Women's health

Despite obvious differences between women and men—biologically, psychologically, and socially—the concept of viewing the totality of women's health as different from men's health arose in Western medicine only in the last two decades of the twentieth century. As recently as the 1980s, students in most Western medical schools were taught that, except for issues related directly to reproductive anatomy and function, women were medically identical to men. According to this belief system, medical research could be carried out on men, and the results could simply be applied to women. As a result, only health care providers who specialized in areas related to reproduction were expected to be knowledgeable about issues particular to women.

In order to understand the modern definition of women's health, it is important to understand the history of how women's health care has been viewed by the medical and medical research establishments. Traditionally, the health of women has been seen as synonymous with maternal or reproductive health. Clearly, the Western medical profession's view of women's health as "maternal health" was concordant with societal mores that valued women mainly for their ability to bear children. However, until well into the twentieth century, the major causes of illness and death in women did, in fact, relate to reproductive issues. Childbirth and sexually transmitted diseases, including cervical cancer, have been the most important health issues for women in all ages and places—except in the West and certain other countries in the twentieth century. Prior to 1900, the majority of elderly persons in the United States were men, reflecting the toll that childbearing took on the health of women.

In 1970 the book Our Bodies, Ourselves became a touchstone of the women's health movement. Authored by a group of women participating in a course on health, sexuality, and childbearing, the book emphasizes the importance of women attaining knowledge about their health and being active participants in health care in both an individual and societal sense. Our Bodies, Ourselves also considers the social context of health, including effects of sexism, racism, and financial pressures on the health of women. Throughout the 1970s, major focuses of the women's health movement included reproductive freedom, understanding health in a broader social context, and a critical orientation toward the medical establishment.

In the 1980s, women's health advocates began to argue for a broader definition of women's health and increased participation of women in research studies. A major new focus became changing the medical establishment. The reasons for this change in orientation, particularly toward the participation by women in research studies, were complex. They included, but were not limited to, the growing number of women living beyond their reproductive years and the growing number of women reaching positions of influence within academic medicine.

In 1983 the United States Public Health Service commissioned a task force on women's health. This task force broadly defined women's health issues to include not only reproductive and social issues, but also biological differences between men and women. The modern field of women's health includes the study of illnesses and conditions that are unique to women, more common or serious in women, have distinct causes or manifestations in women, or have different outcomes or treatments in women. Since the 1980s, research on gender differences in health and disease has had important implications for the treatment and prevention of a variety of common serious illnesses, including heart disease, stroke, lung cancer, depression, colon cancer, and dementia. Research in all these areas is ongoing.

Integral to this new expanded view of women's health has been a change in how medical research has been viewed by the public. In the 1970s, the focus of women's health advocates in the United States was on "protecting" women from potential abuses by seeking to avoid their inclusion in medical research studies. It should be noted that women were excluded from medical research during this time because of a variety of factors, and not solely, or even mainly, because of popular advocacy. Medical research was conducted almost exclusively by male physicians, and because most research scientists believed that effects of the reproductive cycle of women might lead to unreliable research results, most supported the belief that research should be conducted on men and then applied to women. Even most medical research on rats during this period was conducted using male rats.

However, by the 1980s, women's health advocates had realized that because women were being excluded from research studies, knowledge about the diagnosis and treatment of a wide variety of common diseases in women lagged far behind knowledge of diseases in men. A major focus of the women's health movement in the 1980s and 1990s was improving knowledge about disease in women by promoting the inclusion of women in research studies, mainly through mandating inclusion of women in federally funded research studies.

A greater understanding of the factors influencing women's health from a biological perspective has been paralleled by a greater understanding of the psychosocial and societal factors that affect women's health status. As an example, research published in the early 1990s showed that because women were more likely than men to require ongoing, rather than episodic, treatment for their health conditions, federally sponsored insurance in the United States (Medicare) actually covered less overall health costs for women than for men. Differences in employment patterns also result in fewer women being medically insured than men, strongly affecting access to health care and health status. Research on domestic violence, which disproportionately victimizes women, underlined the short-and long-term health effects of what had previously been considered either a nonissue or a law enforcement issue.

Some have suggested that the term "women's health" be replaced by the term "gender-based medicine," in part to reflect that medical research that promotes a greater understanding of the effect of gender on health benefits both women and men. However, others believe that the term "women's health" is most accurate, since it incorporates not only biomedical issues, but also the psychosocial and societal factors that ultimately influence the overall health status of women.

The field of women's health seeks to promote an understanding of the biological and psychosocial factor affecting women's health, and to integrate this understanding into public health initiatives, including training of health care providers. Recognition by the medical research establishment of the need to study health and disease in women as well as men has been essential to this new paradigm. Despite the strong influence of biological factors, psychosocial issues still remain the single most important determinant of health status for many women.

(SEE ALSO: Domestic Violence; Gender and Health; Maternal and Child Health; Reproduction; Women, Infant, and Children Program [WIC])

Bibliography

The Boston Women's Health Book Collective (1998). Our Bodies, Ourselves for the New Century. New York: Simon and Schuster.

Clancy, C. M., and Massion, C. T. (1992). "American Women's Health Care." Journal of the American Medical Association 269:1918–1920.

Council on Graduate Medical Education (1995). Fifth Report: Women in Medicine. Washington, DC: U.S. Department of Health and Human Services.

Haseltine, F. P., and Greenberg-Jacobson, B. (1997). Women's Health Research: A Medical and Policy Primer. Washington, DC.: Health Press International.

Healy, B. (1995). A New Prescription for Women's Health. New York: Penguin.

Schroeder, P. (1999). 24 Years of House Work and the Place Is Still a Mess: My Life in Politics. Kansas City, MO: Andrews McMeel Publishing.

Walzer Leavitt, J. (1999). Women and Health in America. Madison, WI: University of Wisconsin Press.

— JANET P. PREGLER

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Feminist health activism grew out of the women's liberation movement of the 1960s, which argued that ideas of female inferiority pervaded the gender-segregated health care system. In The Feminist Mystique (1963) Betty Friedan assailed physicians who proscribed addictive tranquilizers to dissatisfied suburban housewives; protesters at the 1968 Miss America pageant rejected stereotypical notions of femininity; and New York City's Redstockings and other radical feminists organized "speak-outs" to break society's silence about abortion and rape.

Women's physical and mental health was, feminists argued, best maintained outside the hospital and doctor's office, and self-help groups and alternative clinics sought to demystify medical knowledge. The Feminist Women's Health Center of Los Angeles, founded in 1972 by Carol Downer and Lorraine Rothman, taught women to monitor their gynecological health without intervention of a physician, and issued pamphlets like "How To Stay Out of the Gynecologist's Office." Birthing centers providing drug-free, midwife-assisted childbirth challenged standard high-tech obstetrical care. Initiated at a 1969 feminist conference's workshop on women's health, the comprehensive health text Our Bodies, Ourselves, written by the Boston Women's Health Book Collective, was first a pamphlet and then gained a commercial publisher in 1973; it remains popular in many countries, even in publishing markets now full of other women's health texts.

Activists achieved significant political, professional, and legal reform. Journalist Barbara Seaman's provocative book The Doctors' Case Against the Pill (1969) inspired activism that led to the inclusion of patient packet inserts with each pill prescription. In 1970 the Women's Equity Action League threatened American medical schools with a sex discrimination class-action suit, and the acceptance rates for women candidates suddenly doubled from the standard quota of the previous seven decades of approximately 6 percent. Under the pseudonym Margaret Campbell, Harvard Medical School pediatrician Mary Howell detailed the continuing discrimination women students faced in Why Would a Girl Go Into Medicine? (1973). Working with the National Abortion Rights League, feminists demanded legal reform in the name of equal rights, while others, like the underground Chicago service "Jane" (1969–1973), provided access to illegal abortions. In Roe v. Wade (1973) the Supreme Court ruled that abortion was a private decision between a woman and her doctor, and that the state could not intervene until the fetus was "viable"—a term that has shifted in meaning with improving medical technologies. In 1975, during congressional hearings on the synthetic hormone DES, Barbara Seaman, Mary Howell, Alice Wolfson, and Belita Cowan organized a memorial service to protest the death of women who had taken the drug approved by the Food and Drug Administration (FDA) to prevent miscarriage and as a morning-after pill. The National Women's Health Network, which they then founded, forced the FDA to include lay consumers on its advisory committees. DES-daughter activists later pressured Congress to require research by the National Institutes of Health (NIH) on DES and fetal abnormalities. Frustrated with the unresponsive criminal justice system, groups like Women's Advocates in St Paul, Minnesota, set up the first crisis hotline in 1972; shelters and half-houses for battered women followed. Take Back the Night marches and Susan Brownmiller's Against Our Will (1975) led to changes in state rape laws; federal funding for domestic violence programs; and training for police, prosecutors, and judges.

Most of the early feminist health activists were white, middle-class women, but the movement gradually recognized the class, race, and ethnic diversity of women's health. In 1981 Byllye Avery founded the National Black Women's Health Project, and later Latina, Asian American, and American Indian activists organized separate women's health organizations. The Committee to End Sterilization Abuse publicized the numbers of low-income women of color who, during childbirth or while under heavy medication before a Caesarean section, had been forced to agree to a tubal ligation or hysterectomy. In 1973, media coverage of the case of the twelve-and fourteen-year-old daughters of the African American Relf family, whose illiterate mother was forced by a federal family planning clinic in Montgomery Alabama, to consent to their tubal ligation, resulted in a federal lawsuit that forced the Department of Health, Education and Welfare to revise its informed-consent guidelines.

The growing power of the New Right conservative movements, especially the Right to Life Coalition and later Operation Rescue, led Congress to pass the Hyde Amendment (1976), which severely restricted access to abortion for poor women. During the 1980s and 1990s, the Supreme Court allowed states to impose additional restrictions on abortion access, such as waiting periods and some forms of parental consent, but it has also continued to reaffirm the right to privacy. The training of doctors qualified to perform abortions declined dramatically, however, as did the number of counties with clinics or hospitals providing abortion services.

Lobby groups around women with specific disabilities proliferated during the 1980s and 1990s. In The Cancer Journals (1980) poet Audre Lorde spoke of the inter-connected oppression of race, gender, and disease, and by the 1990s, women's breast cancer coalitions expanded public awareness of mammograms, and gained federal funding for women's health centers. Outraged by the number of clinical trials using few if any women as subjects, feminists in and outside of Congress in the late 1980s forced the NIH to require all funded researchers to include women and minorities in study populations for clinical research. In 1990 the NIH established an Office of Research on Women's Health, and a year later appointed its first female director, cardiologist Bernadine Healy, who announced a "moon walk for women": the Women's Health Initiative, a $625 million, fourteen-year clinical study of 160,000 women aged fifty to seventy-nine. New technologies, including sophisticated prenatal diagnosis, fetal therapies, embryo transfer, and the possibility of human cloning have continued to shape the debate over reproductive rights.

Bibliography

Kaplan, Laura. The Story of Jane: The Legendary Underground Feminist Abortion Service. New York: Pantheon, 1995.

More, Ellen S. Restoring the Balance: Women Physicians and the Profession of Medicine 1850–1995. Cambridge, Mass.: Harvard University Press, 1999.

Morgen, Sondra. Into Our Own Hands: The Women's Health Movement in the United States 1969–1990. New Brunswick, N.J.; Rutgers University Press, 2002.

Weisman, Carol S. Women's Health Care: Activist Tradition and Institutional Change. Baltimore: Johns Hopkins University Press, 1998.

For the women's lifestyle magazine, see Women's Health (magazine).

This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (August 2008)

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Women's Health Protective Association monument, New York City

Women's health refers to health issues specific to human female anatomy. These often relate to structures such as female genitalia and breasts or to conditions caused by hormones specific to, or most notable in, females. Women's health issues include menstruation, contraception, maternal health, child birth, menopause and breast cancer. They can also include medical situations in which women face problems not directly related to their biology, for example gender-differentiated access to medical treatment.

Women's health is an issue which has been taken up by many feminists, especially where reproductive health is concerned. Women's health is positioned within a wider body of knowledge cited by, amongst others, the World Health Organisation, which places importance on gender as a social determinant of health.^[1]

Some health and medical research advocates, particularly the Society for Women's Health Research in the United States, define women's health more broadly than issues specific to human female anatomy to include areas where biological sex differences between women and men exist. Research has demonstrated significant biological differences between the sexes in rates of susceptibility, symptoms and response to treatment in many major areas of health, including heart disease and some cancers. The social view of health combined with the acknowledgement that gender is a social determinant of health inform women's health service delivery in countries around the world. Women's health services such as Leichhardt Women's Community Health Centre which was established in 1974 and was the first women's health centre established in Australia is an example of women's health approach to service delivery^[2].

Contents 1 Issues in reproductive health 2 Other medical issues 3 See also 4 References 5 External links

Issues in reproductive health

One example of this is the Cartwright Inquiry in New Zealand, in which research by two feminist journalists revealed that women with cervical abnormalities were not receiving treatment, as part of an experiment. The women were not told of the abnormalities and several later died. In many countries feminists have campaigned for the right to legal and safe abortion, arguing that it is a health rather than a moral issue. In countries where contraception is difficult to access, campaigns for readily available contraception are conducted on the same lines. Conversely, there have also been campaigns against potentially dangerous forms of contraception such as defective IUDs.

Other medical issues

Bone Health

Taking proton pump inhibitors (like Prevacid, Nexium, or Prilosec), drugs that decrease stomach acid, are a risk for bone fractures if taken for two or more years. This happens because of a decreased absorption of calcium in the stomach.^[3]

See also

• International Women's Day March 8
• Healthcare inequality
• Social determinants of health
• Health disparities
• Lucille Roberts
• Women and smoking
• Women in medicine
• Men's Health
• Menopause
• North American Menopause Society, also known as NAMS

References

1. ^ http://www.who.int/social_determinants
2. ^ Stevens, J (1995). Healing Women: A History of Leichhardt Women's Community Health Centre.
3. ^ Etingin, Orli R. "New findings on fracture risk". Women's Health Advisor 13.8 (August 2009): 1(1). Academic OneFile. Gale. University of Northern Iowa. 16 Sept. 2009.

External links

• Health-EU Portal—Women's health in the EU
• WomanlyHealth website and forum
• www.Unobetta.com—Inspirational Help Guide: How to become pregnant when told it's impossible!
• The Global Library of Women's Medicine—Non-profit website offering peer-reviewed resource of clinical information and guidance for healthcare professionals

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