National Framework for Women’s Health in Canada Bill
Second Reading
March 26, 2026
Honourable senators, women in Canada wait longer, are diagnosed later and are too often dismissed or disbelieved when they seek care, not because we lack compassion or clinical skill but because our system was never deliberately designed with women’s health at its centre.
Bill S-243, the National Framework for Women’s Health in Canada Act, is our opportunity to change that.
This bill, brought forward by Senator Henkel, does something both creative and transformative. I would like to thank Senator Henkel for taking this wonderful initiative.
This bill does not create a new program. It does not intrude on provincial jurisdiction, and it does not medicalize women’s lives. Instead, it asks one clear thing of the federal government: to lead the development of a coherent, national framework for women’s health in collaboration with the provinces and territories, Indigenous Peoples, health professionals, researchers and community organizations. In other words, it creates coordination, not duplication, and accountability, where today there are fragmentation and silence.
For decades, women’s health policy has been a patchwork of projects, pilot programs and well-intentioned announcements, without a durable plan to guide investment, data, research and service delivery across the country. The consequences are visible in every region: women in rural and remote communities travelling hours for basic care; women in equity-deserving groups, including Indigenous, racialized and 2SLGBTQI+ people, facing multiple barriers; and women without regular primary care left to cycle through emergency rooms with preventable conditions.
When half the population is navigating a system that does not consistently see or serve them, that is not a series of individual stories; that is a system failure.
Bill S-243 responds to that failure with a clear, structured approach built on four pillars: understanding, preventing, training and coordinating.
It requires the Minister of Health, within one year, to develop a national framework that strengthens research and innovation on women’s health, improves primary and preventive care across all ages and life stages, enhances training for health care professionals and targets access gaps for those who face the greatest barriers.
Colleagues, it also obliges the federal government to convene at least one national conference in developing the framework, followed by recurring conferences every three years, and to regularly report to Parliament on that progress. This is not a symbolic gesture; it is a cycle of monitoring, evaluation and public accountability.
As a family physician, I have seen how the absence of such a framework plays out in exam rooms and hospital corridors: a woman with debilitating endometriosis told for years that her pain was “normal”; a newcomer juggling two jobs who skips follow-up appointments because there is no child care and no primary care provider who understands her context; a senior in a rural community whose cardiac symptoms are misinterpreted because they do not fit the “classic” male pattern taught in textbooks.
These stories are not outliers, colleagues; they are the predictable result of a system that has not invested adequately in women-specific research, training or access.
Critically, this bill also recognizes that women’s health is not just a health issue; it is both an economic and social imperative. Healthier women participate more fully in the labour force, care for families and communities, and drive innovation and entrepreneurship, including in women-led health businesses.
By fostering collaboration between public systems and the private sector and by creating clearer pathways for women’s health research and commercialization, the framework can support both better outcomes and a more productive, innovative Canada.
Colleagues, some may worry that this legislation will add bureaucracy or burden to already stretched providers. The sponsor and experts have been clear: The goal is not more paperwork but a smarter structure. By asking where the money is going, how it is being used, and where gaps and duplications lie, the framework can help us use existing and future investments more effectively. The risk of inaction is not the absence of process; it is the continuation of uncoordinated efforts that fail to move the dial for the women we serve.
The bill is also grounded in listening. It is informed by the work of the Women’s Health Coalition and Women’s Health Collective Canada, as well as many advocates, clinicians, researchers and community organizations that have pressed for a national approach.
Many women have written to us describing unbearable pain, delayed diagnoses and a profound sense of abandonment by a system that was supposed to help them. Supporting this bill is a way of saying to them, “We see you, we hear you and we are prepared to act with you.”
Honourable senators, the status quo is untenable. Bill S-243 does not pretend to solve every problem in women’s health, but it creates the conditions to do better — fairer, more evidence-based and more accountable care.
Colleagues, I urge you to support this legislation and to send it promptly to committee so that we can refine it where needed, hear from Canadians and move swiftly toward a national framework that finally reflects women’s health as the priority it has always deserved to be.
Thank you. Meegwetch.
Honourable senators, I rise today to express my support for Bill S-243, the “National Framework for Women’s Health in Canada Act.” I commend Senator Henkel for this initiative and for the thoroughness of her work. I also commend all the senators who have already contributed to these debates; we have just heard from our colleague, Senator Ravalia. This is a critical issue.
I do not wish to revisit the personal story I’ve already shared with you, or talk about my experience with the health care system, but it is one of the reasons why I agreed to speak here today.
Women’s health cannot be relegated to the background; it lies at the heart of public health and directly reflects the quality and fairness of our system. We’ve made some progress, but systemic gaps persist: symptoms that go unrecognised, delayed diagnoses and inappropriate treatments. These failures are not isolated errors; they stem from a model that does not sufficiently incorporate the biological, social and cultural specificities of women.
S-243 addresses these shortcomings by proposing a coherent national framework based on four action verbs: understand, prevent, train and coordinate. The aim is clear: to move from a system that corrects after the fact to one that is proactive, takes differences into account and ensures equitable quality of care across the whole country. Let’s not forget the difference between equality and equity. Equality standardizes the services offered, while equity adapts the response to actual needs. Not all women present the same symptoms, face the same risks or live in the same circumstances. Offering them the same thing does not ensure the same opportunities.
Our responsibility is to adjust our policies, practices and tools to ensure that the quality and the safety of care are guaranteed for every woman.
Honourable senators, the birthing process is still prone to serious issues. It is a medical, psychological and social experience all in one. Too often, childbirth is treated like some routine procedure, when behind every birth is a unique story. Every mother in this chamber has a birth story. Pregnancy is just one step; childbirth is another, often more difficult step, marked by diverse realities that are rarely discussed, such as birth-related complications and postpartum depression.
A national framework is therefore highly appropriate. Among other things, it will ensure that medical teams get the tools they need and that women receive support tailored to the realities they face. Adding to this already uneven playing field is another reality that is still poorly understood, a reality known as “misogynoir.” It’s a particular kind of discrimination that combines racism and sexism and specifically affects Black women. I doubt that more than one or two people in this House have ever heard of this phenomenon before, apart from the Black women. It’s well-documented in Canada, however, having been the subject of a television report by ICI Radio-Canada. Misogynoir involves a set of stereotypes that sustain discriminatory mechanisms with tangible effects on Black women’s health. Health care professionals spend less time listening to Black women and take their pain less seriously, because they think that Black women have a higher pain tolerance, if you can believe it. As a result, Black women are examined less thoroughly and their trust is eroded.
This reality takes on a whole new meaning when we think of the late Soki Syayighosola, the mother of my assistant, Magali. She was a Black immigrant woman who died in Montreal in 2008 from internal bleeding following a miscarriage. Despite test results indicating serious danger, the on-call doctor did not believe the findings and did not even come to treat her. This death, which received widespread media coverage at the time, painfully illustrates what experts describe as the medical manifestation of misogynoir, a systemic tendency to downplay the pain, symptoms and credibility of Black women, with potentially fatal consequences.
Naming “misogynoir” means acknowledging that a national framework for women’s health must explicitly address these biases.
This systemic violence does not affect only Black women. It also affects Indigenous women, as tragically illustrated by the case of Joyce Echaquan, an Atikamekw mother who died at the Joliette hospital in 2020 after livestreaming staff using racist slurs against her. That is what our health care system is like. Her case exposed the persistence of discriminatory and dehumanizing practices that directly endanger the lives of Indigenous women.
Honourable senators, the state has a duty to guarantee a health care system that is fair, inclusive and truly responsive to women’s needs. Investing in women’s health should not be a series of isolated measures. It should strengthen the very foundations of our system, support families, foster social participation and promote prosperity. By acknowledging these gaps — whether they involve inequities in diagnosis, flaws in the perinatal continuum, social pressures that render distress invisible, or the specific barriers faced by Black and Indigenous women — we are affirming our commitment to taking sustainable and systemic action. This is how we will build a truly equitable health care system that meets the realities and needs of all women.
Bill S-243 is essential because it ensures that every woman, regardless of her background, identity or where she lives, has access to care based on science, empathy, dignity and equity.
For all these reasons, I fully support this legislative initiative. By passing Bill S-243, we can finally translate repeated observations into measurable results for women, their families and communities and ensure that best practices become the norm across our country.
Honourable senators, I urge you to send Bill S-243 to committee as soon as possible for an in-depth study so that we can finally have a national framework for all women. Thank you.
Honourable senators, I would like to begin by referencing Senator Henkel and the phrase she used, “Mind the gap,” as a powerful way to describe the historic inequities between women’s and men’s health. Women’s health has long been underfunded, under-researched and undervalued across systems.
While this gap exists broadly, it is significantly wider and more dangerous for First Nations women.
Understanding women’s health inequities in Canada requires us to look beyond averages and examine who is being left the furthest behind. The key message here is that to truly understand the gap, we must ground ourselves in the lived realities of First Nations women and recognize that their experiences define the severity of the issue.
I want to introduce a community-based teaching here, and it is moving between a dock and a fishing boat, a familiar experience in many First Nations communities. What is required to move safely from one to the other? Careful timing, steady balance and, most importantly, support from others reaching out. When the timing is off, the risk is immediate and people can fall.
The most dangerous place is not where you start or where you are going; it is the space in between, which is where First Nations women are. That space is unstable, unpredictable and capable of causing real harm.
The key message here is that the health care gap is not a minor inconvenience; it is a place of real and present danger where harm occurs.
Let’s contrast experiences of the lived reality of the gap. For many Canadians, accessing care may feel manageable, like stepping across a small gap. For First Nations women, it is a high-risk leap in unstable conditions.
What do women encounter in that gap? Racism within health care settings, trauma and re-traumatization, delays in care or a complete lack of access.
While working in nursing stations for over 40 years, I have seen all of this with nursing, physician care, dental care and mental health care. That is one of the reasons that I decided to come to the Senate.
These are not isolated incidents; these are patterns within the system. Women are not avoiding care due to neglect, lack of knowledge or lack of effort. They are making decisions based on real experiences of harm and unsafe systems. I have had many conversations with patients over the years.
The key message is that avoidance of care is not the problem; the system itself is.
When we are framing Bill S-243, we need to reaffirm that First Nations women are Canadian women and must be fully included in any national framework.
Bill S-243 is an important opportunity to address long-standing inequities. This bill should reflect the voices and needs of all women. It cannot fulfill that purpose unless it explicitly includes First Nations, Inuit and Métis women. In the bill, “Indigenous” is only mentioned twice. I saw it as an afterthought, and so did the group I met with last week, the First Nations Health and Social Secretariat of Manitoba, or FNHSSM.
The key message is that if a bill does not address these disparities, it cannot meaningfully claim to serve all women in Canada.
The jurisdictional gap is a core structural issue. One of the most significant drivers of inequity is the divide between federal and provincial health care systems. The key realities are that federal services in First Nations communities are chronically underfunded and that provincial systems are often geographically and structurally out of reach.
The difficulty of having both governments work together to address First Nations issues has been problematic, and it’s sometimes impossible. You can look at Jordan’s Principle and what we had to do, and that’s still happening.
What do women navigate? They travel long distances across jurisdictions. The approval process for Non-Insured Health Benefits takes a long time. The delays directly affect care outcomes and exacerbate illness. There are language and financial problems.
The core issue is that women are forced to ask, at the point of care, who will pay.
I have heard of incidents where people have come to Winnipeg to access care, and they end up on the street with no money. It is a very scary situation.
The key message is that this is not an accidental gap; it is a system failure by design, rooted in fragmented responsibility.
Now let’s look at prenatal care gaps. Prenatal care access is significantly unequal, especially in northern Manitoba and inner-city Winnipeg. Only 71% of First Nations, Métis and Inuit mothers have a regular health care provider, compared to 89% of other mothers.
Structural barriers include limited or no providers and outside providers who visit sporadically with limited community connection and who do not and cannot provide seamless care.
When we look at the deeper root causes, we look at the history of forced and coerced sterilization, ongoing child care apprehensions and experiences of racism and medical trauma. And medical assistance in dying, or MAID, has been offered by health professionals unilaterally, and I have had people call and tell me that.
I wanted to reinforce that these factors shape whether care feels safe or accessible. The key message is that the avoidance of care is an informed response to harm, not a failure of individuals.
With health outcome inequities, gaps in access translate into serious health outcomes.
Key stats include that infant mortality is three times higher for First Nations infants in Manitoba, diabetes rates are four to five times higher in First Nations women than other women, cardiovascular disease has earlier onset and more severe outcomes and cancer has a later diagnosis with higher mortality rates. And I have had family members and friends in this situation.
For infectious diseases, hepatitis B rates are four times higher; 47.9% of HIV cases among women are First Nations, Métis or Inuit; and the rate of syphilis is 13 times higher. These are not random or individual issues.
The key message is the following: These outcomes are the result of systemic inequities, not personal choices.
I will speak about the child welfare connection. First Nations children represent 91% of children in care in Manitoba. This connects directly to maternal health. Women navigate pregnancy with the fear of child apprehension, resulting in the avoidance of care and subsequent poorer health outcomes. Women experience four times higher mortality risk when children are apprehended and placed in Child and Family Services care.
What are the impacts? It includes increased mistrust of systems, fear of engagement with health care and emotional and psychological stress. I note:
. . . child removal by child protective services substantially influenced the risk of preventable death in all mothers, with the highest absolute burden and rate of preventable death found in First Nations mothers. . . .
The key message is the following: The child welfare system is not separate. It deepens and reinforces the health care gap.
I will speak about the Indigenous midwifery gap. Indigenous midwifery was once central to community health and matriarchal systems. Indigenous midwifery was made illegal in the 1950s, replaced by an extractive and medical intervention model. I was the first child in my family of 13 to be sent to the hospital.
The current barriers include a lack of regulatory pathways for Indigenous midwives and minimal to no investment in Indigenous pathways for community-led birth work and midwifery education and employment.
Here are existing solutions: the Strengthening Families Maternal Child Health Program and the creation of a First Nations framework for developing Indigenous birth helpers, or doulas, and laddering education into community-based midwifery education.
An example of success of this pathway exists in northern Manitoba with the Opaskwayak Cree Nation, where four Maternal Child Health, or MCH, staff are working as birth helpers and completing midwifery apprenticeship education through the National Council of Indigenous Midwives.
The key message is the following: The knowledge and models exist. The gap is in investment and political will.
I will speak about the birth evacuation gap. Many First Nations women must leave their communities weeks before birth. The impacts are psychological and social: separation from family, language and support, as well as isolation during childbirth. Childbirth is one of the most celebrated ceremonies in First Nations, and the mother is unable to celebrate with family because she is alone in the city or town.
I will speak about the financial impacts. According to the Non-Insured Health Benefits Program data, which is not comprehensive, it does not include travel covered via contribution agreements or other transfer arrangements; travel covered by other programs and initiatives, such as the Indian Residential Schools Resolution Health Support Program, Jordan’s Principle, the Inuit Child First Initiative or provincial or territorial programs; or travel covered by private insurance or paid out of pocket.
At least 8,715 distinct Indigenous and First Nations clients were evacuated for childbirth between 2018-19 to 2024-25. These are First Nations and Inuit clients. It didn’t include the Métis. It is not disaggregated.
For maternal health-related appointments, which include prenatal care, postnatal care and ultrasounds, this is consistently over 5,000 per year. The total for 2024-25 is 5,719, and there are 10,312 escorts.
The key message is the following: This system is harmful, costly and culturally disruptive, yet continues due to a lack of investment in community care.
I will speak about the research gap. Women’s health research is underfunded overall. It highlights a deeper issue: First Nations, Inuit and Métis women are further excluded from data, there’s a lack of distinctions-based approaches and there’s limited First Nations-led, Métis-led and Inuit-led research.
The key message is the following: Without accurate data, inequities remain invisible and unaddressed.
I will speak about the legal and rights-based obligations. We have the Truth and Reconciliation Commission of Canada Calls to Action 18, 19 and 23; the United Nations Declaration on the Rights of Indigenous Peoples regarding health rights and self-determination; and sections 7 and 15 of the Canadian Charter of Rights and Freedoms. These are not recommendations. They are commitments and legal obligations.
The key message is the following: Addressing these gaps is not optional; it is required.
Here is the economic gap: the high cost of evacuation, lost wages and productivity for women who are medically evacuated and long-term health system strain. Preventative community-based care is more effective and less costly.
Senator McCallum, your time has expired. Are you asking for more time to finish your speech?
Yes, please.
Is leave granted, honourable senators?
Thank you to everyone. I know it is a late night.
The key message is the following: Investing upstream is both fiscally responsible and socially just.
What Bill S-243 must do is clearly state required actions: recognize federal responsibility to First Nations women’s health; centre First Nations, Inuit and Métis women; support Indigenous-led care models; and invest in midwifery, prenatal and early childhood support. Research needs to be Indigenous-led, distinctions-based and OCAP compliant. It must address jurisdictional and funding gaps.
In closing, it’s about accountability. This is not about charity or inclusion as an afterthought. There must be calls for accountability to treaties, the Constitution, the Charter, the United Nations Declaration on the Rights of Indigenous Peoples, the Truth and Reconciliation Commission and Jordan’s Principle.
The final message is the following. If First Nations women are not healthy, Canada’s women are not healthy. We cannot leave women in the gap. We must build that bridge.
Thank you.
Honourable senators, I rise today to speak at second reading of Bill S-243, An Act to establish a national framework for women’s health in Canada.
I want to begin by thanking our colleague, the Honourable Danièle Henkel, for her leadership in introducing this important bill. Senator Henkel, your dedication to women’s health is both inspiring and necessary. You have used your platform to shine a light on a systemic oversight that has persisted for far too long, and for that, you have my sincere respect.
As the official critic of this bill, I have spent considerable time reflecting on its provisions. My perspective is shaped by my identity as a woman of Korean descent and as a daughter of immigrants. I watched my parents navigate a health care system that was often a “black box” — one where language barriers and cultural differences were compounded by a medical model that didn’t always see them. And it’s shaped by my identity as a mother of a daughter who is currently the exact age as I was when I gave birth to her and for whom I wish greater precision of health care and services as a woman who may experience childbirth, postpartum depression, menopause or other female-specific health issues in life.
When we talk about women’s health, we are not talking about a niche interest or a special interest group. Women make up the majority of the population in Canada. We are 50.4% of the people in this country. We are the majority of the workforce in health care, education and the service sector. We make a majority of the health care decisions for our families. And yet, for decades, the system has treated the female body as a “variation” of the male body rather than a distinct biological reality.
The preamble of Bill S-243 rightly identifies that historical inequities in research have left women behind. For nearly half a century, the gold standard in clinical research was the “Reference Man,” a 1975 benchmark established by the International Commission on Radiological Protection. This “standard human” was defined as a 70-kilogram, 170-centimetre-tall Caucasian male in his twenties.
This was not a harmless academic shortcut. It became the blueprint for drug dosages, car safety testing, radiation exposure limits and diagnostic criteria for everything from heart attacks to kidney disease. And because women, particularly women of colour, did not fit this 70-kilogram Caucasian male mould, they were often excluded from clinical trials.
The result? Women are 50% more likely to be misdiagnosed following a heart attack and significantly more likely to experience adverse drug reactions because those drugs were tested on men and then scaled down by weight for women, ignoring the fundamental differences in metabolism, enzyme activity and cellular response.
We see this most clearly in the realm of autoimmune disorders. Women account for nearly 80% of all autoimmune cases, across more than 100 conditions. For example, Sjögren’s syndrome has a female-to-male ratio of 9 to 1. I learned that Sjögren’s syndrome is a chronic autoimmune disorder characterized by immune system attacks on moisture-producing glands, leading to characteristic dry eyes and mouth. It primarily affects women, usually in their forties and fifties, causing widespread dryness, severe fatigue, joint pain and potential damage to organs like the lungs or kidneys.
Yet, because these conditions primarily affect women, they are often underfunded and under-researched, leaving women to wait an average of five years and to have to visit four different doctors before receiving a correct diagnosis.
Then there is the issue of reproductive transitions. I think of the Complex Menopause Clinic at BC Women’s Hospital, which I recently learned about when I met a group of brilliant health advocates from B.C. at Senator Henkel’s informative event on the Hill, hosted in collaboration with the Women’s Health Coalition of Canada. It is currently the only clinic of its kind in a province of 5 million people. As someone who navigated a decade-long journey through menopause, I can tell you this: This is not just a medical issue. It is a productivity issue, and one that affects all women.
When a woman in the prime of her career, perhaps a CEO, a senior partner or a skilled tradeswoman, leaves the workforce because her symptoms are dismissed as “stress,” the entire Canadian economy suffers. This “silent tax” on women is a drain on our national prosperity. This is why the conversation Senator Henkel has started is so vital.
Honourable senators, as the critic, my goal is to ensure that Bill S-243 is examined with the highest level of diligence. I believe in the power of a national framework. Indeed, I am a proponent of such frameworks because they provide the North Star for federal-provincial cooperation.
For this framework and others to be truly effective, there needs to be a rigorous study to ensure the implementation of this bill avoids the pitfalls of bureaucracy and jurisdictional friction.
I wish to highlight three specific areas where I believe the committee’s study must provide clarity to this chamber.
The first one is optimizing clinical outcomes over administrative process. Clause 2(3) of the bill mandates a national conference within one year, followed by recurring conferences every three years. While dialogue is essential, the committee must hear from health administrators on how to ensure these conferences result in tangible data sharing rather than just administrative overhead.
In a time of record-high national debt, every dollar must be a working dollar. I want the committee to explore how these conferences can be streamlined — perhaps by integrating them into existing federal-provincial-territorial, or FPT, tables — to ensure that the primary focus remains on front-line research and diagnostic tools. We must ensure the framework’s legacy is measured in lives saved, not in reports filed. Referring to what Senator McCallum has said, we need to make sure that women of Indigenous, Inuit and Métis communities are at that table.
The second area is making federal leadership a catalyst for provincial excellence. Clause 2 calls for federal leadership. In our federation, health care delivery is a provincial and territorial responsibility. The most effective federal leadership is not that which dictates, but that which catalyzes.
We have incredible pockets of excellence in Canada. Ontario has specialized women’s health hubs. British Columbia has world-leading Indigenous wellness programs and, as I previously stated, a one-of-kind Complex Menopause Clinic. A national framework should act as a knowledge-sharing bridge.
I hope the committee will invite provincial representatives to testify on how this federal coordination can best support their unique jurisdictions. By understanding the FPT dynamics now, we ensure the framework is welcomed by the provinces as a tool for innovation, rather than viewed as a jurisdictional encroachment. This clarity is essential for any national health strategy to succeed.
Lastly, the third area is ensuring biological and clinical precision. I want to address the importance of clinical focus. Clause 2 includes references to women-led innovation and entrepreneurship. While these are noble economic goals, the committee must hear from medical experts on how to ensure these social and economic objectives do not distract from the biological heart of the bill. For this framework to be truly transformative, it must remain laser-focused on sex-based biological differences and the documented variations across racial and ethnic groups.
We need to hear from clinicians about why certain populations, such as South Asian or Black women, experience different disease progressions. By ensuring the framework stays grounded in clinical evidence, we ensure it remains a reliable medical tool for generations to come.
Honourable senators, I raise these points as a supportive critic, with the belief that when the federal government provides a coordinated vision, we can solve the most pressing health crises facing our majority population.
For any framework to truly work, it must be disciplined, clinically focused and constitutionally respectful.
Our daughters and granddaughters and future generations of women deserve to grow up in a Canada where their symptoms are not dismissed as anxiety, where their medical dosages are calculated for their bodies and where their cultural background is factored into their care.
Thank you, Senator Henkel, for elevating women’s health to the national stage, where it deserves to be. Thank you.
Are senators ready for the question?
Is it your pleasure, honourable senators, to adopt the motion?
Hon. Senators: Agreed.
(Motion agreed to and bill read second time.)
