Womens Health Issues Ch. 1-7

Other Forms of Contraception

Abstinence • No penis-in-vagina intercourse Withdrawal • Coitus interruptus Breastfeeding • Lactational amenorrhea method (LAM) Intrauterine device (IUD) • Small plastic object placed in uterus for 1-10 years

The Changing Face of Women

By 2030 • 1 in 5 American women will be Hispanic • 1 in 14 American women will be Asian • 1 in 4 American women will be over 65 years of age

Informed Decision Making

Considerations when choosing a health insurance plan • Deductibles- set amounts that individuals must pay out of pocket before benefits kicks in. • Benefits- different benefits insurance provides vary from plan to plan • Network- consider the implications of a restrictive network to the cost of care and access to care • Co-insurance • Emergency services • Co-payments-Fixed amounts of money a patient must pay to receive health-related goods or services.

Birth Control Vs. Contrception

Contraceptive- specific term for any procedure to prevent fertilization of an ovum Birth Control-a broad term that refers to procedures that prevent the birth of a baby Four (main) Methods of Birth control 1. Preventing sperm from entering the female reproductive tract 2. Preventing sperm from fertilizing an ovum once it has entered the female reproductive tract 3. Preventing ovulation and/or preventing the ovum from reaching the sperm 4. Preventing progression or implantation of a fertilized ovum.

Development of Organization & gov. Agencies Related to Women's Health

Department of Health & Human Services •Office of Research on Women's Health(ORWH) -FDA- need to study drugs on both women & Men -Make sure drugs don't have negative effects on women -CDC -National Institute of Health-Need to include women, minorities, & children (if possible) in clinical trials

Hormone Delivery Methods

Depo-Provera • Inject progestins every three to four months Ortho Evra • Patch worn on skin for one-week intervals; fourth week is patch-free NuvaRing • Vaginal Ring worn for three weeks and removed during week of menstruation

Early Signs of Pregnancy

Early signs of pregnancy often occur within the first 6 weeks • Missed periods(s) • Breast swelling/tenderness • Fatigue • Queasiness or nausea/vomiting • slightly elevated body temperature • Mood swings • Frequent urination

Historical Dimensions to Pregnancy

Eighteenth century • America—_________ at births • France—Childbirth moves to hospitals • England—Surgical techniques and development of instruments Nineteenth century • Physician-controlled hospital births • Interventions—Medications, anesthesia, birthing instruments Early twentieth century • Greater medicalization, hospitalization • Greater mystification of childbirth for woman • Controlling fertility Mid- to late twentieth century • Natural-birth relaxation techniques leading toward "prepared births" • 1970s: Benefits of Breastfeeding resurfaced • Childbirth = joy and knowledge vs. fear and ignorance

Important Terns

Epidemiology — Study of pattern of disease in a population Incidence — new cases of a condition that occur during a specified period of time Prevalence — The total number of people affected by a given condition at a point in time or during a period of time

Physical Health and the Gynecological Exam

Exam steps • Medical history • General physical examination - Breast examination and pelvic examination • Pelvic examination - Phase I = external examination - Phase II = use of speculum; collection of specimens - Phase III = bimanual examination

Permanent Methods

Female sterilization • Tubal ligation = fallopian tubes cut and tied - Laparoscopic sterilization - Minilaparotomy Male sterilization • Vasectomy = vas deferens cut and tied

Hormonal Changes

Fertilization • Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) produced by the anterior pituitary gland are suppressed • Pregnancy-specific hormones increase Implantation • Embryo cells secrete hCG • hCG stimulates corpus luteum to secrete estrogen and progesterone

Pregnancy: Conception

Fertilization = Sperm Cell + Egg Cell = Zygote • Sperm cell: 300 million deposited per ejaculation • Egg cell: 1 egg released per month • Dizygotic twins = fraternal twins • Monozygotic twins = identical twins 23 chromosomes from sperm + 23 female chromosomes from egg = 46 chromosomes total = ZYGOTE

Physical and Emotional Symptoms: First Trimester

First trimester • Enlarged and tender breast • Morning sickness (nausea and/or vomiting) • Extreme fatigue • Decreased interest in sex • Moodiness and irritability • Darkening of nipple and areola

Masters and Johnson: Female Sexual Response Cycle

Four Phases 1. Excitement -increased lubrication -swelling of tissue-increased blood flow 2. Plateau -clitoris hood moving back -blood flow held in area 3. Orgasm -ureteral contractions 4. Resolution -sexual system back to normal

Sex & Gender

Gender • The economic, social, and cultural attributes and opportunities associated with male or female Sex • An individual's biological status as male or female Gender identity • An individual's personal, subjective sense of being male or female

Gender role

Gender role • The public expression of one's gender identity, as well as cultural expectations of male and female behaviors - Masculine vs. feminine

Global Perspective on Women's Health

Global threats to women's health - Poverty - Underweight and malnutrition - HIV/AIDS - Violence - Maternal morbidity & mortality Violation of human rights - Domestic and societal violence - Female genital mutilation - Honor killings - Trafficking - Barriers to reproductive health services

HMO/PPO

HMO- PPO-

Public Health Insurance

Health insurance provided by gov sources including Medicare, Medicaid, Veterans Administration (VA), Department of Defense (DOD) ,Bureau of Indian Affairs

Private Health Insurance

Health insurance provided by third-party payers to individuals or employer groups either through indemnity or managed care systems

Choosing a Contraceptive

Kaiser Family Foundation Study Women found the following "very important": • Prevents pregnancy (90%) • Protects against STIs (77%) • No health risk (77%) • Is easy to use (51%) • Requires no advanced planning(45%)

Long-Term Care & Women as Caregivers

Long-term care • Annual cost for home care is > $20000 • Annual cost for nursing home care is >$75000 - Most women spend their life savings to pay for services Insurance options • Private long-term care insurance programs • Medicaid Caregiving • Often provided by women (informal caregivers) • Women caregivers suffer many negative effects - Chronic health conditions - Depression - Sleeplessness

Medicare

Medicare(65 years +)-Single largest insurer in the United States, covering almost 44.3 million people, FEDERAL Part A - Provided to all enrollees and covers inpatient care Part B - Optional and covers outpatient services Part D - Optional and covers a portion of prescription drug costs

Global Perspectives

Motherhood continues to be _ _______ ____to life and health in the developing world (most of Asia, Africa and Latin America)

Other types of Diversity

Other Types of Diversity • Incarcerated women - Drug addictions, mental health issues - Lack of regular health care • Women with disabilities - Focus of less research and clinical attention - Possible physical barriers, such as inaccessible facilities or examination equipment - Possible communication barriers

Phases of a Clinical Trial

Phase I: Tested on small group (20-80) healthy volunteers to evaluate safety, determine safe dosages, & ID safe side effects Phase II: Larger group of people(100-300) to further evaluate safety & effectiveness Phase III: Large groups in clinics and hospitals (1,000-3,000) to confirm effectiveness, monitor side effects, & compare with other treatments Phase IV: Study after drug is marketed to continue collecting info regarding side effects in various populations

Preventive Care & a Focus on Women's Health

Primary, secondary, and tertiary treatment services • Mammograms • Cervical cancer screening • Smoking cessation programs • Prenatal checkups • Universal coverage of gynecological exams • Educational services

Types of Health Insurance

Private health insurance • Purchased and subsidized by employers or individuals Public health insurance • Provided by the government - Medicare - Medicaid - Veterans Administration (VA) - Department of Defense (DOD) - Bureau of Indian Affairs

Barrier Methods: Pros/Cons

Pros: • Condoms offer protection from STIs • Can be used as backup for ___ _____(or with other methods) • Can be used for the short or long term Cons: • Small risk of _______ ________ or toxic shock syndrome for diaphragm, sponge, and cervical cap • Must be used properly • May have higher long-term costs

Reproductive Rights

Reproductive Rights •National January 22, 1973 - Roe v. Wade: legalized abortions in most circumstances - However...some states have since added laws when and where abortions can take place, greatly limiting access •International -Roe V. Wade DID NOT prevent federal gov from imposing abortion restriction in countries that receive US funding.

Sex Chromosomes

Sex of individual: XY for Male; XX for Femal Selected sex chromosome abnormalities • Turner syndrome (Monosomy X, XO) -shorter,lack ovarian development & are infertile • Triple X (XXX) -taller, normal fertility, at risk for motor/language delay • Klinefelter syndrome (Trisomy XXY) -increased height,usually infertile w/smaller testicles, possible breast development at puberty • XYY male -normal sexual function/genitalia/fertility, taller, risk for motor/developmental delay & learning disability

Sexual Orientation

Sexual orientation refers to one's erotic, romantic and affectional response to people of the same sex, opposite sex, or to both sexes • Homosexual • Heterosexual • Bisexual Issues • Homophobia • Profiling • Discrimination in medical care

Sexuality Through the Life Span

Sexuality Through the Life Span Childhood • Self-genital stimulation • Engage in play that may be viewed as sexual in nature • Curious about secondary sex characteristics Adolescence • Puberty - Menarche - primary sex characteristics - Hair growth, breast budding, vaginal walls thicken, uterus enlarges, vaginal pH increases in acidity • First intercourse average = 17.4 years Young to middle adulthood • Increasing number of single sexually active adults • Marriage at later age • Increase in the number of women who never marry • Placing career goals and advanced education before marriage • Increased divorce rate • Increase in cohabitating adults • Increase in the number of women who no longer depend on marriage to ensure economic stability Older adulthood • Climacteric—physiological changes that occur during period from female fertility to infertility • Menopause—cessation of menstruation - Vaginal dryness and thinning, delayed lubrication, hot flashes • Decline in frequency and intensity of sexual activity • Quality vs. quantity of sexual expression

Types of Barrier Methods

Spermicides -To be used with other barrier methods -Breaks down the cell membrane of sperm of a sperm to prevent pregnancy Condoms -Thin sheath that covers erect penis Female condoms -Polyurethane sheath lining entire vagina and external genitals Diaphragm, cervical cap -Dome-shaped latex cup sealing cervix

1st Wave of Feminism

Suffragists and abolitionists, late 19th, early 20th century

Abortion Procedures

Surgical abortion • Vacuum curettage • Dilation and curettage (D&C) • Dilation and evacuation (D&E) Medical abortion ("abortion with pills") • Mifepristone, misoprostol • Misoprostol alone

Physical and Emotional Symptoms: Second Trimester

Symptoms Second trimester • Morning sickness subsides • Gastrointestinal problems (heartburn, gas, constipation) • Gain majority of weight (12-14 pounds) • Breathing problems • Backache • Leg cramps and numbness/tingling of hands • Swollen and bleeding gums • Swelling of feet, hands, and ankles • Braxton-Hicks contractions

Physical and Emotional Symptoms: Third Trimester

Symptoms Third trimester • Heartburn and constipation • Leg cramps • Backache • Breathlessness • Braxton-Hicks contractions • ↑ Leukorrhea • ↑ Colostrum • Hemorrhoids • pelvic and buttock discomfort • Itchy abdomen

Fetal Development

Terms • Amnion: Fetal Sac that envelops the embryo • Amniotic fluid: Provides protection from shocks/bumps and constant environment for floating embryo • Placenta: Supplies fetus with oxygen and nutrients from maternal bloodstream and filters waste back to mother for disposal

The 21st Century

The New Millennium - Human genome - Women's Health Initiative findings - Improved HIV/AIDS medications and care - Public health programs - Inclusion of children in clinical trials -Patient Protection & Affordable Care Act to extend health care to women, men, & children

Uninsured American

The facts • During 2001-2002, 74.7 million Americans were uninsured • 45.8 million Americans were uninsured all year in 2004 • 58% of uninsured are women & children • Higher prevalence in African and Hispanic Americans • 1/5 families has at least one uninsured member • Most uninsured are under age 30 • More likely to be men than women • More likely to be black or Hispanic • More likely to be poor or living near the poverty line. • Border states have higher rates of uninsured The consequences • Significant financial if require emergency care • Avoidance of preventive care and proper follow-up care • Ineligible for discounted pricing structures • Significantly less access to care Result: Poorer health, higher hospitalization rates, more advanced disease states, and earlier deaths

Diversity of Women

The heterogenity of women is reflected in difference of • Race/ethnicity • Socioeconomic status • Geographic location • Sexual orientation • Country of origin • Employment • Education

Types of Research Studies

Types of Research Studies • Descriptive studies -Population or correlation studies -Individual Studies • Analytic studies -Observational studies Retrospective Prospective-track a group of people over time & see what happens -Intervention studies Clinical Studies

Sexual Violence as a Public Health Problem

Types of sexual violence • Sexual assault and rape - crimes of aggression • Female genital mutilation (FGM) • Forced sterilization

Paying for Health Care

U.S. health-care system • Third-party payer system • Indemnity/fee-for-service model • Managed Care model - Decreased access to care - Shorter physician office visits - Higher co-payments - Restrictions on choice of doctor

Healthcare Reform

Universal health care: yes or no? • Found in Canada and the United Kingdom, many parts of Europe • Proponents - Health care is a right, not a privilege and should be available to all citizens • Opponents - Overly costly approach - Prefer private sector to manage and fund health care through a free-market approach

Sex Research

Well-known studies • Kinsey Report (1948 and 1953) -Factors affecting incidence, frequency, and patterns of sexual behaviors in males/females • Masters and Johnson (1966) -Sexual response cycle phases • Redbook Survey (1977) -Sexual behavior and attitudes of American women • Hite Report (1976) -Sexual practices of American women • Blumstein and Schwartz (1983) -Sexual and nonsexual components of relationships • ABC Primetime Poll (2004) - Found most Americans were monogamous and happy about it

Patient Protection and Affordable Care Act (PPACA)

What does it do? • Evolution, not revolution • More Americans (but not all) will receive health insurance • Requires insurance companies to expand coverage • Increases gov coverage of the poor and near-poor (Medicaid) • States will offer "exchanges" where employers and individuals can buy insurance • Reduction in some Medicare payments (from the government to hospitals) •Inacted in 2010, biggest change since Medicaid in 1960s •a technical overhaul of current health system

Perspective on Abortion

Why do women choose abortions? • Pregnancy would reduce a woman's ability to work, finish education, or care for others • Can't afford a(nother) baby • Relationship issues or not wanting to be a single mother • Completed childbearing • Not ready for a(nother) child • Didn't want people to know she was pregnant, or she had sex.

Perspectives on Sexual Health and Sexuality -Cultural and religious dimensions

• "marriage" is universal theme in all cultures sanctioning sexual privileges and obligations • sexual behavior is often defined by cultural values - Normative sex roles - Acceptable types of sexual activity - Sanctions/prohibitions on sexual behavior - Premarital sex - Sexual restraint for females - Same-sex relationships - Contraception decision making

Global Health Issues

• 10 leading risk factos account for more than 40% of the disease burden worldwide (WHO) • Almost 300,000 global deaths related to childbirth-99% in developing countries. • Infectious Diseases, many of them curable, are a much bigger problem in the developing world. • But, chronic, "First World" diseases (heart attacks, diabetes, cancer, strokes) are also important health concerns throughout the world.

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

Transvestite

• A person who dresses like the opposite sex

Transexual

• A person whose gender identity is opposite to her or his biological sex

An Aging Country

• Average life expectancy (2004) = 77.3 years - Women = 79.9 years - Men = 74.5 years • Burden of Aging rests on women - Without support of spouses - More likely to suffer from chronic disease - Increased need for prescription drugs, specialty medical assistance, medical equipment (walkers, etc.)

Adolescence

• Begins with onset of puberty and continues until approximately age 17 • Secondary sex characteristics/menstruation • Sense of identity • Peer pressure • Risky behaviors—sexual relations, substance use, tattooing and piercing Top five causes of death for female adolescents • Accidents (unintentional injuries) • Cancer • Assault (homicide) • Suicide • Heart disease Globally (outside of US) •Infections •Diarrheal Diseases •other communicable diseases like TB

Perspectives on Sexual Health and Sexuality -Economic dimensions

• Daughter in marriage = dowry • Value of bride = virginity • Sexual aggression = power and economic dynamics • Commercial sex industry/prostitution

Diversity of Motherhood

• Delay of marriage and family to focus on careers • New issues: Fertility, parenting at older ages • Teenage mothers - Issues: childbearing responsibilities, grandparents raising children • Choice to not have children - Issues: pursue career and other opportunities

Common Problems Related with Menstruation

• Dysmenorrhea - painful menstrual flow • Premenstrual syndrome (PMS) - Group of symptoms linked to menstrual cycle • Premenstrual dysphoric disorder (PMDD) - severe form of PMS • Amenorrhea - Lack of menstrual flow

Secondary Prevention

• Early detection and prompt treatment of disease • Examples - Screening tools such as mammograms, Pap smears, and HPV testing (find cancer early) - Prompt use of medication after a disease is diagnosed - Lifestyle Behaviours to control chronic diseases that cannot be prevented (e.g., keep diabetes, asthma under control)

Legal Perspectives of Birth Control

• Griswold v. Connecticut (1965) • Mandated coverage for __________ for federal employees via an act of Congress (1998) • Private insurance companies: to pay for contraceptive coverage

Androgyny

• Having characteristics of both sexes

Contraceptive Failure

• High rates of success—oral contraceptives, hormone injectables and implants, IUDs, condoms, vaginal hormonal ring, hormone patch, sterilization • low rates of effectiveness—diaphragms, cervical caps, sponges, spermicidal agents, fertility awareness methods, rhythm method, withdraw

Most Health Care in the U.S. focuses on fixing problems, not preventing them

• If you have advanced heart disease, lung cancer, or another serious condition, you can get the best treatment in the world. • But...it's more effective, cheaper, and less painful for everyone to get someone to quit smoking than it is to try and cure lung cancer. The United States is not as good when it comes to prevention.

Biomed 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 & underfunded in the United States

Perspectives on Sexual Health and Sexuality -Legal dimensions

• Laws prohibiting certain types of sexual behavior/ intimacy—cohabitation,fornication,sodomy • Same-sex partners • Marriage, annulment, separation, divorce, child custody, child support

Diversity in Sexual Orientation

• Misconceptions about health needs of lesbians by health-care providers and individuals themselves • Barriers to health care - Belief that routine gynecological care or contraception to protect from STIs in not needed - Homophobia from health-care providers - Lack of regular insurance because lack of eligibility for lesbian partner vs. heterosexual spouse

Measures of Mortality

• Mortality rate—The incidence of death in a given population during a particular time period. It is calculated by dividing the number of deaths in a population by the total population • Morbidity rate—The incidence of illness in a given population during a particular time period. It is calculated in a similar manner to mortality rate

Birth Control Pills

• Most commonly used form of contraceptive • 99% effective • Supress a woman's natural reproductive hormone cycle

Emergency Contraception

• NOT the same as RU-486, otherwise known as "the abortion pill" • Use of high-dose birth control pills taken within 72 hours of unprotected sex • Brands = Ovral, Alesse, Preven • Plan B = one-step form of emergency contraception

The Department of Health and Human Services (HHS)

• National Institutes of Health (NIH) • Food and Drug Administration (FDA) • Centers for Disease Control and Prevention (CDC) • Agency for Toxic Substances and Disease Registry (ATSDR) • Indian Health Service (IHS) • Health Resources and Service Administration (HRSA) • Substance Abuse and Mental Health Services Administration (SAMHSA) • Agency for Healthcare Research and Quality (AHRQ) • Center for Medicare & Medicaid Services (CMS) • Administration for Children and Families (ACF) • Administration on Aging (AoA)

Gender Dysphoria

• Overall term used to describe negative or conflicting feelings about one's sex or gender roles

Confirming Pregnancy

• Pregnancy tests: detect Human Chorionic Gonadotropin - Home urine pregnancy tests available • Digital and non-digital • Clinical pregnancy test - Performed by clinician • Urine or blood tests • ______ examination

Sexual Dysfunction

• Prevalence - About 40% women report sexual problems, but only 12% are distressed about it • Historically called "frigidity" • Areas of dysfunction - Sexual desire disorders - Sexual arousal disorders - Orgasmic disorders - Sexual pain disorders

Transitioning

• Process in which transsexuals work to change their appearance and social identity to match with their gender identity (MTF or FTM)

Medicaid

• Provides health insurance for low-income Americans • Administered by federal and state governments, but largely run at the state level • Majority of recipients are low-income women and children - State Children's Health Insurance Program (SCHIP) • Covers nearly 60 million people Qualifications • Income status • Level of disability • Need for long-term care • Dependent of a Medicaid recipient Basic services • Inpatient and outpatient medical care • Laboratory and X-ray services • Chronic care facilities for persons older than 21 years • Home health care for nursing facility services • Services provided by a physician or nurse practitioner • Necessary transportation

Primary Prevention

• Reducing exposure to a risk factor that may lead to the disease • Examples - Healthy nutrition (preventing heart disease and cancer) - Regular physical activity (preventing heart disease and other diseases) - Cessation of smoking (preventing lung cancer and other diseases) - Safe sexual practices (preventing sexually transmitted infections)

Intersexuality

• Refers to the sexual physiology of an individual; a person who is intersexed is born with nonstandard sex chromosomes or genitalia

Perspectives on Sexual Health and Sexuality -Political dimensions

• Sex education in schools - Abstinence-only programs - Comprehensive or abstinence-plus programs

Tertiary Prevention

• Takes place once a Disease has advanced • Examples - Alleviating pain, providing comfort to a cancer patient - Halting progression of an illness - Limiting disability after a serious injury - Restoring function through rehab after a person has had a stroke

Socialization

• The process whereby society conveys ________ ________ to the individual

Transgender

• Umbrella term for anyone whose _______, ______, or traits differ from those traditionally ascribed to the person's sex

After Conception

• Within 36 hours of fertilization: Zygote divides • 1 to 2 days: Blastocyte floats freely before implanting in lining of the uterus. • Within 3 to 5 days: Reaches uterus and is known as a blastocyst • First 8 weeks: Known as embryo • 9 weeks to birth: Known as fetus

Women as Health Consumers

• Women make 90% of health-related decisions for their families • Women earn more than $1 trillion annually • More than 68% of women manage their household bills, compared with 55% of men • Increased participation in workforce and government = Growing Economic Power

10 Leading Causes of Death

•Global 1. Lower respiratory diseases 2. Diarrheal diseases 3. HIV/AIDS 4. Heart disease 5. Malaria 6. Stroke 7. Tuberculosis 8. Premature birth and low birth weight 9. Birth trauma and asphyxia 10. Infant infections •United States 1. Heart disease 2. Cancer 3. Lower respiratory diseases 4. Stroke 5. Accidents 6. Alzheimer's disease 7. Diabetes 8. Kidney diseases 9. Flu and Pneumonia 10. Suicide

ORWH

•Office of Research on Women's Health •Gov focal point for women's Biomed Research •Advises NIH director & staff on women's health research •Strengthens & Enhances research related to diseases, disorders, & Conditions affecting women. •Ensures the NIH research addresses issues regarding women's health •develops opportunities for & supports recruitment, retention, reentry, & advancement of women in biomed careers •ensures that biomed & behavioral research studies supported by NIH represent women & women's health issues •supports research on Women's health issues

Fertility Awareness Methods

"Free, no equipment necessary, but not reliable" Calendar method • abstains from intercourse during fertile time of month by calculating time of ovulation Basal body temperature • Fertility cycle related to changes in basal body temperature Cervical mucus or ovulation method • Fertility cycle related to change in type of cervical mucus

Young Adulthood

(Ages 18-44) • Sense of self with increased independence • Risky behaviors—Sexual Activity, substance abuse, violence (date rape), poor nutrition, lack of exercise • Top five causes of death for young adult women • Unintentional injuries • Homicide • Cancer • Suicide • Heart disease

Midlife

(Ages 45-64) • Job advancement and establishment of productive careers • Raising children, caring for elderly parents, working to keep healthy relationships • Menopause • Top five causes of death for women of midlife • Cancer • Heart Disease • Stroke • Chronic obstructive pulmonary disease • Diabetes

Senior Years

(Ages 65+) • Increased life expectancy for women • Issues of retirement, possible loss of spouse and friends, depression, chronic conditions • Top five causes of death for women of senior years • Cancer • Heart disease • Chronic lower respiratory diseases • Stroke • Diabetes

1980s: Changing Public Policy

- Office of Research on Women's Health (ORWH)-Ensures women's participation in clinical trials, strengthens research on diseases affecting women, and promotes the career advancement of women in science. - The Task Force on Women's Health-issued recommendation to increase gender equity in biomedical research & establish guidelines for the inclusion of women in federally sponsored studies -Money for health research: contraception, infertility, breast and ovarian cancer -Medicaid coverage of Pap smear screening and mammography

Stages of Life

1. Adolescence 2. Young adulthood 3. Midlife 4. The senior years

Hormonal Changes(after 3 months)

1. Corpus luteum no longer needed; hCG levels drop 2. Placenta produces estrogen and progesterone 3. Fetal adrenal glands produce precursor hormone to be converted into estrogen 4. Estrogen—regulates progesterone, stimulates fetal maturation (lungs, liver, organs mature), prepare breasts for lactation 5. Progesterone—suppresses uterine contractions, stimulates alveoli of breasts

Progressive Era

1890s to 1920s -Women gained the ability to vote ( 19th Amendment) -Women did not gain equal rights (the Equal Rights Amendment has yet to be passed) -Birth control movement began: the first birth control clinic opened in New York City, but clinics remained rare and birth control (and even talking about it) was mostly illegal.

WWII and Postwar Years

1930s to 1950s - Women entered the workforce during WWII, but often lost their jobs when the war ended - The Kinsey Report: Nearly 6,000 women interviewed about their sexual behaviors. -Conclusion: women have sex and enjoy

2nd Wave of Feminism

1960s and 1970s, specific, often political injustices and inequalities

The Grassroots Movement

1960s-1970s - FDA approval of birth control pill - Civil Rights Act - Title VII-Protecting women against employment discrimination - Congressional Caucus for Women's Issues

3rd Wave of Feminism

1980s and 1990s, examining all areas of society from a feminist perspective

Failure Rates

A _______ _____is the chance that the average couple using a given birth control method will become pregnant in a given year. • Failure rates can be either for "______ ___" (ideal conditions) or "______ ____" (failure rate in the real world) • Failure rates range from less than 1% to 30%. • Condoms, sponges, and diaphragms have the largest difference between these rates

Economics of Health Care

-Average annual spending on health care in the United States is $8200 per person.* That's 18% of all spending in the U.S. -Health care costs are also rising faster than inflation -Money Affects every aspect of health care`

1990: Women's Health at the Forefront

-Brought together Government, Healthcare Institutions, Academia, And Advocacy Organizations to analyze and promote women's health and well being. -1993: NIH(National Institute of Health) Revitalization Act- Congress required that women & minorities be included as subjects in all human subject research funded by NIH -Family & Medical Leave Act(1993)- gives employees unpaid medical leave for themselves or for the care of a family member, Newborn, or adopted infants. -Violence Against Women (1994)- mandated a unified judicial response to sexual crimes against women

Third Party System

-Most people don't pay directly for the delivery of health care -Most have health insurance which they pay for monthly or yearly premium plus a per doctor's visit fee called a copayment and/or deductible

Centers for Disease Control and Prevention(CDC)

-Working with states & other partners -provides health surveillance to monitor and prevent disease outbreaks, implement disease prevention strategies, and maintain national health stats

National Institutes of Health (NIH)

-the worlds premier medical research organization -supports more than 35,000 research projects nationwide studying diseases