriosis field forward and evolve both our definition of the condition and effective treatments, we need to continue breaking down barriers between stakeholder siloes. When I envision the future of endometriosis research, I envision one which strives for personalised medicine. To achieve this, we need to consider the entire person with endometriosis and CPP, as with these conditions there is often more than meets the eye.

To learn more about this work, follow Danielle Perro on Twitter. 

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.

 

Thinking About Egg Freezing? Here are Some Things to Consider

Authors: Maryam Fatima, BHSc (Hons) & Samantha Yee, PhD, MSW | Editors: Romina Garcia de leon, Shayda Swann (Blog Coordinators) 

Published: July 14, 2023

What is Planned Egg Freezing?

Planned egg freezing, also known as social or elective egg freezing, involves administering fertility drugs and using assisted reproductive technologies to retrieve and cryopreserve eggs for future use. It is an elective medical procedure utilized by women without an imminent fertility threat (e.g., cancer treatment), to preserve healthy eggs before age-related fertility decline. Elective egg freezing is an expensive uninsured medical procedure ranging from $12,000 to $15,000 CAD, although some of the costs may be covered by insurance plans. Since the American Society of Reproductive Medicine (ASRM) declared egg freezing an established clinical procedure in 2012, electively cryopreserving eggs has gained popularity. Additionally, the social distancing measures implemented during the COVID-19 pandemic presented a unique circumstance in which single women had limited opportunities for dating, prompting more women interested in preserving eggs proactively as evidenced by a drastic increase in planned egg-freezing cycles at fertility centers during the pandemic. 

Why Do Women Pursue Planned Egg Freezing?

The current societal shifts and increased accessibility to contraceptives have contributed to a trend of delayed parenthood in developed countries. In Canada, a woman’s average age at first birth has increased steadily since the 1970s, from around 24 years to 31 years in 2021. However, fertility and egg quality decline drastically beginning around the mid-30s, leading to heightened interest in cryopreserving eggs to prevent future unintended childlessness or smaller-than-desired family size due to secondary infertility. Contrary to popular belief, research has shown that career development is not the primary reason women want to freeze eggs. Instead, other factors play significant roles, such as the absence of a committed partner to start a family, being in an unstable relationship, wanting a backup plan against age-related fertility decline, alleviating the pressure of the “biological clock”, and avoiding future regret for not making use of available cryopreservation technology. 

Why Are Women Late to Planned Egg Freezing?

A Canadian study conducted at an in-vitro fertilization (IVF) centre found that women underwent planned egg freezing at a mean age of 37, and four in five only completed one egg freezing cycle. This is problematic as the highest likelihood of live birth is when egg-freezing is performed before age 35. Since eggs cryopreserved after this age have much lower quality, older women are often recommended to freeze more eggs by undergoing more freezing cycles. An alternative for older single women is to cryopreserve embryos using donor sperm, as frozen embryos have a higher success rate than frozen eggs. An estimation prediction model suggested that at age 34, one would need to freeze 10 eggs to have a 75% likelihood of at least one live birth, and the projection increases to 20 eggs for 37 years and 61 eggs for 42 years. It is plausible that women may be waiting until they reach mid-35 before considering egg freezing. Affordability is another main reason why this uninsured procedure is out of reach for some women.

A lack of knowledge regarding fertility decline also leads to delayed planned egg freezing. A survey conducted by a Canadian IVF center reported that almost half of the respondents felt inadequately educated on fertility decline before pursuing planned egg-freezing, and only half could correctly identify the age range where fertility decline begins. Concerningly, 37% of respondents obtained egg freezing information from mass media, while only 12% received education from their primary healthcare practitioners.  Some practitioners hesitate to initiate the planned egg freezing conversation with their healthy patients due to insufficient knowledge or feeling skeptical of the procedure’s success. Furthermore, if family planning is not included in the annual checkup discussion, patients are left unaware of their fertility options. Canadian ethicists have also raised concerns about the invasive nature of the procedure, although it is no less risky than patients undergoing IVF. There is also a lack of established studies about the long-term safety of offspring. The procedure may be unnecessary for older women whose egg quality has already been compromised, or if cryopreserved eggs end up unutilized. Most importantly, planned egg freezing may offer women false security about their fertility since there is no guarantee of a successful live birth from cryopreserved eggs. Studies have indeed reported low utilization rates of cryopreserved eggs, from 2.3 – 20.9%, but the follow-up period was often a short 2 years, and it is likely that most women were still attempting to establish a stable relationship or conceive naturally during this time.

The decision to pursue planned egg freezing is highly individualized and influenced by various factors.  By improving communication between practitioners and patients on fertility and family planning matters, enhancing counselling, and providing accessible information, women can make informed decisions about their reproductive futures and avoid future regret. 

 

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.

Spot the Difference: Menopause or Endometrial Cancer?

Author: Malak Ibrahim, MSc Student in the Department of Obstetrics and Gynecology, University of British Columbia | Editors: Romina Garcia de leon, Shayda Swann (Blog Coordinators) 

Published: July 21, 2023

All women* and individuals with a uterus will inevitably experience menopause during their lifetime; however, the stigma around menstruation, aging, and women’s health makes it difficult to have open conversations about menopause. Almost half of women in Canada feel unprepared for perimenopause and menopause, and 54% believe the topic is still taboo.

“Menopause is seen as something women must endure, like a woman’s burden.” 

– Dr. Wendy Wolfman, MD, FRCS(C), FACOG, NCMP, President of the Menopause Society of Canada

Menopause is defined as the time period after a woman has gone 12 consecutive months without menstruating. The time period leading up to menopause when women experience a range of symptoms is called perimenopause. During perimenopause, women may experience changes in their menstruation, hot flashes, sleep disruptions, cold sweats, depression, and many more symptoms. There are more than 30 symptoms that can occur as a result of hormonal changes during perimenopause, and although many women are aware of a few common symptoms such as hot flashes and night sweats, awareness of other symptoms such as depression and anxiety remain low. 

So how does this relate to endometrial cancer? Endometrial cancer occurs in the inner lining of the uterus, called the endometrium. It is the most common type of uterine cancer and the most commonly diagnosed gynecologic cancer in the developed world. Unlike most cancers, the number of new endometrial cancer cases continues to rise each year. Endometrial cancer incidence increases by almost 2% each year in women under 50 years old, and 1% in women over 50 years of age. For most patients diagnosed with endometrial cancer, abnormal uterine bleeding is the first noticeable symptom. Abnormal uterine bleeding is defined as any bleeding or spotting during menopause, or any unpredictable pre-menopausal vaginal bleeding such as changes in regularity, frequency, volume, or duration. Even though abnormal uterine bleeding can prompt earlier detection of endometrial cancer, it is not specific to endometrial cancer and can indicate a number of gynecologic conditions. Up to 30% of women will experience abnormal uterine bleeding in their life, and it is especially common during perimenopause. Almost half of women experiencing abnormal uterine bleeding will delay or not seek medical care, resulting in a delayed diagnosis or leaving the underlying cause undiagnosed. 

Because changes in menstruation are very common and normal during perimenopause, it can be difficult to differentiate between what is regular reproductive aging and early signs of endometrial cancer. So how can you tell the difference between perimenopausal changes in menstruation, and abnormal uterine bleeding that may indicate endometrial cancer? Unfortunately, there is no way to determine if changes in menstruation are associated with perimenopause or more serious pathologies without an endometrial biopsy. However, by raising awareness of both endometrial cancer and menopause, women can be empowered to better understand their health and identify which symptoms of concern need medical attention based on their personal risk of developing cancer. Some risk factors for uterine cancer are obesity, age, diabetes, estrogen only hormone replacement therapy, and genetic predisposition. Open conversation about menstruation and menopause with family, friends, and most importantly, healthcare providers is needed. Women who have an increased risk of uterine cancer should be especially aware of abnormal uterine bleeding and engage in conversation with their health care providers as soon as possible if they experience any unusual uterine bleeding. 

To learn more about symptoms and risk factors of uterine cancer, visit UBC’s own Uterine Health Research Lab website and follow us on social media! 

The Uterine Health Research Lab is currently conducting the RESToRE Study to assess the feasibility and acceptability of early cancer screening and prevention methods. We are recruiting postmenopausal people with a uterus to fill out a risk questionnaire – those who are found to have increased risk factors will be invited to continue in further aspects of the study. For more information or to participate in the RESToRE Study, please click here. 

Facebook: Uterine Health Research Lab

Instagram: @uterinehealth

Twitter: @uterinehealth 

Website: uterinehealth.ca

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. 

 

 

 

 

 

 

 

 

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. 

 

COVID-19 Vaccine Safety in Pregnancy

Authors: Sue Lu, BSc student in Integrated Science at the University of British Columbia and Research Assistant at the Vaccine Evaluation Centre; Manish Sadarangani, MRCPCH, DPHIL, BM.BCh, MA, Director of the Vaccine Evaluation Center at BC Children’s Hospital and Associate Professor in the Department of Pediatrics at the University of British Columbia Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: April 21st, 2023

The COVID-19 pandemic has disproportionately impacted pregnant people. If a pregnant person is infected with SARS-CoV-2, the virus that causes COVID-19, they are at a higher risk of severe disease, hospitalization, intensive care unit admission, and death. COVID-19 infection in pregnant people can also cause poor pregnancy outcomes, such as preterm birth and impaired fetal growth. As found by UBC researchers through the CANCOVID-Preg surveillance program, even cases of mild COVID-19 infection not requiring hospitalization were significantly associated with a higher risk of preterm birth.  In short, COVID-19 is not only threatening to the mother, but to the unborn child as well. 

What did we know about the safety of COVID-19 vaccines in pregnancy?

COVID-19 vaccines have been available in Canada since December 2020. Experts recommended COVID-19 vaccines during pregnancy based on smaller studies of other mRNA vaccines in pregnancy and several decades of administering vaccines in pregnancy. Unfortunately, despite the continued recommendations from experts to get vaccinated, many pregnant people remained hesitant about the COVID-19 vaccines. In fact, recent studies suggest that 49% of pregnant women were accepting of COVID-19 vaccines. 

How did we conduct this study?

This study was conducted through the Canadian National Vaccine Safety (CANVAS) Network. The CANVAS Network is a national research platform that monitors the safety of vaccines, including COVID-19 vaccines, in Canada. This study, led by Dr. Manish Sadarangani, looked at the frequency and nature of severe health events following vaccination in pregnant people. Severe health events, as defined by this study and other CANVAS Network studies, are issues that arise following vaccination that are severe enough to prevent people from going to work or school, or required medical attention.

At the time this study was conducted, over 700,000 total participants and 5,500 pregnant individuals had enrolled from seven provinces and territories across Canada. We looked at female participants of reproductive age and compared how pregnant people reacted to their first and second doses of the COVID-19 vaccines in unvaccinated pregnant people and vaccinated non-pregnant people. 

Overall, this CANVAS Network study allowed us to better understand COVID-19 vaccine safety by looking at changes to health after vaccination for pregnant people and comparing their changes to those of similar vaccinated and unvaccinated groups. 

What did we learn? 

Our study’s findings confirmed that COVID-19 mRNA vaccines are safe to use in pregnancy. Additionally, other studies show them to be both effective and immunogenic, meaning they can protect both the mother and the child from COVID-19 infection. Here are three of our major safety findings: 

  1. COVID-19 mRNA vaccine reaction differences between pregnant and non-pregnant individuals: When we compared pregnant and non-pregnant vaccinated individuals, we found that pregnant people experienced fewer symptoms that prevented daily activities, prevented work, or required a medical visit than non-pregnant people. 
  2. COVID-19 mRNA vaccine reaction differences between vaccinated and unvaccinated pregnant individuals: There was no difference in hospitalization or pregnancy-related complications in these two groups, suggesting that vaccination did not have negative impacts on pregnancy. 
  3. Moderna vaccine: After a second dose of the Moderna mRNA vaccine, vaccinated pregnant people reported more symptoms than unvaccinated pregnant people, but reported similar symptoms to vaccinated non-pregnant people. Vaccinated pregnant people and unvaccinated pregnant people were also more likely to seek care for these symptoms than vaccinated non-pregnant people.

Overall, mRNA vaccines are safe and effective in pregnancy. As this study shows, getting vaccinated against COVID-19 does not increase the risk of miscarriages or other pregnancy complications. 

How can you use this information?

If you’re a health care worker, we hope that this study will provide some insight into the common symptoms that pregnant people may experience after vaccination. Common symptoms following vaccination include redness and pain at the injection site, fatigue, muscle aches, and headaches. This information, from Canada’s top vaccine researchers, can also be used to counter misinformation about vaccines that pregnant people may have encountered.

You can read a full summary of the study here, or check out the full context in the published journal article here. 

The bottom line? Get vaccinated against COVID-19 and protect yourself (and your child)!

 

Behind the Science: Improving the Health of Women Living with HIV

Interviewees: Tetiana Povshedna, PhD Student (University of British Columbia Department of Pathology and Laboratory Medicine); Marie-Soleil Smith, PhD Candidate (University of British Columbia Department of Pathology and Laboratory Medicine)  Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: March 10th, 2023

Could you briefly explain what your research is about?

Tetiana: My research is part of The British Columbia CARMA-CHIWOS Collaboration (BCC3) Study, which seeks to better understand the process of aging among women living with HIV by examining the interplay between biological, clinical, and socio-structural determinants of health. In my thesis, I examine the associations between latent viral infections, inflammation, markers of cellular aging, and risk of comorbidities in women living with HIV. My work also explores chronic pain, which is often referred to as an “invisible disability” by community members due to its negative effects on all aspects of life and, in the context of HIV, treatment adherence and care. By raising awareness of this important comorbidity, we hope to improve chronic pain care for women living with HIV.

Marie-Soleil: My field of study lies at the cross-section of women’s health, HIV research, and the safety of medications taken while pregnant. My main project utilizes human embryonic stem cells as a model of an early developing embryo to find the safest antiretroviral regimens for use during pregnancy.

What led you to become interested in studying HIV and women’s health?

Tetiana: Historically, the majority of HIV research has involved men, thus limiting generalizability of findings to women, who constitute >50% of people living with HIV globally. The specific needs of half of the population of people living with HIV haven’t been addressed for years, and it’s only been changing recently. After my initial interest in HIV and aging, I was lucky to join the Côté Lab and get involved with community-based women-centered research. We have an amazing team of scientists, clinicians, and community members working together to answer women-specific questions in a meaningful way. 

Marie-Soleil: My interest in HIV research stemmed from my time at the BC Centre for Disease Control working as a co-op student. During my time there, my eyes were opened to the wide world of infectious disease research, particularly the more classically stigmatized sexually transmitted infections. I was energized by my brief stint in the field and was so grateful to find an opportunity to continue this important research in Dr. Côté’s lab. Although it was not intentional, I am very lucky to have landed in a lab that puts a major emphasis on women’s health research. This is especially true as women are now disproportionately affected by HIV.

Could you talk more about why clinical and cellular research are important?

Tetiana: It takes decades of diligent basic science research to advance a field to the point when the results are tangible in a clinical setting. While my work involves human specimens and survey data, a lot of other researchers in Côté Lab work with cellular models. Both types of work provide valuable data that can often guide clinical decision-making to improve quality of life for people living with HIV. 

What does your typical day look like?

Marie-Soleil: My days vary greatly depending on upcoming deadlines and whether I have ongoing cell culture experiments. If I do not have any experiments, I spend my day on the computer analyzing data, reading papers, and working on manuscripts. Experiment days vary widely depending on if it is a day where I am starting up the experiment, a maintenance day where I change the cell culture media, or a big analysis day where I harvest and prep the cells for subsequent flow cytometry. The cell culture experiments I conduct require daily lab work, so I try my best to spread my other work out throughout the week in an attempt to avoid burnout.

What impact do you hope to see from your work in the future? 

Tetiana: A powerful message coming from the community of people living with HIV is “Nothing about us without us is for us”. I hope that research projects that meaningfully involve community, such as BCC3, will address the true needs of the people we’re trying to serve. Ultimately, I hope that our study findings will improve care and everyday life for women living and aging with HIV, and also affect the way the research is conducted in this field. 

Marie-Soleil: My research provides information on the relative toxicity of antiretrovirals in an in vitro model, which may help inform and guide future human trials and strategies for the treatment of HIV in women of reproductive age. I would like to highlight the importance of utilizing relevant preclinical models and including people who become pregnant in clinical trials that assess medications that will undoubtedly be taken during pregnancy. Ultimately, I hope there is a future where all women have access to medications with sufficient pregnancy safety data.

Where can people find out more about your work? 

Tetiana: You can learn more about the BCC3 study on our website.

Marie-Soleil: @MarieSunSmith on Twitter

 

Behind the Science: Empowering Women Through Maternal Health Research In Iran


Interviewee: Madelyn Sedehi, Bachelor of Science (Midwifery)  Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinator).

Published: February 10, 2023

Could you please tell us more about the work that you’ve done in women’s health in Iran?

I was educated and worked as a midwife on a multidisciplinary maternity ward at a Golestan Province Hospital, affiliated with the Golestan University of Medical Sciences. I worked in different parts of a maternity ward, including the admission and labour and delivery rooms, and also as a unit manager in the women’s ward. Following that, I worked at a congenital anomaly research centre with a team of gynecologists, pediatricians, and a genetic specialist. We collaborated together to find many different risk factors that may be involved in the development of birth defects. The purpose of our work was to determine how to have a healthy pregnancy and to evaluate how these risk factors are affecting pregnancy outcomes in our area. Some of the areas we worked on were maternal nutrition, pregnancy complications, mortality and morbidity in newborns, maternal knowledge of pregnancy –  especially in youth and young women who were pregnant. We also studied nutrient absorption and even underlying diseases like diabetes or gestational diabetes, as well as conducted experimental research at the university. We’ve published nine articles from this research, three of which I was the first author.

It sounds like you were looking at many different factors in your work. Can you tell us more about that? 

Yes, we worked in a very wide field by working with many different specialists and especially by having an affiliation with the university. We were able to gather and collect data from all over the province to generate a data bank about birth defects, studying related and unrelated factors in our area. 

What led you to become interested in maternal and child health?

I would say it was working as a midwife and being involved with pregnant mothers in many complicated cases, especially the ones who were very young when they got pregnant, based on the culture and traditions in our country, to elevate their level of knowledge toward themselves to be more healthy. I was, and I am, and I always will be passionate about women’s health in the different parts of their life. Women have a very significant role in society, in the family, and for themselves. Being able to educate them as much as we can and give them a chance to know about their body and how they can take care of themselves at different stages of their life is amazing. That’s going to have many different benefits for their family, for themselves, for society, for the government – and, I believe, for everyone. And it starts with research. That’s why it’s great that research opens a gate to accomplish these advancements in different areas of human health and well-being.  

Now that you’re in Canada, what kind of research are you interested in?

I’m very much a newcomer! I would really love to get connected with research here, especially in midwifery, and different areas of pregnancy health and outcomes. However, I’m open to pursuing research related to different areas of women’s health, such as depression, maternity care, vaccination, and even psychology. When you have love, passion, hard work, and organization, you can do well as a researcher. When I first started, I didn’t have any experience as a researcher so I learned by myself, and then the university reached out to me and they wanted me to do more. I believe if you love your job and do your best, that keeps you going. Then, you can help other people gain knowledge and skills. I’m very interested in being connected to the research field here! 

Madelyn Sedehi is currently looking to be involved in women’s health research in Vancouver. If you are interested in contacting Madelyn to join your research team, please reach out to her at ml7.sedehi@gmail.com