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My unconscious bias about young people, reproduction and “women’s health”

My unconscious bias was revealed to me many years ago while working as a registered nurse (RN) at a family planning clinic. A young woman came requesting a pregnancy test. I admit to feeling relief when the test was negative and was genuinely surprised when her reaction was grief. As we discussed the result, she revealed that she had been attempting to achieve pregnancy and had the full support of her partner and family. Where did my reaction come from? Why had I assumed that she was trying to avoid conception rather than trying to achieve it? Had my assumptions caused distress for the patient?

A rights-based approach to reproductive health means that everyone has the right to decide if, when and how often they have children. However, our unconscious bias – our inherent preferences that we’re not knowingly aware of – may impact the mental wellness of patients in our care.

As healthcare providers, we know that the mental wellness of our patients is impacted by many things, including gender, ability, relationships, socio-economic status, education, social support and access to services. But, do we consider the role of how our own comfort and bias impacts people during the significant life events associated with reproductive health care?

Even most of the research on reproductive health and mental wellness has focused on the experience of cisgender women in higher income countries. It’s a fact that the world of reproductive health is hyper-gendered and synonymous with women’s health. Have we unconsciously excluded transgender people, people with non-binary or gender non-conforming identities or men from research and supports that related to reproductive health and wellness? What is the experience of same-sex couples trying to access reproductive health care? Do we have enough information about the intersections of diversity and the impact on mental wellness?

Reproductive health across the lifespan is fraught with transition; consider the list: puberty, trying to prevent pregnancy, trying to get pregnant, infertility, pregnancy, parenting, adoption, abortion, miscarriage, and andropause/menopause. Is that it? I’m not sure, there is probably more. It’s a fact people can have increased risk to their mental wellness during these times of reproductive health transition. We need to be careful not to make assumptions about what the experience means for them, but also be aware of specific risks during these transitions, including:

  • Early puberty may be associated with impacts to self-esteem, body image and early sexualization.
  • Recent studies suggest that depression or feelings of decreased well-being may be possible side-effects of birth control pills. While research is still being conducted, counselling and support around the possibility is needed for patients.
  • Infertility is a stressful experience for all people, which impacts relationships, self-esteem, body-image and can be associated with experiences of anxiety, grief and depression.
  • People with a history of depression have a 20x higher risk of postpartum depression (PPD). Having gestational diabetes also increases the risk for PPD.
  • Risk factors for mental wellness during pregnancy and postpartum include smoking, use of alcohol, use of non-prescription drugs and a history of physical and/or sexual abuse.
  • Rates of mental health problems for women with an unintended pregnancy are the same whether they have had an abortion or have given birth; however, those with underlying mental health concerns may require additional supports.
  • Menopause may impact wellness for people who experience negative effects, including low mood, anxiety, body image, impact to self-esteem over loss of reproductive potential, reduced libido, difficulties with sexual functioning, etc.
  • Andropause may impact wellness for people who experience negative effects, including low mood, reduced libido, fatigue, body image/weight gain and difficulties with sexual function.

There are gaps. We don’t know, what we don’t know. But this is what I know to be true: as health care providers, we have an opportunity to work with vulnerable people during times of transition. For some people, this can be extremely stressful.

  • We need to avoid assumptions about the meaning of the experience and ask them, “How are you doing today?”
  • Avoid assumptions about how they might be impacted; what choices they might make or even whether they are aware of all their choices.
  • Be inclusive when talking about reproductive health and open the conversation to extend past “women’s health.”
  • Use inclusive language and avoid heteronormative assumptions using partner/spouse rather than husband/wife.
  • Know your resources, whether it’s for a person experiencing infertility and looking for assisted reproductive health technologies, a person looking for pregnancy options support, transgender youth during puberty or someone experiencing significant symptoms of perimenopause.

Ultimately, we all need the same thing. Access to timely, inclusive, non-judgmental, non-stigmatizing services. After all, reproductive rights are human rights, for all people.

Press Release: SRH Week Campaign Connects the Dots between Mental Health and Sexual Health

For immediate release

From 12-16 February, Action Canada for Sexual Health and Rights (Action Canada) is proud to host Sexual and Reproductive Health Awareness Week (SRH Week), an annual nation-wide campaign that promotes sexual and reproductive health in Canada. This year’s theme is Mind your “Business” and focuses on the intersections between mental health and sexual health.

While campaigns around de-stigmatizing sexual health or mental health are on the rise, these rarely address how they intersect. This year’s SRH Week campaign was created in consultation with the Canadian Mental Health Association (CMHA) and aims to raise awareness on the many links that are often left out.

For this year’s campaign, Montreal artist Edith Boucher designed a poster, which is free to order on the SRH Week website. More than 4,000 posters have already been mailed out to healthcare providers, public health agencies, schools and non-for-profit organizations across every province and territory in Canada.

SRH Week will launch with a blog from Canada’s Chief Public Health Officer Dr. Theresa Tam on the stigma around sexually transmitted infections and its impact on mental health. Other features include a podcast discussing mental and sexual health with a registered nurse and a health care advocate, a Public Health Agency of Canada webinar for health care providers, a series of blogposts written by community-based organizations and advocates, local events across the country, and a printable handbook for healthcare professionals looking to provide stigma-free mental and sexual health care.

“The handbook includes information and tips for healthcare providers on how to talk about sexual health and mental health with their patients,” says Prasad, Executive Director for Action Canada for Sexual Health and Rights. “Stigma, shame, embarrassment, and fear often prevent patients from talking about their mental health and their sexual health, let alone both.”

The guidebook provides communication tips to help healthcare providers foster trust and openness so that their patients/clients can feel comfortable talking about issues related to their mental and sexual health.

“Everyone is entitled to positive and affirming health care that routinely and proactively meets their mental health and sexual health needs and all the ways in which they connect,” adds Prasad “This is one way we can help fill the gap in access to positive and affirming health care.”

To learn more about Sexual and Reproductive Awareness Week, the connections between sexual health and mental health, and to order free posters, visit www.srhweek.ca

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MEDIA CONTACT
Ani Colekessian
613-241-4474 ext 7
[email protected]

Manitoba SRH Week Events!

In Winnipeg:

Click here to download PDF poster with full list of Winnipeg events

All week long SERC will be releasing self care tips each day on our social media! follow along on Twitter, Facebook, or Instagram.

Thursday Feb 8
9:00-10:00 pm The Sex Files Radio Show on CKUW 95.9 FM – the topic is Sexual Health and Mental Wellbeing: The Mind Body Connection

Monday Feb 12
We will deliver heart shaped boxes filled with condoms, candy & positive messages that have been decorated by Teen Talk’s Peer Support Program youth volunteers to Winnipeg`s Teen Clinics
&
Online release of a new SERC video ‘Facing Stigma in Our Own Words’ based on the experiences of African newcomer communities in Winnipeg

Tuesday Feb 13
11:45-1:00 pm at 200-226 Osborne Street North, `Talking With Youth About Mental & Sexual Health: a Lunch & Learn for Service Providers’ presented by Teen Talk

Wednesday Feb 14
11:00am-2:00 pm second floor, Portage Place shopping centre visit our booth with Nine Circles & pick up some safer sex supplies & Digital Valentine release on SERC’s social media created by Winnipeg artist, Kristen Aleida & Blog release, written by Maree Rodriguez, long time Teen Talk Peer Support Program youth volunteer and mental health advocate

Friday Feb 16
Release of ‘Sex Ed, Broken Hearts & Mental Health blog’ written by SERC staff and released by Action Canada

In Brandon

Click here to download PDF poster with full list of Brandon events

All week long Brandon’s  Sexual Health  Committee will be handing out safer sex kits to local bars and lounges

Wednesday Feb 14
12:00-3:00 PM visit our booth at Brandon University for safer sex supplies

Friday Feb 16
12:00-1:00PM at SERC Brandon, Unit C, 1700 Pacific Avenue
‘Risk Reduction for Safer Sex Toy Use’ Lunch and Learn. Please register by emailing [email protected]-more information here! 

Stay tuned to SERC website for the latest updates on all of our SRH Week events!

Newfoundland and Labrador SRH Week Events!

To bring awareness and celebrate the work of Planned Parenthood – Newfoundland and Labrador Sexual Health Centre, they will be hosting a number of events from Monday, Feb.12th-Friday, Feb.16th.

Click here for exciting events, news, contests and games around the city of St. John’s! 

On MONDAY (Feb. 12th): Planned Parenthood Open House!!! Come to the centre, 203 Merrymeeting Road, at 5:00PM-7:30pm for cake, information and contests! We have some awesome prizes this year!

SRH Week 2018 is just around the corner!

This year,  Sexual and Reproductive Health Awareness Week (SRH Week)  will take place from February 12-16 with the theme: Mind Your “Business”

We want to spark conversations that help make the connection between sexual health and mental health clear and have been consulting with the Canadian Mental Health Association (CMHA) to prepare for SRH Week 2018.

In addition to posters designed by Montreal artist Edith Boucher, SRH Week 2018 will feature a series of blogposts written by community-based organizations, a resource for health care providers on non-stigmatizing comprehensive care that addresses the many connections between mental and sexual/reproductive health, podcasts, a webinar, and more!

We’ll be on Facebook and Twitter too! Find us @srhweek or download our social media kit at www.srhweek.ca (available soon!).

The new campaign and material will be available on www.srhweek.ca as of February 12.

Can’t wait until then? The site and all our exciting tools from past campaigns are available year-round with reliable, easy to access, up-to-date and comprehensive bilingual information on sexual and reproductive health. Visit www.srhweek.ca to see for yourself!

Of course, any campaign needs strong voices to really make a difference. Help promote sexual and reproductive health this SRH Week by displaying the posters, following @SRHweek on Facebook and Twitter, visiting www.srhweek.ca and helping to spread the word!

Want free posters? No problem! If you would like to order copies of the poster, visit www.srhweek.ca and fill out the poster order form. We’ll be happy to send you more at no charge.

Thanks for your support in making the connection between mental and sexual/reproductive health!

It’s time to Mind Your “Business”!

Hey Doctor, why aren’t you prescribing the abortion pill?

The newly available abortion pill (Mifegymiso) is everywhere in the news these days. Based on all the media coverage, you would think the World Health Organization’s “gold-standard” would be widely available, but so far, only a few doctors seem to be offering it. What gives?

The drug is already available and used safely in over 60 countries, and is an effective way to terminate a pregnancy by using medication rather than surgery. It can be used early in a pregnancy (up to 7-weeks gestation in Canada) and is finally available on the Canadian market.

The thing is, many physicians and pharmacists who want to begin prescribing and stocking Mifegymiso don’t know where to locate the training or order the medication. Here’s a handy roadmap for all the doctors and pharmacists looking to provide medical abortion, but simply don’t know where to start.

Are you a physician?

You can access the training here. Click on “Accredited Medical Abortion Training Program” and then “Register Now.”  Fill out the form, and check your email for confirmation. Completing this course will make you eligible to be a Mifegymiso prescriber. Upon completion, you will be asked to enter your physician license number and be contacted by the manufacturer (Celopharma) to order and stock the medication.

Are you a pharmacist?

You can access the training here. Click on “Accredited Medical Abortion Training Program” and then “Register Now”. Fill out the form, and be sure to click the box that says “I am a Pharmacist.” Completing this course will make you eligible to stock Mifegymiso. Upon completion, you will be asked to enter your pharmacist license number and contacted by the manufacturer (Celopharma) to order and stock the medication.

Note: the non-accredited version of the training can also be selected if you do not require or wish to receive Continuing Medical Education credits. The accredited version costs $50.00 and you will receive a certificate upon completion. The non-accredited version is free. Anyone can take the non-accredited version but only practicing physicians and pharmacists will be contacted by Celopharma to order and stock the medication upon completion.

Completing the training will make physicians eligible to dispense Mifegymiso (and stock it, if they wish to do so at their clinics) and pharmacists eligible to dispense Mifegymiso to physicians. For physicians who do not wish to stock the medication at their clinics, or lack the existing infrastructure to do so, they will need to find the nearest clinic or pharmacy that is trained to dispense Mifegymiso and receive it from them.

Start the Conversation

Doctors and pharmacists have been slow to take the training. And those that have are largely existing abortion providers. This is a huge opportunity for existing providers and other physicians, like family doctors, to help close the gap in access to reproductive choice in Canada.

So let’s start the conversation! Ask questions – if you’re a health care provider, talk to your colleagues, if you’re a client/patient, talk to your providers. We’ve got a long way to go until all people in Canada truly have access to all of their pregnancy options but together, we can break down barriers.

Are you a health careprovider? Click here to download the SRH2017 handbook for quick tips on talking about abortion in a non-stigmatizing way.

 

 

Ready for some pillow talk? Open conversation is crucial

Action Canada for Sexual Health and Rights (Action Canada) Executive Director Sandeep Prasad talks to XFM’s Sarah Cowan about the 2017 SRH Week campaign, what it is and why it’s important.

8 Steps toward Quality Care for Northern Indigenous Youth

What does good, non-stigmatized sexual healthcare look like for northern and indigenous youth? This question has become very important to me.

I have had the great privilege of discussing this question at length with youth across the Northwest Territories, the Yukon and Nunavut as a program facilitator for FOXY (Fostering Open eXpression among Youth), an arts based sexual health program that was awarded the 2014 Arctic Inspiration Prize and has taken the north by storm with its revolutionary approach to talking with youth about sexual health, sexuality, and relationships.

The following eight answers are woven from an amalgamation of candid, opened, group discussions with northern and indigenous teens.

  1. Tell them you’re glad they are there

One of the most powerful things you can do to encourage youth to access healthcare, to ensure a positive experience, and to help them spread the word to others, is to welcome them and congratulate them on taking steps to care for themselves. For many, and especially for youth, feeling unwelcomed, or even being treated with neutrality, can be detrimentally off-putting. A warm welcome and a high five for being there really goes a long way.

  1. Confidentiality

When you live in a small town, it can help a lot to be assured that your relationship with your healthcare provider is confidential. Of course, be honest about any restrictions that apply, especially when caring for youth, but confidentiality is so important when it comes to sexual and reproductive health and reminding people that their information is safe is an excellent step to a successful visit.

  1. Be accessible

In the north, healthcare is not always accessible, so you need to be as accessible as possible. This may be the first time, or the first time in a long time that someone has chosen to or been able to access your services – be thorough.

  1. Listen

The number one beef teens have with healthcare providers is that they don’t listen! Whether we don’t think they can understand, or just think they don’t know how to make good decisions, not listening to them is a sure way to shut them down and put up a barrier that will be more difficult to overcome the next time they need to access the healthcare system. After all, they are the experts on themselves and I promise we are much more likely to underestimate them than we are to overestimate them.

  1. Honour language barriers

Recognizing that many northern indigenous youth do not speak English as a first language is important. It is equally as important to balance that knowledge with the reminder that having English as a second language does not denote intelligence or ability to comprehend a concept. People can understand if you can put things the right way.

  1. Don’t assume gender or sexuality

Heteronormativity is a major deterrent for our LGBTQ2+ youth in accessing healthcare. By not assuming a patient’s gender or sexuality you are helping to overcome stigmatization and ultimately provide superior, more thorough care.

  1. Be trauma and violence informed

There is a push in medical circles in Canada right now to become more trauma and violence informed. This can help to provide very crucial services to a wide demographic in a way that will maximize receptiveness and efficacy. There is much that can be done in recognizing violence and trauma and knowing how to shape medical visits when you are working with a patient who is dealing with such experiences.

  1. Set them up for next time

You don’t know who will be providing their care next visit. Remind them not to give up if their next experience is less than ideal and that a second opinion is available, and a responsible option if they don’t feel they receive the care they need.

We all contribute to the legacy of our time, and I do hope that we are moving towards better services for all, including our northern and indigenous youth residing in small, outlying communities. These eight steps can take practice to become second nature, but are worth the extra effort. When we remind them that they are worth it, they remind us right back.

 

 

 

 

 

 

SRH Week 2017 is just around the corner!

This year, Sexual and Reproductive Health Awareness Week (SRH Week) will take place from February 12-18 with the theme: Ready for some pillow talk?

The 2017 campaign will build on last year’s “What’s Your Relationship Status” campaign by asking health care providers and clients/patients to “start the conversation” for the best possible care.

Open communication between health care providers and clients/patients is crucial to sexual and reproductive health.

On February 12th, we’ll be launching a quick reference book for health care providers and a blog series spotlighting health care providers making a real difference. We’ll be on Facebook and Twitter too! Find us @srhweek or download our social media kit (coming soon!).

The new campaign and material will be available on www.srhweek.ca as of February 12. Can’t wait until then? Check out campaign material from last year!
Of course, any campaign needs strong voices to really make a difference. Help promote sexual and reproductive health this SRH Week by displaying the posters, following @SRHweek on Twitter and Facebook, visiting www.srhweek.ca and helping to spread the word!

Want posters? No problem! If you would like to order copies of the poster, click here and fill out the poster order form. We’ll be happy to send you posters at no charge. For campaign graphics, social media tools, PDF copies of the poster and much more keep visiting www.srhweek.ca!

Now let’s start the conversation!