ADVANCING PRIMARY CARE: MODELS OF WOMAN-CENTRED CARE IN CANADA Madeline Boscoe National Primary Health Care Conference

1. ADVANCING PRIMARY CARE: MODELS OF WOMAN-CENTRED CARE IN CANADA Madeline Boscoe National Primary Health Care Conference May 18, 2004 Winnipeg

2. Context • Women are the major users and providers of care • Contribution of the Women’s Health Movement • Women are a focus of public health campaigns – prenatal care, screening • There is opportunity in change

3. Women’s Movement and the Women’s Health Movement • redefining health and relationship with health care providers • Redefining health and health issues

4. Context

5. Context • Many examples: women’s health collectives, programs, research and analysis • Commitment to gender based analysis at the international, national and regional levels

6. Examples A Framework for Women Centred Health Vancouver / Richmond Health Board June 2001 www.vcn.bc.ca/vrhb/ Women's_Health%20Plan.htm

8. Consists of 12 elements • The need for respect and safety • The importance of empowering women • Involvement and participation of women • Collaborative and inclusive work environments

9. Consists of 12 elements • Women’s patterns or preferences in obtaining health care • Women’s forms of communication and interaction • The need for information • Women’s decision-making processes

10. Consists of 12 elements • A gender-inclusive approach to data • Gendered research and evaluation • Gender-sensitive training • Social justice concerns addressed

11. In application: • Many examples of programs and service • Example of Women’s Health Clinic here in Winnipeg

12. Community health centre model • based on the principles of feminism, equity and diversity, promoting the health and well-being of women. • to facilitate empowerment, choice and action.

13. Approach • Woman-Centered Services • Develop A Partnership Between The Woman And Care Provider • Priority Populations and programs • Recognition of inequities in power status – class, racism

14. Healthy Public Policy Counseling Information • Research- Prairie Center • Policy Analysis & Development • Networks/Public Meetings • Women, Income and Health • Women & Health Reform • New Reproductive & Genetic Technological Network e.g. – disordered eating and weight preoccupation • Past abuse • Stress and self care issues • Teen program e.g. – Resource Centre • Info Packages • information requests • Info Sheets/Kits • Newsletter • Phone Triage Circle of Services Empowerment • Individual (skill development, knowledge • Group (self help, action) • Community Liaison/Collaboration with other services and sectors Support Groups Input to WHC Programs Outreach Professional and Community & Self Help Groups Multiple points of entry • Client Surveys, Program Evaluations • Membership in Women’s Health Clinic • Participation on Committees and Board • Advisory Committee • Volunteering • Mothers • weight/body image • Catching Our Breath – tobacco and women • Endometriosis • Breast implants • Motherhood Stress • Weight Preoccupation • Growing Older, Healthy Aging • Menopause, Tobacco and women • Well women care Women encouraged to access information services Most appropriate care provide and service System Change • Reframing health issues • Demonstration of best practices & gender sensitive services • Research & issue identification • Policy analysis & development • Community education • Stakeholder working groups Peer Programs Professional Consultation/Counseling* Medical Care • volunteer based • Birth Control/Unplanned Pregnancy Program • Teen Clinic • Community Education Program • schools, community • Nurse practitioners • MDs- on salary • Midwives • Dietitian • Health Educators • Counseling • Reproductive Health program • Birth Control & Unplanned Pregnancy • Pregnancy and Birth- including Home • Teen Clinic • consultations • Primary Care Note: The services noted above are intended to provide examples and are not an exhaustive listing of WHC services. 2004

15. Approach • Health Promotion, Prevention And Healthy Public Policy strategies • Women only staff and space • Most Appropriate Caregiver And Services • access through a variety of avenues and routes of entry • education, support through groups or individual counseling, medical treatments, health screening, advocacy, community action.

16. Approach • Empowerment • enhance the understanding, self-care, self-help and self-advocacy abilities of women • Structure of the Clinic • participatory management • Board and advisory committees • Client feedback

17. Approach • Use Of Peer Volunteers • modeling self-help skills, demystifying medical information • Community Involvement - Networks, coalitions • Innovative Programs • new understandings of women’s needs and issues

18. Staffing: over 40 • Physicians – on salary , medical assists • Nurse practitioners, dietician • Health educators, advocacy coordinator • Counsellors • Midwives • Unpaid staff - community education and BCUP

19. Healthy Public Policy Advocacy for System Change Why is this important for women? • ‘Socio-economic status and other structural factors (ie. family structure, age and social support) are more important to women’s health status than lifestyle factors (ie. smoking, alcohol consumption and physical activity)’ • Gender differences in structural and behavioural determinants of health: an analysis of the social production of health Virienne Walters and Margaret Denton,

20. Healthy Public Policy at WHC • Identify critical emerging issues • Outreach and policy advice • Midwifery, regulation of drugs, gendered research • Intervention at Supreme court on mandatory treatment of pregnant women

21. Healthy Public Policy Women, Income and Health • Research and outreach project . Goals: • improved health service • Policies the reduce poverty • Knowledgeable public

22. Moving Forward Primary Care Renewal and Women • Inform Indicators and Core Services discussion • Gender Based Analysis • Implementation of Models of Women Centred Care

23. 1. Primary Care Renewal and Women – Core Services • Sex-specific conditions: • Reproductive Health service, including • birth control , unplanned pregnancy and terminations, • pregnancy, childbirth in home or LDRP • menstruation, menopause and female infertility, • screening for cervical cancer. • Conditions more prevalent among women, • breast cancer, thyroid, autoimmune conditions • Sexual assault and violence • disordered eating and body image, • Stress, depression and self-inflicted injuries • Home care

24. Primary Care Renewal and Women – Core Services • Conditions which appear to be sex-neutral, but not are not. • heart disease, tobacco, addictions • Effects of women’s gendered roles in our society influence their health. E.g. • Care giving responsibilities often cause women to give higher priority to the health of others, • the sex-segregation of the labour force, both in general and within health care in particular;

25. Primary Care Renewal and Women – Core Services 4 con’t • Effect of caregiving on their own health; • women have lower average incomes than men and lower incomes are associated with poorer health; • women’s paid work and their working conditions influence their health.

26. Primary Care Renewal and Women – Core Services • Gender stereotypes within the health care system negatively affect women’s health. These include both stereotypes: - about women’s use of care and - about women’s care giving roles. • Women are often assumed to use health care services more than men. • is related to sex-specific care and not to male stoicism or to women’s predisposition to seek help.

27. Primary Care Renewal and Women – Core Services • evidence that negative stereotypes about women lead to women receiving negatively differential treatment . E.g. 2nd prevention of heart attacks- physicians assuming symptoms were psychological in origin • As well, Health promotion and prevention programs frequently target women– as vectors for healthy babies, children, families and communities.

28. Primary Care Renewal and Women – Core Services • Over-medicalization of normal aspects of women’s lives including pregnancy, stress, childbirth and menopause. • Pills for prevention

29. Moving Forward 2. What is Gender Based Analysis What is Gender?

32. What is Gender Based Analysis? • a process or tool • improves our understanding of sex and gender as determinants of health AND • of their interaction with other determinants

33. Resources for Gender Based Analysis • Exploring Concepts of Gender and Health, Health Canada • Places to Start • handout from “A Framework for Women-Centred Health” Vancouver Costal Health Authority

34. Primary Care Renewal and Women – Core Services Good primary health care for women must both incorporate this knowledge and be a catalyst for change, helping to reduce the contribution of gender differences to health inequalities.

35. Moving Primary Care Forward • Policy Commitment to Gender Based Analysis • Inform Indicators and Core Services discussion • Implement Models of Care of Women Centred Care • Keep Networking and Sharing

36. Networking • CD of resources • Primary Health Care and Women listserv—informing policy development • Ongoing dialogue • Canadian Women’s Health Network

37. CD-ROM* selected from the National Coordinating Group on Health Care Reform and Women – primary care the Centres of Excellence for Women’s Health and national Working Groups Others: Ontario Women’s Health Council, Health Canada, WHC, Women’s Health in Women’s Hands, FGM manual * Note: Documents are on the disc- to search web sites you must be on line.

38. Thank you to the Women’s Health Contribution program , Women’s Health Bureau, Health Canada , Canadian Women’s Health Network and the Women’s Health Clinic for support of this presentation