The Next Era of Sex and Gender in Health

Creating a national centre for sex, gender and reproductive health services

There’s no denying it, sex and gender significantly impact health – and yet, they’re often missing from the conversation in healthcare. When healthcare services are offered that are inclusive of or recognize someone’s sex and gender identity, they’re often piecemeal or siloed from other services.

All too often models of care for sex, gender and reproductive health (SGRH) services, like contraceptive healthcare, trans healthcare or gynecological care, fail to be inclusive or culturally responsive, perpetuating barriers to care. This leaves many patients having to travel far distances, wait long periods of time to see a provider or go without care and treatment all together.

“There are no academic programs offering integrated sex, gender and reproductive health services for women, trans, gender diverse or intersex individuals across their lifespan in Canada,” says Jack Woodman, vice-president, strategy, quality, risk and privacy, at Women’s College Hospital (WCH). “We propose to meet this challenge and address this health inequity through the first national Sex, Gender and Reproductive Health Centre at WCH.”

WCH plans to build on its existing range SGRH services, as well as its strength in research, education, community partnerships and advocacy to address gaps in care, enhance integration of services and increase access, particularly for marginalized communities. As a result, the new centre will include new or enhanced care services in areas like sexual function, menopause care, trans care, early pregnancy loss, abortion and others. “Ultimately, our goal is to create a national centre of excellence where patients across the gender spectrum can receive SGRH services in a safe, integrated and inclusive manner throughout their lives,” Woodman explains. 

As a first step, WCH is moving ahead to expand its existing services in areas like abortion care. “Abortion access in Ontario and Canada, more broadly, remains insufficient. There’s no question that there’s a demand for this health service that’s not being met in many areas of the country, forcing people to travel great distances to seek care,” says Dr. Julie Thorne, a gynecologist at WCH.

Jack Woodman, Vice-President, Strategy, Quality, Risk and Privacy & Dr. Julie Thorne, Gynecology

Women’s College has expanded its abortion services to include new procedures like second trimester abortion and virtual “no-touch” abortion. “Previously, there was no hospital-based second trimester abortion program in the Greater Toronto Area that was accessible for all indications,” Thorne explains. “While other clinics exist in the Toronto area, they are out of hospital with limited anesthesia, which can be challenging when caring for patients with more complex health needs.”

“We also know that the pandemic has impacted access to abortion and continues to be a struggle with clinics having to lower their patient or procedure volumes due to staffing shortages,” Thorne adds. “The COVID-19 pandemic has also provided us with an opportunity to re-think how we offer care and allowed us to move towards virtual or no-touch abortions, where we’re hopefully able to improve access by leveraging virtual care tools for patients undergoing a medication abortion.”

Part of the gap in SGRH services stems from a lack of research. Women, trans, non-binary and gender diverse people remain underrepresented in studies, like clinical trials, which inform advances in healthcare and enhance our understanding of how health needs differ based on someone’s sex and gender identity.

“Within mental health research there’s often a lack of consideration given to how sex and gender impact a condition or illness,” says Dr. Lucy Barker, psychiatrist and post-doctoral fellow in perinatal mental health at WCH. “For example, how do hormonal changes impact someone’s mental health? Or how do socially expected gender norms impact mental health? To provide safe and equitable mental healthcare, or any type of healthcare, we need research studies that incorporate a sex and gender lens.”

A recent study led by Dr. Barker in Lancet Psychiatry shows that fewer than half of postpartum psychiatric emergency department visits were followed by timely outpatient care. The study also highlighted the impact of the social determinants of health, as factors like neighbourhood income level and immigration status furthered inequities within the study population. “As researchers within perinatal mental health, our work recognizes how fundamental sex and gender are to someone’s health. However, it is also essential that we incorporate an intersectional lens, recognizing that inequities across factors like income, race, immigration, age and others impact health and healthcare access.”

A new centre of excellence in sex, gender and reproductive health at Women’s College will help shape a more integrated approach to care, providing patients with a broader spectrum of treatment options, coupled with patient-centred design, innovative research and training opportunities for healthcare providers. “At this stage in our evolution as a hospital and academic centre, we are ready to move towards the next era of sex and gender in healthcare. One that goes beyond binary divisions and is inclusive, intersectional and forward-thinking so that more patients can benefit,” Woodman says.

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