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 Women are the major users and providers of care Contribution of the Womens Health Movement Contribution of the Womens Health Movement Women are a focus of public health campaigns – prenatal care, screening Women are a focus of public health campaigns – prenatal care, screening There is opportunity in change There is opportunity in change

3. Womens Movement and the Womens Health Movement Womens Movement and the Womens Health Movement redefining health and relationship with health care providers redefining health and relationship with health care providers Redefining health and health issues Redefining health and health issues

4. Context

5. Context Many examples: womens health collectives, programs, research and analysis Many examples: womens health collectives, programs, research and analysis Commitment to gender based analysis at the international, national and regional levels 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 1. The need for respect and safety 2. The importance of empowering women 3. Involvement and participation of women 4. Collaborative and inclusive work environments

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

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

11. In application: - Many examples of programs and service - Example of Womens Health Clinic here in Winnipeg

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

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

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

15. Approach Health Promotion, Prevention And Healthy Public Policy strategies Health Promotion, Prevention And Healthy Public Policy strategies Women only staff and space Women only staff and space Most Appropriate Caregiver And Services 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 Empowerment – enhance the understanding, self- care, self-help and self-advocacy abilities of women –Structure of the Clinic participatory management participatory management Board and advisory committees Board and advisory committees Client feedback Client feedback

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

18. Staffing: over 40 Physicians – on salary, medical assists Physicians – on salary, medical assists Nurse practitioners, dietician Nurse practitioners, dietician Health educators, advocacy coordinator Health educators, advocacy coordinator Counsellors Counsellors Midwives Midwives Unpaid staff - community education and BCUP 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 womens health status than lifestyle factors (ie. smoking, alcohol consumption and physical activity ) Socio-economic status and other structural factors (ie. family structure, age and social support) are more important to womens 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, 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 Identify critical emerging issues Outreach and policy advice Outreach and policy advice Midwifery, regulation of drugs, gendered research Midwifery, regulation of drugs, gendered research Intervention at Supreme court on mandatory treatment of pregnant women Intervention at Supreme court on mandatory treatment of pregnant women

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

22. 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

23. 1. Primary Care Renewal and Women – Core Services 1. Sex-specific conditions: 1.Reproductive Health service, including birth control, unplanned pregnancy and terminations, birth control, unplanned pregnancy and terminations, pregnancy, childbirth in home or LDRP pregnancy, childbirth in home or LDRP menstruation, menopause and female infertility, menstruation, menopause and female infertility, screening for cervical cancer. screening for cervical cancer. 2.Conditions more prevalent among women, breast cancer, thyroid, autoimmune conditions breast cancer, thyroid, autoimmune conditions Sexual assault and violence Sexual assault and violence disordered eating and body image, disordered eating and body image, Stress, depression and self-inflicted injuries Stress, depression and self-inflicted injuries Home care Home care

24. Primary Care Renewal and Women – Core Services 3.Conditions which appear to be sex-neutral, but not are not. heart disease, tobacco, addictions heart disease, tobacco, addictions 4.Effects of womens 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, 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; the sex-segregation of the labour force, both in general and within health care in particular;

25. Primary Care Renewal and Women – Core Services cont Effect of caregiving on their own health; Effect of caregiving on their own health; women have lower average incomes than men and lower incomes are associated with poorer health; women have lower average incomes than men and lower incomes are associated with poorer health; womens paid work and their working conditions influence their health. womens paid work and their working conditions influence their health. 4

26. Primary Care Renewal and Women – Core Services 5.Gender stereotypes within the health care system negatively affect womens health. These include both stereotypes: - about womens use of care and - about womens care giving roles. - about womens care giving roles. Women are often assumed to use health care services more than men.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 womens predisposition to seek help. is related to sex-specific care and not to male stoicism or to womens 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. 2 nd prevention of heart attacks- physicians assuming symptoms were psychological in originevidence that negative stereotypes about women lead to women receiving negatively differential treatment. E.g. 2 nd 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.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 6. Over-medicalization of normal aspects of womens lives including pregnancy, stress, childbirth and menopause. Pills for preventionPills for prevention

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

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

33. Resources for Gender Based Analysis Exploring Concepts of Gender and Health, Health Canada Exploring Concepts of Gender and Health, Health Canada Places to Start 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 Policy Commitment to Gender Based Analysis Inform Indicators and Core Services discussion Inform Indicators and Core Services discussion Implement Models of Care of Women Centred Care Implement Models of Care of Women Centred Care Keep Networking and Sharing Keep Networking and Sharing

36. Networking CD of resources CD of resources Primary Health Care and Women listservinforming policy development Primary Health Care and Women listservinforming policy development Ongoing dialogue Ongoing dialogue Canadian Womens Health Network Canadian Womens Health Network

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

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