intro to women's health

1. Chapter 1
Introduction to
Women’s Health

2. “The medical model is still male in many ways.
Women have been ignored far too much. This
has gone on too long. It’s traditionally been that
human chemistry and physiology were male
until proven otherwise. Women will make a
revolution in health care.”
“—Kathryn C. Benjamin, MD
Past President
American Medical Women’s Association

3. Historical Dimensions:
Women’s Health Movement (1 of 7)
• 1830s and 1840s: The
Popular Health Movement
• 1861 to 1865: The Civil War
• 1873 to 1890s: The Women’s
Medical Movement
– First training schools for nurses
– Women attending medical
schools Elizabeth Blackwell was responsible
for the opening of several medical
schools for women in the mid-1800s.
Courtesy of National Library of Medicine.

4. Historical Dimensions:
Women’s Health Movement (2 of 7)
• 1890s to 1920s: The Progressive Era
– Women gained the ability to vote (19th
Amendment).
– Women did not gain equal rights (Equal Rights
Amendment has yet to be passed).
– Birth control movement began: The first birth
control clinic opened in New York City, but
clinics remained rare and birth control (even
talking about it) was mostly illegal.

5. Historical Dimensions:
Women’s Health Movement (3 of 7)
• 1930s to 1950s: World War II,
Postwar Years
– Women entered the
workforce during WWII, but
often lost their jobs when the
war ended.
– The Kinsey Report: Nearly
6000 women interviewed
about their sexual behaviors.
Conclusion: women have
sex!
The number of women employed
in the United States increased by
50% during World War II. Many of
these women were forced to leave
their jobs when the war ended.
Courtesy of the National Park Service.

6. Historical Dimensions:
Women’s Health Movement (4 of 7)
1960s to 1970s: The
Grassroots Movement
– FDA approval of
birth control pill
– Civil Rights Act
– Title VII
– Congressional
Caucus for
Women’s Issues
During the 1960s and 1970s, women
challenged the authorities on many issues
regarding gender equality.
© Creatas

7. Historical Dimensions:
Women’s Health Movement (5 of 7)
• 1980s: Changing Public Policy
– Office of Research on Women’s Health
(ORWH)
• The Women’s Health Equity Act
– Money for health research:
contraception, infertility, breast and
ovarian cancer
– Medicaid coverage of Pap smear
screening and mammography

8. Historical Dimensions:
Women’s Health Movement (6 of 7)
1990s: Women’s Health at the Forefront

9. Historical Dimension:
Women’s Health Movement (7 of 7)
2000–2010
• Human genome
• Women’s Health Initiative findings
• Improved HIV/AIDS medications and care
• Public health programs
• Inclusion of children in clinical trials
2010s
• Health insurance debate remerges, PPAC
passes—after delays and compromises—and then
faces a conservative backlash
• #MeToo movement

10. Feminism (1 of 2)
• First wave: Late 19th and early 20th century,
suffragists and abolitionists.
• Second wave: 1960s and 1970s, specific, often
political injustices and inequalities
• Third wave: 1980s and 1990s, examining all areas of
society from a feminist perspective
• Fourth wave: Building on third wave, while slowly
becoming more inclusive with regards to race, sexual
orientation, and gender identity
The idea that women should have the same political,
economic, and social rights and opportunities as men

11. Feminism (2 of 2)
Fourth wave: ??
• What is does being a feminist mean today?
• Do you consider yourself a feminist?
• How can feminists today learn from previous
generations?
• How is being a feminist easier than it was 20 or 50 years
ago? How is it more difficult?

12. Political Dimensions of
Women’s Health
• Policy making
• Financing
• Protecting the health of the public
• Collecting and disseminating information about
health and healthcare delivery systems
• Capacity building for population health
• Managing of health services

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

14. Office of Research on
Women’s Health (ORWH)
• Oversees women’s health research within the
National Institutes of Health (NIH)
• Research on women’s health is important!
– Women get different diseases from men.
– The same diseases affect men and women
differently.
– Social and cultural factors affect the health of
men and women in different ways.
• The ORWH works to make sure that women are
enrolled in research, that research investigates
diseases and conditions that affect women, and that
women are represented as researchers.

15. Investment in
Biomedical Research
• Increased life expectancy
• Improved health throughout life span
• Decreased cost of illness
• Increased understanding of biological,
psychological, and sociological factors
• BUT… Other methods of improving women’s
health and quality of life are underused and
underfunded in the United States

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

17. 10 Gender-Related Differences (2 of 3)
Conditions Women vs. Men
4. Smoking • More negative effect on CV health
• Less successful in quitting
• More severe withdrawal symptoms
5. Sexually
transmitted
infections (STIs)
• 2 times more likely to contract a
STI
• 10 times more likely to contract
HIV
6. Anesthesia • Wake up more quickly (7 minutes
vs. 11 minutes)

18. 10 Gender-Related Differences (3 of 3)
7. Drug reactions • Different reactions and side
effects with antihistamines and
antibiotics
8. Autoimmune
diseases
• Three of four sufferers are
female
9. Alcohol • Lower production of gastric
enzymes
• Higher BAC
10. Pain • Higher effectiveness of kappa-
opiates

19. Types of Research Studies
• Descriptive studies
– Population or correlational studies
– Individual studies
• Analytic studies
– Observational studies
o Retrospective
o Prospective
– Intervention studies
o Clinical trials

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

21. Reproductive Rights
National
January 22, 1973
– Roe v. Wade: legalized abortions in most
circumstances
– However…some states have since added laws
restricting when and where abortions can take
place, greatly limiting access
International
Mexico City Policy/“Global Gag Rule”(repealed in
2009): Foreign family planning agencies may not
receive U.S. assistance if they provide certain
services related to abortion.

22. Access Barriers to Healthcare
Providers, Services, and Health
Information (1 of 2)
• Low socioeconomic status
• Lack of health insurance
• Lack of access to healthcare facilities and services
• Language barriers and illiteracy
• Unfair treatment by medical personnel due to race,
ethnicity, or sexual orientation

23. Access Barriers to Healthcare
Providers, Services, and Health
Information (2 of 2)
• Inability to pay for costs of treatment, medications
• Decline of coverage for healthcare costs deemed
experimental
• Fear of doctors leading to avoidance of health
care

24. Global Perspective on
Women’s Health (1 of 2)
• Global threats to women’s health
– Poverty
– Underweight and malnutrition
– HIV/AIDS
– Violence
– Maternal morbidity and mortality
• Violation of human rights
– Domestic and societal violence
– Female genital mutilation
– Honor killings
– Trafficking
– Barriers to reproductive health services

25. Global Perspective on
Women’s Health (2 of 2)
World Conferences for the Advancement of Women
• 1975: World Plan of Action
• 1980: Convention on the Elimination of All Forms of
Discrimination Against Women
• 1995: Greatest Obstacles to Women’s
Advancement
• 2000: Women 2000—Gender Equality,
Development, and Peace for the Twenty-First
Century