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Health Care Reform Serving Diversity Unpaid Caregiving Midwifery
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What do Women Want? The focus of the second issue of the Research Bulletin is health services delivery. Studies described in this issue give us glimpses into what women want from the health care system in their roles as providers of health care, users of the health care system and decision makers. Although not an exhaustive review of the issues, this set of articles makes it clear that what women want is a high quality, responsive health care system in which they see attention given to women’s priorities, needs and preferences. This issue describes efforts to make the Canadian health care system more effective and appropriate for women. Some of the articles describe specific innovations in care delivery—the introduction of midwifery services, the creation of specialized facilities tailored to particular ethnocultural groups to address a service gap—while others document some of what women are saying needs to change in order for the system as a whole to meet their needs better. Canvassing women’s experience is an important input into designing a more effective system. The issue begins with a report on a series of studies commissioned by the National Coordinating Group on Health Care Reform and Women that investigated what is known about the effects of privatization on women. While little research has investigated the differential effects of health care reform on men and women, these studies suggest that privatization affects women more and differently from men because of their unique relationship to the health care system. For example, because women perform the majority of unpaid caregiving in the family, they are more likely to be affected by the de-insuring of services, the transfer of services from one service provider to another, or limitations on access to respite care. Similarly, because women are greater consumers of health care services, both for themselves and on behalf of their family members, they are more affected by the introduction of user fees, the transfer of care to the community, bed closures, labour conflicts and technological change. While the specific pattern of effects varies across the country, women in all jurisdictions are witnessing the effects of these changes. Whether these effects are positive or negative for women, research that examines privatization must be sensitive to the question of gender. Two reports, "Marginalized Voices from Vancouver’s Downtown Eastside" and "Women-Centred Care in the Context of Cervical Cancer Screening in Ethnocultural Groups" look at the delivery of specialized ethnocultural health services from the perspective of minority women who use these services for disease prevention and general health care. Efforts to create and provide such specialized services have not always been successful; these studies provide insight into the reasons why and suggest ways success might be enhanced. Services for cervical cancer screening, for example, were considered successful when screening was carried out by female practitioners who used appropriate language, were culturally sensitive and were available to provide information about other health concerns. Aboriginal women also wanted to see greater representation of Aboriginal women on staff and in clinics’ decision-making structures. These studies raise the question of whether the health care system needs to develop a number of community-specific services, or whether the ingredients that make these services work can be made more generally available in all health services and to all users. Another pair of studies on health services examines the supports that are needed by unpaid family caregivers, the majority of whom are women. While the study from rural Nova Scotia describes caregivers’ self-reported needs for help, the one from Quebec documents an experiment in supporting caregivers through one of Montreal’s local community health centres. One of the innovative recommendations of the Quebec study is that caregivers be tracked and studied as clients themselves. Such record keeping draws explicit attention to the caregiver as someone in need of support and recognition, in addition to, but separate from, the person who is receiving health care services. The final two reports in this issue of the Research Bulletin look at studies of midwifery services. The first describes a series of studies on the implementation of midwifery as a new health profession within British Columbia. The second outlines experiences of women in Saskatchewan and Manitoba who have received midwifery care. The BC case study demonstrates some of the internal and external challenges facing midwifery as it becomes a regulated practice. Ideally, the lessons learned in BC will help jurisdictions such as Saskatchewan and Manitoba as they implement their own midwifery programs. So, what do women want? These recent studies begin to reveal at least part of the answer. Women want access to high quality care. We want disease prevention services that feel safe and that we understand. We want flexible, individualized services. We want alternatives for perinatal care and birthing. We want recognition of the impact of providing care for others and support for providing that care. And we want a voice in decisionmaking for ourselves, our families and our communities. Ann Pederson |
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