For many women, reproductive care is just another part of standard health care, including regular Pap smears. For others, accessing that kind of care is far more challenging. Women living in conditions of social marginalization, as well as women living in rural and remote communities across Canada and beyond, can face multiple barriers when it comes to reproductive care.
For Dr. Sheona Mitchell-Foster, a practising obstetrician/gynecologist based in Prince George and researcher with the Women’s Health Research Institute at BC Women’s Hospital + Health Centre, the stark health discrepancies among Canadian women are as shocking as they are intolerable. In fact, the academic clinician at the University of B.C.’s Northern Medical Program says it was “righteous indignation” that motivated her to focus her work on underserved populations in the first place.
“It’s completely unacceptable that we’re still seeing such incredible disparities in different populations across Canada,” Mitchell-Foster says. “There are still such differences in maternal and neonatal outcomes, specifically around HIV and cervical cancer. All women should have access to high-quality, culturally safe care regardless of where they live.”
Recognizing Canada's colonial history, culturally safe care allows for health-care professionals to minimize barriers that Indigenous women face. The intergenerational trauma it caused affects the way many women relate to health care today.
“I don’t think enough clinical care providers are aware that our health-care system is ultimately a colonial system,” she says. “Women across generations hesitate to engage with care because of that. If your aunt or mother was sterilized without her consent, would you engage with the health-care system? It makes it incredibly difficult to engage in anything around reproductive care.”
Mitchell-Foster’s research relates to women with substance use in pregnancy and pregnant women living with HIV. She is also pursuing relational ways to dismantle barriers to reproductive screening, specifically cervical cancer screening, by testing for HPV (human papillomavirus).
A mother of three, Mitchell-Foster has long been involved in the ASPIRE program, which offers HPV self-collection to women in low- and middle-income countries. Self-collection entails distributing user-friendly kits with swabs for testing for HPV as well as other sexually transmitted infections, without the need for a pelvic examination. This is coupled with already-existing community women’s groups and empowerment strategies.
She has brought this model to northern B.C., with a pilot project now under way in partnership with Carrier Sekani Family Services and Métis Nation B.C. The hope is that this approach will fit well with women’s needs and experiences in northern B.C., markedly improving participation in screening programs, and will ultimately be implemented throughout the north.
“Consider the multiple barriers that a woman may have in engaging with our health-care system. Now there’s an opportunity to self-collect, to do it confidentially and avoid a particularly invasive medical exam that may be associated with embarrassment, fear or judgment,” Mitchell-Foster says.“It allows women to take control of their own health in a way that was not previously possible.”
Written by Gail Johnson
Photography by Kelly Bergman