“A Woman of Impact”
A champion of women’s health who changed the landscape of sexual and reproductive health policy
Wendy V. Norman, MD, CCFP, FCFP, DTM&H, MHSc, is a Professor in the Department of Family Practice, and an associate member in both the School of Population and Public Health, and the Department of Obstetrics and Gynecology, of the Faculty of Medicine at the University of British Columbia (UBC). She is an Honorary Associate Professor in the Faculty of Public Health and Policy at the LSHTM, in London, UK. She completed a MHSc (UBC), a diploma in Tropical Medicine and International Health (Liverpool University).
She was awarded the Darroch Award in sexual and reproductive health research in 2015 by the New York-based Guttmacher Institute. The Society of Obstetricians and Gynecologists of Canada awarded her their inaugural National Mentorship Award in 2020, and the Canadian Government recognized her in 2021 as a “Woman of Impact”.
Watch the video, listen to the podcast, read the transcript below
“… practice is a lot about getting to know people, to understand their context, their community, the people around them, how these factors have interacted with their health. And in talking to people with unplanned, unintended pregnancies, the factors are no different. You’re listening to what’s going on in people’s lives and the challenges they’ve had to face and the difficulties.”
Let’s start at the very beginning of your academic journey. Tell me where you started in practice and when you got the academic bug.
Wendy Norman: I was a rural GP for many, many years. I had done my training both at Queen’s University, in Kingston, Ontario, and at the University of Alberta, and I went into practice in rural coastal British Columbia in a fishing village, as a full service general practitioner and had been practicing there for ten or 12 years, providing everything from palliative care, emergency services, obstetric care etc and family planning services up and down the coast in the volunteer organization.
DMacA: So, tell me about practice.
WN: I loved being a full service general practitioner, particularly in a small town of about 10,000 people on the Sunshine Coast. Sechelt B.C. in an area spread over 100 kilometers with three or four little communities. There were a lot of people working the land, an artistic community, a fair number of retired. And as part of the community, you were friends and neighbours with the people you were looking after. It was a very enriching environment and I felt quite honoured to have that chance, to have my first practice year there.
DMacA: Then you thought about academia. How did that begin?
WN: Because of my marriage, I needed to move into Vancouver. Not initially, but when we had our second child on the way we realized we were going to have to. My husband was in Vancouver, and I was to 2 to 4 hours away in this small village, so we would have to live in the same spot. Moving into Vancouver, I focused my practice on just providing family planning services at family planning clinics and found this, particularly providing abortion services, to be immensely satisfying. You would see people at the most stressful time in their lives and with a relatively simple, safe, straightforward procedure, all of a sudden their future opened up. They would have the chance to get out of a wretched relationship or to return to the education that they’d always wanted to do. They’d had this chance in life to look at who they were, and where they were, and realise where they wanted to go, which wasn’t continuing on with an unwanted pregnancy. And this is what led me to the academia and research.
I could see so clearly the kinds of barriers that people had tried to address, that had left them in a situation where they were trying to make this very difficult decision about what to do with an unintended pregnancy, and how we could look upstream to help give people the support they needed to time and space in their pregnancies.
DMacA: Let me bring it back. You’re in Vancouver and you’re in clinical practice. How did you make that transition and what was it that actually brought you into academia?
WN: The fortunate thing is, and all of our GP colleagues will probably recognize this, that practice is a lot about getting to know people, to understand their context, their community, the people around them, how these factors have interacted with their health. And in talking to people with unplanned, unintended pregnancies, the factors are no different. You’re listening to what’s going on in people’s lives and the challenges they’ve had to face and the difficulties. In listening to these stories of the challenges people had faced, it was fairly clear in my own mind that we could do things as a health system that could potentially improve this.
I happened to be working in the B.C. Women’s Hospital, mainly in Family Planning Services when the Provincial Health Services Authority of British Columbia decided to set up in a research institute in concert with UBC: The Women’s Health Research Institute. And they sent people around to the different clinical programs to ask if there was anybody thinking of doing research or who has questions? And my hands both shot up. I had a huge raft of questions that I felt needed to be asked and answered. That was maybe 15 years ago now and I’ve been so enjoying the chance to ask and answer questions.
“… I feel like I’ve been in university all my life. I keep going back to study at different intervals …. But again, it’s that fascination to be learning and to understand how you would have more tools to be able to answer questions better and thus be able to provide better care for patients.”
DMacA: There are so many people listening to this who have spent a long time in practice who have research questions and would like to answer those questions. Was there a particular introductory program that brought you from being a neophyte to becoming a researcher?
WN: It’s a good question. And at this stage I had two small children in primary school going into middle school. And during my pregnancies with those kids, I’d done a master’s part time. And that gave me some of the foundational skills to enable me to move forward towards research. A Master’s in Public Health is good for this. Mine was in epidemiology which is very similar. When, with the support of the Women’s Health Research Institute, I wanted want to start to design studies and ask questions, I noticed that our UBC Department of Family Practice offered an enhanced skills program, the Clinician program. And so, I enrolled as a clinician scholar which, at UBC, is a half time position for two years, where you get mentorship and support and monthly meetings with colleagues to be able talk about your process and learn the different steps as you go towards it. As that sun set, I was accepted into a program at the University of Western Ontario, a remote program, the TUTOR-PHC program for transdisciplinary understanding of health research. And this was also exceptionally helpful for me in terms of mentorship of peers that are primary care practitioners and family doctors doing research.
DMacA: That’s terrific. Now tell me about the Masters
WN: I did a diploma in tropical medicine while I was in the coastal fishing village in Sechelt. They had a program there to support rural doctors to take a year away as a sabbatical. I had volunteered to work with Doctors Without Borders – Médecins Sans Frontières
in Africa, and I did a three months diploma in Tropical Medicine in Liverpool before doing that work with Médecins Sans Frontières.
So I guess I, I feel like I’ve been in university all my life. I keep going back to study at different intervals and it was maybe five years later when I completed the master’s at UBC, part time over several years while I was in full time practice with two small toddlers. But again, it’s that fascination to be learning and to understand how you would have more tools to be able to answer questions better and thus be able to provide better care for patients.
DMacA: While you continued on this academic career, many academics would say you’ve got this the wrong way around, because you’re now doing a PhD at this later stage in your career.
WN: Yes, it’s true. I began my research and started to get CIHR grants. I had wonderful mentorship from members of my Department of Family Practice at UBC and a range of other non-family physicians experts but experts in their research fields. And I think that, as a family doctor running a research program it is like so many other situations where we’re a team leader running a team caring for our patients, using all those family doctor skills to lead a team, find people that have the different skills needed to conduct the different kinds of specific research. But as a family doctor, I was able to articulate the important questions and be trusted by the policymakers and the health system decision makers who could use the evidence from the answers to those questions. A lot of my research was around showing how providing free contraception at different stages in people’s lives was an effective measure to get better outcomes and lower health system costs.
So, you need the trust of the decision makers and health system people. And, as a family doctor, I think we’re uniquely placed to be able to do that, not only in bringing together and leading a research team, but connecting to the people who can use the results of the research and make it happen.
Once I’d had a few years in getting research grants, conducting studies and starting to change some of these health policies, I felt that there were so many of the skills that my team members had that I didn’t really have. I knew what we needed to be able to ask and answer the questions but I didn’t have the specific knowledge on the analysis of this kind of data and I was relying on others to assure me that their analysis was correct. I wanted to learn those things myself so I enrolled at the London School of Hygiene and Tropical Medicine in a distance, part time Ph.D. And I’ve been working with my supervisors there to write some papers on research we’ve already conducted in Canada, where I have the data available and want to publish those research papers.
But the part I absolutely love is that there isn’t even one session with my supervisors where I’m not learning something that I didn’t know I didn’t know. At this stage in our lives, if there’s something we realize we don’t know, we can go and find out. But here they are teaching me things I didn’t even realize I didn’t know. And I just can’t tell you how much I enjoy that process. And, in the meantime, the quality of the research I’m doing is better because of the mentorship I’m getting from outstanding researchers who are able to tell me where I’ve got it wrong, where I’ve got to approach things differently or that I’ve got to read more to learn about this or that, things I wouldn’t have known how to do.
“…as a family doctor running a research program it is like so many other situations where we’re a team leader running a team caring for our patients, using all those family doctor skills to lead a team, find people that have the different skills needed to conduct the different kinds of specific research.”
DMacA: What I really love is your approach to academia in moving from being embedded in practice to doing the PhD at this end of your career. But you’re very different in another way, and that is you’re not just an academic sitting in your office, your advocacy work is fantastic. Tell me about your advocacy work for women’s health.
WN: As we started to look at the upstream factors that could help people better time and space in their pregnancies, one of the clear messages was that people weren’t able to afford the better and more effective kinds of contraception that they would use if cost were not a barrier. And so, we began a whole series of studies that looked at contraception and cost effectiveness. Being a family physician and working in hospitals and working in teen care, it was clear that we needed to engage, right from the beginning, the people who could change policies or systems based on the findings that we had. One of the things that worked really well being a family physician was that I was already embedded at BC. Women’s Hospital and was able to talk to the system leaders in that setting to say, you know, we really could make a difference not only for the people that come to our hospital, but for all
the Province if we were able to conduct this research and then translate it into policies such as, perhaps, free contraception for all. The leaders at B.C. Women’s Hospital said, you know, you need to speak to so-and-so. And so, I kept getting introduced by a person who trusted and knew me to the person higher up in the decision-making chain and eventually I started meeting regularly with BC’s Chief Provincial Health Officer and with the Minister of Health of B.C. and a number of decision makers within the ministry. And they became engaged in informing our research, how, what data, what questions should we be asking people in a survey? What data will you need in order to support this decision? And because they were engaged at the beginning of the research, they had the kind of lead time that policymakers need to put in place agreement across their policy framework to be able to make a change once we had our results, and to act on them very quickly. And in fact, for several of our studies, we’ve seen provincial policy changes in B.C. before we’d had our papers written because the policy makers were sitting on the team watching the data come in, watching the preliminary analyses, looking at the analysis that we were about to be released at conferences and making their decisions on policy based on those.
DMacA: So here we have three corners- clinical practice, research evidence and we have policy. But there’s something else you do which is remarkable, and that is you’re very active in the media. Tell us about your media contributions.
WN: Well, I think these are another way of doing what we are trained to do as family doctors. Our hope is that we can help people to find what they need to know to be able to help their health in the way that they feel that works in their context. And I see interviews with media as part and parcel with that, with the additional factor that some of the people who can help with those decisions are policy makers or system leaders, and they are also listening to media. It is sometimes, in some ways, more powerful than writing papers in getting the message out to people making decisions, whether it’s decisions in their own life, their health, or the health for their family, or the decisions of health care workers on the care they will deliver, or of the systems or services they can design, or the policies on how to fund the provision of care in a Province or a country. All of these people listen to media and, in some ways, being able to put across your evidence in a way that makes sense to these people in these short bits on media is, I think, an important role for family physicians and researchers.
“At this stage in our lives, if there’s something we realize we don’t know, we can go and find out. But here they are teaching me things I didn’t even realize I didn’t know. And I just can’t tell you how much I enjoy that process.”
DMacA: So as we finish up, I am sure everyone will agree that the title of one of your awards is the most appropriate that one could ever think for you, and that is “ A woman of impact.” So, what’s the next challenge?
WN: There are always more questions than time! The work that we did to make contraception free in B.C. is now moving nationwide. And we’re fairly confident that contraception will become a universal free part of our health system for people in Canada.
A lot of our work will then be backing up and measuring the impact of those policy changes. At the same time, we’re working to make abortion services more accessible, to make knowledge more accessible for people around their choices for unintended pregnancy. And
we also want to improve safety for abortion services. In Canada that means looking at our rural and remote populations and trying to improve the options that people have in those situations. We’ve just recently, a few weeks ago, been awarded over $3 million from the CIHR to do a four country project looking at rural and remote provision of abortion in Australia, in northern Sweden, in the Scottish Islands and around the world, to look at the factors that are important to ensure safe but accessible abortion care for people in those situations.
DMacA: Thank you very much for sharing your life, your career, your ambition, and your tremendous work for women’s health.
WN: Thank you very much indeed. Its been a pleasure.
