Download Chapter 1

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
4th 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
Office on Research
on Women’s
Health
Food and Drug
Administration
(food and drug
safety)
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
2 to 3 times more likely to suffer
Lower levels of serotonin
3. Osteoporosis
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
Different reactions and side
effects with antihistamines and
antibiotics
8. Autoimmune
diseases
Three of four sufferers are
female
9. Alcohol
Lower production of gastric
enzyme
Higher BAC
Higher effectiveness of kappaopiates
10. Pain
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”(repealed in
2009): Foreign family planning agencies may not
receive U.S. assistance if they provide certain
services related to abortion.
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