| Voices From The Front Lines: Models of Women-Centred Care in Manitoba and Saskatchewan
R. Barnett, S. White, T. Horne
Women-centred care models emerged because the Canadian health care system has not responded adequately to women’s needs. In order to meet women’s needs, numerous health centres and programs have developed to deliver services at the community level and within regional health authorities. Women-centred care, a concept with strong roots in the prairie provinces, is formalized in models and clearly labeled frameworks identified as women-centred or gender-sensitive. These include the Women’s Health Clinic in Winnipeg, the framework for the regulation of midwives in Manitoba, and services specifically for women who have experienced violence and abuse in both provinces.
This research looked at women-centred care within Saskatchewan and Manitoba and compared findings with other women-centred models. We have not provided a specific definition of women-centred care because there is not yet agreement on meanings. Rather, we found many examples of practices that deepen our understanding of women-centred. Additionally, we gained insight into the philosophies and values that need to be present for women-centred care to flourish. The lack of a common understanding is, in part, because women-centred care is a newer concept for many people. In order to reach a better understanding, we tried to look at health care in practice, rather than theoretical statements from those familiar with women-centred language. Women-centred care is about how we do our business, about processes, and whether or not we look at the particular needs of women differently than men.
BACKGROUND ON MODELS OF WOMEN-CENTRED CARE
No one health care service will incorporate everything described in women-centred models because of varying contexts, size of organizations, mandates and resources. However, looking at a wide range of options can assist us in understanding women-centred care. It is our hope that readers can apply what is meaningful to their situations and enhance or develop new services for women.
It is important to note that integrating the concepts and practices of women-centred care may entail changes that go beyond what individuals can accomplish. Training is essential for professionals and staff across the health system. Successful women-centred models may require support in the form of funding and structural changes. Hence, numerous policy issues emanate from this research. Interview participants often describe advocating for policy changes to improve the lives of the women they work with or to expand the type of services they provide. Policies that promote these women-centred approaches need to be put in place.
Interviews and analysis
We used the constant comparative method common in qualitative research, where
earlier category codes are revised to fit with new information as it arises
(Glaser and Strauss, 1967). The thematic categories that emerged from the data
were sorted and compared as we proceeded through the analysis. Links from categories
to broader themes were discussed among the researchers until we reached consensus.
Overall themes and related categories are reported with generous numbers of
quotes to illustrate what these meant to women in their own words and to show
the extent of the issues.
We noted that many participants did not use language such as ‘women-centred’, ‘gender’ or ‘social determinants’. However, because someone does not use the term ‘women-centred’ does not necessarily mean that they are not women-centred in their practice. It is important to look at the concepts participants used to understand how they incorporate elements of women-centred care in their practice. Themes of women-centred care emerged and participants described the efforts, successes, and challenges they face. Themes revolved around how to address the realities of women’s lives, as perceived and described by the service providers we interviewed.
This section begins with a discussion of the social and economic context of women’s lives. Participants highlighted:
Next we present the broader philosophies, both explicit and implicit, that guided interview participants’ responses to women’s lives. These formed the following themes: holistic, spiritual, feminist, and First Nations’ rights. We describe the “cornerstones” of women-centred care. These are the conditions under which women-centred care is possible. Themes about delivering comprehensive services to women reflect the interview participants’ understanding of women’s patterns and preferences for care and acknowledge women’s ways of communication and interaction.
The discussion about knowledge development touches on evaluation and research; it considers research needs and capabilities to carry it out. Workplace environment is also important and participants provided ample discussion about what conditions are important for workers to be able to deliver women-centred care. Finally, a section about social justice links back to where we began, with women’s lives. All of the themes are interconnected. While it is not a component of women-centred care per se, adequate funding is important to facilitating and delivering women-centred care.
Some of the elements we found such as empowerment, respect, and safety are also present in the models underlying our working framework. Others such as Aboriginal spirituality and self-determination, integrated service delivery, a common women-centred philosophy in the workplace, staff mental health and safety arose here for the first time. Our working guide is particularly enhanced, and our understanding deepened, by evidence of how the workplace supports women-centred care. This is done by including Aboriginal perspectives, and utilizing the cornerstones of women-centred care found below. We can surmise that it is not enough to provide certain types of services that are merely "directed to women".
Our research demonstrates that all-encompassing women-centred care is comprised of the elements listed below.
The "cornerstones" of women-centred care are:
Comprehensive services that reflect women's patterns and preferences for care and acknowledge women's ways of communication and interaction:
Gender-sensitive knowledge development requires:
A women-centred workplace must have:
Women can use this integrated guide to validate their own experiences and requests for changes in service delivery. Ongoing public and organizational processes can also engage in scrutiny of this document to develop tools and methods to implement women-centred care in their sites.
In the course of conducting our research it became evident that public policy
in health governance and government needs
Finally, many participants articulated a need to base women-centred practice
by conducting more research and having more evidence. However, they told us
that funding has often been lacking, particularly for expansion of programs
to further meet women's needs based on research. Evaluation of women-centred
care practices is critical for policy makers so that future policies can be
built upon what has been learned. Research that takes a gendered approach and
uses data to describe the context of women's lives, rather than solely counting
the number of clients, is crucial for all concerned. Currently practitioners
are working with resources that are stretched to the limits. Adequate resources
are required to enable service providers to provide care based in women’s
lives that responds to women’s realities.