Ch. #1 Intro To Women's Health

Investment in Biomedical Research

READ GIDDENS

Elizabeth Blackwell

responsible for the opening of several medical schools for women in the mid-1800s

feminism

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

The Health Movement

- 1830's-1840's - small groups of women began advocating taking an active role in preventing disease and staying healthy, rather than relying on formally trained physicians for treatment. - focused on eating a proper diet, the elimination of the corset, and periodic sexual abstinence in marriage to control family size. - Elizabeth Blackwell entered medical school in 1847 and prompted the opening of several medical schools for women. - 1848 the first women's rights convention marked the official beginning of the women's rights movement.

The Civil War

- 1861- 1865 - The Civil War prompted many women to volunteer as doctors and nurses; some women even disguised themselves as men to tend to wounded soldiers on the battlefield - Dorothy Dix and Clara Barton leed a national effort to organize a nursing corps to care for the war's wounded and sick. - Women's participation in the war led to the opening of the first training schools for nurses in 1873 - the relationship between male doctors and female nurses mirrored the domestic sexual division of labor, with males as the authority figures and females as the subordinates

The Progressive Era

- 1890s-1920s - 1920: the 19th amendment to the U.S. Constitution that guaranteed women the right to vote was ratified - The National Women's Party, formed in 1917, proposed the Equal Rights Amendment which to this day remains unratified. - Margaret Sanger and other activists pushed to legalize birth control - 1916, Margaret Sanger opened the nation's first birth control clinic in Brooklyn and was arrested shortly afterward for violating a federal ban on contraception. She was found guilty and sentenced. (In an appeal a judge legalized contraception but only to married couples with a doctor's prescription. - The Sheppard-Towner Act of 1921 greatly increased the availability of prenatal and child health care. This provided federal funding for programs that opened clinics for women and children, educated women about pregnancy and childbirth, and trained midwives and physicians about childbirth. This act lasted until 1929, when a conservative Congress refused to continue its funding.

World War II and Post War Years

- 1930s-1950s - Women made a vital contribution to the increased production the U.S. had during World War II - 12 million women were working when the U.S. entered the war; when it ended 18 million women were employed - When the war ended, women were pressured to leave their jobs and return to begin homemakers - Although many women were using birth control by the 1950s, popular culture still reinforced the idea that sexuality was simply a means for married couples to produce children. - the Kinsey issued in 1953, started to dispel this idea by revealing that for many men and women marriage was not a prerequisite for sex.

The Grassroots Movement

- 1960s-1970s - grassroots organizations challenged medical authority in the delivery of health care to women. These groups believed that the overwhelmingly male medical community excluded women from making decisions about their own health care. - These groups addressed issues such as unnecessary hysterectomies and cesarean sections, postpartum depression, abortion, and childbirth reform from a feminist perspective. - "Our Bodies, Ourselves" was originally published by 12 feminist activist - 1960: FDA approved the birth control pill - 1964: congress passed the Civil Rights Act which protected women against employment discrimination - 1972: congress passed the Equal Rights Amendment though it still was not ratified and added to the constitution - 1972: Title IX forced schools to provide equal funding for men and women in athletic programs. - The women's health movement had mostly been composed of middle-class white women. During the 1960s and 1970s this movement began to be more inclusive. There were many organizations that were developed to focus on issues of women of color.

1980's Changing Public Policy

- 1980s: the U.S. Public Health Service's Task Force on Women's Health Issues formed to assess the status of women's health. This Task Force issued recommendations to increase gender equity in biomedical research and establish guidelines for the inclusion of women in federally sponsored studies. - 1990: the NIH established the Office of Research On Women's Health (ORWH). The ORWH ensures women's participation in clinical trials, strengthens research on disease affecting women, and promotes the career advancement of women in science. - Women's Health Equity Act was passed allocating money to fund health research on particular areas of concern to women, including contraception, infertility, breast cancer, ovarian cancer, HIV/AIDS, and osteoporosis.

Women' Health at the Forefront

- 1990s: New women's health offices in federal agencies and in regional public health offices opened throughout the country. - 1993 NIH Revitalization Act: Congress required that women and minorities be included as subjects in all human subject research funded by NIH. - 1993: The Family and Medical Leave Act gives employees unpaid medical leave for themselves or for the care of a family member or a newborn or adopted infant. - 1994: the Violence Against Women Act mandated a unified judicial response to sexual crimes committed against women.

Major cause of death for women

- Childbirth used to be a major cause of death for women because of lack of access to family planning, the large family sizes that were often the norm. - Reductions in mortality and morbidity or injuries and deaths resulting from pregnancy and childbirth are one of the most important human achievements over the past 200 years

Global Perspective on Women's Health

- Global threats to women's health include poverty, underweight and malnutrition, HIV/AIDS, violence, and maternal morbidity and mortality. - Women are burdened by violations such as domestic violence, female genital mutilation, honor killings, trafficking, and barriers to reproductive services. - Access to clean water, nutritious food, and medical care, as well as protection from violence and poor working conditions, are basic, inexpensive factors that could greatly improve global health. - Sexist attitudes often persist in popular culture and kong those with political and economic power. Educational opportunities for women may be limited, there are often insufficient childcare support systems for women, and men may be indifferent or even hostile toward improving women's place in society.

Reproductive Rights

- January 22, 1973 the landmark Supreme Court decision Roe vs. Wade legalized abortion. Since then the battle has shifted to the state level, with many states with socially conservative governments imposing restrictions that limit where, when, and under what conditions women may receive abortions - 1984: President Reagan imposed the Mexico City policy, or "global gag rule". This rule has been particularly contentious, having been eliminated by President Bill Clinton in 1993, reimposed by resident George W. Bush in 2001, and removed once more by President Barack Obama in 2009.

Access to Healthcare Providers, Services, and Health Information

- Many factors prevent women from receiving adequate health care, including: - poverty or insufficient income to pay for care - lack of health insurance - lack of access to healthcare facilities - inability to understand medical personnel because of language barriers or illiteracy - Unfair treatment by medical personnel because of race, ethnicity, or sexual orientation - Inability to pay for the costs of medications needed for treatment - declined coverage for healthcare costs that are deemed unnecessary or experimental - fear of doctors and avoidance of seeking health care altogether - Health Insurance for underinsured americans may not cover serious illnesses or extended hospital stays, or it may require holders to pay large copayments or deductibles for health services. - Premiums for private health insurance are extremely expensive and therefore many people opt to take a chance and remain uninsured when an employer does not sponsor them.

The Women's Medical Movement

- Mid to Late 1800's - After the Civil War, educational and employment opportunities, though still severely limited, increased for women.

Political Dimensions of Women's Health

- The government role in 6 main areas in women's health: 1) policymaking, 2) financing, 3) protecting the health of the public, 4) collecting and disseminating information about health and healthcare delivery systems, 4) capacity building for population health, 6) managing of health services - the federal government ensures that the food supply is safe, provides highway funding for states that adopt a legal drinking age, and regulates businesses that provide medications to the public. - The Department of Health and Human Services Office on Women's Health (DHHS-OWH) serves as the coordinating agency for women's health initiatives throughout the agencies and offices of the U.S. DHHS including the NIH, FDA, CDC, and others. - The ORWH within NIH is the government's focal point for women's biomedical research - The ORWH encourages research that examines the biological differences between the sexes to more fully understand each and thereby enhance knowledge and practice. - U.S. DHHS also works to provide family planning services, prevent sexually transmitted infections, and reduce unintended pregnancies. - The Title X program provides funding to millions of people for reproductive health and family planning services. - The Administration on Aging has launched a resource center to educate older women about issues such as income security, housing, and caregiving. This administration also increased support for community nutrition services to combat nutrition-related illnesses in the elderly.

The 21st Century

- identification of the human genome, improvements in HIV/AIDS medications, public health programs targeting behavior-related health problems, the inclusion of children and clinical trials, and the passage of the Patient Protection and Affordable Care Act to extend health insurance to millions of women, men, and children. - There were a lot of rollbacks of the advances made in the 1990s - funding for reproductive health initiatives fell both domestically and internationally for the first decade of the 21st century - 2012: a record number of women were elected to congress, with 20 women serving in the Senate, and 80 women serving in the House of Representatives - women across the U.S. and the world continued to be victims of individual and societal violence and discrimination