The following blog post was written by our outgoing student intern, Marina. To learn more about Marina, her placement with us, and why she chose to write this blog post, you can listen to the accompanying podcast available at: https://dcontario.fireside.fm/276

With progressing years healthcare has advanced and triumphed with modern technology and medicine. Women’s healthcare is a fundamental aspect of public health, yet barriers persist that impede access, quality, and equity in Canada and around the world. From a myriad of systemic issues such as underfunding, lack of research, and lack of representation to personal barriers such as stigma and lack of cultural competence within the medical field. It is important to consider these factors to acknowledge and deconstruct the influence of systemic sexism in the healthcare field.

There are countless stories of women, and people on the gender spectrum, who have had difficult relationships with doctors in which their pain was disregarded, and their voices were not heard. This is a stereotype that is often conveyed in medicine where women and female-presenting individuals are deemed as overly sensitive or exaggerating pain for attention. Not only is this deeply misogynistic, but it also puts human lives at risk every day.

“The stereotype about women being oversensitive to pain, or exaggerating it for attention, is deeply rooted in misogyny. But it’s also dangerous and puts women’s lives at risk every day”

NeuPath Centre for Pain and Spine

Systemic Barriers

Underfunding of Women’s Health Programs

Women’s health funding is a critical and necessary resource to appropriately study how different illnesses and diseases manifest compared to men. Yet, according to a 2020 study out of B.C., women’s health researchers received less overall funding and the duration of grants was significantly shorter compared to male-dominated researchers. This funding is extremely necessary in order to address conditions and diseases that impact the overall quality of life. Not only does lack of funding impact the amount of research done, but it also impacts women’s access to tailored care for specific medical issues.

For example, endometriosis impacts approximately 1 million individuals in Canada, yet research related to endometriosis has only received $7.3 million in funding from the Canadian Institutes of Health Research over the past two decades. This lack of investment over 20 years essentially works out to about $7.30 per person with this condition. This means approximately a million people are forced to live with a condition that has little research dedicated to discovering its origins leading to a lack of education in the healthcare field. Not only does this create a barrier to knowledge it also leaves people with a lack of access to direct and informed care. According to a study published in 2020 in the Journal of Obstetrics and Gynaecology Canada, it takes an average of 5.4 years for a woman to receive a diagnosis of endometriosis in Canada, which further leads to approximately 3-9 months of waiting for specialized treatment. Healthcare is a right and it is imperative that adequate funding is directed toward women’s health to prevent individuals from living in chronic pain and mitigate the possibility of illnesses turning into life-threatening scenarios.

“Quality of life is so critically important and yet completely underfunded,”

Davidge

Lack of Research and Data

It is evident that, historically, medicine has been studied and researched with a primary focus on males leading to a lack of understanding of how diseases and treatments affect women differently. Women have been excluded from clinical trials alongside female animals and female cell lines which were disproportionately unused. The reasoning behind this was scientists’ deduction that female hormones would impact and distort their results, which would prevent accurate findings. These barriers and policies impacted the knowledge and risks associated with possible drug effects in women leading to a variety of drugs being produced and sold in the market without thorough research on the impacts due to biological sex. This has unfortunately led to women making up the highest group percentage of 75% when regarding adverse drug reactions. The scientific processes of drug interactions need to be thoroughly studied to determine how biological sex impacts the metabolization of medication, and how organs function when medication is introduced.

Not only do women need to be included in clinical trials, but physical health conditions must be researched in order to determine how symptoms manifest differently in women than men. For example, heart disease is the most prevalent condition that harms and kills Canadian women, yet it is the most underfunded, under-researched, and underdiagnosed disease.

Recently, science has discovered that the symptoms and complications of heart disease present differently in women than in men. Presenting with more complex and undetectable symptoms, the lack of awareness and education for both medical staff and patients can decrease the life expectancy of those in need.

Healthcare Provider Bias

With increasing transparency, evidence, and stories from women, the emerging issues of gender bias within the healthcare system are becoming increasingly prevalent. Women are not being listened to, and their symptoms are not taken seriously resulting in late diagnoses and further health complications. A study was done by the Women’s Health Strategy which reported that nearly 85% of women felt that their voices were not heard, specifically women who were seeking maternity care. Such minimization from healthcare professionals creates an even further gap in care by impacting women from marginalized groups.

When looking at healthcare provider bias, the examination of racism towards women of colour is necessary as it is a significant barrier to accessing equitable healthcare. A study from MBRRACE-UK examined how racial bias impacted inequalities in maternal deaths. The study found that black women are 3.7 times more likely to die and Asian women 1.8 times more likely to die during or within the 6 weeks after pregnancy when compared to white women. Overall, women of colour, especially Black women, often experience misdiagnosis or delayed diagnosis due to healthcare provider bias. Symptoms reported by these women are sometimes dismissed or attributed to non-medical factors, leading to delayed or inadequate treatment for serious medical conditions such as cardiovascular disease, breast cancer treatment, reproductive health issues, and autoimmune disorders.

“So many young Black women are dying of breast cancer in their thirties and forties, in part because they didn’t know about it until it was too late for the treatments to be successful,”

Palmer

Stigma Surrounding Mental Health

Many women face stigma and shame when seeking mental health support, particularly for issues such as postpartum depression or domestic violence. This stigma can prevent women from seeking timely and appropriate care. Women can also have trouble in integrating mental health treatment alongside their primary health treatments. Further barriers such as economic factors prevented 1 in 4 women from taking time off work to access mental health care, as well as avoiding it altogether due to the increasingly high costs of treatment. Additionally, stereotypes about women’s emotional sensitivity or “hysteria” historically perpetuated the idea that women’s mental health concerns are less valid or serious than those of men, leading to under-recognition and under-treatment of mental illness in women.

Cultural and Linguistic Barriers

Women who are from culturally diverse backgrounds may find difficulties in navigating barriers providing access to healthcare to be particularly challenging. These barriers can arise due to differences in language, cultural norms, beliefs, and experiences, leading to disparities in healthcare outcomes and patient experiences. This may result in delays in seeking care, miscommunication with healthcare providers, and inadequate access to culturally competent services. Limited proficiency in the dominant language of a healthcare system can impede effective communication between patients and healthcare providers. Language barriers can also lead to misunderstandings, incomplete medical histories, and challenges in understanding diagnoses, treatment options, and instructions.

Access to culturally competent healthcare services, including providers who understand and respect patients’ cultural backgrounds, beliefs, and values, is essential for addressing cultural and linguistic barriers. Culturally competent care involves tailoring healthcare approaches to meet patients’ cultural preferences, providing language interpretation services, and promoting trust and collaboration between patients and providers. Women from diverse cultural backgrounds may require culturally specific healthcare services, such as reproductive health care that considers cultural norms around family planning, childbirth practices, or gender roles. Lack of access to culturally competent care can result in disparities in health outcomes and patient satisfaction.

Geographic Isolation

Women living in remote or Northern communities may face significant challenges accessing healthcare facilities, leading to disparities in care and health outcomes. The

Canadian Institute for Health Information reported that residents of rural and remote areas have higher rates of chronic disease and lower rates of preventative care, highlighting the impact of geographic barriers on women’s health. Mobile healthcare units, telemedicine services, and outreach programs tailored to rural communities can improve healthcare access and outcomes for women in remote areas.

Solutions and Initiatives

Increased Funding and Resources

Advocating for increased funding for women’s health programs and research can help address systemic gaps and improve access to quality care. An $8.3 million investment from the Canadian Institutes of Health Research is a step in the right direction, but sustained funding is needed to create lasting change. Collaborative partnerships between government agencies, healthcare institutions, and philanthropic organizations can mobilize resources and support innovative healthcare initiatives for women.

Promoting Diversity and Inclusion

Encouraging diversity among healthcare providers and ensuring cultural competency training can help reduce biases and improve the quality of care for diverse populations of women. Initiatives like the Indigenous Cultural Safety Training Program for healthcare professionals aim to enhance understanding and promote equitable care for Indigenous women. Mentorship programs, recruitment efforts, and leadership opportunities for women in healthcare can also contribute to greater diversity and inclusivity in the sector.

“I think even if we have just more diversity in general, more racial diversity, diversity in terms of sexual and gender minorities, diversity in terms of everything, the more of the emergency physician population looks like the population they are treating the better care we will be able to provide”.

Emma McIlveen Brown

Enhanced Sexual Health Education

Implementing comprehensive and inclusive sexual health education in schools and communities can empower women with accurate information and promote healthy behaviours. Organizations like Planned Parenthood Canada offer educational resources and advocacy efforts to promote sexual health literacy and rights. Collaboration between educators, healthcare providers, and community advocates is essential to developing age-appropriate,

evidence-based sexual health curricula that address the diverse needs of young women.

Telehealth and Telemedicine

Expanding telehealth services can improve access to care for women in remote areas and those with mobility challenges, reducing geographic barriers. The COVID-19 pandemic accelerated the adoption of telehealth in Canada, demonstrating its potential to enhance healthcare access and convenience for women across the country. Investment in telemedicine infrastructure, training for healthcare providers, and digital literacy programs for patients can support the widespread adoption of telehealth solutions in women’s healthcare.

Community Outreach and Support Programs

Investing in community-based programs that provide support, education, and advocacy for women’s health issues can help bridge gaps in access and address personal barriers such as stigma and cultural norms. Initiatives like community health centers and peer support groups offer valuable resources and networks for women seeking holistic healthcare solutions.

Collaborative partnerships with community organizations, grassroots activists, and healthcare professionals can amplify the impact of outreach and support programs, reaching underserved populations and empowering women to take charge of their health.

Resources

The Women’s Health Coalition

The WHC offers a central hub of resources regarding information and support for sexual, menstrual, reproductive health and more.
https://thewhc.ca/resources/

BIPOC Women’s Health Network

The goal of the BWHN is to provide culturally competent, anti-oppressive, and feminist healthcare resources for healthcare providers, medical students, and racialized women in local Canadian communities.
https://bipocwomenshealth.com/

Peer Medical Foundation

The Peer Medical Foundation is a volunteer youth-led international not-for-profit organization advancing health equity, inclusivity, diversity, and racial justice in medicine. They  support marginalized patient populations (Migrants, 2SLGBTQIA+, BIPOC & more) and aim to improve the health experiences of vulnerable individuals in our communities.
https://peermedfoundation.org/

The Multicultural Mental Health Resource Centre

They offer a central hub of resources per province in order to help those in need of translators to navigate language barriers with healthcare professionals.
https://multiculturalmentalhealth.ca/services/find-an-interpreter/

The Society of Obstetricians and Gynaecologists of Canada

They offer public resources regarding information for sexual health, menstrual health, contraceptive information and pregnancy. They also offer courses for medical students and residents, as well as further educational events.
https://sogc.org/en/en/content/public-resources/public-resources.aspx

The Government of Canada

The government of Canada offers a central hub of mental health resources that are organized according to provincial location. Resources range from mental health, addiction, domestic violence, crisis lines, Indigenous and other supports.
https://www.canada.ca/en/public-health/services/mental-health-services/mental-health-get-help.html

Distress Lines

As always, distress lines like our Member centres are always a great resource for finding supports in your area. If you would like to find your nearest centre, click here.

References

Bernabei, C. (2024, January 31). Uncovering “Medical misogyny” in the Canadian healthcare system. Seneca Journalism – S@Y News. https://www.senecajournalism.ca/uncovering-medical-misogyny-in-the-canadian- healthcare-system/

Frangou, C. (2022, March 3). Women’s health collective Canada is addressing the gap in women’s health. Best Health. https://www.besthealthmag.ca/article/womens-health-collective-canada/

Frey, S. (2018, May 24). Systemic sexism in health care needs to be addressed in the north and beyond. CBC. https://www.cbc.ca/news/canada/north/gender-based-health-care-1.4676262

Hocking, L. (2023, January 19). Why we need to pay attention to women’s mental health. McLean Hospital | Mental Health Treatment, Research, and Education (Belmont, MA). https://www.mcleanhospital.org/essential/why-we-need-pay-attention-womens-m ental-health

Kondro, W. (2006). Health of rural Canadians lags behind urban counterparts. Canadian Medical Association Journal, 175(10), 1195-1195. https://doi.org/10.1503/cmaj.061306

Laube, A. (2022, March 5). Misogyny hurts: Canadian doctors keep gaslighting women in pain. Daily Hive Vancouver: Latest Stories in Vancity. https://dailyhive.com/vancouver/dismissive-doctors-canadian-women

Leigh, J. P., & Stelfox, T. (2020). Sexism in medical care. Canadian Medical Association Journal, 192(12), E322-E322. https://doi.org/10.1503/cmaj.74854

Life Lines. (2023). Women’s Mental Health: Concerns, Barriers and Support. Mount Royal University | MRU. https://www.mtroyal.ca/SafetyRiskDepartment/WellnessAtWork/_pdfs/Womensm entalhealth.pdf

McKoy, J. (2023, October 31). Racism, sexism, and the crisis of Black women’s health. Boston University. https://www.bu.edu/articles/2023/racism-sexism-and-the-crisis-of-black-womens- health/

Oxford Population Health. (2022, November 9). New report highlights urgent need for improved care regarding continued inequality and mothers’ mental health. https://www.npeu.ox.ac.uk/news/2328-new-report-highlights-urgent-need-for-imp roved-care-regarding-continued-inequality-and-mothers-mental-health

San’yas Indigenous Cultural Safety Online Training. (n.d.). San’yas Anti-Racism Indigenous Cultural Safety Training Program. https://sanyas.ca/