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tatistics Canada defines a rural area as having fewer than 1,000 residents and fewer than 400 people per square kilometer. According to the 2001 census, almost 20% of Canadian women live in rural, remote and northern areas. While all Canadian women share some health challenges, the health of these women is also influenced in unique ways by their rural living.

Women have described many benefits from living in rural, remote or northern environments, such as having more open space, better air quality and experiencing a greater sense of community. But rural, remote and northern living also presents distinct challenges to women's health. These challenges include:

Poverty

Unstable income has been identified as "the single greatest factor in determining health for rural women", according to the Summary report: rural, remote and northern women's health: policy and research directions¹. Many women in rural, remote and northern areas are unemployed and dependent on their spouses for money. When jobs are available, they're often low-paying and seasonal or part-time. Public transportation (where it exists), housing, childcare and healthy foods frequently aren't affordable for rural, remote and northern women living in poverty, and their health and that of their families is often jeopardized as a result.

			Women have the power to affect change
			October 15th was declared World Rural Women's Day at the 1995 UN Conference for Women in Beijing. This international event celebrates the contributions made by rural women, and raises their profile with governments and the public. Past events archived on the website provide readers with ideas on how to mark this important day. The Rural, Remote and Northern Women's Health Community Kit and Good Policy, Good Health: An Information and Action Kit for Women in Coastal Communities are practical tools to help rural, remote and northern women work with policy makers to develop the policies and programming that will influence their health.

Limited health care and support services

Only about 18% of registered nurses², 17% of family physicians and 4% of specialists³ practice in rural areas, which is fewer than needed given the number of people living there. Many communities don't have any health or social services, and women often have to travel long distances for health care. The added costs and stress of traveling, leaving their families, paying for child care and missing work may prevent women from accessing health care services.

With so few health services in rural, remote and northern areas, there is little choice for women who aren't comfortable with their health care providers. If a woman experiences homophobia within the health care system, or has a healthcare provider who doesn't understand women's health issues or the importance of her culture and language to her health, there likely won't be anyone else she can see. For some women, this may mean enduring extra stress and receiving inappropriate or ineffective care when visiting a health care provider. Others will decide not to access health services under these circumstances.

Health care restructuring and limited health care services in rural areas may also mean that some women who care for ill or aging family members can't get adequate relief from trained professionals. For example, in rural Nova Scotia, 15% of caregivers said they were "on-duty" 24 hours a day, and 63% said they got only "occasional relief" from their work at home. Without enough time off, the health of these caregivers is at risk.

			Rural, remote and northern women - they're not all the same
			Nearly three million women have rural living in common. Yet it's important to recognize that this is a diverse group. Rural, remote and northern women come from many different cultures - such as Inuit and Mennonite - and live in many different types of communities - such as on farms, on reserves, in fishing villages and in mining towns. Each of these groups will have their own unique experiences that further impact their health.

Geographic isolation

Women tend to experience better health when they can talk with other women about their health concerns. Being far from neighbours makes it difficult for rural, remote and northern women to establish and maintain social support networks¹.

Online support groups are a great way for women to communicate, but Internet connections still aren't available in many rural, remote and northern communities, or are too expensive to have at home, although libraries or community centres may provide free access to the Internet.

Women living in remote or relatively isolated areas are also at increased risk in emergency situations because of delays in police, fire or ambulance response times.

Lack of confidentiality and anonymity

Living in rural, remote and northern areas often means that "everyone knows your business". Women who want to maintain their confidentiality may not seek health services or feel forced to travel out-of-town for healthcare for fear that their neighbours will learn about their health concerns.

Stress from multiple roles

Women in rural, remote and northern areas often work long hours and juggle many roles, such as providing care for their children and aging family members, working outside the home or on the family farm, and volunteering in the community. Having so many responsibilities can cause stress levels harmful to a woman's health, as documented in a recent report about the impacts of multiple roles on women in farm economies⁴.

Despite these challenges to their health, many women feel living in rural, remote and northern areas has a positive influence on their lives. Better air quality, more access to nature and wildlife, and stronger community ties are some of the benefits they've identified¹.

And more and more, rural, remote and northern women are finding innovative and unique ways to take charge of their health. By working together on initiatives such as World Rural Women's Day, they are organizing themselves to have a say in how health programs and policies are developed.

¹ Summary report: rural, remote and northern women's health: policy and research directions. Prairie Women's Health Centre of Excellence. 2004.
² Supply and Distribution of Registered Nurses in Rural and Small Town Canada, 2000. Canadian Institute of Health Information. 2002.
³ Primary Care Renewal Policy: Recommended Rural Strategies. Society of Rural Physicians in Canada. April 2003.
⁴ Women's Diverse Roles in the Farm Economy and the Consequences for their Health, Well-being, and Quality of Life. Kubik, W., Moore, R.J. 2001.