Hon. Danièle Henkel: Honourable senators, I thank those of you who are still here this evening.

I want to talk to you about women — our mothers, our sisters and our daughters, those who raise children, those who care for loved ones, those who work, those who are entrepreneurs, those who create and innovate, all the women in this country. More specifically, I want to talk to you about their health.

Women’s health in Canada is not a marginal, sector-specific or identity issue, nor is it a debate reserved for a few specialists. No, it’s about half of the population. It’s about the strength of our families, participation in the labour market, productivity, and, ultimately, the prosperity of our country.

As you know, I am not approaching this subject in the abstract. For nearly 30 years, I have worked in a sector that directly affects women’s lives. I have listened to their stories, their pain, their concerns, their incomprehension in the face of a system that too often does not hear them or believe them.

I myself have gone through the ordeal of cancer, as has my youngest daughter. Like so many other women in Canada, I have seen first-hand how symptoms are trivialized, diagnoses are slow to come and prevention is inadequate.

[English]

This bill is a natural extension of my journey as a woman, an entrepreneur, a mother and an immigrant who holds the unwavering belief that women’s health is not a cost but a driver of equity, dignity and prosperity for the entire country.

Before I go any further, I wish to make it clear: This bill is not my bill. It does not belong to me. It was born out of conversations and lived experiences. It is the result of collective, patient and often invisible work carried out over the years by clinicians, researchers, community organizations, committed companies and, most importantly, women who had the courage to share the stories of their pain and suffering. I am simply carrying forward the torch that others have carried for far too long without being heard.

The reality has been clear for years, and so have the needs, yet nothing has changed. This disconnect between what we know and what we are doing should concern us all.

I am firmly of the belief that the Senate is precisely the place where these blind spots must be confronted directly, away from electoral cycles and partisan reflexes.

[Translation]

The fundamental problem we face is that no one is ultimately responsible for women’s health in Canada. The current system is a patchwork of fragmented jurisdictions. The provinces deliver health care, professional associations regulate practitioners and specialty societies set clinical standards. At the same time, universities train doctors and control research. Health Canada approves drugs, while the Canadian Institutes of Health Research fund studies.

I ask you this: Who is responsible for ensuring that the system works overall for female patients? The answer is simple: no one. Everyone operates in silos. What is needed, therefore, is a strong political will to coordinate the entire system, and that is precisely the aim of the national framework I am proposing.

Before introducing this bill, I took the time to listen. I would particularly like to thank the Women’s Health Coalition, an organization that has been working tirelessly for over 15 years to make women’s health a priority across Canada. My office and I have been working closely with this organization for several months. The coalition brings together academics, clinicians, data experts, committed businesses, and community organizations from coast to coast to coast, united by a single goal: to make real progress in women’s health. I have also spoken with more than 30 fellow senators, about 20 members of Parliament, and ministers from across the political spectrum.

I would like to thank everyone who took the time to guide me through this bill, especially my team and the Library of Parliament, as well as all the translators. All of this helped me reflect on the issue, improve the text of the bill, and confirm what is obvious: inaction is no longer an option.

[English]

It is important to make it clear at this stage that this bill does not create any new care program. It does not impose anything on the provinces and territories. It does not further medicalize women’s lives. It does not target a particular disease. Its proposition stems from a different vision.

It assigns the Minister of Health a specific duty to develop a national framework for women’s health in collaboration with the Minister of Women and Gender Equality, other relevant ministers, the provinces and territories, Indigenous Peoples and, let us not forget, civil society organizations that work every day to advance this important cause.

This approach is based on a clear choice — that of collaboration. Lasting improvements in women’s health require structured, ongoing and shared coordination among all actors involved. That is precisely why this bill establishes concrete mechanisms for dialogue and follow-up.

In particular, this bill requires the Minister of Health to convene at least one national conference, bringing together all relevant stakeholders to develop the framework. Subsequent conferences are to be held every three years to gather input, adjust priorities and assess the effectiveness of the measures implemented over time.

[Translation]

This coordination is only valid if it is accompanied by genuine accountability. Indeed, Parliament is not a mere observer: it is a key player.

Unlike an administrative strategy initiated and monitored exclusively by a department, this national framework is subject to explicit parliamentary oversight. Thus, in the year following the act’s coming into force, the minister will have to submit a report to Parliament setting out the priorities and implementation strategy for the national framework. Five years later, there will be a second report on the effectiveness of the framework, progress in research and innovation, and collaboration with the provinces and territories. The bill also provides for women’s health to become a standing item on the agenda at meetings of the country’s health ministers.

All of these obligations finally establish a clear and transparent cycle of monitoring, evaluation and parliamentary accountability with respect to women’s health. This is not a one-off, performative or symbolic approach. In concrete terms, this bill is based on four complementary pillars: understanding, preventing, training and coordinating. I will organize the rest of my remarks around these pillars.

Let’s be clear: Canada is basically groping its way in the darkness today when it comes to women’s health. According to the Hologic Global Women’s Health Index, Canada ranks sixty-fourth in the world, far behind many comparable countries. The United States is thirty-eighth, the United Kingdom is forty-first, and Germany is sixth. Heading the list are Taiwan, Kuwait and Austria. Our ranking should concern us all. It reveals an alarming disconnect between the image we hold of our supposedly universal, accessible and equitable health care system and the lived experience of many women in this country.

This same observation was confirmed last November by the Standing Committee on Health in the other place. In its report entitled Women’s Health in Canada: Closing the Gender Gap, the committee explicitly acknowledged that it hadn’t studied women’s health in 28 years. Twenty-eight years. This number alone reveals an institutional vacuum that can no longer be ignored.

The last federal framework for women’s health dates back to 1999. Not only was it highly focused on reproductive health, it had no measurable targets, no tracking mechanisms and no requirement to report to Parliament. This framework didn’t fail because of a lack of ideas; it failed because of a lack of structure.

[English]

To this day, data on women’s health are scattered across provinces, territories, research organizations, health care institutions and government departments. They are not harmonized, they are not always comparable, and they do not provide a reliable national picture.

Without reliable data, it becomes impossible to clearly identify inequalities, measure their extent, track developments and, most importantly, address the system’s shortcomings. This fragmentation is also reflected in access to care.

First, existing initiatives are too often focused on a specific moment in life — adolescence, pregnancy or menopause — without providing a true continuum of care.

In rural, northern and remote communities, access to services is limited by the scarcity of professionals, the large distances involved and long wait times. These constraints lead to the late identification of diseases and incomplete care.

Finally, as we all know, access issues disproportionately affect Indigenous, racialized and immigrant women, along with women with disabilities, those who face linguistic, cultural and physical barriers and, sometimes, systemic discrimination. These inequalities do not simply add up: they are compounded.

[Translation]

However, all these inequalities in access reveal a broader problem, specifically, chronic underfunding of women’s health research.

In 2020, less than 5% of global research and development funding was devoted to women’s health. In Canada, this share was still only 7% of federal funding in 2025.

This is neither marginal, nor accidental, nor recent.

Between 2009 and 2020, barely 6% of Canadian Institutes of Health Research funding was allocated to projects related to women’s health, most often focused on cancer.

According to data from the Centre for the Advancement of Research and Surgery of the McGill University Health Centre, endometriosis research is still woefully underfunded compared to other chronic conditions.

In 2022, it was estimated that approximately $4 per patient was invested annually in endometriosis research, compared to $31 per patient for diabetes and $130 for Crohn’s disease.

These figures point to a major gap, specifically the absence of a national framework that could set clear shared priorities for women’s health.

Underfunding is only part of the problem. Women are also under-represented in research itself.

One example is particularly telling: Three quarters of MS patients are women.

Yet only a few hundred studies — approximately 350 out of more than 100,000 — address issues specifically related to women’s health.

This knowledge gap is all the more alarming given that chronic diseases affect women more than men.

According to the Public Health Agency of Canada, among people aged 65 and older, osteoporosis is 196% more common in women, osteoarthritis is 38% more common, and dementia is 25% more common.

Under-representation in research does not only affect women in general. It also affects certain groups of women in particular, especially those who work in highly male-dominated professions.

In sectors such as the Canadian Armed Forces, policing, firefighting and even sports, data on women’s health is still very inadequate.

As the honorary captain of the Canadian Coast Guard and lieutenant-colonel of a reserve regiment, I am particularly sensitive to this issue. The available data suggests increased issues with personality disorders, sexually transmitted diseases, incontinence, urinary tract infections and infertility.

This knowledge gap results in bias.

It results in less appropriate treatments and poorer health outcomes for women.

[English]

The same pattern can be seen in the field of cancer care, where the severity of gynaecological cancers stands in stark contrast to the limited resources dedicated to them. For example, ovarian cancer research receives five times less funding than research on breast cancer and half the funding allocated to prostate cancer research. Unsurprisingly, this lack of resources comes at a high price. The five-year survival rate of ovarian cancer is 44% — barely half that of breast cancer, which stands at 89%.

But research, essential as it is, is not enough. The knowledge produced must be translated into effective prevention, early detection and clinical practices that truly reflect women’s experiences.

To understand is to recognize these facts. It means looking at the data as it is without complacency. But understanding is not enough either. We must act much earlier. That is precisely the purpose of the second pillar of this bill: screening and prevention.

[Translation]

Prevention and screening are among the most important and powerful tools for improving women’s health in the long term. Yet they are the ones we use least effectively.

What is lacking is the structured and coordinated implementation of prevention and screening policies.

Cervical cancer is a particularly telling example.

It’s one of the few cancers that can be detected before symptoms appear, and it’s largely preventable thanks to vaccination against human papillomavirus.

Every province and territory offers school-based screening and vaccination programs. Every one of them.

On paper, all the tools are in place, but they’re not getting results. Vaccination rates vary from 68% in Ontario to 93% in Newfoundland and Labrador depending on the jurisdiction, which jeopardizes the goal of eliminating cervical cancer by 2040.

The vaccine is available and effective, preventing approximately 95% of cervical cancers.

So why has there been an increase in cases of uterine cancer after decades of decline, given that it mainly affects women under the age of 50?

It is clear that this increase can be explained in particular by a decline in participation in screening and vaccination programs.

In terms of screening in general, the numbers are worrisome.

In Canada, only 15% of women have been screened for cancer in the past year. Less than one in four women have been tested for diabetes. Furthermore, more than one-third report having forgone care for economic reasons. Breast cancer screening clearly illustrates this disarray.

I do want to point out that Quebec has chosen to take initiative. Health services send a letter of invitation, which serves as a prescription, directly to eligible women. This best practice does away with both administrative and psychological barriers at once. Patients do not have to take the initiative themselves.

However, in other provinces and territories, the responsibility still rests entirely with the patient, who is expected to gather information and take the necessary steps, without even knowing she is at risk, in some cases. Wouldn’t it be more appropriate to move from a system that waits until women fall ill to one that reaches out to them systematically and proactively?

Again, this is not a technology issue; it’s an issue of organization, coordination and political will. Prevention is not enough if a woman’s doctor doesn’t listen to her. This is where our third pillar comes in: better training and a new attitude of finally taking women’s pain seriously.

Understanding is essential. Prevention is indispensable. But a crucial link in the chain from knowledge production to practical application is training and clinical practice. That is exactly where strong biases continue to influence the way women are diagnosed and treated. These biases are neither anecdotal nor accidental. They are rooted in the very history of our health care system, which has long been implicitly designed with the male body as the baseline.

Clearly, women’s health was not conceived as its own integral thing. It was added on in bits and pieces over time.

[English]

To put it simply, treatment for women is not the same as treatment for men, and it shouldn’t be. Yet, all too often, tools, protocols and clinical reflexes are still based on male models.

This reality begins as early as medical training. In Canadian medical schools, less than 10% of programs include content specific to women’s health. The consequences of this lack of specific training are well documented.

Take cardiovascular disease, for example. In women, symptoms are often less clear-cut, less typical and less spectacular. As a result, they are recognized much later.

During a heart attack, only 29% of women receive an ECG within the recommended time frame, compared to 38% of men. Just 32% of women receive timely reperfusion therapy, compared to 59% of men. Moreover, early signs of heart attack are missed in 78% of women, delaying recognition and treatment.

Canadian data shows that the in-hospital mortality rate following a heart attack is higher overall among women, at 6.50%, compared to men, at 4.34%.

This phenomenon goes far beyond cardiovascular health. Today, nearly 70% of patients with so-called medically unexplained symptoms are women. For more than 1,000 common conditions, women are diagnosed, on average, three years later than men.

The result is years of unrecognized pain and years of doubting one’s own body. And this bias becomes even more pronounced when it comes to diseases specific to the female body.

Endometriosis is the most emblematic example. Listen to this: It takes an average of 7 to 10 years to get a diagnosis. According to EndoAct Canada, even after diagnosis, women wait between 6 and 18 months to see a specialist, and then another 6 to 24 months before surgery.

This issue affects a significant part of the population: at least 1 in 10 women of child-bearing age.

[Translation]

Certain populations are even more at risk: women living in rural or remote areas, Indigenous women, women from minority groups and women living on low incomes.

The consequences of this lack of knowledge about the female body can also be seen in medication errors. As a result, women experience more adverse drug reactions and higher rates of hospitalization related to those reactions.

A study published in 2025 in the Journal of the European Society of Cardiology shows that beta blockers, which are widely used in the treatment of heart failure, are less effective in women and may even be associated with increased mortality.

Here is another example. The dosage of Zolpidem, a hypnotic, was not adjusted for women until 2013, 21 years after it was first marketed. It is clear that all this is the result of a system that has long thought of health in masculine terms. Furthermore, women’s health is still too often reduced to breasts and reproductive organs. This renders many pathologies invisible, such as lipedema, which affects almost exclusively women.

I have personally experienced this disconnect between female physiology and certain medical treatments. A few years ago, my eldest daughter developed worrying heart problems. She underwent a series of tests and was diagnosed very quickly. The recommended treatment was heavy medication and possible surgery. Our whole family went through a period of great anxiety.

It was while searching for answers in Canada, France, and the United States that we discovered that the problem was not primarily cardiac, but hormonal. A simple hormonal rebalancing made it possible to avoid heart surgery. This story is far from unique. It clearly reveals a systemic problem: The female body is too often still studied in silos, with the heart on one side and hormones on the other.

[English]

These biases do not stop at diagnosis or treatment. They extend into the very organization of care. A particularly revealing example concerns the way medical procedures are compensated.

A 2023 study published in the Canadian Journal of Surgery shows that surgeons in eight provinces and territories who primarily treat female patients are paid, on average, 28% less than those performing procedures of comparable complexity on men.

For example, a hysterectomy is valued less than a prostatectomy, despite equivalent technical complexity. As a result, when procedures are undervalued, specialties become less attractive, volumes decrease, wait times lengthen and the quality of care suffers.

[Translation]

We also need to remember that these imbalances aren’t limited to physical health. Women are more prone to anxiety and depression and much more exposed to physical, psychological and sexual abuse, all of which increase the risk of mental health disorders. These aren’t individual susceptibilities; they’re structural mechanisms.

There’s a more unobtrusive but equally determinative phenomenon at work as well: Women’s pain is dismissed and portrayed as an inevitable corollary of being a woman. In addition, some cultural and social factors often escape notice. A person’s relationship to their body, pain and words varies greatly depending on the context. In some cultures, pain is suppressed for reasons of modesty. When words don’t flow, our system can’t respond. Symptoms are minimized, diagnoses are delayed and inequities get worse.

All of these mechanisms have one thing in common: They aren’t caused by a lack of goodwill — far from it — but by a lack of training and understanding. When pain is dismissed, when cultural codes are misunderstood, the medical system misses warning signs. This is precisely why professional training is a driving force for prevention.

Honourable colleagues, we all pay the price for the way things are. Canadian women spend 24% more time in poor health and with varying degrees of disability than men. That means training practitioners is essential. That includes medical training as well as cultural and relational training. That’s one of the fundamental pillars of this bill.

These facts raise one unavoidable question: How can we continue to ignore the deep dissatisfaction that women experiencing the system on a daily basis have been telling us about for so long?

Two separate surveys, one by the Izaac Walton Killam Foundation, better known as the IWK Foundation, and the other by the Maple telemedicine platform, found a similar result: More than three quarters of the women who responded said that the existing system doesn’t meet their needs at all.

Honourable colleagues, when the majority of women make it clear that the system doesn’t work for them, that’s no longer individual discomfort. It’s a wake-up call for public decision-makers. That is exactly where the federal government comes in. It can’t replace the provinces, but it can do what no other level of government can do alone. It can provide consistency, harmonize data, connect research, prevention and care, and ensure an equitable pan-Canadian vision. That’s exactly what this bill is for.

[English]

And as a businesswoman, I also want to emphasize the economic cost of a system that does not give women’s health the respect it is due. The World Economic Forum has shown that closing the gap could generate, worldwide, up to US$1 trillion per year by 2040.

Today, Canada faces a troubling paradox. Despite having a universal health care system and being a member of the G7, our country ranks among those where the economic cost of poor women’s health is highest relative to the projected GDP by 2040. In other words, we have the tools, but we are paying the price for inaction.

For instance, the untreated effects of menopause alone are estimated to cost about $3.5 billion per year, according to the Menopause Foundation of Canada. This includes $237 million in lost productivity alone and nearly 540,000 workdays lost each year.

Regarding endometriosis and according to the organization EndoAct Canada, the costs of poor management are estimated at $2.5 billion per year in economic losses.

Based on numbers from the World Economic Forum, addressing gaps and shortcomings in women’s health could reduce the time women spend in poor health by nearly two thirds. Worldwide, this could add an average of seven healthy days of life per woman each year. That amounts to a total of more than 500 days over the lifetime of a woman.

According to, again, the World Economic Forum, this could also boost Canada’s economy by $37 billion per year by 2040. Beyond the economic cost, there is a human cost that is endured by women across the country and far too often ignored. This is intolerable.

[Translation]

Colleagues, we can’t look at investing in women’s health as more public spending; we need to look at it as a means of strengthening our families, our social fabric and our economy. Canada sees itself as — and claims to be — a leader in equity, equality and diversity. Here is an opportunity to translate that ambition into meaningful decisions. We must never forget that behind all these numbers are life stories and real women.

Since this bill was introduced, many women have written to us describing difficult treatments, unbearable pain and a deep sense of abandonment. Some recount procedures that are considered routine yet had consequences that have turned their lives upside down: chronic pain, loss of mobility, loss of intimacy, inability to work.

Colleagues, Bill S-243 does not claim to solve everything. It proposes the conditions required to do better: better as in fairer and more thorough. I therefore invite you to support it, not as a partisan reflex or ideological gesture, but because the status quo is absolutely untenable.

Before concluding, I would like to thank all those who advance women’s health every day, often behind the scenes, often without recognition. This bill owes them a great deal. I want to take a moment to thank the women who shared their stories, who put into words pain that had long been ignored. It takes courage to say that something is not working, especially when we have too often been taught to remain silent.

It is high time to finally send a clear message to all these women. I therefore ask you to support this bill and send it to committee as soon as possible. This is urgent. By doing so, we are simply but firmly saying to all these women: we see you, we hear you, and we are acting for you and with you.

Thank you. Meegwetch.

Hon. Senators: Hear, hear.