Be a Warrior Too


As women worldwide celebrated their remarkable accomplishments as part of International Women’s Day on March 8, I thought it appropriate to acknowledge just a few of the incredible warriors for women’s health that BC Women’s Hospital + Health Centre Foundation is proud to support.

In our second article Respect in the Maternity Ward you will meet Dr. Saraswathi Vedam, associate professor in the Midwifery program at the University of B.C.’s Faculty of Medicine. A renowned advocate and leader in researching maternity care experiences to determine the adherence to, and violations of, respectful maternity care in Canada she examines how it impacts pregnancy, birth and postpartum outcomes.

Another warrior for women’s health we’re honoured to partner with is Dr. Lori Brotto, executive director, Women’s Health Research Institute, professor of Obstetrics and Gynecology at UBC, and Canada Research Chair in Women’s Sexual Health. In A Warrior for Research we’ll introduce you to some of the little-known but worthy projects WHRI is undertaking.

In Reforming a Colonial System we’re pleased to shine a spotlight on Dr. Sheona Mitchell- Foster, practicing Ob/Gyn and assistant professor with UBC’s Northern Medical Program, based in Prince George, B.C. Mitchell-Foster’s cutting-edge work highlights the importance of HPV self-collection for cervical cancer prevention and the reproductive health of marginalized and vulnerable populations.

It is indeed a privilege for BC Women’s Hospital + Health Centre Foundation to align with these brilliant, innovative, and relentless warriors for women’s health. I am incredibly proud that our foundation is funding work that is having positive impacts both here in BC and globally.

As we take time to reflect on these remarkable and ongoing achievements in association with International Women’s Day, I would like to please ask that you lend your passion to ours by donating to BC Women’s Hospital Foundation. Together, we can help fund even more of the necessary research, purchase life-saving equipment, provide valuable educational resources and fuel the advocacy needed to help turn the tide on women’s and newborns’ health.

The next significant medical breakthrough could happen as a result of your generosity, all we need is you. Please know that when you partner with BC Women’s Hospital Foundation, you truly are making a difference on behalf of the women and newborns you love.

Genesa M. Greening, CFRE

President + CEO, BC Women's Hospital + Health Centre Foundation


Reforming a Colonial System

By Gail Johnson | Photography by Kelly Bergman


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.


“It’s completely unacceptable that we’re still seeing such incredible disparities in different populations across Canada.”

“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.”


Respect in the maternity ward

By Jessica Werb | Photography by Claudette Carracedo


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 per cent 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.”


A Warrior for Research

A conversation with Dr. Lori Brotto, executive director of the Women’s Health Research Institute


By Joseph Dubé | Photography by Sherri Koop


In 2016 Dr. Lori Brotto, professor of obstetrics and gynecology at the University of B.C., was named executive director of the Women’s Health Research Institute (WHRI), a leading academic and research centre embedded within BC Women’s Hospital + Health Centre with the goal of enabling women’s health research across the spectrum. Here Brotto talks about her work and her vision.

Q: WHY IS THE FUNDING OF WOMEN’S HEALTH RESEARCH SO IMPORTANT?

A: When women are healthy, all of society benefits…. When we study societies where women are not healthy, it is immediately evident that many different aspects of those societies suffer. Without research, excellent health care is simply not possible, and research absolutely depends on funding.

WHAT ARE SOME OF THE NEW AND INTERESTING RESEARCH PROJECTS ON THE GO AT WHRI?

One of our star WHRI members is a world leader in the vaccine for HPV (human papillomavirus). Her collaborative and international research has the long-term aim of eventually eradicating cervical cancer (because the vaccine prevents many of the strains of HPV associated with cervical cancer). In another [initiative], we are working to develop a smartphone app designed to be culturally safe for Indigenous and immigrant women struggling with postpartum depression…. There’s so much quality work being done by our close to 200 members across B.C., but that’s just a quick snapshot.

WHAT ARE SOME OF THE CHALLENGES UNIQUE TO STUDYING WOMEN’S HEALTH?

One of the challenges is that there is no dedicated funding body for women’s health research. For example, there is the Arthritis Foundation and the Kidney Foundation, but there is no corresponding funding body for research on women’s health topics. As a result, you end up having researchers do this work totally or mostly unfunded, which means it gets done off the side of their desk, or they scrape together some volunteers, or it simply doesn’t happen.

WHAT CAN BE DONE TO BREAK DOWN BARRIERS THAT PREVENT WOMEN FROM ACHIEVING THEIR BEST POSSIBLE HEALTH?

This is going to sound so clichéd but it’s so true. It’s awareness. And that’s part of the reason why I very readily accept invitations to speak with the media, because it’s only through increasing awareness and providing education to the general public—not just women, but everyone—that we will make progress. Knowledge- raising and awareness-raising campaigns are absolutely key.

YOU HAVE AN EXTENSIVE BACKGROUND IN SEX RESEARCH. WHAT ROLE DOES SEXUAL HEALTH PLAY IN THE TOTALITY OF A WOMAN’S WELL-BEING?

Sexuality is a core part of quality of life. It’s not just this small, circumscribed, leisurely activity that some people do some of the time. Everyone, even people who are not sexually active for any number of reasons, still have a sense of their sexuality and how important that is to them. It’s a core part of people’s identity. It shapes self-esteem. It’s associated with depression, anxiety, relationship discord, infidelity—it’s all related to sexuality.

THE THEME FOR THIS ISSUE IS ‘WOMEN’S HEALTH WARRIORS.’ IN YOUR OPINION, WHAT MAKES A WARRIOR FOR WOMEN’S HEALTH?

Someone who is absolutely ruthless in communicating the facts about women’s health to broad audiences, despite all the barriers that might get in the way, like political barriers, systemic barriers or personal barriers. The warrior is someone who still champions the scientific voice, regardless of any potential backlash and says, “Actually, no, these are the facts.”


Photography by Claudette Cararcedo


On behalf of Foundation board chair Karim Kassam (L), BCWH patient Rehana Kassam (R), and NICU alumnus Arman Kassam, thanks for the generous support of donors that make life-saving care and innovation at BC Women's Hospital + Health Centre a reality. It matters.



Did You Know?

In some cases, Angiograms are unable to detect early signs of female heart failure because testing techniques were designed for male subjects.


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.


Until the 1990s, women were not included in most medical research studies.


Women metabolize drugs differently than men.


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.