 All right. And now I would like to take just a moment to introduce your speaker, Jennifer Goldberg. Jen is a PhD student at the Dalalana School of Public Health at the University of Toronto and has a master of public health in family and community medicine with a collaborative specialization in indigenous health from the same school. Jen's research interests include sexual and reproductive health equity for queer, trans and non-binary people. Jen is currently the primary investigator on a survey research project to explore the attitudes of Ontario midwives towards sexual and gender minority people. Jen's PhD research uses narrative inquiry to understand whether and how the narratives within the stories of queer, trans and non-binary people who have used midwifery services in Ontario have been shaped by broader hetero and cis normative discourses. Jen is a member of researching for 2SLGBTQ plus health, a team of LGBTQ and ally community based researchers in Toronto who examine how 2SLGBTQ plus people experience health and healthcare services. All right, thank you all for joining and Jen take it away. Thank you so much for that fantastic introduction. It saves me about a minute of my own. It's really great to see everybody here today. Thank you so much for coming to my presentation and happy international midwives day to all of you. So I'm Jen and I live in Toronto, Canada. And in addition to being a midwife, I'm also a PhD student at the School of Public Health at the University of Toronto. And my substantive area is sexual reproductive health equity for sexual and gender minority people. Also sometimes referred to as the acronym 2SLGBTQ plus. So before I begin, I would like to acknowledge the support of my supervisor, Dr. Lori Ross and my colleagues, Dr. Mustafa Shokuhi and Tatiana Graf. And I believe Tatiana is here joining us from Germany. So this study was funded by a Mentored Midwifery Research Grant from the Association of Ontario Midwives for which I am grateful and was able to fund the study. So I'm presenting some results from our cross-sectional survey that measured the attitudes of midwives in Ontario towards sexual minority and gender minority clients. Sorry, how do I advance the slide? Thank you. So this study was informed on the basis of qualitative research showing how the experiences of lesbian women are shaped by midwives attitudes. We don't yet have quantitative data in the Canadian context that examines the attitudes of midwives towards sexual minorities. And there are no quantitative or quantitative studies that examine midwives attitudes towards transgender and non-binary people. Therefore, the objectives of this study were to measure the attitudes of Ontario midwives towards sexual and gender minority clients and to see if there are any differences in those attitudes across practice settings. The paper survey was mailed to all 926 midwife members of the Association of Ontario Midwives last year. 267 surveys were returned completed for a response rate of 28.8%. The respondents mean age was 40.7 years and the mean years of practice was 8.4 years. Close to one-third of respondents had identified as sexual minority. This includes midwives who identified as bisexual, queer, lesbian, asexual, pansexual, among other sexual minority identities. The majority of respondents identified as women and cisgender and most of the respondents identified as white. 83% of respondents identified their primary practice setting as urban and semi-urban. And the majority of respondents entered the profession through the university-based midwifery education program. Within the survey, we adapted an existing measurement tool to measure midwives' attitudes towards sexual minority clients and gender minority clients. There were 20 questions of which 11 were about midwives' comfort working with sexual minority clients and nine questions specific to working with gender minority clients. Each item was answered on a five-point Likert scale where higher scores reflect more positive attitudes and lower scores reflect less positive attitudes. Overall, the mean attitude scores were positive. The mean score for attitudes towards sexual minority clients was 49.2 out of a possible score of 55. And the mean score for attitudes towards gender minority clients was 38.9 out of a maximum possible score of 45. Potential relationships between the mean attitude scores and demographic and self-identity characteristics were examined. We found an association between sexual orientation and attitudes. Sexual minority identities were associated with more positive attitude scores. We also found that root of entry into the profession is associated with attitudes. There was a statistically significant difference in mean attitude scores between midwives who entered the profession through the university-based midwifery education program compared to midwives who entered through the international midwifery pre-registration program and the prior learning and education assessment. We see that across practice settings, there was no statistically significant difference in midwives' mean attitude scores towards sexual minority or gender minority clients. Despite the limitations of having a sample that is not fully representative of all midwives in Ontario, this study contributes new knowledge summarized in these three takeaway points. First, overall, the attitudes of midwives who participated in the study are positive towards sexual minority and gender minority clients. Second, there was no difference in those attitudes across practice settings. And third, the root of entry into the midwifery profession was associated with the difference in attitudes. Based on these findings, future work could explore how content related to sexual and gender minority people is included or missing within midwifery training and education programs. And future qualitative research could explore what shapes the experiences of sexual and gender minority people who have used midwifery services. So that concludes the presentation in English and I'll just hold questions to the end. I will now present the same presentation in Spanish. Do I need to run through all these slides first? Okay, okay, bueno. Well, bienvenidos y bienvenidas y bienvenidez a mi presentación y feliz día internacional de la partera. Yo soy una partera en Toronto, Canada y también soy un estudiante doctoral de la escuela de salud pública en la Universidad de Toronto. Quisiera reconocer la suerte de la Universidad de Toronto Quisiera reconocer el apoyo de mi supervisora, doctora Lori Ross y mis colegas doctor Mustafa Shokuhi y Tatiana Graff, quien está aquí hoy. Y quisiera reconocer el apoyo financiero por parte de la asociación de partes de Ontario con cual se pudo realizar este estudio. Voy a presentar unos resultados de nuestra investigación, una encuesta transversal que envidió las actitudes de las parteras de Ontario hacia personas de minorías sexuales y de género. La investigación fue informada por las investigaciones cualitativas que demuestran la manera en cual las experiencias de mujeres lesbianas son impactadas por las actitudes de las parteras. Todavía no existen los datos cuantativos en el contexto canadiense, así no sabemos cuáles son las actitudes de las parteras en Canadá hacia las minorías sexuales. Además, no hay estudios cualitativos o cuantativos dirigéndose a las actitudes de parteras hacia las personas transgénero y no binaria. Así, los objetivos de nuestra investigación fueron medir las actitudes de las parteras en Ontario hacia las minorías sexuales y de género y determinar si las diferencias en las actitudes son relacionadas con el tipo de localidad de la práctica. La encuesta que fue empresa en papel fue enviado por correo a todas las parteras que tenía en membrecia con la asociación de parteras de Ontario en el año pasado, en total 926 parteras. De estos 267 encuestas completadas fueron devueltas, así la tasa de respuesta fue 28.8%. El promedio de edad de los respondientes fue 40.7 años y el promedio de años de práctica fue 8.4 años. Casi un tercer parte de los encuestados se identificó como minorías sexual, tal como bisexual, lesbiana, queer, asexual, pansexual, entre otras identidades de minorías sexuales. La mayoría de los encuestados se identificaron como mujer y cisgénero. La mayoría de los encuestados se identificaron como caucasica. 83% de los encuestados se identificaron urbano y semi-urbano como subtipo de localidad de la práctica. Y la mayoría de los encuestados entraron la profesión de partería por el programa universitario de educación de la partería. Dentro de la encuesta, se adaptó una herramienta de medida existente para medir las actitudes de las parterias hacia las minorías sexuales y de género. Había 20 preguntas de la encuesta de los cuales once trataban del confort de las parterias cuidar de las minorías sexuales y nueve preguntas sobre el confort de las parterias cuidar de las minorías de género. Cada pregunta tenía cinco opciones para responder, una escala de cinco puntos like-ert, donde los puntajes más altos reflejan actitudes más positivas y los puntajes más bajos reflejan actitudes menos positivas. En general, el promedio de puntaje de actitudes fue positivo. El promedio de puntaje de actitudes hacia minorías sexuales fue 49.2 de un máximo puntaje posible de 55. Y el promedio de puntaje de actitudes hacia minorías de género fue 38.9 de un máximo puntaje posible de 45. Las asociaciones entre los promedios de puntajes y los datos demográficos y características fueron examinadas. Encontramos una asociación entre orientación sexual y las actitudes. Las identidades de minorías sexual fueron asociadas con puntajes más positivas. Además, encontramos que la ruta de entrada hacia la profesión fue asociada con las actitudes. Había una diferencia estadísticamente significativa en los puntajes promedios entre parteras quienes entraron la profesión por la universidad, comparados con las que entraron por otros programas alternativas. Finalmente, tomando en cuenta los tipos de localidades en la práctica, vemos que no había ninguna diferencia estadísticamente significativa en los promedios de puntajes hacia las minorías sexuales y las minorías de género. A pesar de tener una muestra de encuestados que no es totalmente representativa de todas las parteras de otario, nuestro estudio sí contribuye con los cimientos nuevos resumidos en los siguientes tres puntos. Primero, en general, las actitudes de las parteras que participaron en el estudio son positivas hacia minorías sexuales y de género. Segundo, no había ninguna diferencia en estas actitudes a través de las localidades de la práctica. Y tercero, la ruta de entrada a la partería fue asociada con una diferencia en las actitudes. Estos hallazgos podrían formar investigaciones futuras que podrían explorar cómo el contenido relacionado con las minorías sexuales y de género se incluye o no se incluye en los programas de formación y educación de partería. En el futuro, investigaciones cualitativas podrían explorar qué da forma a las experiencias de las personas de minorías sexuales y de género que han utilizado los servicios de partería. Gracias. So now, if anybody has any questions or comments in English, unas preguntas o comentarios en español. You can feel free to unmute and ask questions or type them into the chat box and I do see someone typing. Jen, while we're waiting for those first questions to come up, I was curious about what surprised you when you started looking at the data. Yeah, that's a really good question. What surprised me, two things surprised me in the data. The first was that almost 34% of the midwives who responded identified as sexual minority. And so I feel like what that speaks to is selection bias, perhaps, that midwives who identify as sexual minority might have been more likely to participate or want to participate in the study. But we can't know that for sure because we don't have any information about the general population of midwives in Ontario. So it's a best guess at that kind of bias. And I guess what surprised me a little bit was that the attitudes were generally positive. One of the reasons for embarking on this research study is that often sexual and gender minority people don't have the most positive experiences with their midwives. So this is one first step in trying to understand that. So again, maybe speaking to selection bias that midwives with more positive attitudes may have been more likely to fill out the survey. So this speaks to the need for future qualitative research into the experiences of sexual and gender minority people. Thanks for that question. And it looks like there is one question or a comment in the chat. And I will let you manage the Spanish. So that's Denise. Lamentablemente aún nos cuesta separar en la atención nuestros prejuicios. Yeah, so to translate that into English, Denise is saying that unfortunately it's difficult or takes a lot of effort to recognize and put attention to our own biases and prejudices, I guess in the context of providing care to sexual and gender minority clients. Definitely, I can speak to efforts in Canada and the province of Ontario and British Columbia to design workshops and trainings to help build competence and capacity amongst healthcare professionals broadly to feel more comfortable caring for sexual and gender minority people. So that is something that fortunately we do have access to here. As far as I know, there's nothing specific for midwives in this context, such trainings. Sorry, Dane, I wonder if you can answer that in Spanish as well. Oh, yes, sorry. Okay, con referencia a la pregunta de Denise o la comentario de Denise, lamentablemente aún nos cuesta separar en la atención nuestros prejuicios. Desafortunadamente sí, es algo que pasa no solamente con parteras, pero con otros proveedores salud. Y yo puedo hablar en el contexto canadiense aquí en Canadá, en Ontario, nuestra provincia. Hay talleres educativos que construyen la capacidad de proveer cuidados que son más sensibles a la gente de la gente de becu. Pero más investigaciones son necesarios para ver si tienen efecto. Bueno, voy a pasar por todas las preguntas. En Argentina, Julia, en Argentina, la folletería es toda de mujeres. No he visto incorporar otros géneros en la publicidad de control prenatal ahí. Sí, entonces este lenguaje, bueno, en inglés también es nuevo. Y poco a poquito el lenguaje sí está cambiando y está más inclusivo. Es muy diferente entre el inglés y el español entre otros idiomas, pero poco a poquito. Yo pienso que las parteras, pues tenemos una responsabilidad ética de ampliar los espacios clínicos tanto en nuestros corazones de aceptar personas embarazadas, partorientes de cualquier identidad de género, de cualquier orientación sexual y aprender cómo proveer, dar cuidado más inclusivo y seguro y realmente que celebra las diferencias entre todos y todas. I guess so in English what I was just answering this question in Argentina, although the written information is all about women and they haven't seen other genders incorporated into the language within those documents and certainly that is something that we see in many places and even in Ontario, I wouldn't say that that is sort of homogenous or equal, equally applied across all midwifery practices. Some places do incorporate gender neutral words and language and some are still learning. I think people are different points in that. Tiene alguna política pública que normatice esto? I don't understand that question, I'm sorry. Spanish is not my first language, so I don't know Denise. En nuestro país hay solo una norma técnica que vincula a la atención de ETS con la atención hormonal para modificación corporal pero solo para mujeres trans. So I think this is a comment and question about a gender assignment surgery for transgender people. I can't really speak to that, it's not my area of expertise or knowledge. Can I say something Jane? Yeah, Denise refers to as regulation about sexual transmitting disease and hormonal modifications. If there is a regulation there in Canada as well. Not that I know of, but again, I can't speak to that point, exactly. Denise, if you email me, I can find out for you later and connect you with someone that would be able to answer that question. Any other questions or comments? Looks like we have a few people typing. I'm sorry, Kelly. Yes. I was going to ask you. Mejor lo digo en español para mis colegas que hablan español. Okay. Que estrategias has visto en este estudio preliminar que pudiesen ayudar a mitigar eso, a eliminar esos prejuicios en las parteras que vienen de diferente formación, no? Si, vienen de diferente formación. Entonces, primer, gracias por la pregunta porque es el siguiente paso que necesitamos tomar es refisar el currículo de la programa a nivel universitario y también refisar el currículo de los otros caminos alternativos hacia la partería porque hay una manera en cual las parteras que no recibieron su educación o aprendizaje aquí en Canadá pueden recibir su registración como partera registrada y los resultados que vimos indican que esos actitudes no son tan positivos como las parteras que se matriculan por la programa universitaria. Entonces, el siguiente paso es refisar el programa para ver qué podemos añadir o agregar en el currículo para construir, para aumentar esa capacidad entre las parteras de proveer cuidado más seguro a esta población. Y a veces, el primer paso es un reconocimiento de los prejuicios y actitudes de uno y pensar cómo se desarrollan, de dónde vienen y por qué. Y una vez que podemos entender cómo se forman, de dónde vienen, se pueden cambiar. Espero que esta contesta la pregunta. Totalmente, muchas gracias. Okay, gracias. Any questions? Yes. Grace, you gave suggestions for future research. Is there currently any research underway in this area that you know of? Great question. So partly this research project came out of a literature review that I did last year that's under review at a journal. And the research that has been done in the world, looking at the experiences of sexual minority women, is all research on lesbian women and these studies have taken place in Europe and Norway, Sweden and the UK. So there are no published studies since 2013 that look at the experiences of any sexual minority group outside of that context and no studies that have looked at the experiences of transgender non-binary people in midwifery care. So and I'm checking the research every few months because this is part of my doctoral work is to conduct a study that uses storytelling to understand the experiences of queer and trans people who've used midwives in Ontario and see how their stories are shaped by either heteronormativity, cisnormativity or how sort of the feminist underpinnings of midwifery also shape those stories. So I'm on the lookout for this research. I'd be very happy to see more of it. And Tatiana Graf, who was the research assistant on this project last year, research is showing that most SGM clients are reporting negative experiences with midwives, but most midwives seem to have positive attitudes towards 2SLGBTQ. Where do you think this discrepancy comes from? I'll just translate this question. A lot of research shows that sex minorities and gender minorities have negative experiences with their partners, but most of the partners have positive attitudes towards sex minorities and gender minorities. Why is there a discrepancy between research results? So I think Tatiana, in part, this is the sample bias that we're speaking of that midwives who have positive attitudes maybe participate in this research more often, more robustly than midwives who have negative attitudes or who don't care about the issue. And on the other hand, it's possible that midwifery clients who've had homophobic, biphobic, or transphobic experiences with their midwives and we know that does happen are very quick to come forward during qualitative interviewing because they would like to see that change. So yeah, the trick is sampling and shocking that there is so little existence but great to know there is more on the horizon. Thank you. Yeah, thank you, Grace. I think, you know, when I think about, you know, why is there such a lack of research? I think in part, just research in general with LGBTQ plus communities has not been prioritized in health and marginalized and also, you know, qualitative midwifery research is often marginalized, at least in Ontario. It's still a growing profession midwifery research. So combining those two intersections, I feel like at least in the Canadian context, there's still a lot to do. But it's coming. And Denise, muchas veces lo que los proveedores de salud entendemos por la calidad de atención es totalmente distinto de lo que piensen y sienten los usuarios, sí. So Denise is saying that many times the health providers, what health providers feel is quality of care is very different and distinct from what the actual health users feel. Yes, I agree, totally. And Kelly agrees, estamos de acuerdo. Y por eso hay que preguntar los proveedores de salud, hay que preguntar a la gente de LGBTQ qué imaginan, qué quieren, qué es bueno, qué no es bueno de los servicios de partería que reciben y cómo podemos mejorar eso. Susana, as far as I understand, you mentioned that the attitudes of Ontario midwives are different depending on the program that midwife graduated, which programs were included. Why do you think that happened? And then thank you, Susana, for following up in Spanish with that question. Yeah, so I think that this speaks to what is included in the content that's included in those training programs. As I was mentioning earlier, next step is to look at the curriculum of the midwifery education program that's offered at three universities here in Ontario and compare with the curriculum of the streaming program called the IMPP, the International Pre-Registration Midwifery Program and see where each of those programs are including health and health issues and content related to sexual and gender minority people as a starting point because it might just be simple as exposure and wouldn't be hard to introduce that into a curriculum that's being done in many places in North America. I will say that across the universities, I didn't put this in a presentation but it will come out in the paper, is that there were differences between schools as well, so between McMaster, Ryerson and Laurentian, there were some differences in those attitudes towards both sexual and gender minority people, but we still have to flesh that out a little bit more. Thanks, Susana, for putting IMPP. And I guess I'll just say that, sorry, in Spanish, to answer Susana's question in Espanol. ¿Por qué los actitudes de las parteras que atendieron el programa internacional son diferentes a las parteras que se matrecularon de la universidad y pensamos que tiene algo que ver con el contenido del programa que es posible que en el programa de la universidad están aprendiendo como cuidar a esta población de gente, de personas y es posible que en el otro programa alternativa todavía no tienen contenido o no hay mucho. Pero hay que ver porque estos programas son muy comunes aquí en Ontario, en Canadá y podemos aumentar la capacidad de las parteras de proveer un cuidado a la gente LGBTQ que es más safe. Julia dice, me toca asistir a una pareja de mujeres. Trata de ser muy abierta, respetarlas todo el tiempo. Resulta que nunca pregunté si eran pareja lo dedujé por el amor que se demostraban y cuando nació el bebé me enteré que eran cuñadas que el papá venía en camino. Eso es un buen ejemplo de gracias por esta historia de nuestros assumptions. No son prejuicios, pero lo que asumimos de la gente. Sí. Thank you so much for sharing these questions and stories and perspectives. Ya, Julia, si Susana siempre debemos preguntar. Thank you so much, Jen, for this really great presentation and to the entire audience for such an engaging discussion. Jen, I appreciate that you were able to engage in both languages as a primary English speaker. I felt pretty much able to follow along through both conversations and I hope that everyone felt the same. Thank you very much for the opportunity at the last minute to present in Spanish. Y lo siento si no me entienden bien pero pienso que es importante difundir la información lo más que se puede. Entonces por eso quería dar la presentación en español. Entonces gracias por su paciencia conmigo.