The importance of SRHR advocacy: Action Canada in conversation with Claire Dion Fletcher and Martha Paynter

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Throughout history, advocacy has been critical to improving access to sexual and reproductive health (SRH) care and ensuring that our human rights are upheld. From abortion access to treatment for HIV, SRH services that we often take for granted in Canada are available today because of the tireless work of advocates who wanted better for themselves and their communities.

On February 8th, 2022, we had the pleasure of hosting two incredible advocates for a conversation about the importance of advocacy as a strategy and practice within public health as part of Sexual and Reproductive Health Awareness Week (SRH Week): Advocacy in Action. We talked about the different ways advocacy can contribute to addressing the social determinants of health and improving health equity. 

Despite its importance to our overall health, SRH is not only shaped by social determinants of health but also deeply impacted by stigma and taboos surrounding matters like sex, pleasure, abortion, and adolescent sexuality. As a result, sexual and reproductive health and rights (SRHR) issues are often ignored, neglected, or actively written out of medical schools, health institutions, and government policies. This is typically justified by the labeling of parts of SRH care as “controversial” or inconsequential, and has disproportionate effects on the most vulnerable and marginalized populations in Canada and globally.

In the area of SRHR, advocacy is often a necessary activity. Advocacy should not be a scary word. It means trying to make changes and has been an important part of many public health achievements over the past 100 years. So much progress has been made due to the tireless work of people who wanted better for themselves and their communities. So much is still left to do so that no one is left behind.

There are many examples to pick from to get a sense of the importance of speaking up and actively working for change to achieve better SRH outcomes for ourselves, those we serve, and our communities. During the webinar, we talked about the decriminalization of abortion and contraceptives, and advocacy to stop harmful practices like eugenics, forced sterilization, coercise contraceptive care, and birth alerts. We discussed the experiences of disabled women and girls when it comes to sex-ed and sexual health services and the disproportionate rate of disabled people who are incarcerated. We pointed out the incompatibility of prisons and health and the deep impact of racism on health outcomes. 

Our first guest was Claire Dion Fletcher, an Indigenous (Lenape- Potawatomi) and mixed settler Registered Midwife practicing at Seventh Generation Midwives Toronto; Assistant Professor at the Ryerson Midwifery Education Program; and co-chair of the National Aboriginal Council of Midwives. She shared with us that as an Indigenous midwife, advocacy is one of the most important parts of her job. She was clear that as a healthcare provider, both individual and system level advocacy is important–she must ensure her clients get the care they need as well as advocate for system-level change. 

As an Indigenous health care provider, Claire also shared the reality of working within a system that not only was not designed for her and her clients, but was also used as a tool of colonization and genocide, from experiments on Indigenous people in residential schools to violence, control of Indigenous knowledge, forced sterilization, and the apprehension of Indigenous children. The health care system is fundamentally not about supporting the health and wellbeing of Indigenous people. That’s why it’s important to advocate for system level change. As such, Claire advocates for the growth of Indigenous midwifery and the return of birth and midwifery to all of Indigenous communities. That’s because the return of birthing practices and Indigenous midwifery is about sovereignty over people’s bodies and health care–the antidote to violence, neglect, and coercion. Indigenous midwifery is advocacy.

We then heard from Martha Paynter, a registered nurse and nurse scientist working in abortion and reproductive care and research and founder and chair of Wellness Within: An Organization for Health and Justice. Martha spoke about SRHR advocacy and nursing. She brought attention to our role in reconciliation work and to the Truth and Reconciliation report recommendations regarding the need to address the harms of incarceration and of family separation. For nurses, the code of ethics that govern the practice is clear that ‘promoting justice’ is a priority. Despite this, sexism, racism, colonialism, and ableism are present in how nurses are trained, the discrimination that nurses face in their daily work lives, as well as perpetuated in patient care.

Many nurses risk everything to be advocates and to lead change work. Martha presented the examples of nurses leading the charge on abortion access and on SRHR work in prisons. For nurses on those frontlines, advocating for prison abolition is part of their duty to promote justice, equity, safety, health, and wellbeing. Prisons are an institution that is in direct opposition to these principles. In fact, it is well documented that prisons cause injury, disease, and death. They are inherently incompatible with reproductive justice, just as they are incompatible with health care. Martha reminds health professionals of their responsibility to educate themselves on the root causes of health inequities and to advocate for basic livable income, right to housing, universal pharmacare, and the end of harmful practices.

Tune in to the webinar to learn about the work it took to secure sexual and reproductive health services so far, the problematic history of SRHR advocacy, and what is left to do for all people to see their right to health realized! Advocacy should not be a scary word: It connects us to ourselves, to our communities and to meaningful work. Promoting justice is central to achieving health equity!

As parting words, our two guests left us with some important advocacy tips: 

Work in relationship with others: Advocacy is not paternalistic. Advocacy is about working in relationship with one another. Advocacy isn’t charity, benevolence or about “empowering” anyone else, it’s about creating conditions where people can find their own power. Both Claire and Martha stressed that people don’t need to be “empowered” to have control over family, body or health decisions, they simply need accurate, judgment-free information about the choices available to make a decision, as well as the tools, services and environments, from contraception to affordable childcare, to support those choices. This is where our work lies.

Understand the three levels of advocacy: Claire describes three levels of advocacy, which, as she compares to the Three Sisters (squash, corn, and beans), help sustain each other: 

  1. Grassroots advocacy, which helps meet the individual needs of community members outside of systems we’re used to working with, for example those without access to health care system;
  2. Advocacy within existing systems, for example midwives who work in the health care system to support their patients; and
  3. Advocacy on a policy level, engaging with policy makers to change laws in order to enact systems change. 

These three levels are all critical to advocacy work, and we need advocates at all three levels to effectively push for change.

Posted on 2022-02-17
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