Obstetrician and Gynaecologist Resources
- Suggested Readings and Resources
- Definitions
- What is implicit bias?
- LGBTQ+ Health
- Black Health
- Indigenous Health
- Patients who are Substance-Involved
- Patients without a Home
- Patients who are Newcomers and Refugees
- Patients with High BMI
- Microaggressions
Suggested Readings and Resources
- For further readings, links to both academic and community resources, and clinical tips, please click here to read the Equity, Diversity and Inclusion in Obstetrics and Gynaecology Primer for Learners and Staff.
Definitions
- Prejudice:
- Prejudice is a “preconceived, unsubstantiated opinion of others based on perceived categorical differences.”
- Prejudiced opinions may be held against individuals or groups.
- Prejudiced beliefs can include stereotypes. For example, the belief that a particular race is intellectually inferior or that foreigners are to be feared or mistrusted.
- Discrimination:
- Discrimination refers to the "unjust treatment of persons based on perceived differences."
- While prejudiced beliefs are opinions, discrimination is when those opinions are acted upon.
- Discrimination can be based on various identities such as race, ethnicity, gender, nationality, sexual orientation, religion, age, or (dis)ability.
- Racism
- Racism is a “system of power entwined with practices and beliefs that produce and maintain an ethnic and racial hierarchy.”
What is implicit bias?
- Implicit bias refers to attitudes, thoughts, or feelings that may exist outside of conscious awareness and may be difficult to deliberately acknowledge and control.
- These implicit attitudes can reflect negative stereotypes of members of marginalized groups. An individual, for example, may have implicit bias against Indigenous people, Black people, other people of colour or individuals who are transgender. There may also be a bias against people of a particular sexual orientation, nationality, religion, educational background, etc.
- Negative implicit attitudes contribute to disparities in quality of healthcare received.
- Implicit bias is prevalent amongst healthcare professionals. [3]
- A systematic review of implicit bias amongst healthcare professionals found evidence of low-to-moderate levels of implicit bias against people of colour.
- These implicit biases translated into poorer patient care.
- In a paediatric study on analgesia, a vignette of White and Black patients was provided. Paediatricians in the study were more likely to prescribe adequate pain treatment to White children than to Black children.
LGBTQ+ Health
- LGBTQ+ is an acronym for lesbian, gay, bisexual, transgender and queer or questionning. Other acronyms may also include Two-Spirit, intersex and asexual. The plus “+” in LGBTQ+ indicates the inclusion of more identities.
- What is gender vs sex? [4]
- Sex: refers to biological differences that distinguish males from females such as genitals and sex chromosomes.
- Gender: includes, but is not limited to, the socially constructed roles of males and females in society.
- Guideline for providing gender-affirming care for Trans, Two-Spirit, and Gender Diverse Patients
- Using a patient's preferred pronouns
- University of Toronto MD Program’s LGBTQ+ health primer.
- Resources for making clinics and hospitals more LGBT friendly.
- Guide on different pride flags and symbols.
- LGBTQ mental health resources.
- Collection of LGBTQ+ clinical resources compiled by Rainbow Health Ontario
- Who are Two-Spirit people?
- American College of Obstetricians and Gynecologists' recommendations for the care of lesbian and bisexual women.
- Assisted reproductive services for people who are a sexual or gender minority.
Black Health
- What is racism? [5]
- Individual racism: the attitudes an individual holds and the behaviours that follow these attitudes in everyday life.
- Institutional (systemic) racism: refers to laws, norms, policies and practices ingrained into society resulting in an unequal distribution of social, economic and political resources among racialized groups.
- Cultural racism: discrimination based on perceived cultural differences in racial groups.
- Racism is a social determinant of health as it can impact various elements of an individual’s life and determine the resources (including quality of healthcare) which they have access to
- Examples of how racism manifests in Canada against Black people:
- In Toronto, Black students are twice as likely to drop out of school.
- Over-policing of Black citizens is another result of structural racism. In Toronto, 25.9% of Black respondents reported being questioned by police and having information recorded without reasonable suspicion.
- Black people are over-represented in correctional institutions in Canada.
- The unemployment rate for Black Montrealers with a graduate degree was 13.4% compared to 12% for non-Black high school dropouts indicating that there is systemic racism in employment hiring practices.
- In Canada, Black people earn 75.6 cents for every dollar earned by a non-racialized person.
- Some research suggests that medical staff over-report Black and Indigenous families to child welfare authorities possibly due to bias.
- Impact of racism on Canadians’ health.
- “Why Black Women Fear For Their Lives In The Delivery Room” article in Huffington Post Canada.
- Preterm delivery among Black Canadian women.
- Black Canadian women’s experience of mistreatment from healthcare workers during childbirth.
- Black experiences in healthcare by the Black Health Alliance.
- Resources on Black health for healthcare providers and patients compiled by the Black Health Alliance.
- Canadian Clinical Practice Guidelines
Indigenous Health
- Who are the Indigenous people of Canada? [6]
- First Nations is an ethnic term used to describe all Indigenous people of Canada who are not Métis or Inuit.
- Métis describes a cultural and collective identity resulting from the union of Indigenous and European people in Canada.
- Inuit refers to a distinct group of Indigenous people living in the North.
- Indigenous people are diverse and it is important not to generalize. Not all Indigenous patients will have the same experiences or preferences for treatment.
- Examples of how racism manifests in Canada against Indigenous people:
- The harm of mandatory birth alerts which can lead to Indigenous parents being over-reported for abuse.
- This harm of over-reporting led Ontario to attempt to eliminate the practice of birth alerts.
- Indigenous people account for 26% of provincial and territorial correctional systems [7]
- Indigenous children make up 10-20 percent of children in care even though they only account for 2% of the population [8]
- There are higher rates of child poverty and chronic underfunding of school systems on Indigenous reserves.
- “First Peoples, Second Class Treatment: The role of racism in the health and well-being of Indigenous peoples in Canada.”
- “Health Professionals Working With First Nations, Inuit, and Métis Consensus Guideline” developed by the Society of Obstetricians and Gynaecologist of Canada (SOGC).
- SOGC policy statement titled “Returning Birth to Aboriginal, Rural, and Remote Communities.”
- The Truth and Reconciliation Commission Recommendations.
- How to promote and support culturally safe Indigenous birth
- Approaches, innovations and challenges to Indigenous maternal and family health.
- “Improving access to Indigenous medicine for patients in hospital-based settings: a challenge for health systems in northern Canada” by Redvers et al.
- Social determinants of health and access to health services for First Nations, Inuit and Métis.
Patients who are Substance-Involved
- What is harm reduction?
- SOGC clinical practice guideline on substance use in pregnancy.
- Toronto Centre for Substance Abuse in Pregnancy at St. Joseph's Health Centre.
- Bridges to Moms program for help with substance use in pregnancy.
- The SOGC’s Compassionate Contraceptive Assistance Program (CCAP) provides contraceptives to women who otherwise could not afford it.
Patients without a Home
- Clinical guideline for providing care to patients who are homeless or precariously housed.
- The SOGC’s Compassionate Contraceptive Assistance Program (CCAP) provides contraceptives to women who otherwise could not afford it.
- The impact of homelessness on reproductive health and pregnancy.
Patients who are Newcomers and Refugees
- Please see page titled “Multilingual Resources for Patients”.
- Evidence-based clinical guidelines for immigrants and refugees to Canada.
- Unmet contraceptive needs.
- Coverage through the Interim Federal Health Program.
Patients with High BMI
- SOGC clinical guideline for the preconception and prenatal care of a patient with obesity.
- SOGC clinical guideline for delivery and postpartum care for patients with obesity.
- Using first-person language for patients with high BMI.
- Instead of saying “obese patient” say, “patient with obesity”
- Instead of saying “morbidly obese” say, “patient with class III obesity or with BMI≥30”
Microaggressions
- Microaggressions in medicine.
- Three steps to interrupt microaggressions.
- Examples of racial microaggressions (created by Simon Fraser University students and staff for the iBelong initiative December 2018):
- What is it? Microaggressions are indirect, subtle, sometimes unintentional statements or actions that show a bias against people based on groups that they belong to.
| THEME | Microaggression | message |
|---|---|---|
| When Asian Canadians/Latino Canadians are assumed to be foreign-born | "Where are you from?" "Where were you born?" "You speak good English." |
You are not Canadian. You are a foreigner. |
| Assigning intelligence to a person of colour on the basis of their race | "You are a credit to your race." "You are so articulate." |
People of colour are generally not as intelligent as Whites. |
| A person of colour if presumed to be dangerous or criminal on the basis of race | A White man or woman clutching their purse or checking their wallet as a Black of Latino approaches or passes. | You are a criminal. You are going to steal. You do not belong. You are dangerous. |
| Statements that indicate that a White person does not want to acknowledge race | "When I look at you, I don't see colour." "There is only one race, the human race." |
Denying a person of colour's racial experiences. Assimilate to the dominant culture. |
| The notion that the values and communication styles of the dominant/White culture are ideal | Asking a Black person: "Why do you have to be so loud? Just calm down." | Assimilate to dominant culture. Leave your cultural baggage outside. |
Retrieved from: Wing, Capodilupo, Torino, Bucceri, Holder, Nadal, Esquilin (2007). Eacial Microaggressions in Everyday Life: Implications for Clinical Practice. American Psychologist, 62, 4, 271-286.
Resources
[1] Fish, J., & Syed, M. (2019). The Multiple Levels of Racism, Discrimination, and Prejudice.
[2] Megan Drupals, M & Ware, M. (2021). Toronto Notes 2021: Comprehensive medical reference and review for Medical Council of Canada Qualifying Exam (MCCQE) and United States Medical Licensing Exam (USMLE) Step 2. Toronto, Canada. Canada: Toronto Notes for Medical Students
[3] Hall, W. J., Chapman, M. V., Lee K. M., et al. (2015). Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. AJPH 2015 Nov 6; 105(12):https://doi.org/10.2105/AJPH.2015.302903
[4]Newman, T. (2018). Sex and Gender: Meanings, definition, identity, and expression.
[5] Henry, F. (2004). Concepts of race and racism and implications for OHRC policy.
[6] CanLit Guides. (2016). A Note on Indigenous Terminology.
[7] Department of Justice. (2016). Statistical Overview on the Overrepresentation of Indigenous Persons in the Canadian Correctional System and Legislative Reforms to Address the Problem.
[8] The Canadian Press. (2011). Native children in care surpass residential school era