Network 12-1.pdf - Canadian Women's Health Network

network
Canadian
the
Women’s Health
fall/winter 2009/10 volume 12 number 1
Canada’s Chemicals
Management Plan
Why we ought to know
Do Pregnant Women
Benefit from Taking
Antidepressants?
Strength in Numbers
Reproductive cancer
support services
Women and Water
CANADIAN WOMEN’S HEALTH NETWORK FALL/.WINTER 2009/2010 1

e d i t o r ’ s n o t e
I’m pleased to write to you for the first time as the new Editor of
Network magazine and Director of Communications at the Canadian
Women‘s Health Network. It is exciting to take the helm of such a
vibrant publication, and as we move forward I hope to continue to
provide you with the best information and news on women’s health you
have come to expect from Network.
In this issue, profiles of work by the Centres of Excellence for
Women’s Health gives readers a look at some of the latest projects on
women’s health in Canada. In a piece by the CWHN’s new Director
of Knowledge Exchange, Jane Shulman, we examine work from the
Atlantic Centre of Excellence in Women’s Health on the support services
available for women with reproductive cancers, and how they might
expand by teaming up with existing breast cancer support networks.
The experiences of young Aboriginal mothers are given a
powerful voice in a report from the Prairie Women’s Health Centre of
Excellence. In “Young Aboriginal Mothers in Winnipeg,” the firsthand
accounts as well as the trends and statistics of motherhood in the city
show the gaps in education and support.
Based in Ontario, the National Network on the Environment and
Women’s Health brings to light the way the chemicals in Canadians’ lives
are regulated with an article on Canada’a new Chemical Management
Plan. Authors Dolon Chakavartty and Anne Rochon Ford break down
Health Canada and Environment Canada’s plan to reexamine the safety of
200 chemicals, and tell the public how they can learn more and voice their
opinions. In “Women and Water,” NNEWH’s new online home for research
on the relationship between women and water in Canada is examined.
In research originally done for Women and Health Protection,
Dr. Barbara Mintzes examines antidepressants, pregnancy, and what
the evidence is for their use. Do they help, harm, or neither? In “Do
The opinions expressed by contributors are their own and do not necessarily
represent the views of the Canadian Women’s Health Network, its funders or
its members. Arcles are intended to provide helpful informaon and are not
meant to replace the advice of your personal health praconer.
The Canadian Women’s Health Network gratefully acknowledges the funding
support provided by the Women’s Health Contribuon Program of the Bureau
of Women’s Health and Gender Analysis, Health Canada, as well as the
support and donaons of the individuals and groups whose work strengthens
the Network.
network / le reséau
volume 12 number 1 fall/winter 2009/10
Editor: Signy Gerrard
Translaon: Intersigne
Subscripons: Léonie Lafontaine
Advisory Commiee: Abby Lippman,
Anne Rochon Ford, Martha Muzychka,
Susan White and Madeline Boscoe
Network/Le Réseau is published in
English and French twice a year by the
Canadian Women’s Health Network
(CWHN). Parts of Network/Le Réseau
are also available on the CWHN website:
www.cwhn.ca
To subscribe to Network magazine, call
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CWHN Staff
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2 FALL/.WINTER 2009/2010 NETWORK

pregnant women benefit from taking antidepressants?,” interesting questions are raised about what we know and
what we assume about the benefits of one of Canada’s most frequently prescribed drugs.
Finally, see an introduction to the CWHN’s latest online expansions - our new webinar series. Launched
in the fall, these hour-long web broadcasts have already brought hundreds of participants new and important
information on women’s health topics, from drug regulation in Canada to more from Dr. Mintzes on the risks and
benefits of antidepressants in pregnancy. Look for upcoming webinars on the CWHN website and in the Brigit’s
Notes newsletter as the year goes on!
Sincerely,
Signy Gerrard
Director of Communications
Support a national voice for women’s health!
CWHN thanks all of our donors, who make such an important contribution to our work.
If you would like to contribute, please go to our website www.cwhn.ca and click on “donate”
or call CWHN at 1-888-818-9172 (toll free).
WHAT’S INSIDE
4 Aboriginal mothers in Winnipeg:
Research looks at attitudes and
understanding around sex and
motherhood
6 Canada’s Chemical
Management Plan:
Why we ought to know
9 The comprehensive feminist
approach to health
11 Do pregnant women benefit
from taking antidepressants?
14 CWHN launches a new
webinar series
15 Strength in numbers:
Project plans to unite support
services for women with
breast and reproductive cancers
16 Women and water
19 What we’re reading:
Recommended resources
from our library
CANADIAN WOMEN’S HEALTH NETWORK FALL/.WINTER 2009/2010 3

A M
Research looks at atudes and unders
By Jane Shulman
Aboriginal teenagers are four
times more likely than non-
Aboriginal teens to have
babies. According to data cited in
the report Young Aboriginal Mothers
in Winnipeg, published in May
2009 by the Prairie Women’s Health
Centre of Excellence (PWHCE),
more than one in five First Nations
babies were born to mothers aged
15 to 19 years in 1999.
By comparison, the Canadian
ratio was one in 20. Aside from
the economic hardships that many
young mothers face, there are increased
health risks for babies born
to teens. Researchers contend that
there are socio-cultural issues at
play that have not been thoroughly
investigated.
In order to uncover the issues
that feed this trend, PWHCE
researcher Lisa Murdock conducted
interviews and group sessions with
28 women living in Winnipeg,
mostly between the ages of 18 and
27 years old. She ventured to find
out why girls from First Nations,
Métis and Inuit populations
are more likely
than non-Aboriginals
to become mothers at
a young age, and support
young mothers by
asking women to tell
her in their own words
about their experiences.
Themes included
the women’s knowledge
of sex before they
became pregnant, their
feelings about intimacy,
where they learned
about pregnancy and
STIs (if they did), the support they
received while pregnant and the
challenges of young parenthood.
You can’t
just stop
and tell
kids they
can’t get
pregnant
at a young
age.
There was significant focus on the
kinds of programs that women
would have accessed had they been
available, and recommendations for
future programming.
Compelling in
Murdock’s report
is the first-person
reporting from the
women she interviewed,
which illuminates
the issues. The
women in the project
had lived experiences
to share and insight
that went beyond the
telling of personal narratives.
Murdock quotes an
interviewee discussing
teen pregnancy within
the context of the oppression of
Aboriginal peoples, and the breakdown
of their family structure.
4 FALL/.WINTER 2009/2010 NETWORK

W
tanding around sex and motherhood
“I think it goes back to a lot of
different things. It goes back to dysfunctional
homes, childhood sexual
abuse, alcoholism, everything. It just
comes down to it. When you get
such abuse, a high percentage of the
time you end up working the streets
or you end up sleeping around, you
end up having kids at young ages
… You can’t just stop and tell kids
they can’t get pregnant at a young
age. It’s not good. You gotta work
on the things that happened to them
too … What’s making them become
like that? It doesn’t mean all
people are being sexually abused,
but a high percentage of the people
live in dysfunctional homes, and
just want to feel loved and decide
to have a baby at a young age. It
becomes then, part of the system.”
Murdock notes that women
mentioned the differences between
Aboriginal and non-Aboriginal
beliefs around abortion and adoption
as another reason for the high
rates of teen pregnancy among
Aboriginal women. Says another
interviewee:
“There’s a lot of girls out there
who just want a baby. Even so
young, they want to have a baby so
they can have something to love, for
someone to love them.”
While the women interviewed
said they were happy with the
children they had, most said they
thought young teens were not
equipped to be having babies. They
suggested prevention strategies
including sex education starting in
elementary school, presentations
in high schools from young parents
talking about their challenges, and
better support programs for young
parents. They stress that communication
within families and between
girls and people in their communi-
ties is the key to prevention.
“I’d say prevention first. Like,
the whole talking to the guardian,
like the parents and the guardian
thing. Like teaching them how to
talk to their kids, that’d be good.
And a class how to talk to your
parents might even help too because
kids are really cocky these
days. They’re trying to be independent,
but that’s not the case. I think
that would help. A class on how to
connect with each other would be
good.”
The report, Young Aboriginal
Mothers in Winnipeg, is available on
the Prairie Women’s Health Centre
of Excellence website at www.
pwhce.ca/youngAborigMothers-
Murdock.htm
Jane Shulman is the Director of
Knowledge Exchange at the Canadian
Women’s Health Network.
CANADIAN WOMEN’S HEALTH NETWORK FALL/.WINTER 2009/2010 5

CANADA’S
CHEMICALS
MANAGEMENT
PLAN
Why
we
ought
to
know
By Anne Rochon Ford and Dolon Charkavartty
ONE WOULD EXPECT THAT THE THOUSANDS OF CHEMICALS IN DAILY USE – IN OUR
HOMES, IN INDUSTRY, AND ELSEWHERE – HAVE BEEN THROUGH A FORMAL REVIEW
PROCESS BY OUR GOVERNMENTS TO ENSURE THAT THEY ARE SAFE FOR HUMAN EX-
POSURE. IN FACT, HOWEVER, MOST CHEMICALS IN CURRENT USE HAVEN’T BEEN FULLY AS-
SESSED AND CAN REALLY ONLY BE CONSIDERED “SAFE” UNTIL IT’S PROVEN OTHERWISE.
Fortunately, there is a possibility that this far-fromreassuring
situation may change. In December 2006,
the Government of Canada announced a new process
for assessing and managing the potential health and
environmental risks from over 23,000 chemicals that
are widely used in Canada. Included in this “Chemicals
Management Plan” (CMP) is a “Challenge” to
industry: unless industry provides information that
suggests otherwise, 200 of these chemicals will be
considered toxic (as defined by the Canadian Environmental
Protection Act or CEPA). In other words, the
ground has shifted – in the case of some chemicals,
at least – from “safe until proven otherwise” to “toxic
until proven otherwise.” Given the increasing evidence
linking exposure to even trace amounts of chemicals
in our air, water, soil, food, and homes with chronic
illnesses including cancer, this is a step in the right
direction.
Over a three-year period, Health Canada and
Environment Canada have been releasing the names
of fifteen of the 200 chemicals in question every three
months. These chemicals will be re-evaluated based
on four factors, namely persistence, bioaccumulation,
inherent toxicity, and greatest potential for exposure.
This re-evaluation is currently underway and
individuals and groups in the general public – not
just scientists and industry – are being encouraged to
become knowledgeable about what is going on and
to get involved. Funding was provided to the Canadian
Environmental Network / Réseau canadien
de l’environnement (RCEN), in collaboration with
the environmental NGO, Environmental Defence,
6 FALL/.WINTER 2009/2010 NETWORK

to coordinate a process of civil
society engagement. When the
names of chemicals are released,
the RCEN notifies a network of
individuals and groups about them
and explains what the government
has concluded (based on existing
research). The RCEN then
provides its own “plain language”
assessment of the literature and
encourages citizen groups to learn
more about these chemicals, many
of which can be found in personal
care products, household cleaners,
cosmetics, and other products
with which humans have regular
contact.
There will be opportunities
for public input both when the
quarterly releases of the names
of chemicals occur (this process
is now complete) and at the later
stages when Health Canada and
Environment Canada deliberate
about how these chemicals will be
“managed.”
These deliberations will go on
until some time in 2011.
Why should women
be concerned?
There are both sex- (e.g.,
biological) and gender-based
(e.g.,social) reasons why women
should be aware of these issues. In
particular, women are known to
have different experiences with
and exposures to many of these
The criteria by which chemicals are being evaluated
1. Possibility for Persistence:
The me it takes for a substance to break down in
the environment
2. Possibility for Bioaccumulaon:
The tendency for a substance to accumulate in the
ssues of living organisms and to travel along the
food chain
3. Inherent toxicity:
Whether a chemical is inherently harmful to human health
or to other living creatures (as disnct from
the legal definion of “toxic” in CEPA)
4. Represenng the Greatest Potenal for Exposure:
Substances in vast amounts of use that can potenally affect
large numbers of the populaon
chemicals. To take the most obvious:
only women get pregnant and
give birth, and their exposures can
affect the embryo and fetus. One
particular concern is based in the
substantial body of scientific literature
demonstrating the unique
vulnerability of the fetus to endocrine-disrupting
chemicals found
in daily environmental exposures
to several chemical substances
(e.g. pharmaceuticals in the water;
Bisphenol A [BPA] found in plastic
and food products; etc.).
However, women’s special concerns
go beyond their reproductive
roles. Women and girls have other
sex- and gender-based vulnerabilities
to being exposed and to being
harmed by the exposures that need
to be considered in discussions
about the control of chemicals.
Sandra Steingraber’s work on the
falling age of puberty provides
compelling evidence to suggest
that myriad factors, including
exposures to endocrine-disrupting
chemicals, play a role in accelerating
puberty in girls.
The social and caretaking roles
carried out by many women,
the nature of much of their paid
employment in the service sector,
and their greater use of personal
care products (cosmetics, lotions,
specialized cleansers, etc.) can
all lead to daily exposure to certain
chemicals, which put women
at higher risk for health-related
problems. Additionally, medical or
health conditions that have been
attributed to chemical exposures,
CANADIAN WOMEN’S HEALTH NETWORK FALL/.WINTER 2009/2010 7

even though these associations
are often deemed controversial
in the medical community (e.g.
fibromyalgia, Multiple Chemical
Sensitivity Syndrome), tend to be
diagnosed at much higher rates in
women than men.
Fitting sex and gender
into the Chemicals
Management Plan
In response to this important
initiative underway at Health
Canada and Environment Canada,
and recognizing the importance of
attention to sex- and gender-based
aspects of it, the National Network
on Environments and Women’s
Health (NNEWH) has undertaken
a project to foster citizen engagement
among women and women’s
groups in the CMP. Janelle Witzel
from Environmental Defence supports
this engagement. “Women’s
involvement and interest in the
case of BPA was instrumental in
prompting government action”,
she said. “There is a large potential
for women’s voice and participation
in the CMP process ... that
could lead to policy change.”
The project, which the Canadian
Women’s Health Network is
consulting on, will involve a public
forum slated for February 2010,
following a web-based survey seeking
input from a broad range of
women across Canada. For more
information on these initiatives,
check the websites of NNEWH
(www.nnewh.org) and CWHN
(www.cwhn.ca) for updates.
Anne Rochon Ford is the Co-Director of
the National Network on Environments
and Women`s Health and Coordinator
of the national working group Women
and Health Protection.
Dolon Chakravartty is a graduate
student in Public Health Sciences and
Collaborative Program in Environment
& Health at the University of Toronto.
She is the Graduate Fellow working
with the National Network on
Environments and Women’s Health from
the Fall 2009 - Spring 2010.
FURTHER READINGS:
Altman, R.G., R. Morello-Frosch,
J.G. Brody, R. Rudel, P. Brown,
and M. Averick. (2008). Pollution
comes home and gets personal:
Women’s experience of household
chemical exposure. Journal of
Health and Social Behavior, 49(4):
417-435. Available on line through
www.ncbi.nlm.nih.gov/pmc/articles/
Steingraber, Sandra. (2007, August).
The falling age of puberty in girls:
What we know, what we need to
know. San Francisco, CA: Breast
Cancer Fund. Available on line at
www.breastcancerfund.org. Steingraber
is careful to point out that a
myriad of factors seem to be contributing
to this trend, environmental
exposures being one significant
one.
O’Grady, Kathleen. (2008/2009,
Fall-Winter). Early puberty for
girls. The new ‘normal’ and why we
need to be concerned. Network,
11(1): 11-13. Available on line at
www.cwhn.ca/en/node/39365
“Managing” the Chemicals
“Management” can include a wide variety of policy measures; the choice
is almost enrely at the discreon of the Government of Canada. While
outright bans, and placing limits on producon, use, import and
emissions of dangerous substances by regulaon are all possible, they
are done relavely rarely.
8 FALL/.WINTER 2009/2010 NETWORK

FURTHER RESOURCES:
The Canadian Environmental Law
Association (CELA) is a community-based
environmental law clinic
funded by Legal Aid Ontario, and
has advocated for improvement
and reform of the Canadian Environmental
Protection Act for many
years. For a collection of submissions,
media releases and other
commentary, see
www.cela.ca/collections/pollution/chemicals-management-canada.
The Canadian Environmental
Network/ Réseau canadien de
l’environnement (RCEN) has funding
from Environment Canada to
coordinate civil society participation
in chemicals management in
Canada:
www.cen-rce.org/CMP/indexcmp.
html
Environmental Defence is an environmental
group that is a member
of the RCEN that “gathers, reviews,
and analyses evidence related to the
CMP on behalf of civil society” and
makes this information available
through the RCEN website. They
have also mounted a campaign to
encourage the federal government
to designate the chemical 1,4-Dioxane
as toxic. http://petition.
environmentaldefence.ca/dioxane/
Film: “Toxic Trespass”
www.toxictrespass.com
T
Adapted from Changeons de Lunettes:
Pour une approche globale et féministe de la santé,
from the Réseau québécois
d’action pour la santé des femmes
THERE ARE MANY DIFFERENT WAYS OF CONCEP-
TUALIZING HEALTH. ALTERNATIVE TYPES OF
KNOWLEDGE HAVE ALWAYS COEXISTED WITH
‘LEGITIMATE’ OR ACCEPTED KNOWLEDGE.
Feminists have consistently played a key role in movements challenging
the biomedical approach. The comprehensive feminist approach
is based on eight pillars and is characterized by its critical
stance toward medical and government institutions.
With the new edition of the framework for women’s health,
the Réseau québécois d’action pour la santé des femmes (RQASF
– Quebec Women’s Health Action Network) offers a critical
reading of the current situation and its causes, including the impact
of globalization on our health and on our lives in general. It
also proposes another vision and another approach to health.
Film: “The Story of Stuff ”
http://storyofstuff.com
CANADIAN WOMEN’S HEALTH NETWORK FALL/.WINTER 2009/2010 9

A different perspective
The following are the eight pillars
of the comprehensive feminist
approach to health:
While biomedicine is a mechanistic
concept of the body that
divides the individual into a collection
of component
parts, the comprehensive
approach is
based on a conception
of the human being
as a whole (body and
mind) interacting
with their social and
physical environment.
Thus, this approach defines health
in a holistic* way, as the result of
social relationships.
In contrast to a homogenizing
vision of health, the comprehensive
feminist approach advocates
the recognition of the physiological
and social differences between
the sexes, while at the same time
recognizing the differences between
individuals, both women
and men. This acknowledgement
of a person’s many different characteristics
— whether they are a
man or a woman, rich or poor, gay
or straight, living with a disability
or not, etc. — is called intersectionality.
According to the comprehensive
feminist approach, in order to
improve health, the social determinants
of health must be taken into
account; these are the factors that
have the greatest impact on health,
such as income, employment and
housing.
Contrary to an interventionist,
cure-oriented medicine, the
comprehensive feminist approach
believes a population’s health cannot
be improved without prevention and
health promotion. Health is a matter
of social justice. Consequently,
It is essenal to exercise
vigilance and crical thinking
with respect to knowledge
that is presented as universal
governments must not abdicate their
responsibility to enact legislation and
regulations in all areas that affect the
determinants of health.
Self-care, taking charge of one’s
own health, is another of the pillars
of the comprehensive feminist
approach. This is something that has
traditionally been promoted by Quebec
feminists, particularly in women’s
health centres. Self-care involves
a personal effort to understand the
links between our health and our life
circumstances. It aims to achieve a
more egalitarian therapeutic relationship
based on respect, communication,
and the full participation of the
person consulting the health care
professional.
Therapists and physicians are
expected to show respect for people’s
autonomy and their right to
informed consent. Informed consent
is a fundamental right, so therapists
and physicians have a responsibility
to provide all available information
to those who consult them.
Thus, certain types of
biomedical knowledge historically
based on the exclusion of
women must be reexamined.
It is essential to exercise vigilance
and critical thinking with
respect to knowledge that is
presented as universal,
often with the support
of economic interests
(the pharmaceutical
industry, for example).
Finally, the comprehensive
feminist
approach to health is
distinguished from the
dominant medical approach
in its openness to alternative
approaches. However, these
approaches must also be underpinned
by guidelines and regulations
to safeguard the rights
of the individual, both in their
relationship with the health
professional and in their choice
of the approach to health care
that best suits them.
The full document Changeons de
Lunettes (French only) is
available to order at the website of
the Réseau québécois d’action pour
la santé des femmes (RQASF )
www.rqsaf.com
The RQASF is an provincial
nonprofit mulitdiscplinary organziation.
Their mission is to work
in solidarity to better the physical
and mental health of women of all
walks of life. To learn more about
their activities, consult their website
10 FALL/.WINTER 2009/2010 NETWORK

Do
pregnant women
benefit
from taking
antidepres sants?
By Jane Shulman
Pregnant North American women are taking anti-depressants more than ever. The medical community has
long advised women to avoid pharmaceuticals during pregnancy, but there is a growing trend to encourage
women taking anti-depressants to keep taking them when they become pregnant, and to prescribe the drugs
to pregnant women with depressive symptoms. The assumption being made with these prescriptions is that the potential
risks to women and fetuses from taking anti-depressants outweigh the potential risks of letting depression go
untreated. But is there really evidence of that these drugs benefit pregnant women, and does that benefit outweigh
the potential risk?
During a popular Canadian Women’s Health Network webinar last October, Dr. Barbara Mintzes discussed the
history of prescription drugs during pregnancy and the current debate. Mintzes is an Assistant Professor at University
of British Columbia’s Department of Pharmacology & Therapeutics, member of the UBC Centre for Health
CANADIAN WOMEN’S HEALTH NETWORK FALL/.WINTER 2009/2010 11

Services & Policy Research, and a
Steering Committee member of
Women and Health Protection.
She and colleagues are aware of the
conflicting information about the
safety and benefits of taking selective
serotonin reuptake inhibitor
(SSRI/SNRI) class anti-depressants
(such as Prozac, Paxil and Effexor)
during pregnancy.
What is known is that anti-depressants
are being prescribed to
pregnant women ‘off-label,’ meaning
prescribed for a use for which
they were not approved. Mintzes
explains that “Anti-depressants are
unapproved for use in pregnancy
in Canada, or actually in any other
country.” While it is illegal for drug
companies to promote their products
for ‘off-label’ use, doctors
can prescribe any drug for any use
once it is on the market.
There is a generally recognized
need for caution when using medications
during pregnancy that has
come out of two disasters – Thalidomide
and Diethylsilbestrol
(DES), drugs that had devastating
effects on babies born to women
who took them while pregnant.
In the case of Thalidomide, some
babies had severe birth defects.
DES caused higher rates of cancer
and reproductive problems in
adult women who were exposed
while their mothers were pregnant
with them. DES sons also have
higher rates of abnormalities of the
reproductive organs. Additionally,
women who took DES while pregnant
have higher rates of breast
cancer.
These disasters, Mintzes notes,
brought attention to the possibility
of unpredictable and long-term
harm from drug use in pregnancy.
With that in mind, and with the
conflicting advice women were
receiving about using SSRIs while
pregnant, Mintzes and colleagues
decided to wade through the studies
that had been done to see if there
was in fact evidence of benefit to
taking these drugs for women and
their babies.
Any time a medicine is used,
there is a need to weigh the potential
benefit against the potential
harm. This is why medicines have
to be tested systematically before
they’re approved for use. With
‘off-label’ use – as is the case with
antidepressants in pregnancy - the
company marketing the drug has
not had to show scientific evidence
to the government of a specific
benefit for this use. That evidence
may or may not exist. Since all
medicines can cause harm as well
as benefit, unless there is rigorous
scientific evidence that benefit is
likely to outweigh harm, a medicine
should not be taken.
Mintzes worked with Patricia
Fortin, a research consultant at
UBC’s drug assessment group Therapeutics
Initiative, Jon Jureidini, an
Associate Professor at the University
of Adelaide’s Department of Psychiatry
and UBC Pediatrics professor
Tim Oberlander. Funded mainly by
Health Canada’s Bureau of Women’s
Health and Gender Analysis, they
carried out a systematic search for
all studies comparing women with
depression who did or did not take
antidepressants during pregnancy,
and evaluated the study results.
Their conclusion? Even after
searching for all published and
unpublished studies – worldwide
– and despite the many claims made
in favour of antidepressant use, they
failed to find any scientific evidence
that either pregnant women or their
babies benefit from use of SSRI/
SNRI antidepressants.
Mintzes’ team found eight studies
of women who were pregnant
and diagnosed with depression. In
all cases, the studies compared the
outcomes for mothers and babies
of those taking antidepressants and
those who had no treatment of
any kind. There were no studies,
Mintzes notes, comparing pregnant
women who took SSRI/SNRIs with
those who were treated in other
ways, such as cognitive-behavioural
therapy or regular exercise.
The size and quality of the eight
studies varied, as did the degree
of depression of the women who
participated. All were observational,
meaning that although there was a
control group, women who chose to
take antidepressants were compared
with others who did not. Interpreting
the results was complicated by
differences between the women
who took antidepressants and those
who did not. For example, some
had a longer history of depression or
more severe depression.
Five of the eight studies were
also quite small, with weaker research
methods, and in those cases,
Mintzes notes it was hard to say why
12 FALL/.WINTER 2009/2010 NETWORK

there were so many poor birth outcomes.
Was it the exposure to the
drug, or was it because of differences
between the women who were
and were not taking antidepressants?
Were issues like poverty, known to
be a factor in depression and birth
outcome, taken into account? The
three larger – and more scientifically
solid - studies they reviewed
followed large populations of
women, including one that included
all women in British Columbia who
gave birth between 1998 and 2001.
However at the end of the review,
none of the studies – whether
large or small – showed any degree
of benefit from antidepressant use.
When there is no scientific evidence
of benefit, says Mintzes, there is
reason to be concerned when use of
a treatment is widespread.
In looking at studies in
non-pregnant women as secondary
evidence of whether or not there
might be a benefit to pregnant
women, Mintzes finds there isn’t
evidence that SSRIs work better
than non-drug treatment, like
psychotherapy for most forms of
depression, and she is concerned
that the benefits of SSRIs in adults –
pregnant or not – have been shown
to be exaggerated. There is also the
consideration that depression is
often incorrectly diagnosed. A systematic
review of studies found that
family doctors incorrectly diagnose
a person with depression 15 times
for every 10 correct diagnoses.
As for the impact on babies, the
eight studies found that children
born to women taking SSRIs had
4.2% (1 in 24) greater incidence
of respiratory distress than among
women with depression without
SSRI exposure, and a 0.6% higher
rate of cardiac malformation (1
in 159), again as compared with
women not taking antidepressants.
This is a signal that babies exposed
to antidepressants seem to be doing
worse in some ways than those not
exposed. It adds to a larger body
of literature on harmful effects of
antidepressants in pregnancy.
“The question is, why is this
treatment being very heavily recommended
for use in pregnancy given
the lack of scientific evidence of
benefit?” asks Mintzes. “There is no
rationale for the recommended use
of SSRIs in pregnancy.”
Jane Shulman is the Director of
Knowledge Exchange at the Canadian
Women’s Health Network.
Watch the webinar at www.cwhn.ca
CWHN is developing an in-depth information sheet about SSRIs and pregnancy available for download soon on our website.
Some SSRI stats:
• Andepressants are among the most frequently prescribed class of
drugs for women of childbearing age in Canada.
• In 2003 – 2004, 11-14% of women in Brish Columbia between the ages
of 25 and 39 received at least one prescripon for an andepressant.
• In 2008, 80% of women in Canada who spoke about depression to
their doctors were given a prescripon, usually for an SSRI.
• In 1998, just over of 2% of pregnant women in BC used an andepressant.
By 2001, the rate of use had grown to 5%.
CANADIAN WOMEN’S HEALTH NETWORK FALL/.WINTER 2009/2010 13

CWHN Launches Webinar Series
Last fall, the Canadian Women’s Health Network (CWHN) launched its new series of webinars.
The interacve lecture format allows presenters to speak to and take quesons from a na-
onwide audience online, and allows audience members to interact and discuss presentaon
material with each other. Sessions are also recorded and available on CWHN’s website for later
viewing by those who couldn’t aend the webinar.
SSRIs in Pregnancy: Is there evidence of benefit?
Recorded October 29th, 2009
An over-capacity registraon of more than one hundred people filled the inaugural webinar
featuring Dr. Barbara Mintzes, who discussed the findings of her new systemac review on the
benefits and risks of an-depressant use in pregnancy. Aendees, ranging from midwives to
university classes and community/social services providers, finished the session with an enthusiasc
queson period. For more informaon, see the arcle on Mintzes’ research, “Do Pregnant
Women Benefit from Taking Andepressants?” in this issue.
The Push to Prescribe
Recorded November 4, 2009
In the second of the webinar series, parcipants from government, the medical professions,
professors, and students tuned in to hear from three authors of A Push to Prescribe, the new
book on women and Canadian drug policy. The product of 10 years of research and policy-related
work by Women and Health Protecon, as moderator and editor Anne Rochon-Ford put
it, the book examines prescripon drug policy in Canada and the impact on women’s health,
from clinical trials to markeng. Chapter authors Colleen Fuller and Abby Lippman spoke on
“Reporng Adverse Drug Reacons – What happens in the real world” and “Inclusion of women
in Clinical Trials – Are we asking the right quesons?” respecvely, and engaged in an acve
discussion with parcipants.
Both SSRIs in Pregnancy: Is there evidence of benefit? and The Push to Prescribe, including the
aer-presentaon discussion period, are available for online viewing at www.cwhn.ca
More are coming up soon!
Check online or subscribe to Brigit’s Notes, CWHN’s monthly newsleer, for the announcement
of upcoming webinars.
14 FALL/.WINTER 2009/2010 NETWORK

STRENGTH
in NUMBERS
Project plans to unite support services for
women with breast and reproductive cancers
By Jane Shulman
Cancer support networks in different parts of the country
are looking at grouping women’s gynaecological
cancers with breast cancer for the purpose of offering
more support to women who have had a cervical,
ovarian or uterine cancer diagnosis. Manitoba has been
working on this for some time, explains Barbara Clow,
director of the Atlantic Centre of Excellence for Women’s
Health, and now New Brunswick and Newfoundland
and Labrador are looking at their own models for
delivering programming under the same umbrella.
In a 2008 report for Canadian Partnership Against
Cancer, called “Where Do We Go From Here? Support
services for women with breast, cervical, ovarian and
uterine cancer in Atlantic Canada,” Clow and co-authors
looked at the idea of merging services to meet
the needs of the underserved gynaecological cancer
population.
The idea is not without its detractors. Some have
expressed concern that breast cancer groups might
jeopardize their funding or lose their identity if they
expand their mandate, or stretch their already overextended
resources.
But the focus on breast cancer over the past several
years, with fundraisers and awareness campaigns popping
up all over the country, means that the disease has
a lot of attention, and Clow notes that it’s the kind of
attention that gynaecological cancers desperately need.
While she says that fewer women are diagnosed with
cervical, ovarian and uterine cancers combined than
breast cancer in Canada each year, with the exception
of cervical cancer, their prognosis is not as good. And
the psychosocial support specific to their kind of cancer
just does not exist.
Clow cites the work of volunteer-based Ovarian
Cancer Canada as the only national gynaecologicallybased
cancer group. There are no national groups for
people with cervical or uterine cancer. The needs are
different, but there’s overlap, which is why a program
that pools resources for cancers that affect women is so
appealing.
The report recommendations included:
Foster new research on the needs of women from
vulnerable and disadvantaged communities who are
faced with a diagnosis of cancer;
Explore the possibility of adopting and adapting the
processes and products developed by breast cancer support
networks in Atlantic Canada to meet the needs of
those with other women’s cancers;
Promote the creation of publicly funded cancer patient
navigator programs throughout Atlantic Canada.
Clow says the next step is to look at how feasible
this idea is, and where the desire lies. So far, nurses
and service providers involved with the planning and
delivering of programming are most passionate about it
because they see the possibilities that lie in making the
most of the services they can offer.
Jane Shulman is a the Director of Knowledge Exchange at the
Canadian Women’s Health Network and a former staff member
of Breast Cancer Action Montreal.
CANADIAN WOMEN’S HEALTH NETWORK FALL/.WINTER 2009/2010 15

Women
and
Water
Wa
By
Signy Gerrard
“Everyone thinks we have all this
water,” says Jyoti Phartiyal of the
National Network on Environments
and Women’s Health, when
speaking of Canadians’ attitude
towards one of our most essential
resources - an attitude that reflects
not only an assumption that supplies
of water are endless and available,
but safe for everyone.
This is an assumption that
new research from NNEWH examines
in a website launched October
6, 2009 – www.womenandwater.ca
– that focuses on water,
women, and their relationship in
Canada today. The idea for the site
was born while NNEWH led a
program-wide research initiative
on women and water in Canada,
exploring Canadian water issues
16 FALL/.WINTER 2009/2010 NETWORK

and the implications for women’s
health.
When asked about the gaps
they found in research in Canada,
Phartiyal immediately responds
with “the biggest gap was the lack
of gender analysis. It was just
completely missing.” A “gendered”
perspective was often limited to
health as it related to fetuses or
new babies. This gap was not just
limited to Canadian research; few
resources gave a gendered perspective
on the issue of water in
any developed countries. Most
research discussed the relationship
between women and water only
in developing nations. While those
studies could provide helpful information
on some of the possible
gender dimensions of water issues,
the issues are likely to look very
different in Canada.
Believing that women have
not only a historical and spiritual
relationships with water, as well
as potentially different effects on
their health, the
searchers, plans are to produce
more documents in plain language
geared towards policy makers and
the general public in the future.
The reports currently available
on the website are organized
into three themes of recent
research: Aboriginal issues,
Contaminants, and Privatization.
In summer 2010 NNEWH will
release the next volume in the
Women & Water in Canada series
on the gendered implications of
chronic exposures to pharmaceuticals
and disinfection by-products.
Aboriginal water issues:
According to womenandwater.ca,
“as of December 31st
2008, 106 First Nations communities
in Canada were under drinking
water advisories” – a dramatic
example of the inequality of access
to a vital resource. In some cases,
these warnings have lasted for
years. As stated in the report from
the Chiefs of Ontario, Aboriginal
As of December 31st 2008, 106
First Naons communies in Canada
were under drinking water
advisories.
Traditional Knowledge and Source
Water Protection Final Report “in
many First Nation cultures, the
women of the community traditionally
carry primary responsibil-
researchers developing
the website
decided to further
the discussion
on women
and Canadian
water policy by
creating a central
online location
for information on the topic,
featuring research from NNEWH,
the Women’s Health Contribution
Program, and key outside sources.
As well as acting as an important
resource for academics and reity
for water.” Clearly, research
needs to explore the social and
cultural as well as physical health
implications of poor water quality
for women.
The first report on this
theme was created in partnership
with the Prairie Women’s Health
Centre of Excellence. Released in
April 2009, the Boil Water Advisory
Mapping Project looks at the
issue of water quality by examining
the data available on boil water
advisories in Canada – a recommendation
typically made when
the public has been alerted to take
precautionary measures, (e.g. boil
the water, at a rolling boil, for one
full minute) to protect against a
potential threat to health in public
drinking water.. Without a standard
measure of water quality in
place, advisories provide a quick,
although imperfect measure.
As well as reviewing these
advisories, the Boil Water Advisory
Mapping Project highlights the
important data
gaps that need to
be filled on topics
like waterborne
illnesses, the cost
of water to consumers,
and gender
analysis in all
of these issues. Future
work in this
area will focus on increasing the
understanding of water’s meanings
in Aboriginal communities, looking
particularly at gender implications,
as well as issues with regulations,
funding, infrastructure, and more.
CANADIAN WOMEN’S HEALTH NETWORK FALL/.WINTER 2009/2010 17

Contaminants in water:
The outbreaks of disease in
Walkerton and North Battleford,
when E.Coli and cryptosporidium
invaded the
water supply,
have thrown the
issue of contaminants
in water
into the spotlight
in recent years.
While Microbiological
contaminants
such as the
ones were found
in those cases remain
the biggest threat; however
there is growing concern over
the issue of chemical contamination
of water. While this form of
contamination may not result in
immediate and dramatic health
effects, the cumulative effects of
long-term exposure are a serious
concern.
These cumulative exposures
were researched and discussed in
two soon-to-be released projects
– in “The Gendered Effects of
Chronic Low Dose Exposures
to Chemicals in Drinking Water,”
by looking at data across the
country, researchers concluded
that although Canada’s drinking
water is “for the most part safe,”
the quality was tied to where you
live. In the second project, “Gendered
Implications of Chronic
Exposures to Pharmaceuticals and
Disinfection By-Products in Typical
Drinking Water” looks at what
is released into our water from
drugs and everyday personal care
products, and by-products used in
water treatment, how they interact,
and what the implications
are.
As primary caretakers, most
oen responsible for the health
of their families, as well as their
personal health, women are
likely to be affected significantly
Privatization of water:
The question of whether water
is a human right or a commodity,
and the implications of those
interpretations, is addressed in the
research theme of Privatization.
This research area addresses the
rise of private sector involvement
in the water supply networks, and
the more business-oriented values
that the sector brings with it. What
do these shifts mean for women?
As primary caretakers, most often
responsible for the health of their
families, as well as their personal
health, women are likely to be affected
significantly by these trends.
The Significance of Privatization
and Commercialization Trends
for Women’s Health, a project
in partnership with the Council
of Canadians, supported by the
Prairie Women’s Health Centre of
Excellence and Women and Health
Care Reform, looks at the push to
privatize water in Canada. It ex-
amines larger philosophical questions
such as whether water should
be privatized at all, and more
practical issues such as water management
models,
privatization experiences
and threats in
Canada. The project
also looks at what
privatization may
mean for women’s
health, particularly
Aboriginal women’s
health.
Signy Gerrard is the Director
of Communications at the Canadian
Women’s Health Network.
Visit the website at:
www.womenandwater.ca
Read the reports:
Privazaon of water:
www.womenandwater.ca/
pdf/NNEWH%20water%20pr
ivazaon.pdf
Contaminants in water:
www.womenandwater.ca/
pdf/NNEWH%20water%20c
ontaminants.pdf
Aboriginal water issues:
www.womenandwater.ca/
pdf/NNEWH%20water%20c
ontaminants.pdf
18 FALL/.WINTER 2009/2010 NETWORK

WHAT WE’RE READING
recommended resources from our library
Rising to the Challenge:
Sex and Gender-based Analysis for Health
Planning, Policy and Research in Canada
By Barbara Clow, Ann Pederson, Margaret Haworth-Brockman,
and Jennifer Bernier (2009)
Rising to the Challenge is a book that describes the process of
sex- and gender-based analysis and offers a collecon of case
studies and commentaries that illustrate SGBA in acon. The
book is of interest to people working on policy, planning and research
and to people at various levels of government. It will help
readers understand sex- and gender-based analysis and learn
how to apply it in their work for and with women and men, girls
and boys. Sex- and gender-based analysis reminds us to ask
quesons about similaries and differences between and among
women and men, such as:
Do women and men have the same suscepbility to lung disease
from smoking? Are women at the same risk as men of contracting
HIV/AIDS through heterosexual intercourse? Are the symptoms
of heart disease the same in women and men? Are x-rays
equally useful for reflecng the level of disability and pain experienced
by women and men living with osteoarthris? Do boys
and girls have similar experiences of being overweight or obese?
Do internaonal tobacco control policies work the same way for
men and women?
By introducing such quesons, sex- and gender-based analysis
can help lead to posive changes in how programs are offered or
how resources are allocated.
To download an electronic copy or request a print copy,
visit the website www.pwhce.ca, www.acewh.dal.ca,
or www.bccewh.bc.ca
Dissonant Disabilies:
Women with Chronic Illnesses
Explore Their Lives
Diane Driedger & Michelle Owen
(Women’s Press, April, 2008)
This collecon of original arcles invites
the reader to examine the key
issues in the lives of women with
chronic illnesses. The authors explore
how society reacts to women
with chronic illness and how women
living with chronic illness cope
with the uncertainty of their bodies
in a society that desires certainty.
Addionally, issues surrounding
women with chronic illness in
the workplace and the impact of
chronic illness on women’s relaonships
are sensively considered.
Racialized Migrant Women
in Canada: Essays on Health,
Violence, and Equity
Vijay Agnew (University of Toronto
Press, 2009)
Despite legislave guarantees of
equality, immigrant women in
Canada oen experience many
forms of prejudice in their everyday
lives. Racialized Migrant Women in
Canada delves into the public and
private spheres of several disnct
communies in order to expose
the underlying inequalies within
Canada’s economic, social, legal,
and polical systems that frequently
result in the denial of basic rights
to migrant women.
CANADIAN WOMEN’S HEALTH NETWORK FALL/.WINTER 2009/2010 19

Diversity and Women’s
Health: No Woman Le Behind
Sue V. Rosser (John Hopkins
University Press, June 2009)
Once focusing solely on reproduc-
on and reproducve maers, the
study of women’s health has expanded
to include cardiovascular
disease, breast cancer, colorectal
cancer, osteoporosis, and more.
Yet the health care issues affecng
diverse groups of women remain
underfunded and understudied.
Diversity and Women’s Health calls
aenon to this glaring discrepancy
and presents cung-edge
reserach on women’s health from
a femenist perspecve. The contributors
argue that health issues
specific to lesbians, elderly women,
women of colour, immigrant
women, and disabled women
must become a central part of the
broader conversaon on women’s
health in the United States.
Polygendered and Ponytailed: The Dilemma of Femininity
and the Female Athlete
Dayna B. Daniels (Women’s Press, June 2009)
Since the 1970s North American women and girls have engaged in
every sport that interests them and have become champions in their
fields. One of the consequences of this success is ongoing cricism,
not of how they perform, but of how they look. In Polygendered and
Ponytailed, Dayna Daniels argues that the femininity-masculinity divide
prevents women athletes from being taken seriously in their sports. As
long as sports remains a male domain, girls and women who parcipate
will be viewed as either masculine to begin with or masculine through
their involvement. By embracing a polygendered way of being, which
emphasizes the similaries between women and men, female athletes
will be given the chance to achieve their full sporng potenal and be
judged for their performance, rather than their appearance.
Textual Mothers/Maternal Texts
Elizabeth Podnieks and Andrea O’Reilly (Wilfred Laurier University
Press, December 2009)
Focuses on mothers as subjects and as writers who produce autobiography,
ficon, and poetry about maternity. Internaonal contributors
show how these authors use textual space to accept, negoate, resist,
or challenge tradional concepons of mothering and maternal roles.
CWHN Info Centre
The Canadian Women’s Health Network invites you to search out women’s health database,
a comprehensive bilingual collecon of women’s health publicaons and resources from
across Canada and the world. With advanced search opons, the CWHN women’s health
database gives you access to over 13,000 resources - publicaons, research, arcles, organizaons,
reviews, and projects covering a wide range of informaon on women’s health and
women’s lives.
Search the CWHN Info Centre at our website: www.cwhn.ca
20 FALL/.WINTER 2009/2010 NETWORK