ADVANCING PRIMARY CARE MODELS OF WOMANCENTRED CARE IN

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

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

Women’s Movement and the Women’s Health Movement n redefining health and relationship with health care providers n Redefining health and health issues n

Context

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

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

Consists of 12 elements 1. 2. 3. 4. The need for respect and safety The importance of empowering women Involvement and participation of women Collaborative and inclusive work environments

Consists of 12 elements 5. Women’s patterns or preferences in obtaining health care 6. Women’s forms of communication and interaction 7. The need for information 8. Women’s decision-making processes

Consists of 12 elements 9. A gender-inclusive approach to data 10. Gendered research and evaluation 11. Gender-sensitive training

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

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

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

Healthy Public Policy Counseling • Research- Prairie Center Information • Policy Analysis & Development e. g. – Resource Centre • Networks/Public Meetings • Info Packages • Women, Income and Health • information requests • New Reproductive & Genetic Technological Network • Newsletter Circle of Services • Past abuse • Stress and self care issues • Women & Health Reform • Info Sheets/Kits e. g. – disordered eating and weight preoccupation Empowerment • Teen program • Individual (skill development, knowledge • Group (self help, action) • Community • Phone Triage Outreach Liaison/Collaboration with other services and sectors Professional and Community • Motherhood Stress Multiple points of entry • Weight Preoccupation • Growing Older, Healthy Aging • Menopause, Tobacco and women • Well women care Most appropriate care provide and service Professional Consultation/Counseling* • Nurse practitioners • MDs- on salary • Midwives • Dietitian • Health Educators • Counseling Women encouraged to access information services Support Groups & Self Help Groups • Mothers • weight/body image • Catching Our Breath – tobacco and women • Endometriosis • Breast implants • Reproductive Health program • Birth Control & Unplanned Pregnancy • Pregnancy and Birth- including Home • Client Surveys, Program Evaluations • Membership in Women’s Health Clinic • Participation on Committees and Board • Advisory Committee • Volunteering System Change Peer Programs Medical Care Input to WHC Programs • volunteer based • Birth Control/Unplanned Pregnancy Program • Teen Clinic • Community Education Program • schools, community • Reframing health issues • Demonstration of best practices & gender sensitive services • Research & issue identification • Policy analysis & development • Community education • Stakeholder working groups • 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

Approach n Health Promotion, Prevention And Healthy Public Policy strategies n Women only staff and space n 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.

Approach n Empowerment – enhance the understanding, selfcare, self-help and self-advocacy abilities of women – Structure of the Clinic § participatory management § Board and advisory committees § Client feedback

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

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

Healthy Public Policy Advocacy for System Change Why is this important for women? n n ‘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,

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

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

Moving Forward Primary Care Renewal and Women 1. Inform Indicators and Core Services discussion 2. Gender Based Analysis 3. Implementation of Models of Women Centred Care

1. Primary Care Renewal and Women – Core Services 1. Sex-specific conditions: 1. 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. 2. 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

Primary Care Renewal and Women – Core Services 3. Conditions which appear to be sex-neutral, but not are not. § heart disease, tobacco, addictions 4. 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;

Primary Care Renewal and Women – Core Services n 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.

Primary Care Renewal and Women – Core Services 5. 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.

Primary Care Renewal and Women – Core Services • evidence that negative stereotypes about women lead to women receiving negatively differential treatment. E. g. 2 nd prevention of heart attacksphysicians 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.

Primary Care Renewal and Women – Core Services 6. Over-medicalization of normal aspects of women’s lives including pregnancy, stress, childbirth and menopause. • Pills for prevention

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

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

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

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.

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

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

n 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.

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