Bulletin Index/

Health Status

1. When It Comes to Health, Do Sex and Gender Matter?

2. Gender,Work and Health: An Analysis of the 1994 National Population Health Survey

3. Women’s Health in Atlantic Canada: A Statistical Portrait

Health Services

4. Health Care Utilization and Gender: A Pilot Study Using the BC Linked Health Data

5. National Gender Economic Costing Group

Health Care Reform

6. Moving in the Right Direction? Regionalizing Maternal Health Services in British Columbia

7. Invisible Women: Gender and Health Planning in Manitoba and Saskatchewan and Models for Progress

8. Coping as a Rural Caregiver: The Impact of Health Care Reforms on Rural Women Informal Caregivers

9. Missing Voices in Long-term Care Policy Making: Elderly Women and Women with Disabilities Receiving Home Care

Diverse Communities of Women

10. Experiences of Immigrant and Refugee Women in Quebec with the Health Care System

11. "Hearing Voices": Mental Health Care for Women

12. Developing Understanding from Young Women’s Experiences in Obtaining Sexual Health Services and Education in a Nova Scotia Community

13. "Voices and Faces": A Qualitative Study of Rural Women and a Breast Cancer Self-help Group via an Audio-teleconferencing Network

14. Centres of Excellence for Women's Health - Contact Information

Developing Understanding from Young Women’s Experiences in Obtaining Sexual Health Services and Education in a Nova Scotia Community

Don Langille, Janice Graham and Emily Marshall, Interdisciplinary Studies, University of British Columbia, Dalhousie University, Melissa Blake, Christina Chitty and Heather Doncaster-Scott, Amherst Association for Healthy Adolescent Sexuality

This study aims to understand the barriers which prevent young women from receiving maximally effective sexual health education in their schools and related services from physicians and in pharmacies. Building upon survey work carried out in the context of the Amherst Initiative for Healthy Adolescent Sexuality, this report describes the lived experiences of young women in Amherst, Nova Scotia as they have attempted to acquire and act upon knowledge related to sexual health.

This work was carried out as a partnership between members of the Department of Community Health and Epidemiology at Dalhousie University and the Amherst Association for Healthy Adolescent Sexuality (AAHAS), a non-profit society with a mandate to work with existing community resources to enhance and protect the sexual health of young men and women in Amherst. Young women representing the diversity of the Amherst community participated in in-depth interviews which examined their experiences in school-based sexual health education programs, in particular "Personal Development and Relationships", offered in grades 7 to 9. Participants were also asked to describe how their physicians approached the issue of sexual health, including providing information about sexual health and prescription of oral contraceptives. Finally, participants talked about what they had experienced in using pharmacies for access to condoms and oral contraceptives. Data from the interviews was analyzed using qualitative techniques to develop an understanding of how participants’ experiences with sexual health education and services resulted in barriers to the most effective use of those community resources.

Barriers to sexual health education in schools related to three main areas:

1. School-based sexual health programs (a repetitive and boring curriculum, avoidance of specific topics, contradictions with teachings from home and church, lack of relevancy on a temporal basis, and lack of credibility within schools themselves for sexual health education programs)
   
   
2. Their teachers (perceptions of teachers as having different values from students and having judgmental attitudes, use of inappropriate personal examples in class, discomfort with certain sexual health topics, and in some situations, lack of knowledge of sexual health)
   
   
3. Students themselves (gender dynamics in sexual health education classes, and not seeing the teachers and guidance counsellors as resources for sexual health)

Some of the key messages articulated by participants for educational policy makers and educators were:

1. Schools should make sexual health education courses more difficult, with challenging projects and appropriate testing
   
   
2. Schools should pay particular attention to the creation of a comfortable learning environment for women, gay and lesbian youth, and students from all religious faiths
   
   
3. Schools should provide continuity of topics and teaching methods between sexual health education classes
   
   
4. Schools should develop methods for increasing the credibility of sexual health education
   
   
5. Teachers should carry out needs assessments for students at the beginning of the school year to add relevance to sexual health education
   
   
6. Teachers should include methods of teaching which allow students to explore how one might feel in different situations, and how one might handle those situations

Participants identified barriers to using and being helped by physicians’ services as:

1. Comfort and communication with the physician – difficulty with trust in the physician- patient relationship, the age and (often) male gender of the physician, physicians’ lack of time for discussion of sexual health, physicians’ apparent reluctance to discuss sexuality
   
   
2. Young women’s needs for support for a high personal level of comfort in looking after their sexual health – need for non-judgmental support for sexual health, the need for a confidential relationship with the physician and a lack of knowledge of their right to such confidentiality, apprehension about Pap testing
   
   
3. Physician access – obtaining physician services in Amherst, impact of presence of parents at the physician’s office

Key messages for policy makers and medical practitioners related to physicians were:

1. Physicians should introduce the subject of sexuality with young women in ways such as, "You are at the age where some people are choosing to become sexually active. If you ever want to talk about your options for sexual activity or birth control, we can do that."
   
   
2. Physicians should explicitly tell young women that their conversations and examinations are confidential, and that they will tell no one, not even their parents, even if they ask the doctor about it.
   
   
3. Physicians should explain the Pap test in detail ahead of time, and not make it mandatory for obtaining oral contraceptives, at least initially.
   
   
4. Ways should be explored to improve young women’s access to family physicians’ services so that they can talk, and talk confidentially, with their physicians.

With respect to pharmacy services, participants located barriers in the elements of the pharmacy including the cost of condoms and oral contraceptives and embarrassment caused by the public aspects of condom purchasing.

Key messages provide by participants for overcoming these barriers at the pharmacy level were:

1. Display and sell condoms in an appropriately private location in the pharmacy to increase young women’s ability to purchase them in a confidential manner
   
   
2. Educate cashiers at pharmacies not to be (or appear to be) judgmental of young people purchasing condoms
   
   
3. Make oral contraceptives available free when young women can’t afford them; make condoms available free at teen health centres.

For further information contact:
Atlantic Centre of Excellence for Women’s Health
P.O. Box 3070, Halifax, NS  Canada B3J 3G9
Tel: (902) 470-6725 Toll Free: 1-888-658-1112 Fax: (902) 470-6752 Website: www.medicine.dal.ca/acewh E-mail: acewh@dal.ca

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