Q&A with Shirley Weir, Founder of MenopauseChicks.com

On World Menopause Day, we’re chatting with Shirley Weir, Founder of MenopauseChicks.com, WHRI community partner, and fierce women’s health advocate.

Q: Can you tell us a little bit about Menopause Chicks and what inspired you to start it?

A: My perimenopause journey began a little over 10 years ago. I was experiencing anxiety & depression for the first time in my life + sleep deprivation and brain fog that was impacting my ability to be the mom and daughter and partner and entrepreneur I always was. I wanted to feel empowered about my health, but I set out without a plan.

Some days I felt good and didn’t think about it. Some days I felt so bad, I could barely function.

I spent money on books. Lots of books. I spent a ton of time surfing the Internet (often at 3 a.m. when I was wide awake.) I talked to my doctor. I went to a naturopath. And a women’s health clinic. I bought vitamins. I dabbled in yoga, meditation and various exercise and weight management approaches. Heck, I even started a website, held events and wrote an e-book…

I was left feeling confused, overwhelmed and alone. You may feel some of these things too.

The truth is, sometimes a single book or event or doctor’s appointment is not enough. Sometimes we need more info…more clarity…sometimes it takes a bit more time and support to let it all sink in…to get it all straight…to find out what is best for our own unique situation. And often, so often…when we read something or hear something, we have questions…lots of questions, but no where to ask them.

This inspired me to launch Menopause Chicks, a website and online community. We empower women to navigate perimenopause and menopause with confidence and ease. We do this by connecting women to the best information, the top women’s health professionals who can support them on their journey–and we connect women to each other via this private community.

Q: Over the past several years Menopause Chicks has grown a lot, on and offline! You’re now one of the Women’s Health Research Institute’s community partners – what does this mean to you?

First off—I am so honoured and proud to be connected to the WHRI. Research—women’s health research—and disseminating quality health information to women—is paramount to being able to achieve our mission (which is to empower women to navigate perimenopause-to-menopause (& beyond!) with confidence & ease.

I love the role WHRI and it’s researchers play in our community. There’s a phrase I was introduced a few years ago called “knowledge transfer.” Everyone talks about how we live in the information age—but what good is information if a) it’s wrong or misleading (which has often been the case in women’s health!) and if b) we don’t have experts who can transfer new information, new findings and new, relevant health education to women so she can be empowered and in charge of her own health! Kudos to Dr. Lori Brotto and her team for taking this knowledge transfer role so seriously—it’s truly making a difference to how women view and talk about their own midlife health!

Programs like free community events on aging well and campaigns like #ItsNotInYourHead are validating women’s experiences. And they are empowering women to realize they are not alone; affirming they are smart and savvy and they can get through anything when they have accurate information and a strong health team working on their behalf.

Q: World Menopause Day is about raising awareness for support, treatment, and research in the area of menopausal health. Do you have any call to action for our community (researchers, healthcare decision makers, clinicians and practitioners)?

I sure do! (And it might surprise you!) My call-to-action for World Menopause Day this year is to media, marketers and even to some members of the medical community: STOP talking about perimenopause and menopause…until you have your facts straight. Otherwise, you’re ruining a woman’s ability to get informed, advocate for her own health—and yes, you’re even ruining a woman’s ability to ENJOY this phase of her life.

Here’s what I mean:

For decades, we’ve all been subjected to myths and misconceptions around menopause. It’s time to draw a line in the sand and ensure that whenever we do talk about menopause, we are speaking from an informed, knowledgeable place—otherwise, we continue to perpetuate misunderstanding and continue to confuse women who are trying to be proactive with their health. Here are three examples:

  • Don’t say menopause if you mean perimenopause. They are not the same thing. It has been very confusing for women to hear the word menopause when they still have a period. Menopause is one day—it’s the 12 month anniversary of the final menstrual period. Every day after that is post-menopause. And the phase of life leading up to menopause—is called perimenopause. The term perimenopause was only coined in 1996! But it’s now 2019 so we need to ensure everyone is using accurate definitions. The experiences of perimenopause are different for every woman. It’s a phase of life that includes hormone fluctuations as a woman’s body transitions from her reproductive years to menopause. Perimenopause is not a synonym for suffering—although for some women, hormone imbalance can lead to experiences that are uncomfortable and impact her quality of life. An example would be irregular periods, heavier bleeding or lighter bleeding. It’s one of the most common experiences of perimenopause, yet one of most under-discussed. This leaves women unprepared and assuming something is seriously wrong if it happens as part of their perimenopause experience.
  • Stop saying normal. If we continue to tell women it’s “normal” to forget things, leak pee when they sneeze, be wide awake at 3 in the morning, lose her temper with her kids, bleed through a single pad every hour, or have low libido, we will continue to have women not listening to the signals their bodies are giving them. What we want to do is tell women that these experiences are common AND there are easy, viable solutions. We don’t want them thinking they have to “suck it up.” This time of our lives is an opportunity to invest in our health; not to put it on the back burner because “it’s just part of being a woman.” We want women to get informed, ask for help when they need it, surround themselves with experienced health professionals and choose the journey that is right for them. We are the first generation to turn 50 and have 50 more years to plan for. This is an incredible opportunity to invest in our health so we can reap the benefits of vitality and longevity into our 60s, 70s, 80s, 90s and beyond!
  • Stop using “hormones” and “hormone therapy” like they are swear words. And get really, really clear on the latest relevant information before you talk about hormones and hormone therapy. For a very long time, the words “hormones + teenagers” led to eye rolls, and that sentiment continues to stretch into women’s midlife health too. Stop it. Now. It also doesn’t help that for over 17 years, women have been making limited health decisions based on headlines telling them hormones cause cancer—headlines that were misleading and inaccurate, and born from the now infamous Women’s Health Initiative (WHI) study that was severely flawed. (By the way the headline announcing the study was flawed got buried.) We need to shift the paradigm to hormones are natural. Our bodies have been producing them for years and hormones serve hundreds of positive functions for our health. Hormone therapy is not a requirement for women navigating midlife, but it is a viable option worth investigating if she needs support managing uncomfortable experiences such as anxiety, depression, hot flashes, heavy bleeding or vaginal dryness. And the more we learn and the longer we live, hormone therapy is also regarded as an investment in our future brain health, bone health and heart health. Rather than something to ignore, it’s something for women to explore by working with their health care professional to conduct a risk assessment, and then if within 10 years of menopause and under 60, consider.

Learn more about Menopause Chicks, and follow them on Twitter.

MenopauseandU | World Menopause Day

October 18th is World Menopause Day, a day to raise awareness and spark a larger conversation about support, research, and treatment in the area of menopausal health.

In honour of the day, we’re talking about MenopauseandU.ca! The site is run by the Society of Gynaecologists and Obstetricians of Canada (SOGC), to provide evidence-based information about menopause to the public.

According to MenopauseandU, “menopause is the point in time when a woman has had no menstrual period for 12 consecutive months.” But before menopause hits, women may notice that their body is already going through a lot of changes, due to fluctuating hormone levels. This period of time is called perimenopause.

The internet is full of (mis)information about women’s health, which is why websites like MenopauseandU are so important. When women have questions about what’s happening to their body, or what they should know about this period of their life, the SOGC sites are built to empower them with facts straight from the experts.

The website provides information about what menopause entails, signs and symptoms of menopause, options for therapies, and health concerns that may arise during this period. Further, the site provides an extensive list of resources for topics as they pertain to menopause, ranging from bladder health, to lifestyle, to sexuality, to mental health.

MenopauseandU is a truly valuable resource for women, and we invite you to start the conversation about menopause by sharing this resource with the women in your life. You can also join the conversation online using #WorldMenopauseDay on Twitter.

BC Women’s Health Foundation launches In Her Words report

On October 9th, 2019 the BC Women’s Health Foundation, in partnership with Pacific Blue Cross, released the In Her Words report, exposing women’s experience with the healthcare system in BC.

The report is informed by a survey of 1000 BC women aged 16 and older, and was designed to assess women’s experience with accessing needed care, and their perceptions of interactions with healthcare providers. There was also an effort to understand the unique needs of Indigenous women.

The Women’s Health Research Institute (WHRI) played a role in the formation of the report, through informing the original survey questions, and contributing re-analysis of data, and data interpretation. Data collection was led by the Mustel group and Reciprocal Consulting.

The report illuminated differences in experiences among women, based on age, geographic location, or whether or not they were Indigenous. These intersections compound negative experiences within the BC healthcare system, with staggering numbers like 3 in 5 mature women reporting their symptoms were diminished or overlooked by a healthcare professional, or that 83% of Indigenous women aged 16-24 reported challenges accessing the medical care they needed.

“We’ve seen research that women see on average five to seven providers over three to five years before they receive an accurate diagnosis,” Dr. Lori Brotto, Executive Director of the WHRI , told the Vancouver Sun. “The report illustrated in a numeric form with a representative sample of B.C. women what we hear clinically: Women feel misunderstood, misdiagnosed, diagnosed too late, over-pathologized with certain conditions such as chronic pain.”

Throughout the report, real women share stories about their experiences within our healthcare system. Their messages are a powerful call-to-action for policy makers, healthcare providers, health researchers, funders, and other stakeholders to pay attention and believe women’s experiences, and to work toward closing the health gap.

Read In Her Words on the BC Women’s Health Foundation site.

IN THE MEDIA

World Mental Health Day Research Spotlight with Dr. Nichole Fairbrother

In honour of World Mental Health Day 2019 we interviewed Dr. Nichole Fairbrother about what fuels her research and how we can make a difference for women in the postpartum period.

What is your background? 

I am a Clinical Associate Professor with the UBC Department of Psychiatry and the Island Medical Program. I received my Ph.D. in clinical psychology from the University of British Columbia in 2002.My doctoral work was in the area of women’s sexual assault and cognitive behavioural theories of post-traumatic stress disorder. Following my PhD, I completed a post-doctoral fellowship in women’s reproductive health through the Child and Family Research Institute and the UBC Department of Health Care and Epidemiology. During that time, I began my current program of research in the area of women’s perinatal mental health with a focus on perinatal anxiety and related conditions and epidemiology.

In addition to the above, I hold the following, appointments: Associate member of the UBC School of Public and Population Health, Maternal-Child Health theme and the University of Victoria’s Faculty of Graduate Studies; Adjunct appointment with the University of Victoria’s Department of Psychology; and an Affiliate faculty appointment with the University of Victoria, Division of Medical Sciences. I am also an active member of the Women’s Health Research Institute.

Can you tell us a bit about your research with the Perinatal Anxiety Research Lab?

My program of research is primarily in the area of perinatal anxiety and related disorders and epidemiology, with an emphasis on prevalence, screening and access to evidence-based psychosocial interventions. At the moment, I am studying new mothers’ thoughts of infant-related harm and their relationship with obsessive-compulsive disorder (OCD) and parenting, fear of childbirth, perinatal anxiety screening tool development and evaluation, and therapist-supported, internet-based therapy for perinatal anxiety and related disorders (AD).

What impact do you hope to make with this work?

Pregnant and postpartum women represent a vulnerable group in society, with unique needs and mental health concerns. Historically, among perinatal women, depression and psychosis are the mental health disorders which have received the most attention. More recently, maternal, perinatal AD have received increasing attention. This is due, in part, to recent evidence that 20% of pregnant and postpartum women report symptoms meeting criteria for one or more AD.

My motivation for working in this topic area is fueled by a desire to improve our understanding of perinatal AD and to improve access to evidence-based treatment for these disorders.

For most of the AD, psychosocial interventions, in particular cognitive behaviour therapy (CBT), are considered first line treatments. CBT typically results in equivalent or superior outcomes to medication, with additional protection against relapse. Despite the superiority of CBT, medication is typically used to treat AD. Of significant concern is the fact that the medications used to treat AD, when taken by pregnant and breastfeeding women, carry non-trivial risks for the developing fetus and infant. Because of these risks, pregnant and breastfeeding women represent a group particularly in need of evidence-based, non-medication approaches to treatment. However, at present, CBT is only minimally publicly funded, and consequently access is limited largely to those with extended health benefits or the means to pay high out-of-pocket costs. As a result, access to evidence-based treatment for mental health conditions in Canada, and in particular for perinatal women, is an issue of financial privilege and heath inequity.

October 10th is World Mental Health Day. What type of action can researchers and healthcare providers take today – and throughout the year – to help improve women’s mental health?

When I think about pregnant women and new mothers, I guess I think about how important it is to reach out and connect. Early mothering can be a socially isolating experience. It’s also really important to normalize the experience. It is normal to be a little bit anxious, to worry about one’s baby, one’s body and how one’s life is going to change. Beyond this, we know that women continue to provide a disproportionate proportion of the domestic work in families, including large amounts of invisible work (making 25 phone calls to find a new day care, planning ahead for family birthdays, making grocery lists, etc.). Think about ways you have lift a little bit of that burden so maybe she gets a few minutes extra sleep, or just gets 10 minutes to drink a cup of tea and watch the rain.

What is the most interesting thing about the work you do?

I think the most interesting aspect of my research is the work I do regarding new mothers’ unwanted, intrusive thoughts (UITs) of infant-related harm, in particular the UITs of hurting one’s baby on purpose. We now know that 100% of new mothers report UITs of accidental harm to their baby, and a full 50% of new mothers report UITs of harming their infant on purpose. Further, there is good evidence that, among psychologically vulnerable women, these kinds of thoughts may lead to the development of OCD – an anxiety-related disorder characterized by recurrent and distressing UITs and repetitive behavioural responses to them (e.g., checking on the safety of one’s loved ones or washing one’s hands over and over). We now also know that UITs of intentional, infant-related harm are not associated with an increased risk of maternal violence towards the infant. We have recently applied for a small amount of money to create an animated, psycho-educational video about new mothers UITs of infant-related harm and their relationship with OCD and parenting.

For more information regarding Dr. Fairbrother’s research and lab visit: https://parlab.med.ubc.ca/

BC Children’s Hospital Research Institute announces the recipients of the 2019 Outstanding Achievement Awards

Congratulations to the recipients, which included students from several WHRI-affiliated research teams.

WHRI-affiliated recipients included:

Outstanding Achievement Award by an Undergraduate Student
Jeff Holmes, Karakochuk* Research Team

Outstanding Achievement Award by a Master’s Student
Lindsay Richter, Lisonkova* and Ting* Research Teams

Outstanding Achievement by a Doctoral Student
Catriona Hippman**, Austin* Research Team

Outstanding Achievement Award by a Resident
Brandon Chalazan, Lehman* Research Team

Canadian Child Health Clinician Scientist Program
Katelynn Boerner, Oberlander* and Dhariwal Research Teams

Read the full announcement: https://bcchr.ca/news/congratulations-recipients-2019-outstanding-achievement-awards-bcchr-studentships-and

*BCCHR/WHRI Joint Member
** WHRI Member

What should you know about breast density? | Breast Cancer Awareness Month

October is Breast Cancer Awareness Month! Learn about breast density and why it’s important to your overall breast health in this article by Dr. Paula Gordon.

WHAT IS BREAST DENSITY

Every woman’s breast is composed of fat and breast tissue, but the proportions vary. On a mammogram, fat appears dark gray or black while breast tissue and cancer appear white.

There are 4 categories of breast density. Category C and D are considered “dense breasts” with over 50% density. Dense breasts are common and normal, in fact 43% of women ages 40+ have dense breasts.

WHY DO I NEED TO KNOW IF I HAVE DENSE BREASTS?

 Mammogram accuracy can be impacted by dense breasts.

Dense breasts are the number one reason for cancer being missed by mammography since both cancer and dense tissue show up white on a mammogram. Mammograms miss about 50% of cancers in the highest category (D).

  • Women with dense breasts have an increased risk of breast cancer.

The higher the density, the higher the cancer risk. Cancer is 4-6 times more likely in the highest density category (D) than the lowest category (A)

  • Higher risk of an interval cancer.

Women with category D are 18 times more likely to have breast cancer discovered between mammogram screenings when cancer masses are larger and can be felt.

 Higher risk of cancer in the other breast.

Women with breast cancer who have dense breasts are nearly twice as likely to develop cancer in the opposite breast.

  • More prevalent risk of cancer than family history.

Dense breasts are a more prevalent risk for developing breast cancer than a family history of breast cancer.

HOW IS BREAST DENSITY DETERMINED?

Breast density is assessed by the radiologist viewing your mammogram. Breast density is not determined by breast size or touch. Dense breasts can feel soft, lumpy or firm and so can fatty breasts.

WHAT CAN I DO IF I HAVE DENSE BREASTS?

  • Speak with your doctor about your breast density, any other breast cancer risk factors and your best screening options.
  • Perform regular self-exams between screenings.
  • A normal mammogram result may not be accurate.
  • To improve early detection, you may wish to consider additional screening, such as ultrasound. In BC, screening ultrasound is covered by MSP if you have a doctor’s requisition.
  • Consider modifying lifestyle factors such as diet, exercise, alcohol intake and hormone use to decrease cancer risk.
  • Continue to have mammograms because they can detect calcifications, which can be the earliest sign of cancer, that aren’t seen on ultrasound.

WHY SHOULD I CONSIDER SUPPLEMENTAL SCREENING?

  •  Additional screening, such as ultrasound, can increase detection of early stage cancer obscured by dense breast tissue.
  • Ultrasound finds an additional 3-4 cancers per 1000 women screened that were not detected by mammogram.
  • Ultrasound finds cancers that are small and have not yet spread to the lymph nodes, reducing aggressive treatments and improving rates of survival.
  • Early detection of cancer is critical for less invasive treatment and the best outcomes.

For more information, please visit densebreastscanada.ca

Study Update: TMIST | Breast Cancer Awareness Month

TOMOSYNTHESIS MAMMOGRAPHIC IMAGING SCREENING TRIAL (TMIST – EA1151)

Comparison of Tomosynthesis to Digital Mammography
in Breast Cancer Screening

Approximately 1 in 9 women will develop breast cancer in their lifetime.  Detecting breast cancer early is important for improving outcomes. The usual approach to breast cancer screening is to have a mammogram every one or two years. This can include a digital mammogram with images of two flat views per breast or a tomosynthesis mammogram for which the number of views is dependent on the tomosynthesis system in use and the preferences of the radiologists at the site. In British Columbia the current standard of care that is available in the Breast Screening Program is a digital mammogram only. For some women, along with the mammogram, other screening tests may be done, such as ultrasound or magnetic resonance imaging (MRI).

The main purpose of this study is to find out if screening for breast cancer with tomosynthesis mammography is better than with digital mammography.

The study will compare the diagnosis of advanced breast cancer among women screened for breast cancer using either method. This study will also compare the number of other/additional tests recommended after each mammogram.

This research is part of a multicentre study sponsored by ECOG-ACRIN in the United States and coordinated by the Canadian Cancer Trials Group in Canada. TMIST is led by Dr. Etta Pisano from the Beth Israel Deaconess Medical Center, Harvard University, in Boston, Massachusetts.

The local Investigators of this study are: Dr. Paula Gordon, radiologist at BC Women’s Hospital Breast Health Program and Dr. Linda Warren, radiologist at the X-RAY 505 office.

About 165,000 people from Canada, the United States and Argentina will take part in this study.

This study should take 10.5 years to complete and the final results should be known in about 12 years.

Enrollment in British Columbia is 185 as of September 9, 2019.  There are 5 sites in Canada – one site in British Columbia, one site in Quebec and three sites in Ontario.

Learn more about breast health in this piece on breast density by Dr. Paula Gordon, Principal Investigator on the TMIST study.

Research spotlight: The Hummingbird Project

“Stillbirth is a traumatic grief.”

Amanda Martin, Project Coordinator for the Hummingbird Project and bereaved parent, shares that this sentiment took years to internalize: women and families who experience a stillbirth have experienced a trauma. Despite the major impact stillbirth has on women and families, it is an area that faces strong stigma, and is severely lacking in research, expertise, and support.

That’s why Dr. Lynn Farrales, Principal Investigator on The Hummingbird Project, is working to address this gap and create a resource that can reach women and families who need support wherever they are.

The Hummingbird Project was developed from prior work led by Still Life Canada (SLC), a stillbirth and neonatal death education, research, and support society based in Vancouver, BC. SLC conducted a participatory-based research project, through which families with lived experience identified needs, objectives, and methodology for research, as well as how findings would be used.

Local collaborations between community clinicians, researchers, and SLC led to the launch of The Hummingbird Project. Through focus groups, The Hummingbird Project research team learned that most support for women and families is based out of Vancouver. This caused many challenges for the focus group participants including time, cost and the ability to even get there.

“Accessibility was really one of the things that started us toward podcasts. Initially we looked at doing group medical visits and then videos, but podcasting gave us more flexibility around timing and the ability to interview experts from around the world,” Martin and Dr. Farrales explain. “The ability to sit and listen to a podcast and really reflect on what is being said is so important when you’re talking about such sensitive topics. The Hummingbird Project podcast series is designed so the listener can either listen to the episodes in the order they were recorded or they can choose the topic which is most relevant to them at that moment.”

Other important factors leading the team toward podcasting is that it not only increases geographic accessibility, but also access to support at any time of day, and at any point of a user’s journey.

“It’s not conspicuous – it’s not like they’re bringing out a video,” explains Dr. Farrales, “so it’s something they can do on their own time.”

The research team has collaborated closely with an advisory committee comprised of physicians, midwives, nurses and bereaved families to help ensure that their work closely mirrors the needs of the community. From the start of the project, research has been conducted in tandem with the development of a resource to begin addressing the need for support as soon as possible.

“It’s not often that you hear about people having a miscarriage or having a baby who was stillborn, unless they are someone close to you,” Martin says. “Everyone has a story of their own – they know someone, they went through it, something happened – and by opening up about their experiences it gives permission, in a sense, to the other person to share their story.

“The more we discuss the topic of stillbirth through focus groups and podcasts the more we are helping to destigmatize having a baby who is stillborn.” Martin says. “This podcast series is designed for parents who have recently experienced having a baby who was stillborn all the way through deciding if they are going to try and have another baby. By creating this resource parents can share this podcast series with their support systems to allow them better insight into what the parents are experiencing.”

The team emphasizes that health care providers and the greater community may benefit from listening to the podcasts themselves and then subsequently sharing it with their patients.

On October 5th, 2019, the inaugural Butterfly Run is being hosted in Vancouver, BC. It is a 2k/5k memorial run and walk raising awareness around infertility, miscarriage, stillbirth and perinatal loss. This year partial proceeds are being used to support The Hummingbird Project.

“We hope to offer support and compassion for families currently facing these challenges, and reduce the stigma surrounding these topics. Being a bereaved parent is a path no one should have to walk alone,” the Butterfly Run team states. The event is now sold out for the 2019 year but people can still participate by making a donation to BC Women’s Hospital via their Running Room fundraising page.

If you’d like to be notified when The Hummingbird Project launches its podcasts, email Amanda Martin.

Meet Dr. Brigid Dineley, Clinical Assistant Professor in Obstetrics and Gynaecology

This World Contraception Day we’re putting the spotlight on Dr. Dineley, whose research focuses on improving contraceptive counselling practices for patients with complex medical needs.

Dr. Dineley believes that it’s important for patients to have the right choice for their unique needs, at the right time.

Inspired by the intersection between contraception, medicine, and patient-driven resources, Dr. Dineley wanted to look at the experiences of patients who had chosen to undergo bariatric surgery. Her research relies on qualitative research methods, which she explains give voices to patients to help shape a program that fits their needs – something that is especially important to her, given Canada’s long history of reproductive coercion.

Designing resources based on this lived experience is important for improving contraceptive counselling, as it helps to ensure that decision making isn’t dictated purely on the basis of ‘best’ practices. She hopes that this work will help produce resources for contraceptive counselling that can help guide both healthcare providers and patients through the decision making process.

Dr. Dineley has finished qualitative interviews, and her next steps include developing a resource and pilot testing it with individuals from BC and Ontario who had bariatric surgery.

Dr. Dineley is also involved in a qualitative study looking at decisions around language used by abortion providers to better understand why they use specific language and how it might impact patient care. She is also investigating women’s experiences with contraceptive care in the Ontario prison system.

To learn more about Dr. Dineley, click here.


Dr. Brigid Dineley completed her Bachelors of Science in Mathematics and medical school at Queen’s University. She graduated from the McMaster OBGYN Residency Program, and recently completed the UBC Family Planning Fellowship.

Reflections on Gender Equality Week | Gender Equality Week 2019

By Dorothy Shaw, OC, MBChB, FRCSC

Dr. Dorothy Shaw

“Gender Equality Week”. Quite a concept in 2019. It deserves unpacking as people have different understandings of what it means and some may dispute whether it is even an issue in Canada. While background reading for a recent chapter, I read the report of a Royal Commission on the Status of Women chaired by Florence Bird (1967-70). I recommend it as a yardstick to measure progress on gender equality in Canada. We still see unconscious bias operating in academia though steps are being taken to address gender discrimination in recruitment, starting salaries for assistant professor, grants and criteria for promotion as written about by Bird 50 years ago. The report also recommended that “…birth control information be available free of charge to everyone and ensure that everyone has access to devices and drugs as needed.”

On September 23rd, the United Nations General Assembly will receive a declaration on Universal Health Coverage that, after many months of contentious discussion, finally includes wording on sexual and reproductive health, women, gender and adolescents.  The wording recognizes “that universal health coverage is fundamental for achieving the Sustainable Development Goals (SDGs) related not only to health and well-being, but also to eradicate poverty in all its forms and dimensions, ensure quality education, achieve gender equality and women’s empowerment…..”. Although the SDGs may be focused on countries with greater challenges, Canada, like other high-income countries, is a signatory to the Sustainable Development Goals, with indicators to be met by 2030.  There are 17 SDGs, much broader in scope than their eight predecessor Millennium Development Goals. Of note is that maternal mortality has been enveloped into the broad health goal SDG 3 and contraception is part of SDG 5 which is Gender Equality.

SDG 5 Gender equality indicators, some proving difficult to track, include:

  • intimate partner violence,
  • early marriage,
  • female genital mutilation,
  • time spent in unpaid work compared to men,
  • representation of women at all levels of political leadership,
  • proportion of women in management positions,
  • ability to make autonomous decisions about sexual relations and contraception [for those married or in union],
  • discriminatory laws or legal gaps and
  • gender-based budgeting.

Since I am often asked “What can I do?” when I give poignant presentations on progress and gaps in women’s sexual and reproductive health and rights, I would offer two suggestions.

Firstly, my hope is that this week will generate discussion and debate based on curiosity. To nudge the reader gently, I have intentionally provided no data in this brief article as evidence alone is not moving the needle and in almost all the bullet points above, we in Canada still have work to do. Gender-based budgeting was introduced in the federal budget of 2018, but we do not collect data on contraceptive prevalence, unlike other high-income countries. I am often asked about the prevalence of female genital mutilation in Canada and we have no national or even provincial data that could inform whatever services and health professional education might be needed. We collect data on gender-based violence but not femicide as a cause of maternal mortality. We do not collect maternal mortality data nationally in a consistent and comprehensive way, though this is part of SDG 3 not 5. I leave the bullet points for the reader to question and explore.

Another question I have been asked is “What do women want?”, not in the context of voluntary sexual activity or love, but gender equality. Women want to be treated with respect, to avoid gender-based violence, to access education, to be believed, to access health information and services, to be in control of their sexual and reproductive lives and importantly to be judged and succeed on merit in their working lives, including wage parity. This includes transgender women and women with disabilities.

Global movements such as #SheDecides, #MeToo and Women Deliver working with those of us who generate the data are making a difference. However, some countries using culture or religion as a rationale are posing a challenge to this groundswell of progress. For example, during this week, it looks as though Indonesia will finally pass a contentious new penal code, outlawing consensual sex outside marriage and effectively outlawing same sex relations.

In British Columbia, our Women’s Health Research Institute and the Women’s Health Foundation have been very effective about engaging with the public and providing information that can help women achieve optimal health throughout their lifespan and BC Women’s (part of Children’s and Women’s and the Provincial Health Services Authority) is committed to seeking to improve how to deliver woman-centred care, including partnering with women for models of care that meet their needs.

Under Canada’s Charter of Rights and Freedoms, equality rights for all are protected. Being inclusive in the rights arena means that the Charter rights of all must be respected and none is absolute.

Secondly, as we near the federal election in Canada, you might want to ask candidates about where Canada stands on the issues highlighted here. Former Nigerian Minister of Health Isaac Adewole, an obstetrician gynaecologist, commenting on the Universal Health Coverage declaration, pointed out that it is not political will that is needed but political commitment and action.  Importantly, where are we in terms of our indigenous women with respect to the SDGs and how are they included in the dialogue to move the needle?

Listen with curiosity, check sources for factual evidence, speak up, speak out and bring your own truth. Gender equality is all about power. Grow your influence by discussing any one of these issues whenever you get the opportunity. Gender equality is associated with economic progress, not simply a matter of rights. We can all help move the needle so that the estimates of 100-217 years to reach equality rapidly become fake news.


About Dr. Shaw

Dr. Dorothy Shaw is the recipient of the 2019 Career Contributions to Women’s Health Award. This award is an opportunity for the WHRI, on behalf of the larger women’s health academic, clinical, and affiliated communities, to recognize, honour, and thank an individual who has made substantial contributions to the health and well-being of women.

Dr. Shaw is internationally renowned for her advocacy of women’s reproductive rights and freedoms. And in the current era where we are seeing the realities of women’s rights to access reproductive health care taken away from them, our need for champions is even more imperative. By all accounts, Dr. Dorothy Shaw embodies the label of champion.

She was the inaugural chair of the FIGO Committee for Women’s Sexual and Reproductive Rights from 2000-2003, and went on to be the first woman President of FIGO, and while she was president-elect of the society for obstetricians and gynaecologists of Canada in 1991, Dr. Shaw lobbied Senate to remove abortion from the Criminal code of Canada.

Dr. Shaw has been a spokesperson for the Partnership for Maternal Newborn Child Health and has a longstanding history of engagement in civil society advocacy related to policy in global Reproductive Maternal Newborn Child Health. She was the inaugural chair of the Canadian Network for Maternal, Newborn and Child Health from 2010-2014 and currently serves as Treasurer of what is now the Canadian Partnership for Women’s and Children’s Health. She is engaged in Canadian and global working groups on maternal and perinatal mortality.

In the last few years leading to her retirement, she was awarded the Christopher Tietze Humanitarianism Award by the National Abortion Federation as its highest distinction, honoring significant, life-time contributions in the field of abortion service delivery or policy.  Later that year, she also received a Queen Elizabeth II Diamond Jubilee Medal.  In 2015, she was the recipient of two medical leadership life-time achievement awards:  the Chris Carruthers Excellence in Medical Leadership Award from the Canadian Society of Physician Executives and the American College of Obstetricians and Gynecologists Distinguished Service Award.

In July 2016, Dr. Shaw was appointed an Officer of the Order of Canada by Governor General David Johnston, for her work as an advocate for women’s health and reproductive rights.

In her own words, Dr. Shaw stated that we must uphold the standards of woman-centered care, which means that judgement and stereotyping no longer have a place, that women are believed, and that their concerns are taken seriously.

Thanks to Dr. Shaw’s voice and her actions, we have moved closer to achieving that desirable goal.

-Dr. Lori Brotto, Executive Director of the Women’s Health Research Institute