1. In some cases, Angiograms are unable to detect early signs of female heart failure because testing techniques were designed for male subjects.
2. Younger women are almost twice as likely to die from heart disease as their male counterparts. Mortality rates for heart diseases are improving for every demographic group, except young women.
3. Each year in Canada heart disease kills more women than men. It is the leading cause of death for women over 55, and the second most common cause of death for women under 55.
4. Until the 1990s, women were not included in most medical research studies.
5. Women are more likely to report severe and long-lasting pain, but are typically not treated as aggressively as men.
6. Women metabolize drugs differently than men.
7. 270,000 women worldwide die from cervical cancer annually. Without immediate action, by 2030 the number is projected to rise to 500,000. Sadly, cervical cancer is almost entirely preventable.
8. Younger women are more likely than men to dismiss health symptoms as “false alarms” not requiring medical attention.
9. Endometriosis is a disease in which tissue from the uterine lining grows outside the uterus. Currently there is no cure.
10. Endometriosis affects approximately 176 million women worldwide during their reproductive years (1 in every 10 women).
The anticipation, the excitement, the unknown and the unrelenting desperation to deliver a healthy baby are shared by every woman in pregnancy. Respect and the opportunity to participate in one’s own decisions in childbirth are likely assumed as
automatic. But according to the World Health Organization (WHO), that is not necessarily so.
In 2017, the organization published standards for quality of maternal and newborn care that included prioritizing respect and patient-led decision-making. A prior WHO review across 34 countries outlined numerous instances of human-rights abuses in childbirth—including physical, sexual and verbal abuse, as well as the loss of autonomy and lack of supportive care. The report concluded there was no consensus on how to measure disrespect in maternity care. However the work of Dr. Saraswathi Vedam, principal of the University of B.C.’s Birth Place Lab and associate professor of midwifery at BC Women’s, is changing that.
“All the major health organizations realized they didn’t reach the millennium development goals for mothers and babies,” explains Vedam from her BC Women’s Hospital research office. “They thought the answer was to institutionalize birth and incentivize people to come to the hospital, but they didn’t increase the amount of resources in the hospital. Many women who come to the hospital from the village in India, sub-Saharan Africa or the Philippines, for example, face overcrowded, understaffed units, a lack of privacy and frustrated providers. We know that their experience of mistreatment leads them to delay coming in or seeking help when needed, which is clearly not safer.”
Throughout her 30-year career as a midwife and researcher, Vedam has focused on respect and autonomy in childbirth. Her unyielding commitment to being a leader in patient-centred care resonates deeply at BC Women’s, which is proud to be the first hospital in B.C. to have credentialed midwife attendants at birth. In that pioneering tradition, Vedam is also breaking new ground in addressing the challenges outlined by the WHO through creating the first quality measures to assess provider-patient relationships and maternal access to person-centred maternity care.
Funding from partners at the Vancouver Foundation, BC Womens Hospital and the Michael Smith Foundation for Health Research enabled Changing Childbirth in BC, a community-led research project, and led to the development of the MADM (Mother’s Autonomy in Decision Making) scale and MORi (Mothers on Respect index). These tools recently received an Innovation award from the National Quality Forum. With new tools in place to quantify a patient’s experience, this data could now be used to measure current practices and inform new ones.
More than 4,000 women across B.C. were surveyed about their childbirth experiences and reported variations in respect and autonomy during pregnancy depending on their health status and preferences for care, as well as where and how they gave birth. Overseen by Vedam, the project is run through a steering group of women from different cultural and socio-economic backgrounds. Despite the diversity of the participants, Vedam says they all raised similar concerns.
“Ninety-five percent of women said it was ‘very important’ or ‘important’ that they lead decisions about their care,” Vedam notes. “But very few said they were able to.” Women who were dissatisfied with their role in decision-making had very low MADM scores, indicating a lack of autonomy. Vedam’s research also found women with higher medical or social risks during pregnancy were four times as likely to have low MORi scores, indicating they felt less respected by their care providers. Recent immigrants and refugees, or women with a history of substance use, incarceration, poverty and/or homelessness were twice as likely to have low MORi scores. Women with midwifery care reported higher MADM and MORi scores compared to women with just physician care.
“We found that overall in B.C., women felt a good level of respect, but there were big differences in how much autonomy they felt,” explains Vedam. “Both respect and autonomy were linked to how much pressure they felt to accept a certain intervention.”
Vedam’s hope is that MADM and MORi will inform efforts to deliver the highest levels of maternal care. “We have very good outcomes for people here, unlike in the global south,” she points out. “Where we haven’t improved is in the experience of care, and that’s where this kind of work that is patient-directed and informed will help…. The whole world is talking about respectful maternity care and respectful standards. Now is our chance to make it better.”
Written by Jessica Werb
Photography by Claudette Carracedo
- Women's Magazine
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
- Women's Magazine