Prepared by Anne Rochon Ford,in consultation with members of theCanadian Women's Health Networkfor the Women's Health Bureau of Health CanadaDecember, 1995

CWHN HOMEPAGE

PART I

1. Purpose

The Canadian Women's HealthNetwork (CWHN) has been actively involved in linking community-basedwomen's health groups and organizations, researchers and healthproviders committed to improving the health status of women inCanada. As a result of these efforts, the Canadian Women's HealthNetwork has been asked by Health Canada to assume a key role inthe Centres of Excellence in Women's Health Program (COEWHP) ofthe federal government. The Program Policies and Guidelines forthe COEWHP (November 9, 1995) states that "Health Canadais supporting the development of a national network for women'shealth aimed at enhancing information flows among the funded Centres,and other institutions, organizations, and individuals concernedwith women's health policy..."

The CWHN will coordinatethe networking component of the Centres program and help to fostercritical debate and influence health and social policies affectingwomen's health. This discussion paper suggest some of the waysthis role can be effectively carried out. The Centres of ExcellenceProgram offers an exciting opportunity to enhance collaborationand linkages among diverse community groups and individuals andacademics concerned with women's health, within a framework thatidentifies the social determinants of health. In order for theCWHN to take on this additional responsibility, a strengtheningof its current resources and clarification of its structure isrequired, both of which are elaborated here.

This paper is also partof a process to generate discussion and feedback from women'shealth groups and applicants to the COEWHP across the countryduring the period of late 1995 and early 1996. As such it shouldbe viewed as a work in progress until definitive decisions aremade about the interface between the CWHN and the Centres of Excellence,and about the structure of the Network.

An extensive call for feedbackby mail in December will be followed by a consultation of CWHNand COEWHP individuals in January. This will be followed by aregional animation process for more feedback in February and aplanned-for meeting of the Network in May.

2. The Centres of Excellencefor Women's Health Program

The Centres of Excellencefor Women's Health Program is a federal initiative announced byHealth Minister Diane Marleau in March of 1995 "to addressthe insufficient attention which has been paid to women's healthissues in Canada". The call for letters of intent (with accompanyingProgram Policies and Guidelines document) was issued from HealthCanada on November 9, 1995. The Program will fund up to 5 centresof excellence in academic and research settings in different regionsof Canada. The focus of the research to be carried out at thecentres is intended to be non-clinical and should demonstratea health determinants approach as outlined in the Women's HealthFramework circulated with the Program Policies and Guidelinesdocument. This involves an understanding of the larger social,cultural and economic context of women's lives as it influenceshealth status, and sensitivity to the needs of women whose healthstatus is particularly at risk.

The research conducted isintended to be policy-oriented, ultimately leading to changesin women's health policies amongst medical bodies, federal, provincialand territorial governments and other decision-making bodies.It is expected that applicants for the centres funding (to bedetermined early in 1996) must have the capacity to network withgroups, organizations and individuals involved in women's healthissues. The funding is intended to last for 4 years and will beoverseen by a coordinator within the Women's Health Bureau ofHealth Canada and a National Advisory Group.

Individual Centres of Excellenceare expected to strengthen or develop networks in their regionsand within their issue-specific areas of research by linking withother researchers, advocates and community-based women's healthgroups, in this way going beyond the walls of traditional academicresearch. Health Canada recognizes that in order for the researchat the Centres to truly make a difference for women, the researchcommunity must work with and allow itself to be responsive towomen from a wide array of groups, organizations and backgrounds.It is hoped that the CWHN will play a catalyst's role in helpingthe centres to develop those networks and forge those links.

3. Some History: TheCanadian Women's Health Network

The formation of a nationalnetwork and the development of links between women's health advocateshas a long history in English and French-speaking Canada. Womenhave come to what has been loosely termed "the women's healthmovement" in Canada through involvement with various organizations- e.g. community clinics and shelters, consumer and support groupsand organizations (e.g. DES Action Canada), and publishing initiativeslike the Montréal Women's Health Press and HealthsharingMagazine. Most of these organizations pre-dated the CWHN. Individualsworking in different ways to improve the health of women in Canadahave all contributed to this history.

In so far as it was givena name and an attempt was made to create a structure for it, theCWHN's roots go back to 1982 when a Committee for a Canadian Women'sHealth Network was struck by a coalition of women from acrossCanada involved in women's health activities and coordinated byHealthsharing Magazine. The women's goals were to exchangeresources on women's health among groups across the country, andto communicate about key issues, creative models and alternativeapproaches to service delivery to improve the health status ofwomen in Canada.

The Committee received fundingto conduct a nationwide survey to determine the extent of Canadianwomen's interest in establishing a Canadian Women's Health Network.The findings of the survey revealed that most women were particularlyinterested in strengthening their networks regionally and feltthat if a national network could assist them in doing that, theywould support the idea.

Over the next 7 years, differentactivities which occurred at a nation-wide level helped to strengthena growing network: the cross-Canada tour of a popular play calledSide Effects, about women and pharmaceutical use, the formationof the Canadian Coalition on Depo Provera (to raise awarenessaround concerns with this drug for use as a contraceptive), andthe formation and strengthening of new women's health groups andservices in various parts of the country.

In 1989, Health Canada grantedfunds for a project entitled "Towards a Canadian Women'sHealth Network". The original sponsors of the project - InterPares (Ottawa), Women's Health Interaction (Ottawa) and Women'sHealth Interaction (Manitoba) - passed responsibility for managementof the project to Healthsharing Magazine. The originalgoals of the project were expanded slightly to include 1) sixregional issues of Healthsharing, 2) preliminary work todevelop a data base of resources and groups working on women'shealth issues, and 3) a national consultation to discuss strategiesfor building and sustaining the network. In addition, a regionalanimation process was created to ensure input from all the regionsinto the issues of the magazine and the data base.

The national consultationtook place in Winnipeg in 1993 and was attended by women representing70 organizations involved in various aspects of women's healthfrom across Canada. A diverse representation of constituencieswas present at the meeting, including a strong presence of francophonewomen both from Québec and outside Québec, womenwith disabilities, Aboriginal women, older women, women of colourand lesbians.

The Canadian Women's HealthNetwork was considered to have been "birthed" at thisgathering in Winnipeg. Women there discussed specific goals forthe network and a means for creating a structure to sustain it.A Coordinating Committee was struck, reflecting the diversityof women from all the regions who were at the consultation. Withthe remaining funds, a report of the consultation ("TheStrength of Links: Building the Canadian Women's Health Network")was produced and translated. Since 1992, the Women's Health Clinicin Winnipeg has offered a home base and administrative supportfor the Network.

Since the consultation inWinnipeg in 1993, the Co-ordinating Committee have met by conferencecall and, in smaller numbers, at various national conferences.Over the past two years, there has been a momentum towards increaseduse of computers as a means of communication amongst CoordinatingCommittee members. The process has been slow but many recognizethat it is the most economical means of communicating nationallyin the long term.

4. Key Goals of the CWHN

The CWHN is committed toworking on the following goals:

× to facilitate communicationamongst groups and individuals committed to improving women'shealth status and fostering change through education, research,health promotion and advocacy;

× to facilitate advocacyfor change in women's health policies and practices particularlywith respect to those of us whose health status is most at riskfor reasons of economics, class, race, geography, age, disabilityor sexual orientation;

× to facilitate theexchange of information and research as mechanisms for changethrough the maintenance of up-to-date data bases of key women'shealth issues and resources;

× to play a "sentinelrole" by articulating emerging women's health issues;

× to provide a forumfor critical debate on women's health issues and effective modelsof care;

× to facilitate networkingamongst academic researchers and the women's health communityacross Canada, both for the Centres of Excellence and beyond.

5. Basic Values and OperatingPrinciples of the CWHN

A mission statement wasdrafted by delegates who attended the CWHN consultation in Winnipegin 1993. The text in its entirety can be found in the CWHN report,The Strength of Links. The fundamental principles whichcharacterize the Canadian Women's Health Network include:

_ advocating feminism,or a woman-centred philosophy which recognizes the importanceof a gender analysis in health and of a woman's right and abilityto make informed choices about her health; this includes recognizingand supporting women-centred and women-run health organizationswhich operate from a perspective of inclusiveness; (Note: Theuse of the term "feminist" was debated at the Winnipegconsultation, but there was agreement on issues of informed choiceand other key elements of a feminist health philosophy.);

_ a holistic view ofhealth, which recognizes that factors which go beyond biologyand health care services influence the health of women; recognizesthat in order to make any change in the health of Canadians, wemust address issues which influence health: socioeconomic status,education, housing, gender, race discrimination, violence, stateof the environment, early childhood care, the burden of doubleand triple workloads to women and the availability of social supports;part of health promotion is a commitment to community developmentas an integral part of health policy;

_ recognition of and respectfor diversity of region, race, age, language, religion, sexualorientation, disability, and a pro-active stance in preventingany discrimination on these grounds;

_ functioning bilingually:operating in English and French; further recognizing the needto produce materials in languages other than French and Englishand in alternate formats;

_ supportive of principlesof the Canada Health Act: universality, portability, accessibility,comprehensiveness and public administration, with particular emphasison implications for women;

_ recognition of healthcare as a fundamental human right.

These principles reflecta view that socioeconomic status, the circumstances of women'shome and work lives, their geographic location, the extent towhich they may be marginalized as a group all can affect our health.A model which recognizes these factors is critical to how women'shealth services are designed and implemented and how women's healthresearch is formulated and carried out. Such a model points tothe need for a more responsive health care system which recognizesthat policies developed outside of the traditionally viewed healthcare sector can have a distinct impact on health services forwomen. The challenge of such a view is that it is held againsta backdrop of increasing fiscal constraint in all jurisdictions.The need to coalesce forces with creative solutions for changehas perhaps never been greater.

The Network has provideda continuous spark for the fostering of critical debate on keywomen's health issues. As a vital linking force for grassrootswomen's health groups, it is well positioned to provide a networkingfunction to enhance the production and dissemination of the needs-based,policy-oriented research required in Canada today.

6. The Current Situation

At this juncture in time,the Canadian government is creating a program aimed at improvingthe quality of women's health research in this country throughits Centres of Excellence in Women's Health Program. In orderto fulfil the mandate set out for the centres, close collaborationwith community-based women's health groups, service providers,and academics conducting research in women's health will be critical.

We do not have a stronghistory in Canada of community-based women's health groups workingin close collaboration with academics doing research in women'shealth. The funding of the COEWHP and the CWHN provides a uniqueopportunity to forge those links where they may not exist andto help strengthen them where they are beginning to develop.

Too often, community-basedgroups (e.g. women's health groups, community health centres,rape crisis centres, women's centres, women's shelters, transitionhouses, and anti-poverty organizations) only have time-limitedfunding and rarely have the opportunity to evaluate their workcarefully or benefit from the outcomes of academic research donein these areas. Most such groups operate from a model of carewhich is holistic and attempts to take a determinants of healthapproach, and yet opportunities are limited for having input tohealth research agendas.

By working with the Centresof Excellence, the CWHN will help to integrate the work and insightsof small groups into the research agendas of the funded centres.It should also lead to improved outcomes for these services asa result of the research and evaluation which will be undertaken.

Similarly, improved networkingbetween all the players involved in women's health will ultimatelyassist those doing "frontline" work by providing themwith current information, by working for change in policies wherethey are needed and by allowing opportunities for dialogue wherethey may not have existed in the past.

7. Participants and Audiencesof the CWHN

Other networks in this countryhave demonstrated that a network is only as good as the commitmentand involvement of its participants and the interest of its audiences.In order to begin to clarify the ways in which the Network andthe Centres of Excellence can work together most effectively,it is helpful to consider the various participants and audiencesof the CWHN. Each may both contribute to and benefit from thework of the CWHN. Some may choose to be members, simply to keepthemselves informed for personal or professional reasons. Othersmay be participants and audiences for particular research andeducation activities, such as conferences, focus groups or anevaluation of services. Others may be "messengers", both feeding information to the CWHN and taking from it to reachothers. It is understood that there is considerable overlap inthe groupings presented here (e.g. service providers can alsobe consumers, media can also be health educators, academics canalso be policy makers).

Consumers

a) individual consumers(for self and as health guardians in the family/community)

b) consumer-based, non-governmentorganizations - including advocacy groups, women's healthgroups and coalitions, health-related agencies

Educators/Service Providers

c) health educators- front line workers (grassroots/women-centred and professional)both community and institutionally based, health librarians

d) service providers- nurses, doctors, midwives, allied health professionals (bothin grassroots/women-centred settings and professionally-lead settings)

Policy-Makers

e) government, policyresearchers and teachers, consultants

Researchers

f) academics and students- clinical, social scientific, in government, large organizationsand academic settings

Other Organizations

g) colleges, universities,professional organizations (e.g. Society of Obstetriciansand Gynecologists of Canada) and research granting bodies(e.g. Medical Research Council)

Media

h) television, radio,newspapers, magazines, etc. (as forms of popular educationand public influence) - to disseminate information about women'shealth research, services, and trends

Private Industry

i) the pharmaceuticaland medical devices industry, private insurers, etc. (as majorplayers in influencing health trends and services, may participatein various forms of information exchange with the Network).

8. Programming and Servicesfor the Network

The services proposedhere are understood to be contingent upon resources availableand upon the feedback which emerges through the consultation processover the next six months.

In taking on responsibilityfor the networking component of the COEWHP, the CWHN would bein a position to enhance specific programs and services whichwere recommended at the consultation in Winnipeg in 1993. Pleasenote that these proposed services are still under discussion andinput is being sought from a wide range of participants and audiencesbefore final decisions are made. The following objectives underlieplanning of specific programs and services for the CWHN:

1) to manage and disseminateinformation in effective ways among key players, including a "qualityassurance" role with respect to the information (e.g verifyingsources and other relevant information to determine reliability);

2) to interpret and makewomen's health research information available and understood bya wide range of women (i.e. in less technical forms and languageand in formats which are accessible to women with disabilities);

3) to offer community-based,user-friendly access points to information and research on women'shealth issues to women and community groups who would not ordinarilyapproach or have access to academic or other medical research;

4) to facilitate broad, criticaldebate among key players (e.g. through a newsletter, face-to-faceand on-line conferences, local public forums, etc.) in an atmosphereof mutual respect, taking into account the interplay of genderand other social determinants of health;

5) to inform women aboutthe potential benefits of linking with others, accessing informationand research, contributing to research relevant to their needs,and advocating for change to improve women's health status acrossregions, constituencies and issues

6) to create an avenue forindividuals and community based women's health groups to havean influence on the research which is carried out in the Centresof Excellence.

These objectives could beaddressed through a variety of services and programs. They include:

A. Clearinghouse for Women'sHealth Information and Resources

The CWHN clearinghouse isenvisioned as both a physical clearinghouse with a collectionof print and AV materials, and as a "cyber clearinghouse"with information available on line by computer. Because so manyorganizations and publications in Canada address specificwomen's health needs (e.g. The Endometriosis Association, DESAction, A Friend Indeed, The Lupus Association, PlannedParenthood Federation, various provincial midwifery organizations,etc.) a clearinghouse operated by the CWHN will serve to put womenin touch with relevant organizations where they exist. The CWHNclearinghouse will function as a clearinghouse of resources ora clearinghouse of clearinghouses. Librarians have been at theforefront of information access and computerization and theirexpertise will be drawn upon both for set-up of the clearinghouseand hiring of staff.

To efficiently operate aclearinghouse, the CWHN will maintain an annotated data base ofgroups, individuals, programs, activities, research and researchersrelevant to a wide range of women's health issues. This processwas begun during the Healthsharing phase of CWHN funding and willbe refined and expanded on with additional resources. A data baseof "who is doing what" will be useful for women whowant to connect with people in their regions. The Centres of Excellencecan access this information in order to enrich their own networksand link with individuals or groups who may be interested in jointresearch ventures. Women contacting the CWHN clearinghouse canalso be given tips on how to access wider international networksof information (e.g. through the Internet), and critical summariesof articles which CWHN affiliated people would prepare.

Quality assurance of materialsis also imperative. The clearinghouse will not carry every singlepamphlet and resource on every women's health issue, but ratherwill be selective and critical in its choices. Guidelines forthis type of quality control have been worked on by other organizations(e.g. in Developing a Consumer Health Information Service,put out by the Consumer Health Information Service at the MetroToronto Reference Library) and will be drawn upon by the staffof the CWHN clearinghouse. The CWHN will be particularly interestedin gathering health information and research relevant to womenfrom diverse cultural groups, lesbians, women with disabilities,and Aboriginal women. It will link with people working on theseissues in a variety of settings.

B. An Animation Process

To maintain a national clearinghouse,an animation process is necessary to ensure that resources availablethrough the clearinghouse reflect the diversity of this country.The CWHN will continue a process which it had already begun inearlier phases of its work. An animation process will be establishedwhich may be based on regions (e.g. Atlantic, Prairies, etc) constituencies(e.g. women with disabilities, women of colour, etc.) or issues(e.g. access to women's health services in remote communities,or the impact of racism on women's mental health, etc.)

Not everyone can read orrelies on the written word to learn about women's health. Sharinginformation and discussing ways to improve women's health oftenrequires facetoface contact. It is one of the better ways of ensuringparticipation by women from all parts of the country. It is proposedthat animators be hired to facilitate this process. Their taskswill include:

× linking a wide rangeof key players in a region, within a constituency or who workon an issue;

× maintaining an updateddata base of resources, projects, services, contacts in a region,within a constituency or related to an issue (which is fed intothe CWHN central data base);

× providing informationand facilitating discussion amongst community and women's groupsabout the roles of the CWHN and the Centres of Excellence;

× engaging in jointactivities (e.g. regional workshops, demonstration and researchprojects) with Centres of Excellence;

× forging links betweenregions and constituencies based on similar areas of need, research,service.

C. Newsletter and OtherPublications

When Healthsharingmagazine ceased publication in 1993, Canada lost the only nationalwomen's health publication it had. To fill that gap, and to linkvarious audiences with the activities of the CWHN and the COEWHP,the CWHN would produce a bilingual, bi-monthly newsletter. Writersfrom across the country will be commissioned to write for thenewsletter to accompany submissions from CWHN staff. It wouldbe posted on the Internet for wider circulation. In order to extendreadership beyond those who speak English and French, specificlinguistic groups will be encouraged to access and translate keyarticles or news items for re-printing in their language-specificpublications or distributed in some other way in their linguistic communities. In addition, the newsletter would be read on totape and made available on disk for scanning for women who areblind or visually impaired or who may have difficulty readingfor other reasons.

A newsletter will be oneof the most cost-effective ways to get information out to theCentres of Excellence and a broad base of women's, community andhealth groups, particularly since it will be simultaneously postedelectronically. It can provide an on-going avenue for criticaldebate (e.g. through letters and editorial sections of the newsletter)and the articulation of emerging women's health issues. The possibilitywill be explored of having the newsletter (or sections of it)circulated through the publications of other organizations ona regular or periodic basis.

In response to needs identifiedthrough research, the CWHN will develop consumer-focused handoutsand information sheets. Women's health information in the formof articles, pamphlets and factsheets will be re-printed in establishedpublications. For example, a factsheet on chronic fatigue syndromecan be circulated to a network of university newspapers on theInternet encouraging them to print it in their newspapers. A pamphleton women and depression can be disseminated through a "piggy-back"mailing to the editors of church bulletins, day care centres,union locals and women's professional organizations. Professionalpublications such as Canadian Nurse, Canadian FamilyPhysician or the Canadian Medical Association Journalcan be approached to reprint an article on the importance of collaborationamong medical doctors chiropractors, naturopaths, massage therapistsand herbalists. This type of linking will serve to get informationout to a very broad base of people to stimulate dialogue.

D. 1-800 Information Line

Most organizations whichprovide a clearinghouse function receive the bulk of their informationrequests by way of telephone, either as a regular phone line ora 1-800 line. The intended role of a 1-800 information line wouldbe to put people in touch with other resources (materials, groups,individuals) in their region or locality. The computerized database will allow volunteers and staff on the line to determinequickly how to respond to each callers request. Given the dissatisfactionmany women have with their medical care, it is anticipated thatthe CWHN will receive many calls for referrals. Operating as theonly national 1-800 line from a women's health organization, itis inevitable that staff will have to field calls of a personaland individual nature (e.g. "These are my symptoms; shouldI take hormone replacement therapy?") Rather than offeringon-the-phone advice, callers will be directed to relevant resourceswhere they exist and encouraged to link with others working onthese issues.

The use of a 1-800 lineis in keeping with the principle of universal access enshrinedin the Canada Health Act: it is one of the most inexpensive waysfor women to get information and to get involved with relevantorganizations in their locality. Working on a 1-800 line is ataxing job, particularly if it is a popular line. It will be essentialfor the CWHN to cultivate a strong volunteer base to staff theline in both English and French. The National Women's Health Networkin the United States have their information line staffed entirelyon a volunteer basis, using interns from health programs fromcolleges across the country. Presumably because the program iswell-co-ordinated by a paid staff person, and because the studentswho come are very keen to work there, the program has been quitesuccessful. The communications technology now exists to have thephone line staffed in a decentralized fashion so that volunteersin different parts of the country could be involved.

E. Using Computers andElectronic Technology

Computers provides the opportunityfor large groups of people to come together for to share resourcesand solve problems in a way which is revolutionizing organizingin Canada. In a country where travel and telephone costs can bevery high because of our vast geography, this technology has particularrelevance for national networks here, potentially making our tasksmuch simpler. This tool also offers the possibility of one centralsource (such as the CWHN) posting useful information to whichany user can gain access. It can provide a forum for policy debateon critical women's health issues. It's exciting to realize thatwomen with the same health problem can "talk" to eachother from one end of the country to another simply by sittingdown at a computer.

To date, the CWHN has setup a homepage site on the World Wide Web, accessible to anyonewho can access the Internet. It has posted some key documentsof the Network (e.g. the report, Strength of Links and, upon completion, this document will also be posted). It is thehope of CWHN organizers that the CWHN homepage will direct womento any number of women's health organizations and services whichhave information posted on the Internet. Users could also gainaccess to a listing of activities of the various centres of excellencethrough the CWHN homepage.

The possibilities whichcomputer technologies offer for the operations of the CanadianWomen's Health Network include:

1) Access to Data Banks - To quote the Web User's Manual, data banks or data bases are "large bodies of information that are organizedin such a way that you can search through them quickly for specialinformation". A data base might contain a listing of allpublished articles on endometriosis since 1990, all the publicationsof a particular organization, or the mailing list of various organizations.You can retrieve documents within data bases (e.g. a newsletteror an article) and have them downloaded to the software programof your computer, completely bypassing the need to go to a library.Accessing data bases will be critical to the maintenance of theclearinghouse.

2) Corresponding by E-Mail - Essentiallyany functioning computer which can be equipped with modems forless than $150., can also provide a means of communicating withpeople around the globe. This has the potential of cutting communicationscosts radically. When the CWHN is in a position to provide anenhanced clearinghouse role, e-mail also will become one additionalmeans by which women from across the country can access the Networkand its resources. The Coordinating Committee of the CWHN havealso begun communicating by e-mail.

3) Computer Conferencing - Similar to e-mail, "conferencing" by computer allowsgroups of people (either a fixed number - determined by whetherthe conference is "closed" - or an unlimited number)to be in touch with each other on a particular topic or issue.It has been described as "several people sharing a centralfiling cabinet". It is a means of communication which isparticularly useful for a group of people united to work througha particular process (e.g. the creation of a discussion papersuch as this one, or planning a workshop) without having to physicallyget together or all be on a telephonationference call at the samepre-determined time. There are different means of accessing computerconferences: "read-only", semi-private, completely private,open to all for two-way communication, etc..

Lest there be any notionthat the CWHN will be operating only by computer, don't worry.The CWHN does not intend to function uniquely by means of electroniccommunications. It intends to evolve a "paper presence"as well as a "computer presence". Organizers withinthe CWHN are aware that the transition to functioning by computeris not an easy one for all women. Even though many women typeand use word processors in their jobs, many have not made theleap to using the same technology for communication with others.

While we must be sure weare building an organization which will be able to adapt to thetechnology needs of the future, we must also be cognizant of thebarriers women face in accessing that technology. Many Canadianwomen do not have ready access to computers and to the necessarysoftware, often for financial reasons. To communicate on lineand to understand the manuals and on-line instructions requiresan ability to function comfortably in English or French; roughlyone in three adult women in Canada has some reading difficulty.Particular regions and communities are currently less well-accessedthan others. It has also been noted that younger women tend totake to the technology more readily than women over a certainage. All of these issues must be considered in the CWHN's useof computer technology in the coming years.

We recommend that a parallelprocess must occur which allows for widespread training for womenon the use of computer technology. The one-on-one human contactwhich makes learning most effective will be critical here, particularlyfor women who are anxious about getting on line. Organizationssuch as NirvCentre's WEB for Women Program in Toronto and Women'spacein rural Nova Scotia have demonstrated a commitment in gettingmore women on-line and comfortable with this technology, recognizingits tremendous potential as a means of communication and networkdevelopment.

The CWHN's link to the Centresof Excellence may provide an opportunity for computer trainingas well. Most universities are well linked by computer networksand universities and community colleges offer training to staffin the use of these technologies. These institutions could beencouraged to welcome local women from community based organizationsto join staff in these training sessions.

To help broaden access formore women, businesses will be approached about donating slightlyused computer hardware and software to community organizations.Women's health and professional organizations who use computertechnology will be encouraged to serve as a contact point forinformation for smaller, sister groups in their locality, regionor constituency who do not have the same access.

9. Advocating for Change

The women's health movementin this country, and indeed the many Canadian movements for socialchange, have been characterized by a steady history of advocacywork. Policy changes which have occurred in the area of women'shealth over the past decade in Canada (e.g. on the use Cesareansections, on the prescribing of mood-altering drugs to women,or the availability of abortion services) have all been the resultof persistent, often nation-wide, advocacy work by consumer-basedcoalitions.

There are many ways of doingadvocacy work. Effective advocacy depends on sound arguments andresearch and on an ability to form strong networks. One of thekey roles the CWHN can play in this regard would be to use theNetwork's many contacts to put like-minded groups and individualsin touch with each other and to facilitate the formation of coalitions.

To be effective, the policy-basedresearch done through the COEWHP must have an impact on the servicesand programs related to that research. The CWHN can play a keyrole by facilitating debate and creating linkages between thecommunity and researchers. This could be assisted by the CWHNthrough electronic conferencing, through dissemination of opinionby the newsletter or through a national workshop which would bringtogether the various perspectives from the regions and acrossconstituencies. Such events are also important in the developmentof coalition building amongst those doing women's health workin different sectors.

The CWHN would not replacethe work of organizations which speak on behalf of their members,such as the National Action Committee on the Status of Women,the Native Women's Association of Canada or the Canadian Confederationof Midwives. The CWHN will help to facilitate the important advocacywork done by organizations such as these, with the intended outcomeof improving policies and practices which would strengthen women'shealth in Canada.