essay about women's health

Essay on Womens Health

Students are often asked to write an essay on Womens Health in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

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100 Words Essay on Womens Health

Introduction.

Women’s health involves the physical and mental well-being of females. It’s crucial to understand that women have unique health needs.

Importance of Women’s Health

Women play many roles, like being mothers, daughters, and workers. Their health impacts families and societies. Hence, focusing on women’s health is essential.

Common Health Issues

Women may face issues like breast cancer, osteoporosis, and heart disease. Menstrual health and reproductive health are also important aspects of women’s health.

Prevention and Care

Regular check-ups, balanced diet, exercise, and mental health care can prevent many health issues. Education about women’s health is also necessary.

Women’s health is a vital topic that needs more attention and awareness. We should all work together to ensure women’s health and well-being.

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• 10 Lines on Womens Health

250 Words Essay on Womens Health

Women’s health encompasses a broad spectrum of issues that are unique to females. This field goes beyond reproductive health and includes mental, physical, and social aspects of wellbeing. It is a critical area of focus due to the unique challenges women face in maintaining their health.

Gender Disparities in Health

Historically, medical research has been male-centric, often excluding women from clinical trials. This has led to a lack of understanding and consideration of the unique physiological differences and health issues women face. For instance, heart disease manifests differently in women, often leading to misdiagnosis and ineffective treatment.

Reproductive Health

Reproductive health is a significant aspect of women’s health. It involves issues such as menstruation, pregnancy, childbirth, and menopause. Women’s reproductive health is often neglected, leading to severe consequences like maternal mortality and morbidity.

Mental Health

Women are more likely to experience certain mental health issues, like depression and anxiety, due to hormonal fluctuations, societal pressures, and gender roles. The stigma associated with mental health often prevents women from seeking help.

Addressing women’s health issues requires comprehensive strategies that consider the unique challenges women face. Increased research, improved healthcare services, and societal changes can help bridge the gender gap in health. Ultimately, ensuring women’s health is integral to societal progress and development.

500 Words Essay on Womens Health

Women’s health is a multifaceted issue that encompasses a variety of biological, psychological, and social factors. It is a crucial aspect of global health and development, and understanding its complexities is essential for promoting health equity and ensuring the well-being of women worldwide.

Biological Factors in Women’s Health

The biological differences between women and men contribute to unique health risks for women. Women’s reproductive health is a primary concern, with issues such as menstruation, pregnancy, childbirth, and menopause having significant health implications. For instance, complications from pregnancy and childbirth are the leading cause of death for girls aged 15-19 in low and middle-income countries.

Furthermore, women are more susceptible to certain diseases, such as osteoporosis and breast cancer, due to their biological makeup. It is crucial to invest in research and medical interventions that address these unique health challenges.

Psychological Factors in Women’s Health

Women’s health is not limited to physical well-being – mental health plays a significant role as well. Women are more likely than men to experience mental health disorders such as depression and anxiety. This disparity can be attributed to hormonal differences, societal pressures, and the stress associated with balancing multiple roles.

Moreover, the stigma associated with mental health often prevents women from seeking help, leading to untreated conditions. Addressing these issues requires a combination of public health initiatives, societal change, and individual support.

Social Determinants of Women’s Health

Social determinants significantly impact women’s health. Socioeconomic status, education, and cultural norms play a crucial role in determining access to healthcare, health behaviors, and health outcomes.

In many societies, gender inequality limits women’s access to healthcare and their ability to make decisions about their health. For instance, lack of education and economic dependence can prevent women from seeking necessary healthcare services.

Moreover, harmful cultural practices, such as female genital mutilation and early marriage, directly affect women’s health. Addressing these social determinants is crucial for improving women’s health globally.

Women’s health is a complex issue that requires a comprehensive approach. The interplay of biological, psychological, and social factors necessitates a multidisciplinary approach to health promotion and disease prevention. By addressing these factors, we can ensure that women worldwide have the opportunity to lead healthy and fulfilling lives. This endeavor requires the concerted efforts of individuals, communities, healthcare providers, and policymakers alike. The future of women’s health depends on our collective action and commitment to gender equality and health equity.

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Home — Essay Samples — Nursing & Health — Maintaining Health — Women's Health

Essays on Women's Health

It's a crucial topic that affects the well-being of half the population. Writing an essay about Women's Health can help raise awareness, educate others, and spark important conversations. Plus, it's a chance to dive deep into a subject that impacts so many lives.

When choosing a topic for your Women's Health essay, consider what interests you the most. Are you drawn to issues like reproductive health, mental wellness, or access to healthcare? Think about what you're passionate about and what you think others should know more about. This will help you narrow down your focus and make your essay more engaging.

For an argumentative essay on Women's Health, you could explore topics like the impact of gender stereotypes on healthcare, the importance of reproductive rights, or the challenges of maternal healthcare in underserved communities. For a cause and effect essay, consider topics such as the link between mental health and hormonal changes, the effects of gender-based violence on women's well-being, or the impact of societal beauty standards on women's self-esteem.

If you're leaning towards an opinion essay, you might want to delve into topics like the role of women in healthcare leadership, the importance of inclusive healthcare policies, or the impact of social media on women's body image. And for an informative essay, you could explore topics like the history of women's reproductive rights, the science behind menopause, or the prevalence of mental health issues in women.

For a thesis statement on Women's Health, consider statements like "Access to comprehensive reproductive healthcare is a fundamental human right," "Societal beauty standards have a detrimental impact on women's mental health," or "Gender biases in medical research have led to disparities in women's healthcare."

When crafting your essay , you might want to start with a compelling statistic or a thought-provoking question. For example, "Did you know that women are 50% more likely to be misdiagnosed following a heart attack?" or "Imagine living in a world where your access to healthcare is determined by your gender."

In your essay , you can reinforce your main points and leave the reader with a call to action or a question to ponder. For example, "It's time to prioritize women's health and work towards a more inclusive and equitable healthcare system," or "What steps can we take to ensure that all women have access to the care they deserve?"

With the right topic, a strong thesis statement, and compelling s and s, your Women's Health essay has the potential to make a real impact. Let's dive in and start writing!

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The Health of Women and Girls Determines the Health and Well-Being of Our Modern World: A White Paper From the International Council on Women’s Health Issues

Patricia m. davidson.

Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Broadway, New South Wales, Australia

SARAH J. McGRATH

Afaf i. meleis.

School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA

PHYLLIS STERN

Department of Family Health Care Nursing, Indiana University School of Nursing, Indianapolis, Indiana, USA

MICHELLE DiGIACOMO

Centre for Cardiovascular and Chronic Care, University of Technology, Sydney; and Curtin University of Technology, Broadway, New South Wales, Australia

TESSA DHARMENDRA

Rosaly correa-de-araujo.

Office on Disability, U.S. Department of Health and Human Services, Washington, DC, USA

JACQUELYN C. CAMPBELL

School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA

MARGARETHE HOCHLEITNER

Medical University Innsbruck, Innsbruck, Austria

DeANNE K. H. MESSIAS

College of Nursing and Women’s and Gender Studies Program, University of South Carolina, Columbia, South Carolina, USA

HAZEL BROWN

School of Nursing, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA

ANNE TEITELMAN

Siriorn sindhu.

Department of Surgical Nursing, Mahidol University, Bangkok, Thailand

KAREN REESMAN

Department of Nursing, College of Health Sciences, Appalachian State University, Boone, North Carolina, USA

SOLINA RICHTER

Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada

MARILYN S. SOMMERS

Doris schaeffer.

School of Public Health, University of Bielefeld, Bielefeld, Germany

MARILYN STRINGER

Carolyn sampselle.

School of Nursing, University of Michigan, Ann Arbor, Michigan, USA

DEBRA ANDERSON

School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia

JOSEFINA A. TUAZON

College of Nursing, University of the Philippines Manila, Manila, the Philippines

YINGJUAN CAO

Nursing Department, Qilu Hospital of Shadong University, Shadong, China

ELEANOR KRASSEN COVAN

School of Health and Applied Human Sciences, University of North Carolina, Wilmington, Wilmington, North Carolina, USA

The International Council on Women’s Health Issues (ICOWHI) is an international nonprofit association dedicated to the goal of promoting health, health care, and well-being of women and girls throughout the world through participation, empowerment, advocacy, education, and research. We are a multidisciplinary network of women’s health providers, planners, and advocates from all over the globe. We constitute an international professional and lay network of those committed to improving women and girl’s health and quality of life. This document provides a description of our organization mission, vision, and commitment to improving the health and well-being of women and girls globally.

In 2011, women and girls remain victims of gender inequality ( Read & Gorman, 2010 ). Despite progress in eliminating the social and health disparity between men and women during the last century, gender equality remains an elusive goal, particularly in the developing world. Although women work two-thirds of the world’s working hours, they earn only 10% of the world’s income. This represents less than 1% of the world’s property and illustrates the inequity experienced by women. In many countries, women and girls have less access to education, an important predictor of well-being ( Bobbitt-Zeher, 2007 ). Impoverishment equates not only to hunger and sickness, but also to disempowerment and marginalization. As a result, many women and girls are subject to violence and other human rights abuses. When addressing women’s lives, it is crucial to examine the underlying social, cultural, environmental, epidemiological, and economic determinants of health ( Marmot, Friel, Bell, Houweling, & Taylor, 2008 ).

Women and girls have specific health needs, and health systems around the world are failing them ( World Health Organization [WHO], 2009 ). The WHO states that today women’s health has become an urgent priority, yet the data surrounding this issue are limited and often unreliable ( WHO, 2009 ). It is ICOWHI’s aim to improve the health, health, care and well-being of women worldwide. The vision, mission, and strategic goals of ICOWHI are aligned with the WHO’s Millennium Development Goals (MDG; see Table 1 ). We believe it is important that these goals are not dealt with independently; many of them are closely interrelated, as development in one area will promote improvement in another. Depending on the global region and social, political, and economic climate, a range of activities and strategies are required to achieve optimal health outcomes. In all instances, strategic initiatives need to be undertaken within a framework of cultural competence and consideration of the health and well-being of women and girls across the life span.

Vision and Mission of the International Council on Women’s Health Issues

We are excited to support the United Nation’s (UN’s) women’s initiative launched on January 1, 2011. UN Women emerged from agreement by UN Member States, with strong support of women’s organizations that more needs to be done so that women can claim equal rights and opportunities ( United Nations [UN] Entity for Gender Equality and the Empowerment of Women, 2011 ).

THE RIGHTS OF WOMEN AND GIRLS AS HUMAN RIGHTS

In most societies, women have lower social status than men, producing unequal power relations. For this reason, women and girls can be particularly vulnerable to human rights abuses and suffer poor health outcomes as a result. Arguably, women need special attention when framing an agenda for global health due to the fact that women are biologically different from men and therefore have different needs throughout their lifespan ( Sankaran, 2010 ).

The Convention on the Elimination of all Forms of Discrimination against Women (CEDAW) is the principal international human rights treaty addressing the rights of women. In 1997 the United Nations Economic and Social Council (ECOSOC) adopted a resolution calling on all specialized agencies of the UN to mainstream a gender perspective into all their policies and programes. Numerous other conferences and declarations have resulted in the reaffirmation of women’s rights and needs in the health sector ( Sankaran, 2010 ).

A gender-based approach is established on the recognition of the differences between men and women. Policies that support women’s empowerment serve to alleviate inequitable gender roles ( Rosenfield, Min, & Bardfield, 2010 ). Despite much effort toward creating gender equality, women remain vulnerable, with many women still not able to experience enjoyment of their fundamental human rights. Recognition of the importance of women’s rights is central to any discussion of the MDGs, as innumerable studies have demonstrated that gender equality is a precondition for sustainable growth and poverty reduction.

MILLENNIUM DEVELOPMENT GOALS

For the MDGs to effectively redress the inequalities experienced by women and ensure a healthier future, a gender-based approach must be considered for each of these goals. A gendered approach means not only examining biological differences but also the socially constructed expectations that differentiate the roles and attributes of men and women ( Correa-de-Araujo, 2006 ; Pinn, 2003 ). Increasingly, policymakers and nongovernment organizations have determined that the health and well-being of communities and societies is dependent on the welfare, education, and empowerment of women.

Goal 1: Eradicate Extreme Poverty and Hunger

In some regions, such as Asia and Oceania, the percentage of impoverished people in the region has more than halved since 1990, surpassing the WHO target for 2015 ( UN, 2006 ). Unfortunately, those who still live in disadvantaged areas are more likely to report fair or poor health as compared with those from more affluent areas ( Patel & Burke, 2009 ).

Across all ages of women, the highest mortality and disability rates are found in Africa ( WHO, 2009 ). The improvement of women’s health and well-being hinges on a detailed understanding of the social determinants of health and their interaction. While socioeconomic status plays a large role in health and well-being, social networks and individual factors are also important.

It is ICOWHI’s aim to lobby for funding to strategically address poverty and hunger through supporting sustainable and culturally appropriate strategies, and to reduce the disparities between developed and developing countries. Applying a structured framework to define, address, and improve women’s health outcomes ensures implemented strategies remain both effectual and sustainable. In addition, increasing the profile of women’s health issues in public debate and discourse is critical to affect change and enable health policy that recognizes the discrete needs of women and children.

In order to address social determinants of health and achieve gender equality, the following factors need to be considered ( Marmot, 2005 ):

• Preventing people from falling into long-term disadvantage
• Addressing the social and psychological environmental effects of health
• Ensuring a good environment in early childhood
• Addressing the impact of paid and unpaid work on health and well-being
• Addressing the problems of unemployment and job insecurity
• Promoting friendship, social relations, strong supportive networks, and social cohesion
• Addressing the dangers of social exclusion
• Addressing the effects of alcohol and other drugs
• Ensuring access to supplies of healthy food
• Ensuring access to healthier transport systems.

Goal 2: Achieve Universal Primary Education

Globally, despite a net increase in enrollments, a gender gap persists in education attainment. In many countries, educating girls is widely perceived as being of less value than educating boys ( UN, 2010 ). It is estimated that one in every five primary school age girls are unenrolled, compared with one in every six boys ( Lavin, 1992 ). Education directly benefits women and their children, and it is strongly associated with good health and is an important predictor of well-being ( Grown, Gupta, & Pande, 2005 ; Lavin, 1992 ). In all countries with reliable data, child mortality rates are highest in households where the education of the mother is lowest ( WHO, 2009 ). In addition, literacy plays a distinct role in determining a population’s level of disease and mortality by affecting accessibility to health-related literature and information ( Wilson, 1992 ). In 1996 there were approximately 597 million illiterate women in the world, as compared with 352 million men.

The ICOWHI seeks to promote education initiatives because of the positive correlation between education and health outcomes. Education not only needs to be addressed at the primary level, but at secondary and tertiary levels as well. Raising education rates at a primary and secondary level will have positive flow on effects for women in terms of employment, health, and minimizing social disadvantage. Secondary education is associated with a higher age of marriage, low fertility and mortality, enhanced maternal care, and reduced risk of contracting HIV/AIDS ( Grown et al., 2005 ). In addition, each additional year of secondary school education reduces the probability of public welfare dependency in adulthood by 35% ( Lavin, 1992 ), exemplifying the correlation among education, social disadvantage, and health outcomes. The ICOWHI plans to support women in educational endeavors to promote empowerment and positively affect gender inequality in the educational sphere. We need to advocate for doctorally prepared graduates who can provide leadership and direction for research.

Strategies to ensure that these goals are met include the following; reducing the costs of education, providing scholarships, ensuring schools are girl friendly, educating men on the benefits of educated women, and reducing the physical barriers in accessing education such as issues surrounding transportation ( Grown et al., 2005 ). Not only does accessibility need to be improved, but content and structure also need to be addressed. This can occur via teacher training and curriculum reform and by addressing institutionalized gender bias that exist within schools ( Grown et al., 2005 ).

Through supporting higher-degree education and research in developing countries, ICOWHI is well placed to support initiatives to promote women’s health issues.

Goal 3: Promote Gender Equality and Empower Women

Gender inequality also pervades labor markets and the political landscape. It is deeply rooted in entrenched attitudes, societal institutions, market forces, political values, and ideas ( Kettel, 1996 ). Since 1990, there has been a steady global increase of women in nonagricultural wage employment. The WHO estimates that women remain at a disadvantage in securing paid jobs, however, due to pervading sociocultural attitudes, minimal options for balancing work and family responsibilities, and challenges in birth control ( UN, 2006 ).

In the health profession, women make up the majority of health workers in most settings but are often excluded from positions of responsibility and authority. The WHO describes the current situation as a paradox, as women are the backbone of formal and informal health care: however, they are often excluded from these services or have limited access ( WHO, 2009 ). Similarly, these factors contribute to the underrepresentation of women in politics and business ( Terjesen, Sealy, & Singh, 2009 ). While the percentage of parliamentary seats held by women has increased from 12% to 19% since 1990, progress is slow and there is still much advancement to be made ( UN, 2010 ). Some countries have implemented mandatory or voluntary measures to increase the number of women in politics, which partially may account for such increases.

It is the ICOWHI’s aim to support such legal, political, and business changes, which positively assert gender equality and promote fair and equitable workplace policies. The ICOWHI intends to facilitate increased female participation in decision-making positions not only in the governance of health but other policy area as well.

Goal 4: Reduce Child Mortality

Mortality rates for children under the age of 5 have decreased globally, with the rate dropping 28% ( UN, 2010 ). Unfortunately, the number of children who die every year from preventable disease significantly exceeds the goal set for 2015 and remains at 87 deaths per 1,000 live births. Pneumonia, diarrhea, malaria, and AIDS account for 43% of all deaths in children under 5 worldwide in 2008 ( UN, 2010 ). The leading risk factors for child mortality include malnutrition (under nutrition), unsafe water, poor sanitation and hygiene, suboptimal breastfeeding, and indoor smoke from solid fuels ( WHO, 2009 ). The under-5 mortality rate is highest in developing areas with low household wealth and poor maternal education rates. Similarly, a link between maternal education level and child vaccination has been identified. This further exemplifies the critical link between poor levels of education, social disadvantage, and adverse health outcomes.

Every year around nine million children under 5 years, including 4.3 million girls, die from conditions that largely are preventable and treatable ( WHO, 2009 ). It is therefore crucial to promote the provision of early childhood education to all mothers, including programs regarding breastfeeding, nutrition, and child vaccination and targeting women in low socioeconomic and impoverished areas. As a result of the positive correlation between education and health outcomes, it is ICOWHI’s goal to target women for education initiatives. Improved and wider access to education paired with the provision of basic health services and vaccination will likely have a cost-effective and dramatic effect in reducing child mortality.

Improving child mortality is closely linked to advancing maternal health, as it will reduce those who die at birth and ensure health development in the early stages of the child’s life ( Shaw, 2006 ). It is therefore vital that these goals are addressed codependently, rather than separately.

Goal 5: Improve Maternal Health

When a mother dies, it impacts negatively on the health, education, nutrition, and economic status of her orphaned children and the community, and it also leads to a welfare loss that may take generations to overcome ( Alban & Andersen, 2007 ). More than half a million women continue to die every year in pregnancy and childbirth due to entirely preventable reasons, 99% of whom live in the developing world ( Grown et al., 2005 ). In developed countries, there are, on average, nine maternal deaths per 100,000 live births; however, for disadvantaged developing countries this figure is 1,000 or more per 100,000 live births ( WHO, 2009 ). Maternal mortality remains highest in sub-Saharan Africa and Southern Asia. Despite a global increase in the number of births attended by skilled health care personnel, ratios of maternal mortality in these areas have changed very little since 1990. Significantly, wealthy and urban mothers are three to six times more likely than rural and poor mothers to deliver with health personnel present. In sub-Saharan Africa, where approximately half of the world’s maternal death occurs, only 46% of births occur with the assistance of a skilled health professional, an increase of merely 4% since 1990 ( UN, 2006 ).

Regular use of antenatal services prior to delivery also has been shown to improve maternal and neonatal health outcomes. Lack of access to antenatal and postnatal care services is commonly associated with social isolation, a lack of recognition of the importance of gestational care, or lack of resources such as transport ( Womens Health Outcomes Framework, 2002 ). Given that the two main causes of maternal mortality in developing regions are hemorrhage and hypertension ( UN, 2010 ), providing skilled health care prior to and at delivery is pivotal to minimizing maternal mortality. In some areas of Asia and Africa, less than half the women giving birth are attended to by skilled health personnel ( UN, 2010 ). The ICOWHI seeks to support universal education and health strategies that aim to increase the proportion of births attended by skilled health personnel, particularly for women in remote and rural areas. In addition to providing care at delivery, it is important to make available adequate reproductive health services, postpartum care, and family planning. While no single answer can address the multiple causes of maternal deaths, the ICOWHI intends to lobby for increased funding for health care interventions that reduce maternal death rates. The ICOWHI also intends to make these interventions more widely available, particularly in rural and impoverished areas.

Goal 6: Combat HIV/AIDS, Malaria and Other Diseases

Women are exposed to diseases such as HIV/AIDS and malaria through a number of gender-specific ways, particularly sexual intercourse, rape, and working patterns ( Jewkes, Dunkle, Nduna, & Shai, 2010 ). For this reason it is important to examine women’s exposure to and the prevalence of HIV/AIDS by looking at their occupational risks, sociocultural behaviors, and gender-specific roles and practices. An example of women’s specific vulnerability to HIV/AIDS is the increased exposure to domestic violence and employment in sex-based work.

The ICOWHI will support the development of education programs that promote and facilitate the HIV prevention strategies, targeting women in high-risk groups and areas. While HIV prevalence has leveled off in the developing world, deaths from AIDS continue to rise in sub-Saharan Africa and South east and Central Asia. Further, in many areas more than half of those living with HIV are women. Young women currently make up more than 60% of all 15- to 24-year-olds living with HIV/AIDS. Seventy-seven percent of all HIV-positive women live in sub-Saharan Africa. Specific to this region, young women living with HIV outnumber HIV-positive young men 3.6 to 1 ( United Nations [UN] Population Fund, 2005 ). In other regions, epidemics are spreading from particular population groups—such as sex workers or injecting drug users—into the general population, with women and girls increasingly affected. As a result, in many poor countries, the birth of an HIV-infected child is not uncommon ( Paintsil & Andiman, 2009 ). Although access to AIDS treatment has expanded, the need continues to grow. Prevention is the best solution to the rapid spread of AIDS, yet such measures are failing to keep pace with the spread of HIV. The ICOWHI intends to support preventative strategies such as education, and to reduce the prevalence of mother-to-child transmissions.

The ICOWHI will lobby for increased accessibility to antiretroviral therapy for women and children to ensure management and further preventions. The goal of ICOWHI is to ensure that testing and counseling becomes more widely available, particularly in high-risk areas and for high-risk women. Furthermore, the ICOWHI hopes to facilitate the development of a functioning health care infrastructure in those high-risk areas. This includes ensuring that these areas have enough health workers to meet the demands of the community. Importantly, the ICOWHI also will work to remove the discrimination and stigma associated with those infected and will educate those who are infected to effectively manage the disease and remove possibilities of further transmission.

HIV is an immunosuppressive illness, and the spread of HIV can significantly increase one’s vulnerability to other infectious diseases, in particular, malaria and tuberculosis ( Alban & Andersen, 2007 ; Chaisson & Martinson, 2008 ). Malaria-control efforts are paying off; however, additional effort is needed as 150 to 300 children die each hour from malaria, amounting for 1 to 2 million deaths yearly ( Breman, 2009 ). In total, malaria kills up to three million people per year worldwide, and, like many other diseases, most of the victims are from sub-Saharan Africa ( Sachs, 2005 ). The prevalence and mortality rates surrounding malaria are astonishing considering that the disease is treatable and highly preventable. The ICOWHI intends to advocate for the sustainability of malaria reduction programs and maximize capacity building by targeted investments, such as the distribution of insecticide-treated bed nets and effective medicines to impoverished rural areas of Africa.

The incidence of tuberculosis is leveling off globally, but the number of new cases is still rising. Reaching global targets for tuberculosis control will require accelerated progress, especially in sub-Saharan Africa and the Commonwealth of Independent States. Whilst Africa is home to only 11% of the world’s population, it carries 29% of the global burden of tuberculosis cases and 34% of tuberculosis-related deaths ( Chaisson & Martinson, 2008 ). The ability of African health care systems to respond to and manage the incidence of tuberculosis is constrained by limitations of funding, facilities, personnel, drug supplies, and laboratory capacity ( Chaisson & Martinson, 2008 ). It is ICOWHI’s goal to reduce the prevalence of tuberculosis by pushing for improvements in domestic health facilities and laboratories, reduce the conditions that facilitate the transmission of infection, and educate health workers to promote early detection.

Other strategies need to be implemented to ensure that women are not falling victim to treatable and preventable diseases and viruses. The human papilloma virus (HPV) is the primary cause of death from cancer in the developing world ( Shaw, 2006 ), and globally almost all cases of cervical cancer are linked to genital infection with HPV ( WHO, 2009 ). Prevalence of HPV is the highest in Africa, where one in five women are infected ( WHO, 2009 ). The highly effective HPV vaccine is neither accessible nor utilized in developing countries due to cost; however, this vaccine is easily accessed within developed countries. Many preventative strategies are not implemented in developing countries, despite the fact that regular screening has positive links to reducing the prevalence of cervical cancer. The ICOWHI will encourage the increased accessibility and availability of the HPV vaccine and will lobby for domestic infrastructure to be implemented to ensure that more women are being screened for potentially preventable diseases.

Goal 7: Encourage Sustainable Development

Billions of people suffer ill health as a direct consequence of environmental factors. Environmental diseases such as diarrhea, dysentery, hepatitis, and typhoid are major preventable causes of death in developing countries ( Chenoweth, Estes, & Lee, 2009 ). Fifty percent of people lack basic sanitation, and 20% live without clean drinking water. There also has been a global increase in slum populations as more than 50% of people now live in urban areas. In addition, overpopulation and inadequate infrastructure in both urban and slum areas create unsafe public spaces, high levels of pollution, and increased crime. Also, deforestation rates remain high despite improvements in some regions ( Laurance, 2010 ).

Women, more so than men, suffer from poor health, diminished productivity, and missed opportunities for education due to poor urban environments ( Kettel, 1996 ). In addition, women commonly experience a higher burden of urban environmental difficulties as a result of their common gender-based roles as household providers and maintainers. This places them at increased risk of experiencing inadequate space and housing whilst caring for children and reduced public transport facilities. These environmental hazards severely impact women’s quality of life.

Women’s vulnerability and poor health is closely linked to availability of basic infrastructure such as transportation and sanitation services ( Grown et al., 2005 ). Access to such facilities will not only improve women’s health and safety, but also enhance economic independence and personal empowerment. The type of development, however must be closely considered. An example can be seen in the investment in major road projects in developing countries, where often this type of development will not meet the transport needs of many poor people, particularly women whose trips are primarily local and off road ( Woodcock et al., 2007 ). Increasing transport access and use through sustainable development is encouraged and should be developed by improving walking and cycling infrastructures, increasing access to cycles, and investment in transport services for essential needs ( Woodcock et al., 2007 ).

In order to minimize environmental illness, the ICOWHI wishes to support gender sensitive environmental health policy to protect and maintain healthy life spaces for women. This must include increasing the worldwide provision of basic sanitation and clean drinking water by lobbying for increased funding to rural and remote areas. Participation of women in policy formation will ensure environmentally sustainable development that recognizes the needs of women.

It is the ICOWHI’s goal to endorse the role of women as environmental and health policymakers at a government level to positively affect urban design and environmental health. Women need to be engaged at all levels of discussion from the local, domestic, and international levels.

Goal 8: Develop a Global Partnership for Development

The health of women and girls is a global issue, and therefore global co-operation and collaboration needs to occur in policy, practice, education, and research. In order for further improvement to take place, professional organizations need to be consulted and included in discussions surrounding women’s health; this includes research collaborations and partnerships, including public-private collaborations. Partnerships with parliamentarians, religious leaders, media, businesses, civil society groups, women’s and youth groups, research institutions, and nongovernmental organizations also must be considered ( Shaw, 2006 ). These collaborative partnerships will facilitate the education of local communities and health care workers.

Improving women’s health globally is beneficial to men and women in both developed and developing countries. Men must work in effective partnerships to develop and support the improvement of women’s health globally. While the focus of the White Paper and ICOWHI is women, men are an essential part of the solution. Since the majority of policymakers are men, they must therefore be informed on women’s health issues and the appropriate measures that need to be taken. Strengthening leadership capacity will prioritize women’s health and hopefully result in a greater allocation of funds ( ProCor, 2009 ; United Nations Population Fund, 2005 ).

The WHO notes that there are many gaps in the data surrounding women’s health and often the quality of the data is questionable ( ProCor, 2009 ; World Health Organization, 2009 ). The ICOWHI also intends to support organizations and systems that facilitate the production and collection of reliable data surrounding women’s health. High-quality data need to be available at the local, national, and international level ( ProCor, 2009 ). These data will enhance the knowledge surrounding women’s health, will ensure that changes can be closely monitored, and data can be correctly analyzed in totality, therefore influencing more appropriate policy decisions. Once obtained, this data must be disseminated globally, not just amongst developed countries.

The role of health professionals is crucial in achieving these goals. The ICOWHI therefore intends to help coordinate ethical frameworks of migration to ensure developing countries do not experience a brain drain to developed countries. Further, it is important that health professional education models are dynamic and responsive to the needs of the contemporary health and social systems ( Frenk et al., 2010 ). Women play a pivotal role in the provision of health care, formally as health professionals and informally as family caregivers, and it can be estimated that women make up 50% of the formal workforce in many countries ( WHO, 2009 ). It is therefore important not only for the recipients of health care but also the providers that ethical codes of conduct are developed, monitored, and respected.

REDUCING VIOLENCE AGAINST WOMEN AND GIRLS GLOBALLY AND ENHANCING THE SUPPORT AVAILABLE TO THE VICTIMS OF VIOLENCE

Empowering women and girls against domestic and family violence is a priority for the ICOWHI in promoting gender equality ( Ellsberg, Jansen, Heise, Watts, & Garcia-Moreno, 2008 ). Domestic violence includes physical, sexual, and psychological assault, forced isolation, economic deprivation, harassment, and any other action that causes a person to live in fear ( Womens Health Outcomes Framework, 2002 ). Women and girls are more likely to be abused than men and boys, and they are at high risk if they are under 24 years of age, experienced abuse as a child, or if they live in remote or rural areas. At least one in three women will be the victim of abuse—physical, sexual, or psychological—at some point in her life ( Rosenfield et al., 2010 ).

In addition, most forms of violence are not unique one-off events but rather often occur continually over a number of years ( Watts & Zimmerman, 2002 ). Violence against women and girls is particularly harmful in that the consequences go far beyond the initial act to include psychological damage, loss of personal freedom, and diminished capacity to participate in public life ( Rosenfield et al., 2010 ). Violence against women is not only a symptom of gender inequality, but it also serves to maintain this unequal balance of power ( Watts & Zimmerman, 2002 ).

Unfortunately, only a minority of women who experience domestic violence go on to report the incident, meaning that violence against women remains a hidden problem with a number of associated human and health care costs ( WHO, 2009 ). Reducing domestic violence must include culturally sensitive strategies to educate and empower high-risk groups to speak out against offenders. Through such strategies, ICOWHI hopes to contribute to significantly reducing violence and its impact on vulnerable women across their lifespan. In order to affect change globally, ICOWHI intends to develop worldwide coalitions and partnerships for the purpose of decreasing violence and improving women’s health, by facilitating partnerships between congress conveners and ICOWHI members. In addition, ICOWHI hopes to inform and educate health workers globally about the prevalence of gender-based violence and provide them with the tools to manage such cases appropriately. Reducing violence against women will not only improve the life of the individual but also will enhance the existence of the entire community.

ADDRESSING THE BURDEN OF CHRONIC DISEASES AND RECOGNIZING THE NEEDS OF WOMEN AND GIRLS ACROSS THE LIFE-SPAN

For arange of social, political, and economic factors, predominately policymakers have focused on issues impacting on women’s reproductive health. Globally, the world is facing an epidemic of chronic disease ( Beaglehole, Reddy, & Leeder, 2007 ). Chronic diseases such as cancer, cardiovascular disease, and diabetes are the number one killer of women in the world and are responsible for huge individual and societal costs ( Phillips & Currow, 2010 ; Reddy & Yusuf, 1998 ). Whilst often ignored by policymakers ( Beaglehole & Yach, 2003 ) and not mentioned in the MDGs, ICOWHI recognizes the substantial impact chronic diseases have on women’s health, both in the developed and developing world and will lobby for an increased priority of such diseases in the post-2015 global health agenda ( Asaria et al., 2010 ). Efforts must be made to increase the awareness of symptoms and risk factors for chronic diseases. A life course approach to health will reduce the risk of many chronic diseases. As the population ages, women are an increasing proportion of the population, yet their health care needs are poorly studied, recognized, and resourced ( Richmond, 2008 ). We also need to be mindful of the impact of urbanization and globalization on the health and well-being of women and girls. Tailoring and targeting of policy and health care policy and interventions are required to meet the context of contemporary society.

Women and girls have distinct needs and potential and face different obstacles. Women continue to experience inferior health outcomes across a number of conditions, despite human rights advances and improvements in certain areas of health and development. Improvements in women’s health on a global level must be developed from basic principles of human rights and gender equality and equity ( Mane, 2010 ). The ICOWHI intends to act on the goals outlined above and implement practical and achievable strategies to ensure these goals are met. This must occur through enhanced collaboration with a range of partners and by empowering women and enhancing access to knowledge at local, regional, national, and international levels. The time has now come to take action to ensure the health and well-being of women and girls globally.

The views expressed in this article are those of the authors, and do not necessarily represent the views of the U.S. Department of Health and Human Services or the U.S. federal government.

The strategies are clear. A plan is in place. The needed resources are attainable. The time to act is now. ( United Nations Population Fund, 2005 )

Contributor Information

PATRICIA M. DAVIDSON, Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Broadway, New South Wales, Australia.

SARAH J. McGRATH, Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Broadway, New South Wales, Australia.

AFAF I. MELEIS, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

PHYLLIS STERN, Department of Family Health Care Nursing, Indiana University School of Nursing, Indianapolis, Indiana, USA.

MICHELLE DiGIACOMO, Centre for Cardiovascular and Chronic Care, University of Technology, Sydney; and Curtin University of Technology, Broadway, New South Wales, Australia.

TESSA DHARMENDRA, Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Broadway, New South Wales, Australia.

ROSALY CORREA-de-ARAUJO, Office on Disability, U.S. Department of Health and Human Services, Washington, DC, USA.

JACQUELYN C. CAMPBELL, School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.

MARGARETHE HOCHLEITNER, Medical University Innsbruck, Innsbruck, Austria.

DeANNE K. H. MESSIAS, College of Nursing and Women’s and Gender Studies Program, University of South Carolina, Columbia, South Carolina, USA.

HAZEL BROWN, School of Nursing, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA.

ANNE TEITELMAN, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

SIRIORN SINDHU, Department of Surgical Nursing, Mahidol University, Bangkok, Thailand.

KAREN REESMAN, Department of Nursing, College of Health Sciences, Appalachian State University, Boone, North Carolina, USA.

SOLINA RICHTER, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

MARILYN S. SOMMERS, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

DORIS SCHAEFFER, School of Public Health, University of Bielefeld, Bielefeld, Germany.

MARILYN STRINGER, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

CAROLYN SAMPSELLE, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA.

DEBRA ANDERSON, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.

JOSEFINA A. TUAZON, College of Nursing, University of the Philippines Manila, Manila, the Philippines.

YINGJUAN CAO, Nursing Department, Qilu Hospital of Shadong University, Shadong, China.

ELEANOR KRASSEN COVAN, School of Health and Applied Human Sciences, University of North Carolina, Wilmington, Wilmington, North Carolina, USA.

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Chapter 3: Women and Health

Chapter summary, unequal in health, recent trends encouraging, more to be done.

• Profile: Salwa Al-Najjab

International Partnerships

• Empowering Women, Protecting Children  

Additional Resources

This chapter discusses women’s health as an indicator of a nation’s political, social, and economic development. As women are half of any given nation’s population, productivity is lowered when women’s health is poor. Women’s health is important from human rights and economics perspectives. Nearly 380,000 women die from preventable causes related to pregnancy each year. The majority of maternal deaths occur in sub-Saharan Africa and South Asia. However, maternal deaths declined by one-third globally between 1990 and 2008. Also, while women are marrying later throughout the developing world, large unmet family planning needs remain.

The chapter examines two cases of women and organizations who have been breaking down barriers in health. Salwa Al-Najjab is a Palestinian activist who was the only female student in her medical school and went on to provide crucial health services for women in Palestinian refugee camps. Najjab’s work led her to become cognizant of the economic, social, and environmental determinants of health. She founded the Women’s Social and Legal Guidance Center in Ramallah. The second case study concerns the mothers2mothers (M2M) program, which operates 680 sites across sub-Saharan Africa, reaching 85,000 new and expecting mothers per month. M2M provides treatment and testing for HIV-positive pregnant women and ensures access to medication. The program provides employment and community engagement opportunities for women who are HIV-positive, and participants can become empowered members of the community.

• Antiretroviral (ARV) medication
• Elton John AIDS Foundation
• Global Information and Advice on HIV & AIDS (AVERT)
• Guttmacher Institute
• Highly Active Antiretroviral Treatment (HAART)
• Johnson & Johnson
• Juzoor Foundation for Health and Social Development
• Mother-to-child transmission
• Mothers2mothers
• Prevention of mother-to-child transmission (PMTCT)
• Salwa Al-Najjab
• United Nations Joint Program on HIV/AIDS (UNAIDS)
• United Nations Population Fund (UNPF)
• United States Department of State
• U.S. Center for Disease Control (CDC)
• U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)
• Women’s Social and Legal Center
• World Health Organization (WHO)

By Lori S. Ashford

W omen’s health can be a barometer of a nation’s progress. Countries afflicted by poverty, corruption, war or weak governance often neglect their most vulnerable citizens. Frequently these are women. When women are unhealthy, their productivity is lowered and their children and families are less secure. This has an economic impact. So investing in women’s health makes sense from both an economic and a human rights perspective.

Women live longer than men, statistics show, but they may spend a greater proportion of their lives in poor health for a variety of reasons, attributable less to biological differences than to poverty and gender discrimination. Poor families may invest less in their daughters, giving them less nutrition, health care and education than their sons. Such disadvantages early in life have long-term consequences for girls’ health and well-being. For example, adolescent childbearing, common in countries and communities that condone child marriage, poses health risks and limits life prospects for the teen mothers and their children. If women are undernourished they risk having low birth-weight babies who, in turn, face a higher risk of early death and poor health. An added threat to the health of women and girls exists in countries where there is a cultural preference for sons, such as China and India. Sex-selective abortions and female infanticide are responsible for millions of “missing girls.” The resulting shortage of women relative to men can have alarming social repercussions. An April 2011 report in The Economist cited evidence that a skewed sex ratio in India has led to increased trafficking of girls, among other abuses. Data from U.N. Population Fund studies also support this (UNFPA, 2004).

Pregnancy and childbirth take a heavy toll on women’s health in the developing world. According to 2010 estimates by the World Health Organization (WHO), 358,000 women die of preventable causes related to pregnancy and childbirth every year; 99 percent of these deaths are in developing countries. In contrast, in developed countries where women deliver their babies in hospitals and have access to care for pregnancy complications, maternal deaths are extremely rare.

The vast majority of the world’s maternal deaths occur in the two poorest regions: sub-Saharan Africa and South Asia. In sub-Saharan Africa, where high fertility multiplies the dangers that mothers face over a lifetime, one in 31 women is likely to die as a consequence of pregnancy or childbirth (WHO, 2010). In developed countries, that chance is one in 4,300. Outside of Africa, Afghanistan is the riskiest place on earth to become pregnant and bear children, with a one in 11 lifetime chance of dying from pregnancy-related causes.

Millions of women suffer physical injuries or long-term disabilities, such as incontinence or ruptured organs, resulting from lack of proper care during pregnancy and childbirth. Many of these disabilities go unreported because women in developing countries consider them normal. The technology and knowledge to prevent needless deaths and injuries has long been available, but geography, substandard health systems, gender bias and political inertia all create barriers to making motherhood safer.

The HIV/AIDS pandemic also threatens women’s health in poor countries and communities. Where the virus is spread through heterosexual contact, women are more vulnerable to infection than men for physiological and social reasons, such as women’s economic dependence on men, their lack of power to ask male partners to practice safer sex and — too often — coerced sex. According to a 2009 UNAIDS report, “An estimated 50 million women in Asia are at risk of becoming infected with HIV from their intimate partners … men who engage in high-risk sexual behaviours.”

The good news is that today women are marrying later throughout the developing world. They are delaying first births and having fewer children than their mothers did. These trends reflect the fact that more girls are staying in school and more women and couples are practicing family planning. But there still is a large unmet need for family planning: According to a 2009 report from the Guttmacher Institute, more than 200 million women worldwide who want to avoid pregnancy do not use modern contraception. This contributes to tens of millions of unplanned births and unsafe abortions annually, often among the poorest women, who are least able to obtain and use the health services they need.

Estimates from WHO in 2010 revealed that maternal deaths dropped by about one-third globally from 1990 to 2008, thanks to a number of factors such as increased availability of contraception, prenatal care and skilled assistance during childbirth. Countries as diverse as Bolivia, China, Eritrea, Iran, Romania and Vietnam have made remarkable progress. Much more work remains to be done, however, for all countries to meet the Millennium Development Goal to reduce maternal deaths by three-fourths (compared with 1990 levels) by 2015.

Where countries have prioritized women’s health in national policy, great progress has been made. Women should be encouraged to recognize and speak out about their health care needs, so policymakers may learn and take action. Concern about women’s issues, including health care, prompted President Obama to appoint Melanne Verveer the first ambassador-at-large for women’s issues, to help address such problems. Secretary of State Hillary Rodham Clinton has made global women’s issues a high priority of the U.S. State Department. In 2009 President Obama designated $63 million — to be spent over six years — for the Global Health Initiative, a partnership among U.S. agencies to boost health care in the developing world, particularly for women and children. HIV/AIDS treatment projects such as mothers2mothers, which is highlighted in this chapter, are funded by the U. S. Agency for International Development and the U.S. President’s Emergency Plan for AIDS Relief.

Improving women’s health starts by recognizing that women have different needs from men and unequal access to health care. Focusing a “gender lens” on health services is necessary to reveal and address the inequalities between men’s and women’s care. This means paying more attention to girls, adolescents and marginalized women who suffer from poverty and powerlessness and changing the attitudes and practices that harm women’s health. Also, men should be partners in promoting women’s health, in ensuring that sex and childbearing are safe and healthy and in rearing the next generation of young leaders — both girls and boys.

Lori S. Ashford, a freelance consultant, has written about global population, health and women’s issues for 20 years. Formerly with the Population Reference Bureau (PRB), she authored the widely disseminated PRB “Women of Our World” data sheets and “New Population Policies: Advancing Women’s Health and Rights” for the Population Bulletin, among other publications.

PROFILE: Salwa Al-Najjab – Palestinian Health Care Activist

By Naela Khalil

S alwa Al-Najjab was the best female math student in her class, and her passion for mathematics would have led her to study at the College of Engineering, but for her Russian math teacher’s advice to study medicine: “With your intelligence and your strong personality, you will be of more benefit to the women of Palestine as a doctor than as an engineer,” the teacher said. Salwa Al-Najjab followed her teacher’s advice, and today she is changing medical care in the Palestinian Territories.

The hospital environment stirred Al-Najjab’s curiosity and her love of knowledge. She hadn’t realized that her medical career also would show her that many women lived in very different circumstances from her own. Al-Najjab admits: “The hospital and the medical profession opened my eyes wide to conditions which I hadn’t realized were as bad and as difficult as they were.” Her lifelong professional and personal battle to support women’s rights and to help provide better health care for women started when she began practicing medicine in 1979 at Al-Maqasid Hospital in Jerusalem.

She expanded her efforts to create better conditions for women in the mid-1980s. Carrying her physician’s bag and instrument case, Al-Najjab visited Palestinian villages and refugee camps to give women medical check-ups and treatment. She volunteered her time under the most difficult and complex conditions. She was creating change on the ground.

Today, after more than 30 years of work in hospitals and clinics in different parts of the Palestinian Territories, Al-Najjab heads the Juzoor (Roots) Foundation for Health and Social Development, based in Jerusalem. She continues to enthusiastically pursue her dream, although now, she says, it is more difficult “to influence health care policy decisionmakers to improve and develop the level of health care services provided to women, and to bridge the gap between service providers and recipients.”

Al-Najjab’s optimism is infectious. She maintains her smile despite the challenges she has faced in her life. During her early school years, she attended eight different schools in Ramallah, Hebron and Jordan. Her father worked first at the Jordanian Ministry of Education, then at UNESCO, so her family moved frequently. This meant she and her three siblings often changed schools, making it difficult to maintain long-term friendships. However, it was always easy for her to maintain her academic excellence.

Al-Najjab traveled to Russia to attend Moscow University in 1971. After one year of Russian language study, she enrolled at Kuban Medical School in Krasdnada. Dealing with her fellow students was more difficult than learning a new language or other demanding subjects. Some Arab students looked at her disapprovingly; others underestimated her ability to succeed because she was a woman. She persevered in her studies, defying those who doubted her, and became a model of academic success. She became a mentor to Palestinian women studying abroad.

Her first job at Al-Maqasid Hospital presented her with major challenges. She was the only female resident doctor, and she began working in the obstetrics and gynecology section. It was difficult for the male doctors to accept a female colleague and professional competitor. The hardest thing for Al-Najjab was that the female nurses did not accept her either, because they were accustomed to dealing with male doctors. They believed that a male doctor was more competent and professional than his female counterpart. The atmosphere at the hospital reflected this masculine bias in the way they divided the work: Al-Najjab would do routine examinations of female patients at the hospital clinic, while the male doctors would perform surgical operations and circumcisions. They did not expect that this quiet, beautiful young woman would resist this arrangement, nor that the section head would support her.

Al-Najjab says: “I refused to accept their masculine [-biased] division of labor, and I stuck to my position: ‘I will participate in surgical operations, and I will perform circumcisions on boys.’ This didn’t please them, and they nicknamed me ‘the rooster.’”

Al-Najjab says that the first time she experienced discrimination against women was at the hospital: “I grew up in a family that offered the same opportunities to both sexes. Even my grandfather, back in the 1960s, allowed my aunts to study in Britain, to work outside of the house and to spend the night away from home. Therefore, the attitude that I faced from my colleagues at the hospital astonished me.”

Al-Najjab also learned about the unequal status of women. She says, “I felt that I was getting to know my society for the first time. I would feel distraught when I delivered the baby of a girl who was no older than 15, or when I heard women affirming to me, unprompted, that men had a monopoly over decisions regarding who their daughters would marry, whether or not to use contraceptives or how many children they would have.” Al-Najjab adds, “Women don’t have the right to defend their own right to an education … It’s a cycle that must be broken.”

Al-Najjab’s family valued knowledge. Her father defied convention by sending her to study in Russia. Although her mother hadn’t completed her studies, she encouraged her four children, girls and boys alike, to continue their education. All of them graduated from college.

“Unlike other mothers, mine never talked to me about marriage. Instead, she would always talk to me about the importance of education for a woman’s life,” Al-Najjab recalls.

After seven years at Al-Maqasid Hospital, during which time she helped establish several high-quality clinics in Jerusalem and its suburbs, Al-Najjab left the hospital to work in the field. “I discovered that only a small number of people go to hospitals, either due to poverty or ignorance,” she says. “If I wanted to provide health care to women, I had to go to them, wherever they were.”

In 1985, Al-Najjab and a group of health professionals began visiting villages and refugee camps to provide health care. People’s reactions were positive, but some doctors criticized her for damaging doctors’ “prestige” by going to the patients rather than insisting that people come to the doctor.

By breaking this rule of prestige, Al-Najjab and her colleagues found conditions that they did not encounter in well-organized clinics equipped with winter heating and summer fans. They met people in far-flung places who suffered from a severe lack of health care compounded by the complex political conditions resulting from the Israeli-Palestinian conflict. Al-Najjab says, “I treated women who had no bathrooms in their homes and others living in homes unfit for human habitation. I came into contact with a bitter reality that overturned all of my convictions regarding the concept of health: I realized that it wasn’t only a question of physical well-being, but that health is also related to economic, social and psychological conditions, and to the environment.”

She has fought many battles and continues to do so. Her convictions and her decisions are sometimes contrary to social traditions that limit women’s rights. Al-Najjab is an activist who gets things done. She co-founded the Women’s Social and Legal Guidance Center in Ramallah. The center shelters women who are victims of violence, offers them legal assistance, refers their cases to the police and refers them to a safe house for their protection.

“I used to believe that as the years went by, change for the better would take place. But what I am noticing today is the opposite. In this social environment of political frustration and poverty, fundamentalist movements have strengthened and are actively working to move society backwards at every level. Women and women’s rights are the most prominent victims,” she says.

Besides leading the Juzoor Foundation, which seeks to influence health care policies, Al-Najjab heads the Middle East and North Africa Health Policy Forum, where she continues to strive for change. She was nominated by the U.S. Consulate General in Jerusalem for the U.S. Department of State’s 2010 International Women of Courage award.

With a husband and three children, in addition to her medical practice and activism, Dr. Salwa Al-Najjab has a full life. Her prescription for success is this: “We cannot but be optimistic about life.”

Naela Khalil is a Palestinian journalist. She won the 2008 Samir Kassir Award for freedom of the press.

PROJECT: Mothers2mothers – Help for HIV-Positive Women

By Maya Kulycky

HIV/AIDS is the scourge of Africa, but in Kenya, the nongovernmental organization mothers2mothers enables HIV-positive women and their families to live full lives despite the disease.

T eresa Njeri, a single mother in Kiambu, a northern suburb of Kenya’s capital, Nairobi, has a dream. She wants to build a home for herself and her six-year-old son. Recently, Teresa bought a plot of land. When she looks out over it she pictures the house she plans to build, with three bedrooms, a “big kitchen” and a yard where her son can play. Teresa is confident and optimistic. But planning for a bright future, and having the means to make it a reality, is a big change for her. Ten years ago Teresa was convinced that she and her son were going to die.

In 2001, Teresa was diagnosed as HIV-positive when she was five months pregnant. “The first thing that came to my mind was death,” says Teresa. “All of my hopes were shattered.” The nurse at the clinic told Teresa she could protect her baby from HIV, but the nurse “wasn’t convincing, she was not very sure.” Regardless, Teresa joined a prevention of mother-to-child transmission (PMTCT) program. Meanwhile, she disclosed her status to her husband, who also tested HIV-positive. Like others who were afraid of the stigma associated with HIV, the couple hid their status. They separated shortly after the birth of their son, who is HIV-negative.

A few months later, Teresa was hospitalized and told she had AIDS. When her father discovered her status from the hospital staff, he told her family, who isolated her and took her son away to live in the family’s village. “So I was left alone, all alone in the world,” Teresa remembers.

Teresa fled, sought treatment and volunteered to speak to others with AIDS. But she says she still “didn’t have any focus in life. I didn’t have any hope. I didn’t know what to do.” Then Teresa found mothers2mothers, thanks to nurses in the hospital where she volunteered. They told her that mothers2mothers was seeking to hire women trained in PMTCT. Teresa applied and became a mothers2mothers mentor mother.

Mothers2mothers — funded by USAID, PEPFAR (U.S. President’s Emergency Plan for AIDS Relief) and the CDC (U.S. Centers for Disease Control), the Elton John AIDS Foundation, Johnson & Johnson and other corporate and foundation partners — trains and employs HIV-positive mothers to be “mentor mothers” to provide counseling, education and support to newly diagnosed HIV-positive pregnant women and new mothers. It is an innovative, sustainable model of care at the forefront of prevention of mother-to-child HIV transmission. Mothers2-mothers operates 680 sites in nine sub-Saharan African countries, reaching about 85,000 new pregnant women and new mothers a month.

The African continent is struggling under the burden of HIV/AIDS. Of the 33 million people carrying HIV worldwide, 22 million live in sub-Saharan Africa. Ninety percent of HIV-infected babies are born in the region and 75 percent of the world’s HIV-positive pregnant women live in 12 African countries, according to studies done by AVERT ( www.avert.org ), the UNAIDS Regional Support Team for Eastern and Southern Africa ( http://www.unaidsrstesa.org/unaids-priority/2-preventing-mothers-dying-and-babies-becoming-infected-h ) and the World Health Organization Universal Access Report 2010 . Meanwhile, the region is desperately short of doctors and nurses.

Mothers2mothers fills a gap by enlisting HIV-positive mothers to counsel pregnant women about how testing and treatment can ensure their babies are born healthy and that, if necessary, they can get medication. Mentor mothers work beside doctors and nurses in health care facilities, helping patients understand, accept and adhere to the interventions that are prescribed. They are paid members of the medical team.

Empowering Women, Protecting Children

The results are clear. In Lesotho, data collected by mothers2mothers show that 92 percent of pregnant women who attended the organization’s instruction sessions three or more times took antiretroviral (ARV) medication during pregnancy, compared to 71 percent of those who attended once. Adhering to the ARV regime is critical to decreasing mother-to-child transmission of HIV. Furthermore, 97 percent of frequently-attending mothers2mothers clients get CD4 tests, which determine the number of T-helper cells with which the body combats infections. A CD4 test shows how advanced an HIV infection is and is a first step toward receiving the life-saving highly active antiretroviral treatment (HAART).

Women are empowered by the support they receive in mothers2mothers programs. They become peer educators who are role models in their communities, while earning a salary and gaining valuable work experience.

Teresa credits mothers2mothers with giving her a sense of purpose. Her mothers2mothers colleagues encouraged her to pursue her college degree. She is studying community health and development. “I feel like God created me … to talk to these women, and help them, empower them, encourage them,” she says.

Teresa points to her success in helping a pregnant woman from the traditional African religion of Wakorino, whose adherents often eschew professional medical care. “I saw her when I was coming to work,” she says. She gave the woman her telephone number, and “the following day she called me and said, ‘I am here at the [hospital] gate.’” The woman tested HIV-positive. “I told her, ‘Don’t worry, because you are going to live a very long time.’ I disclosed my status to her.” Teresa convinced her to adhere to PMTCT treatment and deliver in the hospital. The woman gave birth to an HIV-negative child. “I feel like a star,” Teresa laughs.

Mothers2mothers is working to expand its reach to women in more countries and in countries where it currently operates. The impact is clear and the method is simple — a woman talking to another woman can help prevent mother-to-child transmission of HIV.

Maya Kulycky is the global communications manager at mothers2mothers. She also lectures in political journalism at University of Cape Town, South Africa. She previously reported for ABC News and CNBC. A graduate of Johns Hopkins University, she received a master’s degree from the University of London, Goldsmith’s College, and a law degree from Yale Law School.

Multiple Choice Questions

• Biological differences (Women are unhealthier by nature)
• Poverty and gender discrimination
• Adolescent marriage and childbearing
• Cultural preferences for sons over daughters
• All except for A
• Sub-Saharan Africa
• South-East Asia
• Latin America
• Both A and B
• Afghanistan
• None of the above
• Sub-standard health systems
• Gender bias
• Political inertia
• All of the above
• Contraception
• Prenatal care
• Skilled assistance during childbirth
• Answers A, B, and C.
• The Bill and Melinda Gates Foundation
• The Global Health Initiative
• More girls are staying in school longer
• Girls are delaying their first births
• More women and couples are practicing family planning
• Many women have insufficient access to contraception
• Maya Kulycky
• Teresa Njeri
• Juzoor (Roots) Foundation for Health and Social Development
• Kuban Medical School
• Al-Maqasid Hospital
• Performing circumcisions on boys
• Being the only female doctor
• Male doctors not accepting a female colleague
• Not being accepted by female nurses, who were used to working with male doctors.
• Growing up at home with her family
• At Kuban Medical School in Russia
• When she began practicing at Al-Maqasid Hospital in Jerusalem
• Working in Palestinian refugee camps
• Her family valued knowledge
• Her family included boys and girls to go to school alike
• Her mother never spoke about marriage
• She observed her aunts moving abroad to study
• The importance of the economic, social, and psychological determinants of health
• The value of privatized pharmaceutical research
• The importance of technology in treating neglected tropical diseases
• Shelters women who are victims of violence
• Offers them legal assistance
• Refers their cases to the police
• Refers them to a safe house for their protection
• Centre for Disease Control (CDC)
• Bill and Melinda Gates Foundation
• Enlisting only nurses who are mothers
• Recruiting only female doctors
• Enlisting HIV-positive mothers to counsel pregnant women about how testing and medication can ensure that babies are born healthy
• Providing foreign women health practitioners to carry out capacity-building workshops
• Experience a sense of purpose
• Participate in a community with other HIV-positive mothers
• Assume leadership roles amongst their peers
• Earn a salary and work experience
• Answer E (all except for A) is correct. The chapter states that biological differences (answer A) are lesser determinants of health inequalities. Instead, poverty and gender discrimination (B), adolescent marriage and childbearing (answer C), and cultural preferences for sons (D) are listed as factors that exacerbate gender inequality in health.
• The correct answer is E. The vast majority of the world’s maternal deaths take place in South Asia and sub-Saharan Africa (both A and B are correct).
• The correct answer is Afghanistan (answer D).
• The correct answer is all of the above (answer E).
• The correct answer is E (answers A, B, and C).
• The correct answer is the Global Health Initiative (answer C). The Bill and Melinda Gates Foundation is a private foundation (answer A), and mothers2mothers (answer B) was funded by the Global Health Initiative. PEPFAR (answer D) was the response to HIV/AIDS initiated by President George W. Bush in the year 2000.
• The correct answer is D (insufficient access to contraception). While staying in school (answer A), delaying first births (answer B), and practicing family planning (answer C) all illustrate progress in women’s health, many women still do not have access to contraceptives (answer D).
• The correct answer Salwa Al-Najjab (answer C). Maya Kulycky (answer A) is the global communications manager at mothers2mothers and Teresa Njeri (answer B) was a participant in the mothers2mothers program.
• The correct answer is the Juzoor (Roots) Foundation for Health and Social Development (answer A). The Kuban Medical School (answer B) is where Al-Najjab earned her medical education in Russia and the Al-Maqasid Hospital (answer C) is a Jerusalem-based hospital where she began practicing medicine.
• According to Al-Najjab, the hardest thing about practicing medicine at Al-Maqasid hospital was also not being accepted by female nurses who were used to dealing with male doctors (answer D). Discrimination experienced by being the only female doctor (answer B) and being seen as less professional by her male colleagues (answer C) were also significant challenges, but not having the support of female nurses was especially difficult.
• Al-Najjab first experienced discrimination when she began practicing at the Al-Maqasid Hospital (answer B).
• Al-Najjab realized the importance of the economic, social and psychological determinants of health (answer A).
• The correct answer all of the above (answer E).
• Answer D is correct. Mothers2mothers is not funded by the Bill and Melinda Gates Foundation. The funders for the mothers2mothers program include USAID (answer A), PEPFAR (answer B), the CDC (answer C), and the Elton John Aids Foundation (answer E).
• 22 million is correct (answer C).
• Mothers2mothers enlists HIV-positive mothers to counsel pregnant women about how testing and medication can ensure that babies are born healthy (answer C). The program does not enlist only nurses who are mothers (answer A), recruit only female doctors (answer B), or recruit international women health practitioners to run capacity-building workshops (answer D).
• The correct answer is 92% (answer D).
• The correct answer is 97% (answer D).

Discussion Questions

• What are some of the structural health factors influencing the differing levels of poor health among men and women? How is women’s health issues affected by politics and culture?
• How do gender norms influence the way health is viewed and discussed?
• What encouraged Salwa Al-Najjab to pursue a career in medicine?
• What did Salwa Al-Najjab realize about health during her tenure at the Al-Maqasid Hospital?
• How does the mothers2mothers campaign build community and support among HIV-positive women?
• What are the connections between health and economic growth? What are the benefits and drawbacks of using economics and rights-based perspectives in the context of women and health?
• If technologies and knowledge to treat and prevent maternal deaths and injuries are available, why are they not reaching certain populations?
• Scholars and practitioners in the public health field have begun using the term “vertical transmission” instead of “mother-to-child transmission.” What could be the reasons for this evolution in terminology?
• Salwa Al-Najjab stated that it was “difficult to influence health policy decision makers” while she was providing medical services in Jerusalem. What does this statement demonstrate about the differences between service provision and policy advocacy? Further, what are some challenges in influencing policy change that are particular to the Palestinian context?
• The chapter states that while 75% of the world’s HIV-positive pregnant women live in 12 African countries, sub-Saharan Africa is desperately short of doctors and nurses. What are the reasons for this? (You will have to look outside of the text.)

Essay Questions

• To what extent should health fall under the responsibility of the individual, and to what extent should it be under the purview of the state?
• Under which presidency was the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) implemented? (You will have to look outside of the text.) What, if any, were some challenges or oversights of the program and what were their implications in terms of gender and sexual orientation?

Bill & Melinda Gates Foundation. More information about the Bill & Melinda Gates Foundation.

http://www.gatesfoundation.org/

Courtenay, W.H. “Constructions of Masculinity and their Influence on Men’s Well-Being: A Theory of Gender and Health.” Sco Sci Med. (2000). 50(10): 1385 – 1401. Paper on the linkages between masculinity, social status, economics, and sexual orientation influence men’s health outcomes.

https://www.ncbi.nlm.nih.gov/pubmed/10741575

Diaz-Tello, F. Invisible Wounds: Obstetric Violence in the United States. Reproductive Health matters 24 (47), 56 – 64. (2016). Contributes to the growing attention to coercion of pregnant women by health care personnel in the USA.

http://www.sciencedirect.com/science/article/pii/S0968808016300040

Institute for Health Metrics Evaluation. “Global Health Data Visualizations.” Database with graphics and visualizations allowing the user to compare illnesses, causes, and demographics across states, regions, and globally.

http://www.healthdata.org/gbd/data-visualizations

Hickel, J.  “Neoliberal Plague: AIDS and Global Capitalism.” Al Jazeera. (2012). A critical piece on the impact of structural adjustment policies, privatization, and border security on global health, particularly the HIV & AIDS crisis.

http://www.aljazeera.com/indepth/opinion/2012/12/201212685521152438.html

Ramjee, G. & Daniels, B. “Women and HIV in Sub-Saharan Africa.” AIDS Research & Therapy 10 (30): (2013). Article expanding on the particular vulnerabilities of women to HIV & AIDS in Sub-Saharan Africa.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874682/

The World’s Women 2015. “Health.” (2015). Annually updated data and analysis on the gendered dimension of health, with indicators including HIV rates, STIs, access to information, antenatal care, and non-communicable diseases.

http://unstats.un.org/unsd/gender/chapter2/chapter2.html

Wood, S. Abracinskas, L. Correa, S. & Pecheny, M . Reform in Abortion Law in Uruguay: Context, Process and Lessons Learned. Issues in Current Policy : (2016). Examines the strategies and actors that led to passing Uruguay’s “Voluntary Interruption of Pregnancy” bill through a feminist lens.

http://www.sciencedirect.com/science/article/pii/S0968808016300428

This work ( Global Women's Issues: Women in the World Today, extended version by Bureau of International Information Programs, United States Department of State) is free of known copyright restrictions.

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• Published: 03 August 2021

Feminism, gender medicine and beyond: a feminist analysis of "gender medicine"

• Ayelet Shai 1 , 2 ,
• Shahar Koffler 3 &
• Yael Hashiloni-Dolev 4  

International Journal for Equity in Health volume  20 , Article number:  177 ( 2021 ) Cite this article

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The feminist women’s health movement empowered women’s knowledge regarding their health and battled against paternalistic and oppressive practices within healthcare systems. Gender Medicine (GM) is a new discipline that studies the effect of sex/gender on general health. The international society for gender medicine (IGM) was embraced by the FDA and granted funds by the European Union to formulate policies for medical practice and research.

We conducted a review of IGM publications and policy statements in scientific journals and popular media. We found that while biological differences between men and women are emphasized, the impact of society on women is under- represented. The effect of gender-related violence, race, ethnic conflicts, poverty, immigration and discrimination on women’s health is seldom recognized. Contrary to feminist practice, GM is practiced by physicians and scientists, neglecting voices of other disciplines and of women themselves.

In this article we show that while GM may promote some aspects of women’s health, at the same time it reaffirms conservative positions on sex and gender that can serve to justify discrimination and disregard the impact of society on women’s lives and health. An alternative approach, that integrates feminist thinking and practices into medical science, practice and policies is likely to result in a deep and beneficiary change in women’s health worldwide.

Introduction

The women’s health movement, which emerged during the 1960s and 1970s along with the second wave of feminism, recognized the female body as the vessel that mediates male dominance. Feminists demanded improved healthcare and the elimination of sexism in healthcare systems. Activists fought to empower women’s knowledge, gain control over reproductive rights, and reclaim power from the paternalistic medical community [ 1 ]. They likewise battled against the oppression of women, manifest in the denial of access to abortions and contraceptives, prostitution, sexual violence, pornography, and beauty industry standards. Later, feminists criticized the medicalization and commercialization of reproduction and labor and the exploitation of underprivileged women in the reproductive industry [ 2 ].

Feminist thinkers coined the term “gender” to differentiate between biological and social aspects of being male or female and to emphasize the role of culture and society in the construction of human sexuality [ 3 ]. Later thought problematized the biological category of sex itself, pointing to it as a social construct no less than gender [ 4 ]. Moreover, recent scientific evidence reveals that it is impossible to separate sex and gender [ 5 , 6 ], and that the dichotomy of two sexes is ignoring a more complex biological and social reality [ 7 ].

The new discipline of gender medicine (GM) aspires to examine the influence of gender on general medical issues. It argues that modern medical knowledge is based on observations and trials conducted mainly on men and that this wrong should be righted to achieve medical knowledge better suited to women [ 8 ]. The International Society for Gender Medicine (IGM) was founded in 2006 and was embraced by the European Union and the FDA [ 9 ]. It is consulted by institutions such as the Israeli parliament [ 10 ] and professional societies, for example the European Federation of Internal Medicine [ 11 ]. The IGM was granted financial resources from the European Union to promote its cause [ 12 ] and holds international conferences. Recently, medical schools introduced GM into their curricula. Since many consider the IGM to be representative of women’s health interests, it is vital to assess its views and actions and their implications for women [ 13 ]. Moreover, the recognition of GM as a discipline and its endorsement by the professional milieu is an opportunity to assess the attitude of the bio-medical world to feminist thinking and criticism. Thus, our goal was to analyze GM from a feminist perspective.

For this purpose, we reviewed scientific publications by past and present officials of IGM and of the Israeli Society for Gender and Sex Conscious Medicine (ISGSCM), listed on their websites, as well as their public appearances and press interviews. The scientific literature review included 27 articles concerning sex/gender-related issues published from 2010 until May 2020 in journals with an impact factor of 4 or more or a rank of 40 or less. In addition, we reviewed the report of the European Gender Medicine Network (EUGENMED) [ 12 ], an extensive project held between 2013 and 2015, that aimed to summarize the scientific data on gender and medicine and formulate recommendation for future policies. The popular media literature review included 24 relevant interviews and articles that were retrieved by searching the internet for entries containing the names of the IGM and the ISGSCM officials and reviewing their content. Interviews and articles in English and Hebrew, containing discussions on sex/gender and medicine, were included. Popular media publications were included in the analysis because GM has an explicit political agenda which it aims to promote also in popular venues.

Our study builds on the Foucauldian analysis of knowledge looking into the relationship between discourse and power, through the lens of the discourse of professional disciplines, in order to study the boundaries of thought used in a given time and discipline [ 14 ]. Thus, we analyzed the studied texts through the lens of power/knowledge relationships, ideology, and inequality. We formed two integrated files, one consisting of medical publications, the second of texts from the media. The texts were analyzed using a qualitative analysis method. Main themes concerning sex/gender and medicine were extracted from the texts inductively [ 15 ]. In addition, in dialog with themes in the feminist literature, we searched for what is missing in the discussion, in a deductive manner. The first two authors of the study who are MD’s read and discussed in several rounds the first medical file, identifying themes, and matching them with the relevant literature. The second file was analyzed by the third author, who is a social scientist. As a second step agreements were reached between all authors to prevent the potential bias of a single researcher and using inter-rater reliability to increase the validity of the results.

We hereby critically assess these publications in the context of current feminist thinking, noting both the topics discussed and those that were overlooked, or only seldom mentioned. After presenting our findings we discuss their implications.

Analysis of GM works

The scientific articles we reviewed focus on several subjects: Seventeen articles focused on the association between sex/gender, risk of disease and response to therapy, mainly in the field of cardiovascular diseases and related disorders [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. Two articles studied the influence of sex/gender on treatment decisions and care plans [ 33 , 34 ]; 5 articles focused on associations between sex/gender and the human brain, cognition, and mood [ 25 , 35 , 36 , 37 , 38 ] ; 2 dealt with the effect of sex/gender on working conditions and promotion in healthcare [ 39 , 40 ], 2 focused on sex/gender in medical education [ 41 , 42 ] and 1 focused on sex in preclinical research [ 43 ]. The articles we reviewed are summarized in Table  1 . The EUGENMED project summary reported on 5 working fields: 1. Sex/gender, risk of disease and treatment outcomes in cardiovascular medicine, pulmonary medicine, diabetes mellitus and psychiatry (depression). 2. Sex/gender and public health, focusing on risk factors for non-communicable diseases 3. Sex/gender in basic research. 4. Sex/gender in medical education. 5. Sex/gender and pharmacology, clinical trials and pharmaceutical regulation [ 12 ]. Each summary of a working field contained a detailed review of scientific literature and advocacy for future actions.

In the following paragraphs, we discuss the reviewed medical and popular literature according to topics raised by feminist writings on sex/gender in health/medicine.

Is it possible to separate the effect of sex and gender on health?

Although it uses the word “gender”, GM focuses mostly on biological sex, stressing biological differences between the sexes in physiological and pathological conditions. However, this division ignores human complexity and the criticism of determinist models of sex differences highlighted by feminist thinkers since the 1990s [ 3 ] and subordinates the critical concept of gender to the biological concept of sex.

Many behavioral, psychological, and social variables correlate with sex category (being female or male). It is therefore often impossible to distinguish the contribution of these factors (i.e., gender) from that of biological variables (i.e., sex) to observed health differences between women and men. In addition, gender-related behaviors and experiences were shown to affect biological qualities thought to stem from sex category, such as levels of sex hormones, making the separation between sex effects and gender effects even more difficult [ 5 , 44 , 45 , 46 , 47 ].

Indeed, many unacknowledged factors may mediate ostensibly sex-driven differences. For example, GM publications quote observational studies according to which women suffer from more cardiac sequalae after acute coronary syndrome (ACS) [ 17 , 27 ]. However, a recent study demonstrated that gender roles, such as being the primary provider, employment, and household responsibilities, rather than sex, are those associated with prognosis after ACS [ 48 ]. Gender associated behaviors were shown to influence seemingly sex related differences in osteoporosis [ 49 , 50 ] and melanoma [ 51 , 52 ]. Researchers have shown that sex related differences documented in laboratory animals can stem from behavior and living condition and not from biological differences [ 46 ]. Thus, sex differences are often caused by other variables, that correlate with the sex category. Searching for these variables and their significance to health, instead of using sex as a proxy for their values, would benefit personalized medicine [ 6 ].

Feminist researchers pointed out that research often builds on a pre-assumption that sex differences in the brain exist [ 44 ] and that arguments about alleged sex differences that echo cultural stereotypes receive public attention [ 53 ]. It was shown that sex differences in the brain are often context- related, and change with time and circumstances [ 7 , 47 ]. Of note, mothers were shown to behave differently towards male and female babies [ 54 ], implying that the brains of women and men are exposed to different stimuli from an extremely early stage of development.

While sex and gender are regarded as two separate entities [ 12 ], biological qualities of sex such as sex hormone levels are altered by gender related experiences and behaviors such as nurturing, competition and sexual activity in both men and women [ 55 , 56 , 57 ]. This suggests that social, material, and cultural factors likely contribute to some of the differences between men and women in health outcomes. It also suggests that addressing gender disparities is essential to improve health outcomes for women, and that both epidemiological and basic research should address the numerous social factors which differ between men and women. Gender disparities and their relation to health are addressed in a minority of the GM publication we reviewed [ 22 , 28 ] and are mentioned in working field 2 of the EUGENMED report [ 12 ], but the vast majority of publications do not address gender issues. The EUGENMED workshop dedicated to basic research discusses biological sex alone, and does not acknowledge the data concerning the entanglement of biological sex and gender, nor does it call for research on this subject [ 12 ]. Moreover, some IGM officials explicitly state that “gender medicine is not feminist, it’s about real science” [ 58 ], thus denying the political and scientific origins of the GM project.

Exposure to physical and sexual violence in childhood and adulthood have a profound and prolonged impact on many women’s lives. Although violence is generally under-reported, the United Nations reported in 2012 that between ten and 40% of women worldwide experienced sexual violence during their lifetime and between seven and 68% experienced physical violence [ 59 ]. Studies have repeatedly shown the association of childhood abuse with cardiovascular [ 60 , 61 ], autoimmune, metabolic diseases [ 62 ], chronic pain [ 63 , 64 , 65 ] and with mortality in women [ 66 ]. Studies discern long- lasting biological changes in abuse survivors such as increased pituitary stress response [ 67 ], increased inflammation [ 68 ] and even DNA changes such as decreased telomere length in leukocytes [ 69 ] and epigenetic changes in the brain, which can be transmitted to subsequent generations [ 70 ]. These gender-related life experiences often go unnoticed in the public sphere and in healthcare systems [ 71 ], and may mediate many seemingly sex differences in health.

Depression and anxiety are twice as common in women than in men. Abuse and violence increase the risk of depression, anxiety and post-traumatic stress disorder [ 72 , 73 , 74 ] mediated by chronic biological changes in multiple cellular and molecular components of brain function [ 75 ]. Failing to address the causative role of gender-related violence and discrimination in women’s mood disorders results in women being labeled “emotional” and “unstable”, bolstering discrimination and the silence surrounding gender-related violence. The GM studies and policies we reviewed refer to violence and childhood abuse only marginally, and do not address violence and abuse when discussing mood disorders [ 12 ]. The Israeli GM society, led by the former IGM president, states that trauma is less common in women on its webpage, reflecting a lack of understanding of the prevalence and consequences of childhood abuse and adult-life violence experienced by women [ 76 ]. Only one IGM member, Gillian Einstein, addresses violence in her scientific work [ 77 ] and public appearances.

Unfortunately, we do not fully understand the long-term health consequences of abuse and violence in women. Likewise, specific diagnostic and therapeutic interventions are not being developed. GM does not address these important issues, nor does it mention the urgent need to improve our understanding of the long-term health consequences of gender-related violence.

Some perceived sex differences in health may arise from diagnostic criteria that do not account for gender differences in manifestations of diseases. For example, depression in men may be overlooked when manifested as alcohol and substance abuse [ 78 , 79 ]. Gender appropriate diagnostic criteria of osteoporosis improves its diagnosis and treatment in men [ 80 ]. Autism in women was shown to be underdiagnosed, probably because the tendency to internalize problems and camouflage social difficulties, as well as gender appropriate repetitive interests are common in autistic females [ 81 ]. These examples demonstrate that simply focusing on sex differences in epidemiology, without considering complex interactions with gender, can result in under-diagnosis and inappropriate treatment in both men and women.

Is there a binary division between the physiology of women and men?

Dividing men and women into two biological categories with different features and qualities constituted the basis for women’s oppression throughout history [ 82 , 83 ]. Several GM publications assume the existence of biological differences between male and female brains, cognitive abilities, and emotional expressions, attributing these to biological factors such as sex hormones [ 36 , 37 ]. However, scientific evidence shows that even when a statistically significant difference in found, considerable overlap in the distribution of measurements of single variables (e.g., specific psychological qualities and cognitive abilities) between the sexes exists [ 5 , 6 , 84 ]. For example, an extensive review of 26 meta-analyses looking for sex differences in psychological and cognitive traits found that, for almost all the traits studied, differences were close to zero or small and a considerable overlap existed [ 85 ].

In addition, when multiple variables are tested simultaneously in female and male brains, a mosaic distribution of “feminine” and “masculine” qualities across variables is found [ 7 , 51 , 86 , 87 ]. This means that in an individual brain, each variable tested shows its own degree of similarity to the phenotype more common in females or in males, so that varying degrees of “femininity” and “masculinity” are found across variables in each person. Mosaic patterns were seen in brain structure on functional MRI, when assessing psychological traits by questionnaires [ 86 ], and even when assessing cellular brain structure postmortem [ 88 ]. Mosaic pattern are also seen in the effect of external stimuli, like stress, on brain function [ 89 ]. These important data shed light on the complex interactions between biological sex, the environment, and the brain, and highlight the fact that it is impossible to categorize human brains as ‘male’ or ‘female’. Of note, the groundbreaking study that delineated the brain mosaic theory was firmly rejected by the former IGM president [ 38 ].

Listening and learning from other disciplines and from women themselves

The women’s health movement empowered women to learn and share their health-related knowledge. The revolutionary book ‘Our Bodies Ourselves’, written by women for women, cherished women’s experience and challenged the authoritative position of the healthcare system. This enabled women to expose misconceptions and prejudice in medical practice. GM is practiced and discussed by physicians and scientists. In our review of GM work we did not find studies regarding women’s concerns in health, not a call for such work. While GM focuses mainly on cardiovascular health and diabetes [ 12 , 18 , 22 , 26 , 27 , 28 , 30 ], it is plausible that women from diverse backgrounds have different health concerns and priorities. The EUGENMED project involved patient’s organizations, but not feminist organizations, as stakeholders [ 12 ]. Empowerment of women regarding their health is also absent from GM discussions and recommendations.

Intersections between gender, oppression, and racial discrimination

Poverty, discrimination, economic insecurity and ethnic conflicts profoundly affect the epidemiology of common diseases and treatment outcomes [ 48 ]. These adversities generate chronic stress and affect nutrition, physical activity, exposure to pollution, access to healthcare and more. The capitalistic system generates and broadens economic inequalities between countries worldwide and within states and societies. “Black feminism” and intersectionality theory demonstrate how race, class, ability, and appearance interact with gender to generate privilege and discrimination [ 90 ]. GM publications recognize the effect of poverty and racial discrimination on cardiovascular risk [ 12 , 28 ], however a call to improve and study minority women’s health is lacking. Minority women in the US, Canada, Israel, Europe, and Australia report discrimination within healthcare systems and discriminatory institutional policies and stigmas, with negative effects on their health [ 91 , 92 ]. Gender discrimination in healthcare is suggested by the findings described in several of the studies we reviewed [ 16 , 18 , 19 , 20 , 23 , 27 ]. For example – a study found that women undergoing hemodialysis in Austria were less likely to be treated via a vascular shunt and less likely to be referred to kidney transplantation [ 16 ]. Other studies showed that women with type 1 diabetes [ 20 ] and women hospitalized for heart failure [ 27 ] were less likely to be treated per current guidelines, that women were at higher risk for acute ischemic events in a cohort of patients after cardiac catheterization [ 19 ], and that women with type 1 diabetes were more likely to suffer hypoglycemia and severe hypoglycemia when treated in clinical trials of galgarin insulin [ 18 ]. Discrimination in healthcare practices and access to medical and social services may contribute to these and other [ 23 ] findings, however only 1 article [ 27 ] mentions this possibility. A discussion regarding the need for further studies looking specifically at discriminatory practices is also lacking. Racial discrimination in healthcare is not discussed at all in the publications we reviewed, and even refuted when faced with findings regarding inadequate treatment provided to Arab minority women in Israel [ 24 ].

The “Me-too” protest against sexual violence and the “Black Lives Matter” movement reminded us that gender related violence and racial discrimination are prevalent even among seemingly liberal institutions in western societies. These uprisings share values and practices with the feminist movement, empowering women and minorities and cherishing their voices and perspectives. They teach us that real change is accomplished only by questioning the practices, interests, and power-structures of institutions.

GM has brought the issue of sex/gender and general health to the forefront of popular and professional discourse, appropriating, and mainstreaming the discussion that was initiated by the feminist women’s health movement in the 1960s. This process has obvious advantages and opportunities, such as raising awareness of health professionals, institutions, and regulatory agencies to gender differences in health, allocation of funds to research on gender and health, and better designed pharmaceutical studies. However, this mainstreaming has been accompanied by the return of professional dominance, while the voices of feminist activists go unheard. Moreover, GM ignores important scientific progress, made by feminist scientists, regarding the complex associations between sex, gender, and health. By stressing the biological division between sexes, on the one hand, and under-representing the toll of violence, oppression, ethnic conflicts, and discrimination on the lives and health of women, on the other, GM accepts conservative positions on sex and gender and reaffirms the current practices of healthcare systems worldwide. Generally, it does not posit poignant criticism to mainstream medicine, and the topics studied tend to avoid more contested health issues such as chronic pain syndromes, sexual abuse, ethnic conflict, the health consequences of beauty standards, and others.

A way forward

Feminist scientists have shown that much can be achieved by studying the mechanisms linking biology, gender, and society. A continued effort in this direction is required to improve our understanding of these mechanisms, and to implement this knowledge into clinical practice. An approach that integrates feminist epistemology and methodology into the study and practice of medicine and strives to understand the complexity of gender can improve the health of both women and men [ 79 , 80 ] worldwide. Feminist activists should work together with physicians to re- define “Gender Medicine”, prioritize research and policy topics, and participate in the design of clinical studies. Efforts should be made to listen to diverse women, learn about the health challenges they face and incorporate their priorities into policies and studies. Studies that critically examine healthcare systems and the bio-scientific world for discriminatory practices and blind spots, and studies that examine the health toll of diverse forms of gender related violence and oppression should be encouraged.

Our review of the IGM/ ISGSCM indicate that while their work focuses on sex differences, it neglects the influence of gender, namely the social aspect of being a woman or a man, on biology, physiology, and health. We found that for the most part, their writing ignores the effect of gender norms, gender-related behaviors, and gender-related violence on biology and health. Moreover, it endorses a binary vision of 2 distinct sexes with different biological qualities, while overlooking the evidence that indicate a more complex social and biological reality. Indeed, the IGM/ ISGSCM work may improve some aspects of women’s health, however we should aim to promote a wider approach to gender and medicine – one that studies complex interactions between society and biology and that tackles difficult subjects such as debilitating chronic pain syndromes, violence, and health concerns of racial minorities. We believe that integrating the achievements of the IGM, those of the feminist women’s health movement and of current feminist scientists and activists can bring about a deep and meaningful change in the health of women worldwide.

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Ayelet Shai initiated the work described in this manuscript. Ayelet Shai and Yael Hashiloni-Dolev formulated the article’s concept and defined the work’s specific goals and methodology. All authors contributed to the literature search and analysis. Ayelet Shai and Yael Hashiloni-Dolev wrote the manuscript. The author(s) read and approved the final manuscript.

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Ayelet Shai is the head of Oncology in the Galilee Medical Center. She specializes in breast cancer and gynecological malignancies and conducts bio-medical research on women’s cancers. She also studies the intersections between medicine and society. She served in the leading committee of the “women and reproductive technologies” project in the feminist organization Isha Le’Isha and is currently a fellow in the Center for Health, Law and Ethics of the University of Haifa. She is member of Israel’s National Council for Prevention, Diagnosis and Treatment of Malignant Diseases and serves on the ethics Committee of the Galilee Medical Center. She has published several articles on bio-medical research as well as medical ethics and teaches Oncology and medical ethics.

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Shai, A., Koffler, S. & Hashiloni-Dolev, Y. Feminism, gender medicine and beyond: a feminist analysis of "gender medicine". Int J Equity Health 20 , 177 (2021). https://doi.org/10.1186/s12939-021-01511-5

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In today's ever-evolving societal landscape, the imperative to address the gaping disparities in women's health cannot be overstated. Across diverse cultures and regions, women continue to grapple with multifaceted challenges that impede their access to quality healthcare services and jeopardize their overall well-being. From the intricate realms of reproductive health to the relentless battle against chronic ailments, women navigate through a labyrinth of obstacles that often overshadow their health prospects. Nevertheless, the path towards rectifying these inequities lies in the […]

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The voyage through women's health is akin to navigating a labyrinthine landscape, where each twist and turn reveals new challenges and opportunities for growth. From the earliest whispers of adolescence to the seasoned wisdom of menopause, women embark on a journey marked by trials and triumphs that shape their physical, emotional, and mental well-being. As we embark on this odyssey, it becomes apparent that understanding the multifaceted nature of women's health is paramount in crafting effective solutions to address the […]

The Cornerstone of Health and Equality: Reproductive Health and Rights

The discourse surrounding reproductive health and rights remains prominently featured in global health and human rights dialogues, emblematic of a pivotal domain where healthcare, gender parity, and human rights converge. This sphere encapsulates an array of concerns encompassing access to contraception, maternal healthcare, family planning services, abortion rights, all working towards the overarching aim of diminishing maternal mortality and morbidity rates on a global scale. Each facet assumes a pivotal role in enabling individuals to lead more robust, self-determined lives, […]

Addressing the Shadows: the Fight against Violence Towards Women

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Women’s Health, Essay Example

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Political, Social, and Sociocultural Influences on Women’s Health

Introduction

Birth control is a complex political, social, and sociocultural issue throughout modern society, as it represents a challenge to the religious beliefs of some politicians and what they represent. Furthermore, religious concerns regarding birth control also influence societal norms and expectations. Birth control is also an issue from a sociocultural perspective, as it is perceived differently across cultures. The challenges of birth control in the modern era are typically based on religious grounds, but they also demonstrate the varied perspectives regarding this issue and its impact on women, men, and families. The healthcare industry also has its own approach to birth control, which is also influenced by the aforementioned factors. These issues represent a number of controversies for many individuals with respect to their personal choices regarding family planning and other matters. Birth control continues to make headlines for its influence on couples and reproductive rights.

Although contemporary approaches to birth control have been in existence for many decades, modern politicians often challenge the right and freedom to use birth control as a preventative measure in conceiving children (Gerhart, 2012). Politicians often argue that birth control should not be provided as part of health insurance plans, particularly for employees working for religious organizations (Abdullah, 2012). These factors are significant because they impact political strategies and support for election and reelection campaigns, particularly if political hopefuls support measures involving birth control (Abdullah, 2012). This is a politically charged issue that continues to be influential in the lives of many women and men, many of whom seek to engage in sexual activity without the burden or responsibility of pregnancy (Abdullah, 2012).

In a social context, birth control is a public health matter because it supports the prevention of pregnancy, which contributes to improvements throughout the population (Sawhill and Karpilow, 2013). In particular, those persons in disadvantaged populations are likely to benefit from birth control choices because they favor the prevention of unwanted pregnancies that are financially difficult to sustain (Sawhill and Karpilow, 2013). Furthermore, birth control is a sociocultural matter because it may be discouraged in some cultures whose sole purpose of sexual intercourse is to bear children (The Guardian, 2011). These factors contribute to the overall direction of birth control matters in the modern era, particularly when social agendas are at work (The Guardian, 2011). It is also expected that sociocultural needs and expectations have a significant impact on outcomes associated with birth control in the modern era, particularly as healthcare organizations are influenced by political expectations and sociocultural norms that impact health in today’s society. These factors are essential to discussions regarding the needs of women, men, couples, and families in today’s complex society.

Birth control continues to be a significant and highly controversial issue in many communities due to its politically charged platform. In addition, its social impact is evident and plays a role in matters involving public health. Finally, sociocultural needs and expectations are significant indicators of personal preferences regarding birth control and its influence on individuals. Each of these focus areas has a significant impact on matters involving birth control and the ability to have the freedom to choose whether or not birth control is the appropriate option. Those who choose birth control should not be chastised or discriminated against on the basis of this practice, nor should those who choose not to use birth control experience the same fate. These factors are critical in the development of new directions that have an impact on societal norms and expectations in today’s complex society.

Abdullah, H. (2012). Why birth control is pushing political buttons. Today, retrieved from http://www.today.com/id/46500633/ns/today-today_news/t/why-birth-control-pushing-political-buttons/

Gerhart, A. (2012). Birth control as election issue? Why? The Washington Post, retrieved from http://www.washingtonpost.com/national/health-science/birth-control-as-election-issue-why/2012/02/17/gIQASW6kPR_story.html

The Guardian (2011). Socio-cultural barriers to family planning. Retrieved from http://www.theguardian.com/journalismcompetition/2011-theme-family-planning

Sawhill, I.V., and Karpilow, Q. (2013). Three facts about birth control and social mobility.  Brookings, retrieved from http://www.brookings.edu/blogs/social-mobility-memos/posts/2013/10/31-three-facts-about-birth-control-and-mobility-sawhill-karpilow

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FPsim: an agent-based model of family planning

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npj Women’s Health is an online open-access journal dedicated to publishing high-quality, peer-reviewed content on all aspects of women’s health throughout the lifespan, including adolescent, sexual, reproductive, maternal/newborn, midlife, and geriatric care.

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Women’s Health Services Analysis Essay

Analysis of faith & main primary marketing research results, secondary research article summary, additional information for research, incorporating demographics and feedback.

From the market research done by Faith & Main, East Chestnut Regional Health System (ECRH) faces competition from a for-profit healthcare provider known as Banford Medical Center (BMC) due to unstable leadership, and the CEO of BMC is using the opportunity to his advantage to take market share from ECRH. ECRH also has challenges related to marketing and making sound strategic long-term goals to address women’s healthcare (Berlin, 2021). Still, ECRH has managed to maintain its clients by purchasing land across the interstate from BMC and is building an oncology center. Additionally, ECRH has an orthopedic hospital and two ambulatory surgical centers, which have emerged in the hundred best hospital list. Lastly, ECRH has also ventured into a collaborative community imaging center, medical school, and hospital, giving it a market advantage.

The first article, “The Broad Spectrum and Continuing Needs for Women’s Health,” highlights the diversity by which primary healthcare has taken with the motive to improve care for women (Binns et al., 2022). The diversity is experienced with the development of modern scientific medicine, addressing anemia, nutrition, and climate change. The article supports Faith & Main consultants since it highlights the women’s service line improvement as one of its major strategic plans. Additionally, in the article “Ten Years Later,” Texas Legislature has made various advances to increase funds to support women’s healthcare, such as access to physicians. (Berlin, 2021). The article, in this case, supports Faith and Main Consultants’ findings since ECRH plans to recruit physicians to improve services received by women.

In the third article, “Health Literacy,” the author addresses the need to promote health literacy and health-promoting behaviours (Yusefi et al., 2022). Women should therefore be educated to make sound decisions about their health. The article supports Faith &Main Consultants since ECRH plans to use its marketing team to communicate to women consumers and address women’s health through social media platforms hence creating literacy. From this relation between ECRH and the articles, Faith & Main consultant needs to conduct additional primary market research to help establish if the strategies proposed and marketing plans are effective to help address women’s health.

The research should be able to highlight the common health risks in women and their prevalence. In such a case, it is easier to research women’s health based on underlying factors. This can create a wider perspective on which technology and medicine can be invested in and how to market the various health issues affecting women.

The techniques used in this kind of case study are interviews and surveys. The interviews, in this case, should be conducted in healthcare facilities to collect data on challenges women encounter while accessing healthcare. The survey should be conducted in small, medium, and large cities to achieve a period survey. In this case, the data will be analyzed using descriptive and inferential statistical methods. The techniques, in this case, are recommended because they are simple to use and are a source of first-hand information. The methods would therefore be the most efficient and effective since they take a shorter time and is a cheap method to use.

Demographics and feedback can help design products, know what services to offer, and brand consumer healthcare preferences. For example, knowing a patient’s ethnicity can help personalized conversations and offer them the required services. Also, a design or brand can be innovated or improved to fit a consumer’s interests through feedback. Lastly, demographics and feedback can also be used to know which gender appreciates a brand and hence can be used in decision-making to devise ways for a product, design, or service to be acceptable to all genders.

Berlin, J. (2021). Ten years later: Tma advocacy nets investments in women’s health. Texas Medicine , 117 (12), 32–34.

Binns, C., Lee, M. K., & Wren, L. (2022). The broad spectrum and continuing needs of women’s health. In International Journal of Environmental Research and Public Health (Vol. 19, Issue 3, p. 1446). MDPI.

Yusefi, A. R., Barfar, E., Daneshi, S., Bayati, M., Mehralian, G., & Bastani, P. (2022). Health literacy and health promoting behaviors among inpatient women during COVID-19 pandemic. BMC Women’s Health , 22 (1), 1–10.

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Protecting and Advancing the Health of Women Through Policy, Research, Education and Outreach

By: Robert M. Califf, M.D., Commissioner of Food and Drugs and Kaveeta P. Vasisht, M.D., PharmD, Associate Commissioner for Women’s Health and Director of the Office of Women’s Health

Thirty years ago, the U.S. Food and Drug Administration’s Office of Women’s Health (OWH) was established to promote the inclusion of women in clinical trials and to provide leadership on topics related to the health of women. Since its inception in 1994, OWH has been at the forefront of ensuring that the unique health needs of women are prioritized through a multifaceted approach that encompasses policy, research, education, and outreach. In 2024, the office celebrates 30 years of service and paving a pathway to promote and support advancements in the health of women. 

Advancing the Health of Women Through Policy and Research

OWH continues to focus on conducting and driving groundbreaking research initiatives. This commitment to women’s health research has led to the agency funding over 450 intramural and extramural research projects. Recent projects include studies to evaluate the application of machine learning algorithms to the management of postpartum hemorrhage, improve the diagnosis and treatment of women with myocardial ischemia and non-obstructive coronary artery disease, and develop a database collating pharmacokinetic information on pregnant people. Research has shown that biological differences between males and females can influence various aspects of health and response to treatment. By advocating for Sex as a Biological Variable (SABV) in research design, analysis, reporting and education, the research efforts help to fill critical knowledge gaps and make changes in regulatory policy and improvements for women.

Furthermore, OWH has been instrumental in promoting diversity and the inclusion of women in clinical trials through its Diverse Women in Clinical Trials initiative. The initiative raises awareness about the importance of the participation of women of different ages, races, ethnic backgrounds, abilities, and those with chronic illnesses and health conditions in clinical trials. Although advancements have been made over the years, opportunities remain to further this progress. The office supports the agency’s efforts to improve clinical trial diversity and the representation of women in clinical trials. This emphasis on inclusivity not only enhances the scientific rigor of clinical research, but also ensures that health care interventions are relevant and effective for all. 

OWH also champions better health outcomes on conditions that disproportionately, differently or uniquely impact women. Of particular importance is maternal health—the office strives to understand and address critical knowledge and research gaps to improve maternal outcomes. Additionally, the office maintains a list of available Pregnancy Exposure Registries —studies that collect health information on exposure to medical products such as drugs and vaccines during pregnancy. This effort aims to increase awareness of opportunities to participate in this research and ultimately enhance the understanding of medication and vaccine safety during pregnancy.

The OWH Research Fellowship Program, launched in 2020, continues to advance women’s health. The program promotes research collaborations among FDA experts, research fellows, and OWH within FDA’s intramural research environment, to address critical regulatory science knowledge gaps. The research fellows studied sex differences in response to medicines that treat HIV and Hepatitis C and sex differences in cannabinoid use and response. The program plays a vital role in addressing disparities in women’s health research and further embodies the commitment to addressing complex women’s health issues. 

Earlier this year, President Biden released an Executive Order directing a comprehensive set of executive actions to expand and improve women’s health. To support this, OWH is updating the Women’s Health Research Roadmap, outlining OWH's priority areas in which new or further research is needed and documents research collaborations, both internal and external to the agency. The purpose of this roadmap is to provide a science-based framework to address women’s health research questions and to encourage women’s health considerations across FDA’s research activities. 

Education and Outreach Promote Greater Understanding of Women’s Health Topics

OWH’s educational training and outreach initiatives help promote a greater understanding of women’s health and FDA regulated products. In recent years, OWH launched a variety of free public educational opportunities focused on topics such as: pregnancy and lactation medication information; bringing clinical research to patients; sex and gender differences in CBD use; and a public workshop to discuss the impact of menopause on drug pharmacology. When faced with emerging critical health issues, such as the COVID-19 public health emergency, the OWH team mobilizes quickly, leveraging its expertise and resources to disseminate critical information, for example by hosting webinars to discuss the impact of COVID-19 on women during the height of the pandemic.

In an effort to continually meet the needs of the public, OWH launched the Knowledge and News on Women Health (KNOWH) initiative.   KNOWH leverages high impact dynamic messaging such as creating engaging video content to effectively deliver messaging on important health topics like uterine fibroids, heart health, and diabetes to educate women on their risk of disease and complications as well as how to prevent and manage health conditions. By meeting women where they are and providing educational resources tailored to their needs, the office’s outreach and education program further protects and promotes the well-being of all women. 

OWH is committed to highlighting the unique health care needs of women, supporting women’s health research to advance regulatory science knowledge, set new directions in regulatory policy, and collaborate with interested parties to establish new standards of excellence for women’s health.

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Thirty years later, the Women’s Health Initiative provides researchers with key messages for postmenopausal women

Researchers from the NHLBI-supported Women’s Health Initiative , the largest women’s health study in the U.S., published findings from a 20-year review that underscores the importance of postmenopausal women moving away from a one-size-fits-all approach to making medical decisions. Through this lens, the researchers encourage women and physicians to work together to make shared and individualized decisions based on a woman’s medical history, age, lifestyle, disease risks, symptoms, and health needs and preferences, among other factors. These findings support the concept of “whole-person health” and published in  JAMA .  After reviewing decades of data following clinical trials that started between 1993 and 1998, the researchers explain that estrogen or a combination of estrogen and progestin, two types of hormone replacement therapies, had varying outcomes with chronic conditions. The evidence does not support using these therapies to reduce risks for chronic diseases, such as heart disease, stroke, cancer, and dementia. However, the authors caution that the study was not designed to assess the effects of FDA-approved hormone therapies for treating menopausal symptoms . These benefits had been established before the WHI study began.  Another finding from the study is that calcium and vitamin D supplements were not associated with reduced risks for hip fractures among postmenopausal women who had an average risk for osteoporosis. Yet, the authors note women concerned about getting sufficient intake of either nutrient should talk to their doctor. A third finding was that a low-fat dietary pattern with at least five daily servings of fruits and vegetables and increased grains did not reduce the risk of breast or colorectal cancer, but was associated with reduced risks for breast cancer deaths. 

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• The Women's Health Initiative trials: clinical messages
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• Major study supports safety of HRT in early menopause
• Hormone therapy for menopause doesn't reduce heart disease risk
• No need to fear menopause hormone drugs, finds major women's health study
• Researchers review findings and clinical messages from the Women’s Health Initiative 30 years after launch

Pelvic health problems are a common experience for women – our research shows why many don’t get the help they need

PhD Candidate, Pelvic Health Conditions, University of Stirling

Director of Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling

Lecturer in Psychology, University of Stirling

Disclosure statement

Clare Jouanny receives funding from an Economic and Social Research Council Studentship award from the Scottish Graduate School of Social Science.

Margaret Maxwell receives funding from the National Institute for Health and Care Research (NIHR).

Purva Abhyankar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

University of Stirling provides funding as a member of The Conversation UK.

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Pelvic health problems – such as bladder and bowel leaks, pelvic pain, heavy menstrual bleeding or vaginal prolapse – are a common experience for women . Yet despite how common these issues are and the serious effect they can have on a woman’s life, research shows that most women don’t seek help from their doctor.

To find out what stops women from seeking medical help, we reviewed existing studies on the topic. We looked at 86 studies from several wealthy countries, including Australia, the US, the UK, Ireland, the Netherlands and Sweden. Altogether, we were able to look at the experiences of over 20,000 women.

We identified three main reasons women don’t seek care for pelvic symptoms. If you’re a woman, these reasons may not come as a surprise to you. But by better understanding what stands in the way of people getting help, we hope to improve the care sufferers receive.

Stigma was the number one reason women didn’t seek help in 56% of studies. This often led to suffering for years with undiagnosed or untreated symptoms.

As one woman with urinary incontinence explained: “You don’t know why, you feel sort of ashamed, you feel embarrassed to talk about it, as if you are somehow a failure.”

Another woman who’d suffered from a pelvic prolapse, revealed: “I was embarrassed to speak to anybody … about it for a long time. But now, I regret that I did that, because I left myself to a bad stage.”

The stigma and embarrassment women experienced led many to delay seeking help for around four years on average.

2. Lack of awareness

Another reason women didn’t seek help for pelvic issues was because many didn’t know if they should – and sometimes felt afraid to.

For instance, one woman who’d experienced a pelvic prolapse said: “I did not know that happened to women … I was scared because I didn’t know what it was.”

And because of this lack of knowledge, women often assumed their symptoms were normal and not a sign of a health issue. As one woman said : “I have some good friends, and my daughter … Well, they have the same problem … It’s age. That’s all we boil it down to is age. Nothing you can do about it.”

This lack of knowledge also caused many women to ignore their symptoms when they first began or feel that getting help with these symptoms wasn’t a priority.

3. Not being taken seriously

‘You’ve got a rectocele.’ ‘What is it?’ ‘Oh, you don’t need to know.’ Well, hey, if it’s to do with you, you’re the one person who needs to know about it. You shouldn’t be sort of kept like, ‘Oh, you’re a child being a nuisance. Go away. You don’t need to know.

This quote , from a woman who’d experienced a prolapse of the wall between the rectum and vagina, encapsulates a feeling that many interviewees had – that their concerns weren’t taken seriously.

Other women also reported delays in getting care because their symptoms were trivialised by doctors. One interviewee even revealed a doctor simply advised her to “wear a Kotex” when she told them she was constantly having bladder leaks.

Even when women asked for help with symptoms, the attitudes they encountered from some doctors delayed their care. A 20-year-old woman with pelvic pain reported being told by her doctor that she should maybe “learn to live with it”. She felt this was “a bit crazy” and that she wasn’t being taken seriously.

Even when participants were taken seriously, many felt their doctors lacked knowledge and training in providing the care they needed.

Improving care

Symptoms of pelvic health problems can be isolating and difficult to cope with. Study participants talked about the effect it had on their mental health and social life.

Knowing the main reasons women don’t seek help means we can now work to find solutions and ensure women don’t miss out on early, non-invasive interventions for a range of conditions. It will also mean they don’t miss out on social and work opportunities , and may improve their body image and quality of life .

Women should be able to access information about their pelvic health and know what’s normal, what’s not, what they can do about it – and when to seek professional help. They should feel they can speak to doctors and nurses without shame or embarrassment and without being dismissed or having their symptoms trivialised. But as our research has shown, this is often not the case.

To encourage women with common pelvic symptoms to seek help, we need to raise awareness and tackle stigma. Our next step is to develop a programme to enable GPs to be more open in discussing and assessing women for pelvic symptoms. This will help to tackle the trivialising of symptoms that women experience.

If you’re experiencing any pelvic health symptoms that are bothering you, be sure to speak with your doctor, nurse or physiotherapist. Too often women wait for their doctor to ask, but you should raise your concerns as soon as you can. If you don’t feel confident saying what’s bothering you out loud, write it down.

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Mind and Body: Supporting Women's Health

For many women, particularly mothers and other caregivers, the daily juggle of family responsibilities and career demands often leads to not prioritizing our own well-being. It's not uncommon for women to put the needs of our families and jobs before our own, sometimes at the cost of our health. I certainly have done it myself, over and over again, and need to remind myself that my health is a priority – we only have one body to live in!  National Women's Health Week empowers women to take charge of our health including access to important services through our job-based health coverage.

The Affordable Care Act (ACA) makes it easier to address your health needs. For your job-based health coverage, the ACA provides access to preventive services like screenings for cancer (such as mammograms and pap tests), urinary incontinence, diabetes and interpersonal and domestic violence with no out-of-pocket cost, as well as critical health benefits such as maternity and newborn care and general well woman care. This ensures you can access these important screenings without financial barriers and receive comprehensive services at all stages of life. The ACA also mandates coverage for services including blood pressure checks, cholesterol screenings, some forms of nutritional counseling, obesity counseling, diabetes tests, help quitting smoking, lactation support, intervention and counseling for interpersonal and domestic violence, and contraception and family planning services - all empowering women to take control of our health. The ACA requires plans to provide coverage without out-of-pocket costs for medications and devices related to preventive care such as contraception medications and devices and breastfeeding equipment and supplies. These comprehensive protections explained further by the Health Resources and Services Administration Women's Preventive Services Guidelines help you prioritize your health while managing your busy life.

Your mental health is also an important part of your overall well-being. Many job-based health plans cover mental health services such as counseling and therapy. The ACA requires health plans to cover screenings for anxiety at no out-of-pocket cost. Mental health parity laws generally require that mental health and substance use disorder benefits are provided in a similar way as medical and surgical benefits in job-based health plans. When you seek treatment, you should not face barriers or roadblocks that don’t exist for medical and surgical treatments. We offer publications and resources to help women understand their benefits and protections such as Understanding Your Mental Health and Substance Use Disorder Benefits . 

During National Women's Health Week, we want women to know their health protections so they can make informed decisions and use their job-based health coverage to stay strong and healthy. We have benefits advisors who can help you understand your health benefits, answer your questions and assist if you run into problems. Reach a benefits advisor at  askebsa.dol.gov or call 1-866-444-3272 (EBSA). As we celebrate women and mothers and highlight women’s health, let's help all women feel supported and empowered to speak up about their health and health care needs, and take advantage of their job-based health coverage. It’s the greatest gift we can give to ourselves!

Lisa M. Gomez is the Assistant Secretary of Labor for the Employee Benefits Security Administration.

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A Proclamation on Women’s Health Week,   2024

     Women comprise more than half our population, but women’s health is understudied, and its research is vastly underfunded.  Too many of our medications, treatments, and textbooks are instead based on men’s needs.  As a result, women spend more of their lives in poor health — too often having their symptoms dismissed, leaving medical appointments with more questions than answers, or waiting years to get the diagnosis and treatment they need.  During National Women’s Health Week, we commit to changing that by investing in women’s health, closing the research gap, and getting every woman in this country access to the affordable, quality health care that she deserves.  

     Last year, the First Lady and I were proud to launch the first-ever White House Initiative on Women’s Health Research, pioneering the next generation of medical breakthroughs and transforming the care that women receive.  We jumpstarted this effort with an investment of $200 million to the National Institutes of Health specifically for cross-cutting research on women’s health, and I called on the Congress to deliver $12 billion more to accelerate this work.  These investments will spur much-needed research into conditions that affect women uniquely, like menopause and endometriosis, or that affect women differently or at higher rates, like heart disease and Alzheimer’s.  Further, I issued the most comprehensive set of executive actions ever to expand and improve research on women’s health, ensuring that women’s health gets integrated and prioritized across Federal agencies.  These actions will galvanize new research on a wide range of topics and help prevent, diagnose, and treat women’s health conditions once and for all.  Meanwhile, the Advanced Research Projects Agency for Health is investing $100 million in its first-ever “Sprint for Women’s Health” to radically accelerate the next generation of discoveries.

     Early in the Administration, the First Lady and I re-ignited the Cancer Moonshot initiative to end cancer as we know it — building a future where the one in three women who will be diagnosed with cancer in their lifetimes have access to the best treatments and care.  Screening is an essential tool for survival; my Administration has boosted funding for breast and cervical cancer early detection and other diagnostic services for low-income Americans and those who do not have adequate insurance so everyone can access life-saving preventive care.  We are also funding new research into heart disease — the top killer of women in America — while enacting a national strategy to help everyone access healthier food and get more exercise.  

     Health care should be a right in America, not a privilege.  As Vice President, I helped pass the Affordable Care Act, expanding coverage to millions of women and guaranteeing that no one can be denied health insurance due to a pre-existing condition or pregnancy.  It also ensures that important preventative services, like Pap smears and mammograms, are covered.  As President, I am not only protecting the Affordable Care Act — I am strengthening it, saving millions of working families an average of $800 per year on their health insurance premiums.  We are also cracking down on junk insurance so that people are not scammed into low-quality coverage.  We finally secured Medicare the ability to negotiate lower prescription drug prices.  We have slashed the cost of insulin for seniors on Medicare to just $35, down from as high as $400.  Starting next year, we are capping out-of-pocket prescription drug costs at $2,000 per year for 30 million women on Medicare, even for drugs that can cost many times that amount.

     Even as we have made progress in expanding access to care and lowering health care costs, the threat to women’s reproductive health is greater today than at any time in generations.  In the wake of the Supreme Court overturning Roe v. Wade, millions of women live in States with dangerous abortion bans that put women’s health and lives at risk, force them to travel out of State for care, and threaten doctors with jail time.  We are seeing threats to a broad range of reproductive health care, from contraception to fertility services, undermining women’s ability to make decisions about their own futures and families.  These are the most personal and private health care decisions that a person can make and should be left to a woman and her doctor, not to politicians.  I have signed three Executive Orders to protect access to reproductive health care and will continue to take action to defend reproductive freedom.  I will continue to call on the Congress to send me a bill supporting the right to choose.  I will sign it and restore Roe v. Wade as the Federal law of the land. 

     We have also taken steps to protect the health and lives of our Nation’s mothers, and data shows that rates of maternal mortality are decreasing across the country.  Thanks to Vice President Kamala Harris’ efforts, 46 States now ensure access to Medicaid postpartum coverage for 12 months after childbirth.  We will continue to work toward guaranteeing access to essential care before, during, and after childbirth so that we can finally end the unconscionable maternal mortality crisis that we have in this country today.  To support new moms struggling with postpartum depression, anxiety, or a substance use disorder, my Administration has launched the National Maternal Mental Health Hotline so that mothers can get confidential help from a professional right away by calling 1-833-TLC-MAMA.  

     Meanwhile, we are supporting the healing and recovery of domestic and sexual violence survivors.  I wrote the original Violence Against Women Act years ago; today, we are bringing its funding to record levels, supporting shelters and rape crisis centers, addressing the needs of LGBTQI+ people and other underserved groups, and broadening protections for survivors. 

     This Women’s Health Week, I encourage women across America to make their health a priority, and I promise that we are making it a national priority as well.  To realize our potential as a land of possibilities, we have to protect and support the health of every woman and girl in our Nation and build a health care system that puts women, their lives, and their lived experiences at its center. 

     NOW, THEREFORE, I, JOSEPH R. BIDEN JR., President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim May 12 through May 18, 2024, as National Women’s Health Week.  During this week, I encourage all Americans to join us in a collective effort to improve and support the health of women and girls and promote health equity for all.  I encourage all women and girls to prioritize their health and catch up on any missed screenings, routine care, and vaccines.

    IN WITNESS WHEREOF, I have hereunto set my hand this tenth day of May, in the year of our Lord two thousand twenty-four, and of the Independence of the United States of America the two hundred and forty-eighth.

                        JOSEPH R. BIDEN JR.

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One of the budget papers will be all about women. Here's what you need to know

For the fourth consecutive year, the pile of budget papers deposited on the desks of journalists this afternoon will contain a booklet dedicated exclusively to women.

Inflation is making everything more expensive, including  essentials women can't avoid buying.

On top of that, on average women are  earning less than a man in the same sector and doing more of the work that they don't get paid for at home too.

And that's before you get to facing an increased risk of violence  and chronic shortages of essential products women need.

For women of colour, those with disabilities or from low-income backgrounds, these problems are even greater.

The booklet will detail how the government plans to improve their lives and how particular measures will help 51 per cent of the country's population.

But how much of a difference will that actually make to most women? And what do we know about what's already inside?

Shout-out to the ladies

The Women's Budget Statement, first introduced in the 1980s by the Hawke government, was a longtime fixture of budget day. It was then stopped by the Abbott government, resumed in the last years of the Morrison government, and has been a consistent feature under the Albanese government.

Most budget measures are not specific to women, so the women's budget statement is often used as a place for the government to spruik the ones that stand out as benefiting them, or to reframe general policies in terms of their benefit to women.

For example, the first item mentioned by Treasurer Jim Chalmers in a Mother's Day message about the women's statement was "a bigger tax cut for more than 90 per cent of women", a cut which also applies to men.

But the Albanese government has also used the statements to highlight targeted changes to address economic gender equality.

Super on paid parental leave

As first announced on International Women's Day, the government will pay superannuation on the publicly funded Paid Parental Leave (PPL) scheme starting in the 2025-26 financial year.

That's a proposal the government says will help close the gender gap in retirement incomes, since the vast majority of the 180,000 who receive the payment every year are women.

Labor first promised the move at the 2019 election, then ditched it at the 2022 election owing to its cost. Previous modelling suggested it would cost about $200 million a year, but the government confirmed on Sunday it would cost $623.1 million a year.

That's in part because the government is in the process of increasing the number of weeks that can be accessed under the scheme, up to 26 by 2026. There will also be incentives for parents to share more leave.

Higher wages in aged care and child care

The budget will also provision a "multi-billion-dollar" amount for higher wages in two female-dominated workforces, aged care and child care.

In both cases, its hand has been forced by the Fair Work Commission (FWC), which approved a pay rise for aged care workers in 2023 and is expected to do the same for childcare workers in June. The government supported both cases before the FWC.

Other female-dominated workforces will get support targeted at the trainee level through the introduction of paid placements in teaching, nursing, midwifery and social work courses, each to the value of $319.50 a week and benefiting an estimated 73,000 students.

But Students Against Placement Poverty has criticised the measure as insufficient, saying the commitment amounts to about $8 an hour for a full work week, and many students will miss out because it's means-tested.

Beyond that, the government has pointed to a range of general measures which will disproportionately benefit women, such as the decision to reduce indexation of HELP debts and other student loans, since 58.5 per cent of outstanding debt is held by women.

Endometriosis funding

The government has already announced that longer specialist consultations for women with endometriosis and other complex gynaecological conditions such as chronic pelvic pain and polycystic ovary syndrome (PCOS) will now be covered under Medicare from July next year.

Two new rebates will be added to the Medicare Benefits Schedule, enabling extended consultation times and increased rebates for specialist care.

The $49.1 million investment is expected to provide about 430,000 more services to women across the country.

Including this new funding, the federal government has committed a total of $107 million in endometriosis support for women since coming to government, including by establishing endometriosis and pelvic pain clinics across the country and providing funding for research and awareness.

They've also flagged a scholarship fund to encourage nurses and midwives to get a higher qualification so they have the power to prescribe, order pathology and give their patients referrals.

The Primary Care Nursing and Midwifery Scholarship Program will run for four years, costing the government $50 million.

In May 2023, a Senate inquiry found women around Australia were facing major challenges to accessing abortion, contraception, pregnancy and birth care.

Health Minister Mark Butler and Assistant Health Minister Ged Kearney said a recent Senate inquiry into access to reproductive and sexual healthcare would help inform how those commitments would be reached.

The government's response to the report's recommendations is now nearly a year overdue.

Violence against women and their children

The government has promised additional measures to support women's safety, building on the already-announced $915 million over five years to make permanent a trial program which has seen women fleeing violence paid up to $5,000 in financial support.

But this has been heavily criticised as not going far enough to protect some of those most vulnerable to violence because it only covers violence by an intimate partner — not a carer or family member.

Women with disabilities say they're being left behind , while the federal government says they should approach Centrelink or the NDIS  if they're being abused by a carer.

And Social Services Minister Amanda Rishworth has said the government has no plans to expand that eligibility.

Treasurer Jim Chalmers has also said there will be "additional steps" on welfare payments, the level of which is often identified as a barrier to women seeking to leave violent relationships.

But it's not clear whether this will include an increase to the JobSeeker unemployment benefit or the Single Parenting Payment.

Instead, the government has hinted it is likely to increase the more narrowly available Commonwealth Rent Assistance payment.

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