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 

1-888-818-9172 or email cwhn@cwhn. 

ca for details and payment opons. 

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PUBLICATIONS MAIL AGREEMENT NO. 40036219 

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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 


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. 


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. 


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, 


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, 


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. 


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 


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 


Do 

pregnant women 

benefit 

from taking 

antidepres sants? 


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 


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 


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%. 


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. 


STRENGTH 

in NUMBERS 

Project plans to unite support services for 

women with breast and reproductive cancers 


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. 


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 


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. 


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 


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: 


pdf/NNEWH%20water%20c 

ontaminants.pdf 

Aboriginal water issues: 


pdf/NNEWH%20water%20c 

ontaminants.pdf 


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. 


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

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