Law and Public Policy

D02(b) - Contesting Social Policy

Date: Jun 3 | Time: 10:15am to 11:45am | Location:

Chair/Président/Présidente : Anne Lachance (Université de Moncton)

Discussant/Commentateur/Commentatrice : Tobin LeBlanc Haley (University of New Brunswick)

Reconsidering the Role of Identity-Defined Community Organizations in HIV Prevention: Liam O'Brien (Carleton University)
Abstract: The community-organization oriented response dominates the HIV-related health landscape in Canada, as it builds from the origins of the HIV epidemic as an individualized, demonized, and othered health epidemic. Though community organizations continue to provide significant cultural competency in the alleviation of stigma regarding access to HIV prevention resources, the concentration of health services as direct-to-community, housed within community organizations, heightens associational stigma, obscures funding directed at HIV prevention, and restricts access for those outside of the identity-defined community organization. My research challenges the existing HIV-related prevention landscape by analyzing a literature surrounding the HIV epidemic, followed by a case study of Vancouver, British Columbia’s HIV prevention network. I argue that identity must be separated from the provision of health resources, and that community building initiatives (often targeted at identity characteristics) must be distinct from health services. I propose a network of increased collaboration and knowledge transparency that recognizes and prioritizes community building and culturally competent health services, but organizationally distances them. In positioning this argument, I also build on the tenets of intersectionality to position one’s individual lived experiences and structural determinants of health as deterministic of their HIV risk, rather than associating risk directly to identity. Overall, my argument develops from the exclusionary response to the HIV epidemic and opposes the conflation of HIV risk and identity, instead promoting the role of comprehensive knowledge exchange and community collaboration to build networks of culturally competent and accessible support systems which ultimately empower one’s bodily autonomy regarding their HIV risk.

“They asked if I was sad about the baby”: Surrogates’ Experiences of Birth in Canada: Eleanor McGrath (University of Waterloo), Alana Cattapan (University of Waterloo)
Abstract: The regulation of assisted reproductive technologies in Canada is largely understood as occurring through the federal Assisted Human Reproduction Act (2004), its criminal provisions and regulatory scheme. Yet, the experiences of those who engage in the processes and practices of assisted reproduction, including those who act as surrogates, are shaped by a wider range of public policy and law including the policies of any given fertility clinics, medical practitioner, or hospital with which they engage. This paper draws on the results of a national survey with 174 surrogates in Canada. Focusing on birth experiences, the paper provides first-of-its kind data exploring the nature of surrogates’ experiences in hospitals or birthing centres, including some of the challenges they faced. While survey participants largely identified that they had neutral or positive birth experiences, the data reveals some practices—including institutional policies—that had important implications for their overall experience of birth, including what could be changed to better support them. Ultimately, the paper argues that law and policy reform related to assisted human reproduction in Canada—if interested in understanding surrogates as patients deserving of high-quality care—needs to move beyond the Assisted Human Reproduction to pay attention to the day-to-day policies and practices the lives, and wellbeing of surrogates.

Comparing Service Providers and Youth Advice on Coordinated Service Delivery in Ontario’s Child Welfare System : Abigail Jaimes Zelaya (McMaster University), Maria Gintova (McMaster University)
Abstract: This study examines the challenges and opportunities of coordinated service delivery in Ontario, comparing the perceptions of youth and service providers regarding service coordination challenges. Using a user-centered design approach, we conducted focus groups with 57 participants (49 Black youth with lived experience in the child welfare system and eight service providers serving Black communities) exploring existing service delivery issues and developing potential policy solutions. The findings underscore key issues such as: service fragmentation, delayed referrals, and mistrust within the child welfare system. Efforts to address such issues are further impeded by systemic racism and a lack of culturally appropriate services. According to Black youth, the most prevalent issue was perceived racial bias, with the preferred solution being diverse staff recruitment in the system and for other service providers (e.g. mental health, health, education). In contrast, service providers highlighted the most prevalent issue to be cultural and linguistic barriers in the system, with the preferred solution being increased outreach from community partners and other ethno-specific organizations to improve culturally appropriate services. We conclude that identifying issues of similarity and differences as well as potential policy solutions can provide a holistic and comprehensive analysis that can inform policy makers of strategies that will benefit both Black youth and service providers. This will imply a more effective and proactive approach to service delivery in Ontario’s child welfare system. This research addresses a gap in literature on service coordination challenges in the Canadian context (OCC Expert Panel 2018).

Medicalization and Deservingness: The Policy Feedback Effects of Reproductive Healthcare in Canada: Jenna Quelch (University of Toronto)
Abstract: Since the first baby conceived by in vitro fertilization in Canada was born in 1983, the use of assisted reproductive technologies has expanded at a rapid pace. In recent years, changes have also been seen in expansions of how provinces fund this type of care, resulting in a patchwork of access across Canada. This mirrors the variation in availability often seen in other areas of gendered and reproductive healthcare, including abortion access and gender-affirming care, such that gendered health services related to the reproductive body are subject to intense debate as to what is considered medically necessary. To examine this variation, this paper interrogates the feedback effects of provincial health policies and the degree to which social constructions of medical necessity shape coverage for contentious, gendered health services. Using an original survey administered across Canada, this paper examines conceptions of deservingness and medicalization for in vitro fertilization, abortion, gender-affirming and human papillomavirus vaccination programs. The survey design captures broad conceptions around the role of government in delivering benefits more broadly, whether specific health services are considered medically necessary, and includes vignettes to capture how the perceived deservingness of target beneficiaries impacts views on the public funding of specific health services. The results have implications for understanding the feedback effects of variable healthcare availability and speak more broadly to the literature on the role of social constructions of target beneficiaries in policy design. Further, the results contribute to the longstanding discussions on provincial inequities in healthcare against the backdrop of the Canada Health Act.