women's health

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CHAPTER 5

Women’s Health

Introduction

Women are the foundation of our communities, and their health and well-being matter independent of their roles as mothers.

The category of women includes anyone whose internal sense of self is as a woman and/or functions in society as a woman, regardless of her particular biological characteristics.

Women’s health and well-being are impacted by factors at all levels of the social ecological model.

Racism and discrimination can have devastating effects on individual and population health.

Complex History: 18th and 19th Centuries

In 1848, the Declaration of Sentiments was signed at the Seneca Falls Convention.

Childbirth was mostly attended by women midwives.

Physicians (mostly men) aimed to control childbirth and undermine midwives.

“Innovations” in obstetric care were developed through experimentation on Black women’s bodies.

Complex History: 20th Century

In the early 1900s, Margaret Sanger founded Planned Parenthood Federation of America.

Improved family planning was named one of the 10 greatest public health achievements in the 20th century by Centers for Disease Control and Prevention.

The eugenics movement of the 1920s and 1930s focused on controlling the fertility of people of color, and those who were poor, had disabilities, or criminal backgrounds.

The National Institutes of Health created the Office of Research on Women’s Health to address the lack of women’s health research.

Complex History: 21st Century

Early 2000s saw important advances that impacted the health care of reproductive-age and older women.

In 2006, the FDA approved the first human papillomavirus (HPV) vaccine for prevention of cervical cancer.

In 2010, Congress passed the Affordable Care Act (ACA), which created a number of essential benefits for women.

Continued legal challenges to insurance coverage for contraception and abortion have resulted in unequal access for women.

Life Expectancy

Women in the U.S. have a longer life expectancy than men, living an extra 5 years on average

There are disparities in life expectancy by race, education, and other social determinants.

In 2017, the life expectancy at birth was 81.2 years for White non-Hispanic women and 78.5 years for Black non-Hispanic women.

The U.S. ranks poorly in life expectancy and other health measures for women and men when compared to other developed countries. Disparities are linked to structural and historic racism in the U.S.

Leading Causes of Death

Heart Disease and Cancer

Heart disease and cancer are the leading causes of death for women and men.

Heart disease and stroke are the leading causes of maternal mortality in the U.S., causing more than 1 in 3 pregnancy-related deaths.

Breast cancer is the most common cancer in women, followed by lung and colorectal cancer.

Screening for cervical cancer using the Pap test has been successful in reducing incidence and mortality.

Lesbian, gay, bisexual, and transgender people experience challenges accessing cervical cancer screenings.

Obesity and Cardiovascular Disease Risk

Severe obesity is more common among women than men, and more common among people of color.

Women who are obese often experience explicit and implicit bias and stigma, including among health care providers.

Rising rates of chronic hypertension, diabetes, and cardiovascular disease are tied to the obesity epidemic.

Limited access to resources, and stress related to racism and poverty are tied to higher rates of obesity and chronic disease among women of color.

Hypertensive disorders of pregnancy and gestational diabetes are nontraditional risk factors for heart disease.

Health Disparities

Gender inequality and racism, alone and in concert, are important contributing factors to disparities in women’s health.

Violence against women remains a continual source of morbidity and mortality across all ages and age groups.

Across all racial groups in the U.S., women earn 82% of what men earn for equivalent work (gender pay gap).

Transgender women also earn less than men, and their income tends to decline after transitioning or coming out despite not making significant career changes.

Health Disparities

Many of the health advances of previous decades have not been available to all women – particularly women of color.

Infant and maternal mortality rates are significantly higher for Black and Native American women than for White women.

HIV remains one of the leading causes of death for Black women ages 1=559 years and Hispanic and Latinx women ages 30–49 years.

During the past decade, reproductive justice principles were introduced to the U.S. and are having a major impact on public health and health care.

Sexually Transmitted Infections (STIs)

STIs disproportionately affect women.

Women experience higher rates of diagnoses for syphilis, gonorrhea, and chlamydia.

STIs are often asymptomatic in women, leading to delays in diagnosis and treatment.

Women are more likely to suffer from long-term complications of STIs than men, including infertility.

Structural forces, including racism, place Black women at disproportionate risk for poorer care and treatment of HIV.

Transgender women also have a high rate of HIV infection.

Mental Health and Substance Use

Depression and anxiety are nearly twice as common among women than men.

The greater prevalence is related to psychosocial factors, not biological differences.

Lesbian, gay, or bisexual women have disproportionately higher rates of some mood disorders.

Postpartum depression affects up to 15% of mothers annually, with a greater prevalence for racial and ethnic minority women and low-income women.

1 in 20 nonpregnant women of childbearing age experience major depression, with only 1 in 3 receiving treatment.

Mental Health and Substance Use

Women can be more sensitive to the effects of drugs and experience addiction with smaller amounts of substances used over less time than men.

Untreated mental health conditions like anxiety or depression may contribute to misuse of substances for women.

White non-Hispanic women are more likely to report heavy drinking (>7 drinks per week) than Black non-Hispanic, Mexican, and Hispanic women.

Treatment options for substance use programs need to address biological and social barriers that are more significant for women.

Human Sex Trafficking and Sex Work

Human trafficking is the third most profitable criminal activity in the U.S.

Girls ages 12–15 years are more likely to become involved in sex trafficking.

Sex workers are adults who exchange goods for money.

There are 1–2 million full-service sex workers in the U.S.

Transgender women face social and structural circumstances that place them at high risk for participating in sex trafficking and make sex work a viable path for income.

Violence Against Women

The United Nations estimates that 35% of women worldwide have experienced either physical or sexual intimate partner violence (IPV) or sexual violence by a nonpartner at some point in their lives.

1 in 3 U.S. women has experienced sexual or physical violence and/or stalking by an intimate partner in their lifetime.

Women who are Black, Native American, immigrant and undocumented, in the military, and incarcerated or in detention experience higher rates of violence than White non-Hispanic women.

The Violence Against Women Act (VAWA) has changed accepted norms for victims of violence.

Women’s Health Care in the U.S.

The U.S. health care system does not always meet the needs of women.

Health disparities by race, socioeconomic status, and geography are related to barriers to accessing quality care and individual experiences of racism in health care.

Lesbian, gay, bisexual, and queer-identified women experience discrimination in health care and are more likely to underuse care.

Up to 19% of transgender people report being refused care due to their gender identity or expression.

The Health Care “System”

Much of the U.S. system continues to create challenges for the provision of women’s health care over the life course.

Due to differences in the scope of medical training, women often have to seek care from multiple health care providers, which has led to gaps in care.

Traditional medical care, including contraception, management of pregnancy, and pregnancy complications, are controlled by politics and religious recommendations, not evidence-based medicine.

Insurance coverage varies by life stage, and coverage for women has improved with the passage of the ACA.

Transgender people face substantial barriers to health coverage for medical services.

Data Sources for Women’s Health

Most data are funded by national surveillance systems and are collected at the local level.

Most data sources are produced by the CDC through the National Center for Health Statistics (NCHS).

Population-based studies are critical to understanding the health of people in the U.S.

The NCHS produces summary reports on a regular basis that are available on their websites or published in the Morbidity and Mortality Weekly Report (MMWR).

Innovations in Health Care

The Department of Health and Human Services houses multiple agencies with funding directed toward issues that affect women:

CDC

Office of Women’s Health

Office of Population Affairs

Women’s health care is moving from a focus on reproductive and infant health to the health and well-being of women over the life course.

New models of care delivery

Community health workers

Group prenatal care models

Doulas

Integration of mental health into primary care

Conclusion

The history of care and services for women is complex.

Women are essential members of communities and families.

Their health is equally of importance for their own well-being, life goals, and dreams.

Women of color should be centered in the design of services and programs. MCH professionals must work to dismantle structural racism.

It is important to put the “W” in MCH if we are to see improved health for families, communities, and populations.

women's health

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