Prairie Women's Health Centre of Excellence

  Action Plan For Women's Health In Manitoba and Saskatchewan: Key Priorities and Strategies


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The research and publication of this study were funded by the Prairie Women's Health Centre of Excellence (PWHCE). The PWHCE is financially supported by the Centre of Excellence for Women's Health Program, Bureau of Women's Health and Gender Analysis, Health Canada. The views expressed herein do not necessarily represent the views of the PWHCE or the official policy of Health Canada.

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Produced by the Prairie Women's Health Centre of Excellence © 2001

Summary of Table of Contents:

Did You Know?
Healthier Prairie Women : A Plan for Action
Why Action is Needed
Key Priorities and Strategies


  • Women make up over half of the population in Saskatchewan and Manitoba.
  • 19% of adult women in Canada are poor - the highest rate of women's poverty in 20 years. Prairie women, working full time, earn 73% of what men earn on average.
  • In Saskatchewan and Manitoba, senior women out number senior men. The number of women over age 65, and especially over age 80, is greater on the Prairies.
  • Women in Manitoba (28%) and Saskatchewan (37%) are more likely to live in rural areas than elsewhere in Canada.
  • Aboriginal women live in Saskatchewan and Manitoba in greater numbers than elsewhere in Canada. Aboriginal women live shorter lives and are more likely to die of violence. Women and girls commit suicide three times more often than other Canadian women and girls.
  • Immigrants and refugees make up 12% of Manitobans and 5% of Saskatchewan residents. More than 50% of them are women.
  • Women with disabilities are the poorest in Canada. They face systemic barriers in the labour market and in getting quality health services.
  • Within the health system, many factors work against women:
    • Low numbers of women in policy and decision making positions; high numbers of women in low paying jobs in the health sector; a narrow understanding of women's health; AND too much medical interference with normal aspects of women's lives such as pregnancy, childbirth and menopause.


This Action Plan is a response to recent health system changes that affect women's health. It reflects the Centre's for Excellence focus on social factors that influence well-being.

What the Priorities Are:

  • Reduce Poverty Among Women and Address the Consequences of Poverty on Women's Health
  • Improve Conditions for Formal and Informal Caregivers
  • Address the Specific Health Needs of Aboriginal Women
  • Address Violence Against Women
  • Develop and Support Best Practices and Knowledge in Women's Health
  • Recognize the Importance of Women as Decision Makers
  • Act to Improve Women's Mental Health
  • Act to Improve Women's Sexual and Reproductive Health
  • Address the Health Needs of Older Women
  • Address the Specific Health Needs of Women with Disabilities
  • Improve the Health of Women Living in Rural and Remote Areas


The different characteristics and roles between men and women influence health. Successful programs and policies consider the biological, social, and economic differences between men and women. This is important because women face unequal treatment in employment, have lower incomes and face enhanced social expectations from families and communities. They often live in violence.

Provincial governments are changing the health system in ways that affect women's health. Women are the majority of paid health care workers who under-go job cuts and workload increases. Community-based care places severe burdens on women. Women are not well represented on health boards and in senior management positions in the health system. And there is little evidence that health bodies in Saskatchewan and Manitoba have the knowledge or tools needed to identify and respond to women's health needs.

How to Make Improvements

  • Consult with women on how heath services should be changed to meet their needs.
  • Make changes based on women's input.
  • Expand the range of publicly funded services.
  • Place women in key positions in the health system.
  • Support the development and use of the most effective practices in women's health.
  • Develop women's health strategies within provincial health departments.
  • Provide a full range of services to ALL women, particularly in rural and remote areas and between health districts and regions.
  • Acknowledge the unique health needs of Aboriginal women, older women, younger women, lesbian and bisexual women, immigrant and refugee women, women with disabilities and women living in rural and remote areas.
  • Address women's poverty.


The incidence of poverty among women reflects a societal problem, not an individual one. Almost 19% of adult women in Canada are poor - the highest rate of women's poverty in two decades. Prairie women working full-time, all year, earn 73% of what men earn, on average. Poverty is experienced by social assistance recipients, single mothers and women working for low wages.

Strategies within the health system:
Ask poor women how health care services can be changed to meet their needs. Provide health services at home and in community based facilities supported by women in poverty. Make funding available for low income people who require vision care, dental care and prescription drugs.

Outside of the health system:
Increase minimum wages, provide safe affordable housing for all and increase earned income exemptions for social assistance recipients. Determine the affects of housing, education, transportation, communication and financial policies on low-income women's health.

Women's work as paid and unpaid caregivers reduces the demand for formal health services. This work takes its toll on women. After only 18 months of continuous caregiving, the health of 60% of unpaid caregivers declines. Unpaid caregivers who work in the paid labour force can suffer career and financial losses, lowered opportunities for promotions, loss of benefits and pensions. Many older women are primary caregivers to family members, particularly spouses, and often grandchildren. Immigrant and refugee women are often hired as live-in caregivers, raising issues of race and class discrimination.

Strategies within the health system:
Recognize caregiving as important employment providing and adequate salary, benefits, job security and opportunities for training and advancement. Provide leave from employment with no loss of seniority or benefits to women providing care.

Provide caregivers with necessary supports, including respite care. Home care services and publicly funded attendant care should be available on an equitable basis in rural and northern areas. Training for caregivers is important.

Outside of the Health System:
Provide live-in caregivers with adequate wages and uphold provincial employment standards legislation. Encourage immigrant, refugee and refugee women to participate in a broad range of employment activities.

The Health Needs of Aboriginal Women
The health and well-being of Aboriginal peoples is influenced by a history that caused segregation and dependency. Aboriginal people, including women, must be empowered to redesign health services and programs to reflect their traditions and culture.

Aboriginal women have less access to health services than other Canadian women. Effective health strategies will ensure their active participation in addressing and advocating for their own health challenges.

Strategies within the health system:
Recognize and use the expertise of Aboriginal women in building healthy public policies and health services. Involve the community in designing programs and ensure that programs are accountable to the community.

Provide services which are culturally appropriate, which focus on healing rather than treatment, which recognize the links between individual and community wellness, and which care for the whole person. Build capacity to deliver services among Aboriginal peoples.

Support Aboriginal women in addressing their health issues at all levels with respect for Aboriginal nations cultural context (Indian, Metis, Inuit). Provide woman-centred, culturally based health services for Aboriginal women in prison.

Outside of the health system:
Enact employment equity legislation to improve the socio-economic status of Aboriginal women and mandate employment equity as a condition of provincial funding and procurement contracts. Provide housing and community supports for elder women, starting at age 55.

Violence Against Women
The health related costs of violence against women and children are around $1.5 billion. Violence against women increases costs in health, social services, criminal justice and in employment through lost working days.

Violence against women has been linked to suicide, substance abuse, stress related disorders, poor mental health, high health system usage. Children who witness violence may experience behavioural, emotional and social problems and may perform poorly in school.

All women are vulnerable to violence in society. Immigrant and refugee women, Aboriginal women, young and senior women are particularly at risk. Effective prevention strategies see violence as a public health issue resulting from the power imbalance between women and men, and reinforced by societal attitudes.

Strategies within the health system:
Develop and implement gender-sensitive training for health professionals to promote early recognition of violence and better care for victims, particularly those who are immigrant and refugee women.

Train multicultural health workers to address violence against women , using a community development approach.

Outside of the health system:
Provide: continual, global funding to agencies that provide services to women living in violent situations and to community based programs directed to young women experiencing violence;

Train: criminal justice workers, including police, prosecutors, judges and others. Ensure that the training is mandatory, comprehensive and consistent and that it recognizes gender as a factor that influences violence.

Provide: Anti-violence curriculum, conflict resolution and mediation skills in schools that is anti-racism/ sexism/ homophobia.

Women's Mental Health
Addressing mental health issues is a high-priority among Prairie women. The current system focuses on illness rather than addressing the determinants of health. Mental health issues are a consequence of women's disadvantaged position in society.

Women rely on outpatient mental health services. Women are more likely than men to experience emotional disturbances, like depression and anxiety disorders. They often have "borderline" personality disorders, and eating disorders. The experience of physical and sexual abuse influences women's mental health status. Under mental health system reform, women are often expected to care for family members experiencing mental illness with little pay, support and recognition.

Strategies within the health system:
Educate health professionals on mental health issues among women and develop appropriate treatments and services. Develop gender and culturally sensitive mental health services based on holistic concepts of women's health and include strategies for individual and societal empowerment in all geographic areas, including women's prisons. Ensure that adequate supports are provided for the families of women suffering from mental illness and that community care is provided with supports to women and families.

Outside of the health system:
Develop curriculum for educators and students on childhood sexual abuse, sexual assault and violence on women's health. Integrate this curriculum into educational programs in health fields. Fund community based organizations focusing on women's mental health,. Work with departments of education and organizations that serve young women to develop programs that promote self-esteem and empowerment among young women.

Sexual and Reproductive Health
Prevention of sexual and reproductive health problems, and effective care and support for those affected, must be a health system priority. Teen pregnancy rates are high. There are unacceptably high rates of low birth weight babies, large numbers of young people affected by sexually transmitted diseases (STDs) including HIV and AIDS. Infertility affects around 7% of couples, often resulting from earlier untreated STDs. Sexual abuse and family violence are prevalent.

Healthy societal values and attitudes about sexuality and reproduction, family and community networks and supports, educational and economic opportunities, a healthy physical environment, and access to effective services enable life time sexual and reproductive health. Policies and programs must address the particular reproductive health needs of Aboriginal women, women with disabilities, remote and rural women, immigrant and refugee women, young women and lesbian women.

Strategies within the health system:
Ensure access to and public funding for a full range of reproductive health services for women, including medical and surgical abortion services. Ensure access to reproductive health services to ALL women including abortion services in rural and remote areas. Education and services should be culturally appropriate and available in a variety of languages. Health professionals should be aware of genital mutilation and able to care for women who have undergone it. Midwives should be employed in all regions and health districts.

Outside of the health system:
Provide environments and workplaces that are free of reproductive hazards. Reduce the high teenage pregnancy rate by providing: information on healthy sexual choices, free and low cost birth control supplies, programming that is appropriate for ALL young women and men.

The Health Needs of Older Women
Older women's health is affected by the social isolation that they experience, often due to the loss of a partner and health problems and disability related limitations. The absence of a social network relates to poor health and an increased use of health services. Older women experience more perceptual difficulties due to their longer lives. They often are required to care for a spouse with dementia.

More older women than men are inactive, particularly those who are widowed, live alone, have less education, and lower incomes. Older women take more prescription medication and over-the-counter preparations than men of any age group.

Older women experience a greater risk for adverse drug reactions which may result in disorientation, falls, and stomach problems, and a greater risk of hospital admission for adverse drug reactions than older men. Falls are the major cause of hospitalization and accidental death for seniors and are a concern for women.

Strategies within the health system:
Involve older women and their caregivers in all areas of decision-making, and mobilize seniors to work in their own interest. Encourage gender based research on older women. Explore ways to motivate older women to be active; provide accessible, low-cost community-based activities. Provide greater availability of respite and other support programs for caregivers.

Outside of the health system:
Ensure that programs and services for older women are appropriate to their needs, low in cost, and easily accessed. Provide appropriate low-cost services, including home maintenance and renovation, to assist older women to remain at home.

Provide supportive housing options, with a range of service and program options. Regulate housing and long term care facilities to ensure appropriate service options and the availability of trained and knowledgeable staff.

Provide accessible, affordable, door-to-door transportation to ensure the safety of older women and to facilitate local travel.

The Health Needs of Immigrant Women and Refugee Women
Discrimination based on race, gender and immigration status impact negatively on the health of immigrant and refugee women. Studies in Manitoba conclude that immigrant and refugee women face multiple access barriers to health and social services and to the labor market. Discriminatory policies worsen the employment and economic situation of immigrant and refugee women. To be effective, health policies should recognize the immigration process as a determinant of health.

Strategies within the health system:
Empower immigrant and refugee women to take control over their health through community development, popular education and by involving immigrant and refugee women in the development of policies that affect their health.

Design, plan and implement the appropriate programs for immigrant and refugee women's health. Fund research on the health needs of the women, including coordination of professional interpretation services and subsidies for cost of services.

Respond to the diverse issues of immigrant and refugee women through cultural awareness training and other professional development training of service providers. Work towards the inclusion of multi-cultural awareness in the educational curriculum for the schools of medicine, education, social work and nursing. Use interpreters and provide language training to remove access barriers to health care system.

Outside of the health system:
Increase funding to agencies serving immigrants and refugees and promote multi-sectoral, holistic approaches to addressing the needs of immigrant and refugee women. Recognize the credentials, skills, abilities/competencies, knowledge and experiences acquired prior to immigrating to Canada. Implement equity policies to diversify the workforce.

The Health Needs of Women with Disabilities
Strategies to address poverty, employment, and housing issues are crucial to the well being of women with disabilities. Adequate primary health care services are also needed. Stereotyping affects disabled women's life opportunities and self esteem. Addressing mental health issues among women with disabilities is key. Educating professionals on disabilities, conditions, and health issues would improve services for women with disabilities.

Strategies within the health system:
Examine and change the barriers to women with disabilities taking prescription medications. Expand knowledge and expertise among health professionals on appropriate care for women with disabilities. Enhance mental health services to include a focus on women with disabilities.

Outside of the health system:
Revise policies relating to housing, education, transportation, communication and finance to better reflect the needs of women with disabilities. Enhance employment opportunities for women with disabilties. Provide safe, affordable, housing for all women with disabilities. Increase income supports for women with disabilities.

Women in Rural and Remote Areas Women living outside of cities and towns travel greater distances to reach health services, particularly specialized ones. This adds to the stress and uncertainty of rural and remote life. The creation of health regions and districts may increase the geographic barriers that women face in obtaining health care, if services are only available within a particular area to residents. Midwifery services in Manitoba and mental health services in Saskatchewan are areas of particular concern.

Recruiting and retaining physicians is a struggle for remote and rural communities; obtaining the care of a female physician is particularly difficult. Physicians, who are new to Canada are sometimes unable to provide appropriate, culturally sensitive care to women. Farming hazards are often increased for farm women due to the stress of a triple workload that includes unpaid farm labour, work off the farm, and work at home and in the community.

Strategies within the health system:
Integrate and incorporate rural women's health needs in gender-sensitive programs. Use gender identified health information for a clear picture of the health of rural and remote women.

Devise a consultation mechanism to give rural women continued input in health planning. Support safe houses and shelter for women living in rural, remote and northern communities who are victims of violence.

Outside of the health system:
Address poverty and its causes among rural and remote women. Advocate for stable social programs including mental/emotional health services for women in rural and remote communities, child care and services for senior women in rural and remote communities.

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