Chapter

1

Introduction to Women

’

s Health

“ The medical model is still male in many ways. Women have been ignored far too much. This has gone on too long. It ’ s traditionally been that human chemistry and physiology were male until proven otherwise. Women will make a revolution in health care.

”

—Kathryn C. Benjamin, MD Past President American Medical Women

’

s Association

Historical Dimensions: Women

’

s Health Movement

• 1830s and 1840s: The Popular Health Movement • 1861–1865: The Civil War • 1873 to 1890s: The Women ’ s Medical Movement – First training schools for nurses – Women attending medical schools

Historical Dimensions: Women

’

s Health Movement

1890s to 1920s: The Progressive Era Women gained the ability to vote (19th Amendment) Women did

not

gain equal rights (the Equal Rights Amendment has yet to be passed Birth control movement began: the first birth control clinic opened in New York City, but clinics remained rare and birth control (and even talking about it) was mostly illegal.

Historical Dimensions: Women

’

s Health Movement

• 1930s to 1950s: World War II, Postwar Years – Women entered the workforce during WWII, but often lost their jobs when the war ended – The Kinsey Report: Nearly 6,000 women interviewed about their sexual behaviors. Conclusion: women have sex!

Historical Dimensions: Women

’

s Health Movement

1960s –1970s: The Grassroots Movement – FDA approval of birth control pill – Civil Rights Act – Title VII – Congressional Caucus for Women ’ s Issues 1980s: Changing Public Policy – Office of Research on Women ’ s Health (ORWH) – The Women ’ s Health Equity Act Money for health research: contraception, infertility, breast and ovarian cancer Medicaid coverage of Pap smear screening and mammography

Historical Dimensions: Women

’

s Health Movement

1980s: Changing Public Policy – Office of Research on Women ’ s Health (ORWH) The Women ’ s Health Equity Act Money for health research: contraception, infertility, breast and ovarian cancer Medicaid coverage of Pap smear screening and mammography

Historical Dimensions: Women

’

s Health Movement

1990s: Women ’ s Health at the Forefront Government Health-Care Institutions

Women

’

s Health

Advocacy Organizations Academia

Historical Dimension: Women

’

s Health Movement

The New Millennium – Human genome – Women ’ s Health Initiative findings – Improved HIV/AIDS medications and care – Public health programs – Inclusion of children in clinical trials

Feminism

The idea that women should have the same political, economic, and social rights and opportunities as men.

First wave: Suffragists and abolitionists, late 19th, early 20th century - Second wave: 1960s and 1970s, specific, often political injustices and inequalities - Third wave: 1980s and 1990s, examining all areas of society from a feminist perspective

Feminism

4 th wave: ??

• What is does being a feminist mean today?

• Do you consider yourself a feminist?

• How can feminists today learn from previous generations?

• How is being a feminist more easy than it was 20 or 50 years ago? How is it more difficult?

Political Dimensions of Women

’

s Health

• Policy making • Financing • Protecting the health of the public • Collecting and disseminating information about health and health-care delivery systems • Capacity building for population health • Managing of health services

Development of Organizations and Government Agencies Related to Women ’s Health

Department of Health and Human Services Food and Drug Administration (food and drug safety) Office on Research on Women’s Health Centers for Disease Control (national statistics and trends National Institute of Health (federal health research)

Office of Research on Women

’

s Health (ORWH)

• Oversees women’s health research within the National Institutes of Health (NIH) • Research on women’s health is important!

– Women get different diseases from men – The same diseases affect men and women differently – Social and cultural factors affect the health of men and women in different ways • The ORWH works to make sure that women are enrolled in research, that research investigates diseases and conditions that affect women, and that women are represented as researchers.

Investment in Biomedical Research

• Increased life expectancy • Improved health throughout life span • Decreased cost of illness • Increased understanding of biological, psychological, and sociological factors • BUT…

Other methods of improving women

’

s health and quality of life are underused and underfunded in the United States

10 Gender-Related Differences

Conditions Women vs. Men 1. Heart disease Kills 50,000 more per year Strikes 10 years later Higher chance of 2nd attack within 1 year 2. Depression 3. Osteoporosis 2 to 3 times more likely to suffer Lower levels of serotonin 80% of sufferers Higher rate of bone mass loss

10 Gender-Related Differences, Cont.

Conditions 4. Smoking 5. Sexually transmitted infections (STIs) 6. Anesthesia Women vs. Men More negative effect on CV health Less successful in quitting More severe withdrawal symptoms 2 times more likely to contract a STI 10 times more likely to contract HIV Wake up more quickly (7 minutes vs. 11 minutes)

10 Gender-Related Differences, Cont.

7. Drug reactions 8. Autoimmune diseases 9. Alcohol 10. Pain Different reactions and side effects with antihistamines and antibiotics Three of four sufferers are female Lower production of gastric enzyme Higher BAC Higher effectiveness of kappa opiates

Types of Research Studies

 Descriptive studies • Population or correlational studies • Individual studies  Analytic studies • Observational studies –Retrospective –Prospective • Intervention studies –Clinical trials

Phases of a Clinical Trial

Phase I: Healthy volunteers • Evaluate safety and side effects Phase II: Larger group of people • Further evaluate safety and effectiveness Phase III: Large groups in clinics and hospitals • Effectiveness, side effects, comparisons Phase IV: Study after drug is marketed • Effectiveness in various populations

Reproductive Rights

National

January 22, 1973 –

Roe v. Wade:

legalized abortions in most circumstances – However…some states have since added laws when and where abortions can take place, greatly limiting access

International

Mexico City Policy/ “ Global Gag Rule services related to abortion.

” (repealed in 2009): Foreign family planning agencies may not receive U.S. assistance if they provide certain

Access Barriers to Health-Care Providers, Services, and Health Information

• Low socioeconomic status • Lack of health insurance • Lack of access to health-care facilities and services • Language barriers and illiteracy • Unfair treatment by medical personnel due to race, ethnicity, or sexual orientation

Access Barriers to Health-Care Providers, Services, and Health Information

• Inability to pay for costs of treatment medications • Decline of coverage for health-care costs deemed experimental • Fear of doctors leading to avoidance of health care

Global Perspective on Women

’

s Health

Global threats to women ’ s health – Poverty – Underweight and malnutrition – HIV/AIDS – Violence – Maternal morbidity and mortality Violation of human rights – Domestic and societal violence – Female genital mutilation – Honor killings – Trafficking – Barriers to reproductive health services

Global Perspective on Women

’

s Health

World Conferences for the Advancement of Women • 1975: World Plan of Action • 1980: Convention on the Elimination of All Forms of Discrimination Against Women • 1995: Greatest Obstacles to Women ’ s Advancement • 2000: Women 2000—Gender Equality, Development, and Peace for the Twenty-first Century