Women's health is an example of
population health, where health is defined by the
World Health Organization
The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
(WHO) as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Often treated as simply women's
reproductive health
Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's Human reproductive system, reproductive system and sexual well-being during all stages of their life. Se ...
, many groups argue for a broader definition pertaining to the overall health of women, better expressed as "The health of women". These differences are further exacerbated in
developing countries
A developing country is a sovereign state with a less-developed Secondary sector of the economy, industrial base and a lower Human Development Index (HDI) relative to developed countries. However, this definition is not universally agreed upon. ...
where women, whose health includes both their risks and experiences, are further disadvantaged.
While the rates of the leading causes of death,
cardiovascular disease
Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina, heart attack), heart failure, hypertensive heart disease, rheumati ...
,
cancer
Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...
and
lung disease
The lungs are the primary organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the backbone on either side of the heart. Their function in the respiratory syst ...
, are similar in women and men, women have different experiences.
Lung cancer
Lung cancer, also known as lung carcinoma, is a malignant tumor that begins in the lung. Lung cancer is caused by genetic damage to the DNA of cells in the airways, often caused by cigarette smoking or inhaling damaging chemicals. Damaged ...
has overtaken all other types of cancer as the leading cause of cancer related death in women, followed by
breast cancer
Breast cancer is a cancer that develops from breast tissue. Signs of breast cancer may include a Breast lump, lump in the breast, a change in breast shape, dimpling of the skin, Milk-rejection sign, milk rejection, fluid coming from the nipp ...
,
colorectal,
ovarian,
uterine and
cervical cancers. While
smoking
Smoking is a practice in which a substance is combusted, and the resulting smoke is typically inhaled to be tasted and absorbed into the bloodstream of a person. Most commonly, the substance used is the dried leaves of the tobacco plant, whi ...
is the major cause of lung cancer, amongst nonsmoking women the risk of developing cancer is three times greater than among nonsmoking men. Despite this, breast cancer remains the most common cancer in women in developed countries, and is one of the major
chronic diseases of women, while cervical cancer remains one of the most common cancers in developing countries, associated with
human papilloma virus (HPV), a
sexually transmitted infection
A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is Transmission (medicine), spread by Human sexual activity, sexual activity, e ...
.
HPV vaccine
Human papillomavirus (HPV) vaccines are vaccines intended to provide acquired immunity against infection by certain types of human papillomavirus. The first HPV vaccine became available in 2006. Currently there are six licensed HPV vaccines: ...
together with
screening offers the promise of controlling these diseases. Other important health issues for women include cardiovascular disease,
depression,
dementia
Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects a person's ability to perform activities of daily living, everyday activities. This typically invo ...
,
osteoporosis
Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in Bone fracture, fracture risk.
It is the most common reason f ...
and
anemia
Anemia (also spelt anaemia in British English) is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin availabl ...
.
In 176 out of 178 countries for which records are available, there is a gender gap in favor of women in
life expectancy
Human life expectancy is a statistical measure of the estimate of the average remaining years of life at a given age. The most commonly used measure is ''life expectancy at birth'' (LEB, or in demographic notation ''e''0, where '' ...
. In
Western Europe
Western Europe is the western region of Europe. The region's extent varies depending on context.
The concept of "the West" appeared in Europe in juxtaposition to "the East" and originally applied to the Western half of the ancient Mediterranean ...
, this has been the case at least as far back as 1750. Gender remains an important
social determinant of health, since women's health is influenced not just by their biology but also by conditions such as
poverty
Poverty is a state or condition in which an individual lacks the financial resources and essentials for a basic standard of living. Poverty can have diverse Biophysical environmen ...
, employment, and family responsibilities. Women have long been disadvantaged in many respects such as social and economic power which restricts their access to the necessities of life including
health care
Health care, or healthcare, is the improvement or maintenance of health via the preventive healthcare, prevention, diagnosis, therapy, treatment, wikt:amelioration, amelioration or cure of disease, illness, injury, and other disability, physic ...
, and the greater the level of disadvantage, such as in developing countries, the greater adverse impact on health.
Women's
reproductive and sexual health has a distinct difference compared to men's health. Even in
developed countries
A developed country, or advanced country, is a sovereign state that has a high quality of life, developed economy, and advanced technological infrastructure relative to other less industrialized nations. Most commonly, the criteria for eval ...
,
pregnancy
Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins.
Conception (biology), Conception usually occurs ...
and
childbirth
Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy, where one or more Fetus, fetuses exits the Womb, internal environment of the mother via vaginal delivery or caesarean section and becomes a newborn to ...
are associated with substantial risks to women with
maternal mortality accounting for more than a quarter of a million deaths per year, with large gaps between the developing and developed countries.
Comorbidity
In medicine, comorbidity refers to the simultaneous presence of two or more medical conditions in a patient; often co-occurring (that is, concomitant or concurrent) with a primary condition. It originates from the Latin term (meaning "sicknes ...
from other non-reproductive diseases such as
cardiovascular disease
Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina, heart attack), heart failure, hypertensive heart disease, rheumati ...
contribute to both the mortality and
morbidity
A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are asso ...
of pregnancy, including
preeclampsia.
Sexually transmitted infections
A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, or ...
have serious consequences for women and infants, with
mother-to-child transmission leading to outcomes such as
stillbirths
Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can often result in the feeling of guilt or grief in the mother. T ...
and
neonatal deaths, and
pelvic inflammatory disease leading to
infertility
In biology, infertility is the inability of a male and female organism to Sexual reproduction, reproduce. It is usually not the natural state of a healthy organism that has reached sexual maturity, so children who have not undergone puberty, whi ...
. In addition, infertility from many other causes,
birth control
Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only be ...
,
unplanned pregnancy,
rape
Rape is a type of sexual assault involving sexual intercourse, or other forms of sexual penetration, carried out against a person without consent. The act may be carried out by physical force, coercion, abuse of authority, or against a person ...
and the struggle for access to
abortion
Abortion is the early termination of a pregnancy by removal or expulsion of an embryo or fetus. Abortions that occur without intervention are known as miscarriages or "spontaneous abortions", and occur in roughly 30–40% of all pregnan ...
create other burdens for women.
Definitions and scope
Women's experience of health and disease differ from those of men, due to unique biological, social and behavioral conditions. Biological differences vary from
phenotype
In genetics, the phenotype () is the set of observable characteristics or traits of an organism. The term covers the organism's morphology (physical form and structure), its developmental processes, its biochemical and physiological propert ...
s to the
cellular biology
Cell biology (also cellular biology or cytology) is a branch of biology that studies the Anatomy, structure, Physiology, function, and behavior of cell (biology), cells. All living organisms are made of cells. A cell is the basic unit of life th ...
, and manifest
unique risks for the development of ill health.
[ WHO defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Women's health is an example of population health, the health of a specific defined population.
Women's health has been described as "a patchwork quilt with gaps". Although many of the issues around women's health relate to their ]reproductive health
Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's Human reproductive system, reproductive system and sexual well-being during all stages of their life. Se ...
, including maternal and child
A child () is a human being between the stages of childbirth, birth and puberty, or between the Development of the human body, developmental period of infancy and puberty. The term may also refer to an unborn human being. In English-speaking ...
health, genital health and breast health, and endocrine (hormonal
A hormone (from the Greek participle , "setting in motion") is a class of signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physiology and behavior. Hormones a ...
) health, including menstruation
Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and Mucous membrane, mucosal tissue from the endometrium, inner lining of the uterus through the vagina. The menstrual cycle is characterized ...
, birth control
Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only be ...
and menopause
Menopause, also known as the climacteric, is the time when Menstruation, menstrual periods permanently stop, marking the end of the Human reproduction, reproductive stage for the female human. It typically occurs between the ages of 45 and 5 ...
, a broader understanding of women's health to include all aspects of the health of women has been urged, replacing "Women's Health" with "The Health of Women". WHO considers that an undue emphasis on reproductive health has been a major barrier to ensuring access to good quality health care for all women.[ Conditions that affect both men and women, such as ]cardiovascular disease
Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina, heart attack), heart failure, hypertensive heart disease, rheumati ...
, osteoporosis
Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in Bone fracture, fracture risk.
It is the most common reason f ...
, also manifest differently in women. Women's health issues also include medical situations in which women face problems not directly related to their biology, such as gender-differentiated access to medical treatment and other socioeconomic
Economics () is a behavioral science that studies the Production (economics), production, distribution (economics), distribution, and Consumption (economics), consumption of goods and services.
Economics focuses on the behaviour and interac ...
factors. Women's health is of particular concern due to widespread discrimination
Discrimination is the process of making unfair or prejudicial distinctions between people based on the groups, classes, or other categories to which they belong or are perceived to belong, such as race, gender, age, class, religion, or sex ...
against women in the world, leaving them disadvantaged
The "disadvantaged" is a generic term for individuals or groups of people who:
* Face special problems such as physical disability, physical or mental disorder, mental disability
* Lack money or economic supportKingdom of Nepal: Economic and Soc ...
.[
A number of health and medical research advocates, such as the Society for Women's Health Research in the United States, support this broader definition, rather than merely issues specific to human female anatomy to include areas where biological sex differences between women and men exist. Women also need health care more and access the health care system more than do men. While part of this is due to their reproductive and sexual health needs, they also have more chronic non-reproductive health issues such as ]cardiovascular disease
Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina, heart attack), heart failure, hypertensive heart disease, rheumati ...
, cancer
Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...
, mental illness
A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
, diabetes
Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...
and osteoporosis
Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in Bone fracture, fracture risk.
It is the most common reason f ...
. Another important perspective is realising that events across the entire life cycle (or life-course), from '' in utero'' to aging effect the growth, development and health of women. The life course perspective is one of the key strategies of the World Health Organization.[
]
Global perspective
Gender differences in susceptibility and symptoms of disease and response to treatment in many areas of health are particularly true when viewed from a global perspective. Much of the available information comes from developed countries
A developed country, or advanced country, is a sovereign state that has a high quality of life, developed economy, and advanced technological infrastructure relative to other less industrialized nations. Most commonly, the criteria for eval ...
, yet there are marked differences between developed and developing countries
A developing country is a sovereign state with a less-developed Secondary sector of the economy, industrial base and a lower Human Development Index (HDI) relative to developed countries. However, this definition is not universally agreed upon. ...
in terms of women's roles and health. The global viewpoint is defined as the "area for study, research and practice that places a priority on improving health and achieving health equity for all people worldwide". In 2015 the World Health Organization identified the top ten issues in women's health as being cancer, reproductive health, maternal health, human immunodeficiency virus
The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause AIDS, acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of th ...
(HIV), sexually transmitted infections, violence, mental health, non communicable diseases, youth and aging.
Life expectancy
Women's life expectancy is greater than that of men, and they have lower death rates throughout life, regardless of race and geographic region. Historically though, women had higher rates of mortality, primarily from maternal deaths (death in childbirth). In industrialised countries, particularly the most advanced, the gender gap narrowed and was reversed following the Industrial Revolution
The Industrial Revolution, sometimes divided into the First Industrial Revolution and Second Industrial Revolution, was a transitional period of the global economy toward more widespread, efficient and stable manufacturing processes, succee ...
.
Despite these differences, in many areas of health, women experience earlier and more severe disease, and experience poorer outcomes.
Despite these differences, the leading causes of death in the United States are remarkably similar for men and women, headed by heart disease
Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina pectoris, angina, myocardial infarction, heart attack), heart failure, ...
, which accounts for a quarter of all deaths, followed by cancer
Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...
, lung disease
The lungs are the primary organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the backbone on either side of the heart. Their function in the respiratory syst ...
and stroke
Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...
. While women have a lower incidence of death from unintentional injury and suicide
Suicide is the act of intentionally causing one's own death.
Risk factors for suicide include mental disorders, physical disorders, and substance abuse. Some suicides are impulsive acts driven by stress (such as from financial or ac ...
, they have a higher incidence of dementia
Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects a person's ability to perform activities of daily living, everyday activities. This typically invo ...
.[
The major differences in life expectancy for women between developed and developing countries lie in the childbearing years. If a woman survives this period, the differences between the two regions become less marked, since in later life non-communicable diseases (NCDs) become the major causes of death in women throughout the world, with cardiovascular deaths accounting for 45% of deaths in older women, followed by cancer (15%) and lung disease (10%). These create additional burdens on the resources of developing countries. Changing lifestyles, including diet, physical activity and cultural factors that favour larger body size in women, are contributing to an increasing problem with ]obesity
Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...
and diabetes
Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...
amongst women in these countries and increasing the risks of cardiovascular disease and other NCDs.
Women who are socially marginalised are more likely to die at younger ages than women who are not. Women who have substance abuse disorders, who are homeless, who are sex workers, and/or who are imprisoned have significantly shorter lives than other women. At any given age, women in these overlapping, stigmatised groups are approximately 10 to 13 times more likely to die than typical women of the same age.
Social and cultural factors
Women's health is positioned within a wider body of knowledge cited by, amongst others, the World Health Organization
The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
, which places importance on gender as a social determinant of health.[ While women's health is affected by their biology, it is also affected by their social conditions, such as ]poverty
Poverty is a state or condition in which an individual lacks the financial resources and essentials for a basic standard of living. Poverty can have diverse Biophysical environmen ...
, employment, and family responsibilities, and these aspects should not be overshadowed.
Women have traditionally been disadvantaged in terms of economic and social status
Social status is the relative level of social value a person is considered to possess. Such social value includes respect, honour, honor, assumed competence, and deference. On one hand, social scientists view status as a "reward" for group members ...
and power, which in turn reduces their access to the necessities of life including health care
Health care, or healthcare, is the improvement or maintenance of health via the preventive healthcare, prevention, diagnosis, therapy, treatment, wikt:amelioration, amelioration or cure of disease, illness, injury, and other disability, physic ...
. Despite recent improvements in Western nations, women remain disadvantaged with respect to men. The gender gap in health is even more acute in developing countries
A developing country is a sovereign state with a less-developed Secondary sector of the economy, industrial base and a lower Human Development Index (HDI) relative to developed countries. However, this definition is not universally agreed upon. ...
where women are relatively more disadvantaged. In addition to gender inequity, there remain specific disease processes uniquely associated with being a woman which create specific challenges in both prevention and health care.
In low- and middle-income countries, women’s diets, often rich in staple foods, are frequently poor in vitamins and minerals, with consequences for health. Low dietary diversity jeopardizes nutrient adequacy.
Deeply ingrained cultural, religious, and patriarchal systems within the MENA
The Middle East and North Africa (MENA), also referred to as West Asia and North Africa (WANA) or South West Asia and North Africa (SWANA), is a geographic region which comprises the Middle East (also called West Asia) and North Africa together ...
region perpetuate gender-based power dynamics within communities and lead to discrepancies in healthcare
Health care, or healthcare, is the improvement or maintenance of health via the preventive healthcare, prevention, diagnosis, therapy, treatment, wikt:amelioration, amelioration or cure of disease, illness, injury, and other disability, physic ...
access. In a speech, UNFPA
The United Nations Population Fund (UNFPA) is a UN agency aimed at improving reproductive and maternal health worldwide. Its work includes developing national healthcare strategies and protocols, increasing access to birth control, and leadin ...
executive director Thoraya Ahmed Obaid outlined these difficulties and emphasized the need to change cultural and societal norms in order to improve the health of women in the area.
Even after succeeding in accessing health care, women have been discriminated against, a process that Iris Young has called "internal exclusion", as opposed to "external exclusion", the barriers to access. This invisibility effectively masks the grievances of groups already disadvantaged by power inequity, further entrenching injustice.
Behavioral differences also play a role, in which women display lower risk taking including consume less tobacco, alcohol, and drugs, reducing their risk of mortality from associated diseases, including lung cancer
Lung cancer, also known as lung carcinoma, is a malignant tumor that begins in the lung. Lung cancer is caused by genetic damage to the DNA of cells in the airways, often caused by cigarette smoking or inhaling damaging chemicals. Damaged ...
, tuberculosis
Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption, is a contagious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can al ...
and cirrhosis
Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, chronic liver failure or chronic hepatic failure and end-stage liver disease, is a chronic condition of the liver in which the normal functioning tissue, or parenchyma, is replaced ...
. Other risk factors that are lower for women include motor vehicle accidents. Occupational differences have exposed women to less industrial injuries, although this is likely to change, as is risk of injury or death in war. Overall such injuries contributed to 3.5% of deaths in women compared to 6.2% in the United States in 2009. Suicide rates are also less in women.[
The social view of health combined with the acknowledgement that gender is a social determinant of health inform women's health service delivery in countries around the world. Women's health services such as Leichhardt Women's Community Health Centre which was established in 1974 and was the first women's health centre established in Australia is an example of women's health approach to service delivery.
Women's health is an issue which has been taken up by many ]feminists
Feminism is a range of socio-political movements and ideology, ideologies that aim to define and establish the political, economic, personal, and social gender equality, equality of the sexes. Feminism holds the position that modern soci ...
, especially where reproductive health
Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's Human reproductive system, reproductive system and sexual well-being during all stages of their life. Se ...
is concerned and the international women's movement was responsible for much of the adoption of agendas to improve women's health.
Biological factors
Factors that specifically affect the health of women compared to men
A man is an adult male human. Before adulthood, a male child or adolescent is referred to as a boy.
Like most other male mammals, a man's genome usually inherits an X chromosome from the mother and a Y chromosome from the fa ...
are most evident in those related to reproduction
Reproduction (or procreation or breeding) is the biological process by which new individual organisms – "offspring" – are produced from their "parent" or parents. There are two forms of reproduction: Asexual reproduction, asexual and Sexual ...
, but sex differences have been identified from the molecular to the behavioral scale. Some of these differences are subtle and difficult to explain, partly due to the fact that it is difficult to separate the health effects of inherent biological factors from the effects of the surrounding environment they exist in. Women's XX sex chromosomes compliment, hormonal environment, as well as sex-specific lifestyles, metabolism, immune system function, and sensitivity to environmental factors are believed to contribute to sex differences in health at the levels of physiology, perception, and cognition. Women can have distinct responses to drugs and thresholds for diagnostic parameters. All of these necessitate caution in extrapolating information derived from biomarkers from one sex to the other. Young women and adolescents are at risk from STIs, pregnancy and unsafe abortion, while older women often have few resources and are disadvantaged with respect to men, and also are at risk of dementia and abuse, and generally poor health.
Reproductive and sexual health
Women experience many unique health issues related to reproduction and sexuality and these are responsible for a third of all health problems experienced by women during their reproductive years (aged 15–44), of which unsafe sex is a major risk factor, especially in developing countries. Reproductive health includes a wide range of issues including the health and function of structures and systems involved in reproduction, pregnancy
Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins.
Conception (biology), Conception usually occurs ...
, childbirth
Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy, where one or more Fetus, fetuses exits the Womb, internal environment of the mother via vaginal delivery or caesarean section and becomes a newborn to ...
and child rearing, including antenatal and perinatal care.[ Global women's health has a much larger focus on reproductive health than that of developed countries alone, but also ]infectious diseases
infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
such as malaria
Malaria is a Mosquito-borne disease, mosquito-borne infectious disease that affects vertebrates and ''Anopheles'' mosquitoes. Human malaria causes Signs and symptoms, symptoms that typically include fever, Fatigue (medical), fatigue, vomitin ...
in pregnancy and non-communicable diseases (NCD). Many of the issues that face women and girls in resource poor regions are relatively unknown in developed countries, such as female genital cutting, and further lack access to the appropriate diagnostic and clinical resources.
Maternal health
Pregnancy
Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins.
Conception (biology), Conception usually occurs ...
presents substantial health risks, even in developed countries, and despite advances in obstetrical science and practice. Maternal mortality remains a major problem in global health
Global health is the health of populations in a worldwide context; it has been defined as "the area of study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide". Problems th ...
and is considered a sentinel event
A sentinel event is "any unanticipated event in a healthcare setting that results in death or serious physical or psychological injury to a patient, not related to the natural course of the patient's illness". Sentinel events can be caused by major ...
in judging the quality of health care systems. Adolescent pregnancy represents a particular problem, whether intended or unintended, and whether within marriage or a union or not. Pregnancy results in major changes in the life of a young female: physically, emotionally, socially and economically, and jeopardizes their transition into adulthood. Adolescent pregnancy, more often than not, stems from a girl's lack of choices. or abuse. Child marriage (see below) is a major contributor worldwide, since 90% of births to females aged 15–19 occur within marriage.
Maternal death
In 2013 about 289,000 women (800 per day) in the world died due to pregnancy-related causes, with large differences between developed and developing countries. In developed nations maternal mortality had been steadily falling and on average means 16 deaths per 100,000 live births, as measured by the maternal mortality ratio (MMR). By contrast rates as high as 1,000 deaths per 100,000 live births are reported in the rest of the world, with the highest rates in Sub-Saharan Africa
Sub-Saharan Africa is the area and regions of the continent of Africa that lie south of the Sahara. These include Central Africa, East Africa, Southern Africa, and West Africa. Geopolitically, in addition to the list of sovereign states and ...
and South Asia
South Asia is the southern Subregion#Asia, subregion of Asia that is defined in both geographical and Ethnicity, ethnic-Culture, cultural terms. South Asia, with a population of 2.04 billion, contains a quarter (25%) of the world's populatio ...
, which account for 86% of such deaths. These deaths are rarely investigated, yet the World Health Organization considers that 99% of these deaths, the majority of which occur within 24 hours of childbirth, are preventable if the appropriate infrastructure, training, and facilities were in place. In these resource-poor countries, maternal health is further eroded by poverty and adverse economic factors which impact the roads, health care facilities, equipment and supplies in addition to limited skilled personnel. Other problems include cultural attitudes towards sexuality, contraception, child marriage
Child marriage is a practice involving a marriage or domestic partnership, formal or informal, that includes an individual under 18 and an adult or other child.*
*
*
*
Research has found that child marriages have many long-term negative co ...
, home birth
A home birth is a birth that takes place in a residence rather than in a hospital or a birthing center. They may be attended by a midwife, or lay attendant with experience in managing home births. Home birth was, until the advent of modern medi ...
and the ability to recognise medical emergencies. The direct causes of these maternal deaths are hemorrhage
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, ...
, eclampsia
Eclampsia is the onset of seizures (convulsions) in a pregnant woman with pre-eclampsia. Pre-eclampsia is a hypertensive disorder of pregnancy that presents with three main features: new onset of high blood pressure, large amounts of proteinuria ...
, obstructed labor
Obstructed labour, also known as labour dystocia, is the baby not exiting the pelvis because it is physically blocked during childbirth although the uterus contracts normally. Complications for the baby include Perinatal asphyxia, not getting e ...
, sepsis
Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs.
This initial stage of sepsis is followed by suppression of the immune system. Common signs and s ...
and unskilled abortion
Abortion is the early termination of a pregnancy by removal or expulsion of an embryo or fetus. Abortions that occur without intervention are known as miscarriages or "spontaneous abortions", and occur in roughly 30–40% of all pregnan ...
. In addition malaria
Malaria is a Mosquito-borne disease, mosquito-borne infectious disease that affects vertebrates and ''Anopheles'' mosquitoes. Human malaria causes Signs and symptoms, symptoms that typically include fever, Fatigue (medical), fatigue, vomitin ...
and AIDS
The HIV, human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system. Without treatment, it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS). It is a Preventive healthcare, pr ...
can also endanger pregnancy. In the period 2003–2009 hemorrhage was the leading cause of death, accounting for 27% of deaths in developing countries and 16% in developed countries.
Non-reproductive health remains an important predictor of maternal health. In the United States, the leading causes of maternal death are cardiovascular disease (15% of deaths), endocrine, respiratory and gastrointestinal disorders, infection
An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...
, hemorrhage and hypertensive disorders of pregnancy (Gronowski and Schindler, Table II).
In 2000, the United Nations
The United Nations (UN) is the Earth, global intergovernmental organization established by the signing of the Charter of the United Nations, UN Charter on 26 June 1945 with the stated purpose of maintaining international peace and internationa ...
created Millennium Development Goal (MDG) 5 to improve maternal health.[ Target 5A sought to reduce maternal mortality by three quarters from 1990 to 2015, using two indicators, 5.1 the MMR and 5.2 the proportion of deliveries attended by skilled health personnel (physician, nurse or midwife). Early reports indicated MDG 5 had made the least progress of all MDGs.][ By the target date of 2015 the MMR had only declined by 45%, from 380 to 210, most of which occurred after 2000. However this improvement occurred across all regions, but the highest MMRs were still in Africa and Asia, although South Asia witnessed the largest fall, from 530 to 190 (64%). The smallest decline was seen in the developed countries, from 26 to 16 (37%). In terms of assisted births, this proportion had risen globally from 59 to 71%. Although the numbers were similar for both developed and developing regions, there were wide variations in the latter from 52% in South Asia to 100% in ]East Asia
East Asia is a geocultural region of Asia. It includes China, Japan, Mongolia, North Korea, South Korea, and Taiwan, plus two special administrative regions of China, Hong Kong and Macau. The economies of Economy of China, China, Economy of Ja ...
. The risks of dying in pregnancy in developing countries remains fourteen times higher than in developed countries, but in Sub-Saharan Africa, where the MMR is highest, the risk is 175 times higher. In setting the MDG targets, skilled assisted birth was considered a key strategy, but also an indicator of access to care and closely reflect mortality rates. There are also marked differences within regions with a 31% lower rate in rural areas of developing countries (56 vs. 87%), yet there is no difference in East Asia but a 52% difference in Central Africa
Central Africa (French language, French: ''Afrique centrale''; Spanish language, Spanish: ''África central''; Portuguese language, Portuguese: ''África Central'') is a subregion of the African continent comprising various countries accordin ...
(32 vs. 84%). With the completion of the MDG campaign in 2015, new targets are being set for 2030 under the Sustainable Development Goals
The ''2030 Agenda for Sustainable Development'', adopted by all United Nations (UN) members in 2015, created 17 world Sustainable Development Goals (SDGs). The aim of these global goals is "peace and prosperity for people and the planet" – wh ...
campaign. Maternal health is placed under Goal 3, Health, with the target being to reduce the global maternal mortality ratio to less than 70.[ Amongst tools being developed to meet these targets is the WHO Safe Childbirth Checklist.][
Improvements in maternal health, in addition to professional assistance at delivery, will require routine antenatal care, basic emergency obstetric care, including the availability of ]antibiotics
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...
, oxytocics, anticonvulsants
Anticonvulsants (also known as antiepileptic drugs, antiseizure drugs, or anti-seizure medications (ASM)) are a diverse group of pharmacological agents used in the treatment of epileptic seizures. Anticonvulsants are also used in the treatment ...
, the ability to manually remove a retained placenta, perform instrumented deliveries, and postpartum care that is financially accessible, such as through insurance. Research has shown the most effective programmes are those focussing on patient and community education, prenatal care, emergency obstetrics (including access to cesarean sections) and transportation. As with women's health in general, solutions to maternal health require a broad view encompassing many of the other MDG goals, such as poverty and status, and given that most deaths occur in the immediate intrapartum period, it has been recommended that intrapartum care (delivery) be a core strategy. New guidelines on antenatal care were issued by WHO in November 2016.[
]
Complications of pregnancy
In addition to death occurring in pregnancy and childbirth, pregnancy can result in many non-fatal health problems including obstetrical fistulae, ectopic pregnancy, preterm labor, gestational diabetes, hyperemesis gravidarum, hypertensive states including preeclampsia, and anemia
Anemia (also spelt anaemia in British English) is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin availabl ...
.[ Globally, complications of pregnancy vastly outway maternal deaths, with an estimated 9.5 million cases of pregnancy-related illness and 1.4 million near-misses (survival from severe life-threatening complications). Complications of pregnancy may be physical, mental, economic and social. It is estimated that 10–20 million women will develop physical or mental disability every year, resulting from complications of pregnancy or inadequate care. Consequently, international agencies have developed standards for obstetric care.][
Many do not understand how past pregnancy complications impact future pregnancy birthing options. It is a common misconception that after one Cesarean Section birth, it is medically necessary for all future births. One C-section procedure does not deem parents ineligible for safe vaginal delivery.
]
= Obstetrical fistula
=
Of near miss events, obstetrical fistulae (OF), including vesicovaginal and rectovaginal fistulae, remain one of the most serious and tragic. Although corrective surgery is possible it is often not available and OF is considered completely preventable. If repaired, subsequent pregnancies will require cesarean section.[ While unusual in developed countries, it is estimated that up to 100,000 cases occur every year in the world, and that about 2 million women are currently living with this condition, with the highest incidence occurring in Africa and parts of Asia.][ OF results from prolonged ]obstructed labor
Obstructed labour, also known as labour dystocia, is the baby not exiting the pelvis because it is physically blocked during childbirth although the uterus contracts normally. Complications for the baby include Perinatal asphyxia, not getting e ...
without intervention, when continued pressure from the fetus in the birth canal
In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The vaginal int ...
restricts blood supply to the surrounding tissues, with eventual fetal death, necrosis
Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. The term "necrosis" came about in the mid-19th century and is commonly attributed to German pathologist Rudolf Virchow, who i ...
and expulsion. The damaged pelvic organs then develop a connection (fistula) allowing urine or feces, or both, to be discharged through the vagina with associated urinary
The human urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressu ...
and fecal incontinence
Fecal incontinence (FI), or in some forms, encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents—including flatus (gas), liquid stool elements and mucus, or solid feces. FI is a sign or a symptom ...
, vaginal stenosis
Stenosis () is the abnormal narrowing of a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture).
''Stricture'' as a term is usually used when narrowing ...
, nerve damage and infertility. Severe social and mental consequences are also likely to follow, with shunning of the women. Apart from lack of access to care, causes include young age, and malnourishment
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is a deficiency, excess, or imbalance of energy, protein and other nutrients which adversely affects the body's tissues a ...
.[ The ]UNFPA
The United Nations Population Fund (UNFPA) is a UN agency aimed at improving reproductive and maternal health worldwide. Its work includes developing national healthcare strategies and protocols, increasing access to birth control, and leadin ...
has made prevention of OF a priority and is the lead agency in the Campaign to End Fistula, which issues annual reports[ and the United Nations observes May 23 as the International Day to End Obstetric Fistula every year.][ Prevention includes discouraging teenage pregnancy and child marriage, adequate nutrition, and access to skilled care, including caesarean section.
]
Sexual health
Contraception
The ability to determine if and when to become pregnant, is vital to a woman's autonomy and well-being, and contraception can protect girls and young women from the risks of early pregnancy and older women from the increased risks of unintended pregnancy. Adequate access to contraception can limit multiple pregnancies, reduce the need for potentially unsafe abortion and reduce maternal and infant mortality and morbidity. Some barrier forms of contraception such as condoms, also reduce the risk of STIs and HIV infection. Access to contraception allows women to make informed choices about their reproductive and sexual health, increases empowerment, and enhances choices in education, careers and participation in public life. At the societal level, access to contraception is a key factor in controlling population growth
Population growth is the increase in the number of people in a population or dispersed group. The World population, global population has grown from 1 billion in 1800 to 8.2 billion in 2025. Actual global human population growth amounts to aroun ...
, with resultant impact on the economy, the environment and regional development.[ Consequently, the United Nations considers access to contraception a ]human right
Human rights are universally recognized moral principles or norms that establish standards of human behavior and are often protected by both national and international laws. These rights are considered inherent and inalienable, meaning t ...
that is central to gender equality
Gender equality, also known as sexual equality, gender egalitarianism, or equality of the sexes, is the state of equal ease of access to resources and opportunities regardless of gender, including economic participation and decision-making, an ...
and women's empowerment
Women's empowerment (or female empowerment) may be defined in several method, including accepting women's viewpoints, making an effort to seek them and raising the status of women through education, awareness, literacy, equal status in society, ...
that saves lives and reduces poverty,[ and birth control has been considered amongst the 10 great public health achievements of the 20th century.][
To optimise women's control over pregnancy, it is essential that culturally appropriate contraceptive advice and means are widely, easily, and affordably available to anyone that is sexually active, including adolescents. In many parts of the world access to contraception and family planning services is very difficult or non existent and even in developed counties cultural and religious traditions can create barriers to access. Reported usage of adequate contraception by women has risen only slightly between 1990 and 2014, with considerable regional variability. Although global usage is around 55%, it may be as low as 25% in Africa. Research shows that women in the ]Middle East and North Africa
The Middle East and North Africa (MENA), also referred to as West Asia and North Africa (WANA) or South West Asia and North Africa (SWANA), is a geographic region which comprises the Middle East (also called West Asia) and North Africa together ...
use contraception at low rates. Only 14% of women who completed a survey in Jordan
Jordan, officially the Hashemite Kingdom of Jordan, is a country in the Southern Levant region of West Asia. Jordan is bordered by Syria to the north, Iraq to the east, Saudi Arabia to the south, and Israel and the occupied Palestinian ter ...
said they used condom
A condom is a sheath-shaped Barrier contraception, barrier device used during sexual intercourse to reduce the probability of pregnancy or a Sexually transmitted disease, sexually transmitted infection (STI). There are both external condo ...
s with their spouses. Worldwide 222 million women have no or limited access to contraception
Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only be ...
. Some caution is needed in interpreting available data, since contraceptive prevalence is often defined as "the percentage of women currently using any method of contraception among all women of reproductive age (''i.e.'', those aged 15 to 49 years, unless otherwise stated) who are married or in a union. The "in-union" group includes women living with their partner in the same household and who are not married according to the marriage laws or customs of a country." This definition is more suited to the more restrictive concept of family planning
Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marit ...
, but omits the contraceptive needs of all other women and girls who are or are likely to be sexually active, are at risk of pregnancy and are not married or "in-union".[
Three related targets of MDG5 were adolescent birth rate, contraceptive prevalence and unmet need for family planning (where prevalence+unmet need = total need), which were monitored by the Population Division of the UN Department of Economic and Social Affairs.][ Contraceptive use was part of Goal 5B (universal access to reproductive health), as Indicator 5.3.][ The evaluation of MDG5 in 2015 showed that amongst couples usage had increased worldwide from 55% to 64%. with one of the largest increases in Subsaharan Africa (13 to 28%). The corollary, unmet need, declined slightly worldwide (15 to 12%). In 2015 these targets became part of SDG5 (gender equality and empowerment) under Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights, where Indicator 5.6.1 is the proportion of women aged 15–49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care (p. 31).][
There remain significant barriers to accessing contraception for many women in both developing and developed regions. These include legislative, administrative, cultural, religious and economic barriers in addition to those dealing with access to and quality of health services. Much of the attention has been focused on preventing adolescent pregnancy. The ]Overseas Development Institute
ODI Global (formerly Overseas Development Institute) is a global affairs think tank, founded in 1960. Its mission is "to inspire people to act on injustice and inequality through collaborative research and ideas that matter for people and the ...
(ODI) has identified a number of key barriers, on both the supply
Supply or supplies may refer to:
*The amount of a resource that is available
**Supply (economics), the amount of a product which is available to customers
**Materiel, the goods and equipment for a military unit to fulfill its mission
*Supply, as ...
and demand side, including internalising socio-cultural values, pressure from family members, and cognitive barriers (lack of knowledge), which need addressing.[ Even in developed regions many women, particularly those who are ]disadvantaged
The "disadvantaged" is a generic term for individuals or groups of people who:
* Face special problems such as physical disability, physical or mental disorder, mental disability
* Lack money or economic supportKingdom of Nepal: Economic and Soc ...
, may face substantial difficulties in access that may be financial and geographic but may also face religious and political discrimination.[ Women have also mounted campaigns against potentially dangerous forms of contraception such as defective intrauterine devices (IUD)s, particularly the Dalkon Shield.
]
Abortion
Abortion is the intentional killing of an unborn child, as compared to spontaneous termination (miscarriage
Miscarriage, also known in medical terms as a spontaneous abortion, is an end to pregnancy resulting in the loss and expulsion of an embryo or fetus from the womb before it can fetal viability, survive independently. Miscarriage before 6 weeks ...
). Abortion is closely allied to contraception in terms of women's control and regulation of their reproduction, and is often subject to similar cultural, religious, legislative and economic constraints. Where access to contraception is limited, women turn to abortion. Consequently, abortion rates may be used to estimate unmet needs for contraception. However the available procedures have carried great risk for women throughout most of history, and still do in the developing world, or where legal restrictions force women to seek clandestine facilities. Access to safe legal abortion places undue burdens on lower socioeconomic groups and in jurisdictions that create significant barriers. These issues have frequently been the subject of political and feminist campaigns where differing viewpoints pit health against moral values.
Globally, there were 87 million unwanted pregnancies in 2005, of those 46 million resorted to abortion, of which 18 million were considered unsafe, resulting in 46,068,000 deaths. The majority of these deaths occurred in the developing world. The United Nations considers these avoidable with access to safe abortion and post-abortion care. While abortion rates have fallen in developed countries, but not in developing countries. Between 2010 and 2014 there were 35 abortions per 1000 women aged 15–44, a total of 56 million abortions per year. The United nations has prepared recommendations for health care workers to provide more accessible and safe abortion and post-abortion care. An inherent part of post-abortion care involves provision of adequate contraception.
Sexually transmitted infections
Important sexual health issues for women include Sexually transmitted infections
A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, or ...
(STIs) and female genital cutting (FGC). STIs are a global health priority because they have serious consequences for women and infants. Mother-to-child transmission of STIs can lead to stillbirths
Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can often result in the feeling of guilt or grief in the mother. T ...
, neonatal death, low-birth-weight and prematurity, sepsis
Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs.
This initial stage of sepsis is followed by suppression of the immune system. Common signs and s ...
, pneumonia
Pneumonia is an Inflammation, inflammatory condition of the lung primarily affecting the small air sacs known as Pulmonary alveolus, alveoli. Symptoms typically include some combination of Cough#Classification, productive or dry cough, ches ...
, neonatal conjunctivitis, and congenital deformities. Syphilis
Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms depend on the stage it presents: primary, secondary, latent syphilis, latent or tertiary. The prim ...
in pregnancy results in over 300,000 fetal and neonatal deaths per year, and 215,000 infants with an increased risk of death from prematurity, low-birth-weight or congenital disease.[
Diseases such as ]chlamydia
Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium ''Chlamydia trachomatis''. Most people who are infected have no symptoms. When symptoms do appear, they may occur only several w ...
and gonorrhoea are also important causes of pelvic inflammatory disease (PID) and subsequent infertility
In biology, infertility is the inability of a male and female organism to Sexual reproduction, reproduce. It is usually not the natural state of a healthy organism that has reached sexual maturity, so children who have not undergone puberty, whi ...
in women. Another important consequence of some STIs such as genital herpes
Genital herpes is a herpes infection of the genitals caused by the herpes simplex virus (HSV). Most people either have no or mild symptoms and thus do not know they are infected. When symptoms do occur, they typically include small blisters ...
and syphilis increase the risk of acquiring HIV by three-fold, and can also influence its transmission progression.[ Worldwide, women and girls are at greater risk of ]HIV/AIDS
The HIV, human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system. Without treatment, it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS). It is a Preventive healthcare, pr ...
. STIs are in turn associated with unsafe sexual activity that is often unconsensual.[ In the Middle East and North Africa (MENA), a large number of HIV-positive women contracted the virus from their spouses or partners. In comparison to men, taboos, and discrimination against women living with HIV are more pervasive throughout the MENA region.] Women in the MENA region are more vulnerable to HIV because of gender inequity, gender-based violence, and restricted access to comprehensive healthcare systems.
Female genital mutilation
Female genital mutilation
Female genital mutilation (FGM) (also known as female genital cutting, female genital mutilation/cutting (FGM/C) and female circumcision) is the cutting or removal of some or all of the vulva for non-medical reasons. Prevalence of female ge ...
(also referred to as female genital cutting) is defined by the World Health Organization (WHO) as "all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons". It has sometimes been referred to as female circumcision
Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. T ...
, although this term is misleading because it implies it is analogous to the circumcision of the foreskin
In male Human body, human anatomy, the foreskin, also known as the prepuce (), is the double-layered fold of Human skin, skin, Mucous membrane, mucosal and Muscle tissue, muscular tissue at the distal end of the human penis that covers the glans ...
from the male penis.[ Consequently, the term mutilation was adopted to emphasise the gravity of the act and its place as a violation of human rights. Subsequently, the term cutting was advanced to avoid offending cultural sensibility that would interfere with dialogue for change. To recognise these points of view some agencies use the composite female genital mutilation/cutting (FMG/C).][
]
It has affected more than 200 million women and girls who are alive today. The practice is concentrated in some 30 countries in Africa, the Middle East and Asia. Female genital mutilation is still common, impacting around 50 million women and girls in the five countries of Yemen
Yemen, officially the Republic of Yemen, is a country in West Asia. Located in South Arabia, southern Arabia, it borders Saudi Arabia to Saudi Arabia–Yemen border, the north, Oman to Oman–Yemen border, the northeast, the south-eastern part ...
, Egypt
Egypt ( , ), officially the Arab Republic of Egypt, is a country spanning the Northeast Africa, northeast corner of Africa and Western Asia, southwest corner of Asia via the Sinai Peninsula. It is bordered by the Mediterranean Sea to northe ...
, Sudan
Sudan, officially the Republic of the Sudan, is a country in Northeast Africa. It borders the Central African Republic to the southwest, Chad to the west, Libya to the northwest, Egypt to the north, the Red Sea to the east, Eritrea and Ethiopi ...
, Djibouti
Djibouti, officially the Republic of Djibouti, is a country in the Horn of Africa, bordered by Somalia to the south, Ethiopia to the southwest, Eritrea in the north, and the Red Sea and the Gulf of Aden to the east. The country has an area ...
, and Iraq
Iraq, officially the Republic of Iraq, is a country in West Asia. It is bordered by Saudi Arabia to Iraq–Saudi Arabia border, the south, Turkey to Iraq–Turkey border, the north, Iran to Iran–Iraq border, the east, the Persian Gulf and ...
in the Middle East and North Africa (MENA) region, as adolescent women frequently experience a lack of bodily autonomy in the Arab world. According to data, the frequency of FGM among women between the ages of 15 and 49 is high: 94% in Djibouti, 87% in Egypt and Sudan, 19% in Yemen, and 7% in Iraq. FGC affects many religious faiths, nationalities, and socioeconomic classes and is highly controversial. The main arguments advanced to justify FGC are hygiene, fertility, the preservation of chastity
Chastity, also known as purity, is a virtue related to temperance. Someone who is ''chaste'' refrains from sexual activity that is considered immoral or from any sexual activity, according to their state of life. In some contexts, for exampl ...
, an important rite of passage
A rite of passage is a ceremony or ritual of the passage which occurs when an individual leaves one group to enter another. It involves a significant change of social status, status in society. In cultural anthropology the term is the Anglicisa ...
, marriageability and enhanced sexual pleasure of male partners. The amount of tissue removed varies considerably, leading the WHO and other bodies to classify FGC into four types. These range from the partial or total removal of the clitoris
In amniotes, the clitoris ( or ; : clitorises or clitorides) is a female sex organ. In humans, it is the vulva's most erogenous zone, erogenous area and generally the primary anatomical source of female Human sexuality, sexual pleasure. Th ...
with or without the prepuce ( clitoridectomy) in Type I, to the additional removal of the labia minora
The labia minora (Latin for 'smaller lips', : labium minus), also known as the inner labia, inner lips, or nymphae, are two flaps of skin that are part of the primate vulva, extending outwards from the inner Vagina#Vaginal opening and hymen, vagi ...
, with or without excision of the labia majora
In primates, and specifically in humans, the labia majora (: labium majus), also known as the outer lips or outer labia, are two prominent Anatomical terms of location, longitudinal skin folds that extend downward and backward from the mons pubis ...
(Type II) to narrowing of the vaginal orifice ( introitus) with the creation of a covering seal by suturing the remaining labial tissue over the urethra
The urethra (: urethras or urethrae) is the tube that connects the urinary bladder to the urinary meatus, through which Placentalia, placental mammals Urination, urinate and Ejaculation, ejaculate.
The external urethral sphincter is a striated ...
and introitus, with or without excision of the clitoris ( infibulation). In this type a small opening is created to allow urine and menstrual blood to be discharged. Type 4 involves all other procedures, usually relatively minor alterations such as piercing.
While defended by those cultures in which it constitutes a tradition, FGC is opposed by many medical and cultural organizations on the grounds that it is unnecessary and harmful. Short-term health effects may include hemorrhage, infection, sepsis, and even result in death, while long term effects include dyspareunia
Dyspareunia ( ) is painful sexual intercourse due to somatic or psychological causes. The term ''dyspareunia'' covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the f ...
, dysmenorrhea
Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in th ...
, vaginitis
Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy.
The three mai ...
and cystitis. In addition FGC leads to complications with pregnancy, labor and delivery. Reversal (defibulation) by skilled personnel may be required to open the scarred tissue. Amongst those opposing the practice are local grassroots
A grassroots movement is one that uses the people in a given district, region or community as the basis for a political or continent movement. Grassroots movements and organizations use collective action from volunteers at the local level to imp ...
groups, and national and international organisations including WHO, UNICEF,[ UNFPA][ and ]Amnesty International
Amnesty International (also referred to as Amnesty or AI) is an international non-governmental organization focused on human rights, with its headquarters in the United Kingdom. The organization says that it has more than ten million members a ...
. Legislative efforts to ban FGC have rarely been successful and the preferred approach is education and empowerment and the provision of information about the adverse health effects as well the human rights
Human rights are universally recognized Morality, moral principles or Social norm, norms that establish standards of human behavior and are often protected by both Municipal law, national and international laws. These rights are considered ...
aspects.
Progress has been made but girls 14 and younger represent 44 million of those who have been cut, and in some regions 50% of all girls aged 11 and younger have been cut.[ Ending FGC has been considered one of the necessary goals in achieving the targets of the Millennium Development Goals, while the United Nations has declared ending FGC a target of the Sustainable Development Goals, and for February 6 to known as the International Day of Zero Tolerance for Female Genital Mutilation, concentrating on 17 African countries and the 5 million girls between the ages of 15 and 19 that would otherwise be cut by 2030.][
]
Infertility
In the United States, infertility affects 1.5 million couples.[ The rates of infertility in the Middle East and North Africa (MENA) are difficult to measure due to varying definitions of the condition. When infertility is defined as failure to have a successful birth, the MENA region has a very high rate at 33%. Morocco has the highest percentage of infertility among the MENA countries with an infertility rate of 56.8%. Rates of infertility, defined as failure to conceive (clinical infertility), are probably lower in the region but there is a lack of data on the exact numbers. There is a dearth of research on clinical infertility in the MENA region, with the exception of ]Iran
Iran, officially the Islamic Republic of Iran (IRI) and also known as Persia, is a country in West Asia. It borders Iraq to the west, Turkey, Azerbaijan, and Armenia to the northwest, the Caspian Sea to the north, Turkmenistan to the nort ...
, which is attributed to a societal reluctance to discuss infertility openly.
Many couples seek assisted reproductive technology
Assisted reproductive technology (ART) includes medical procedures used primarily to address infertility. This subject involves procedures such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and cryopreservation of ga ...
(ART) for infertility. In the United States in 2010, 147,260 in vitro fertilization
In vitro fertilisation (IVF) is a process of fertilisation in which an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating the ovulatory process, then removing an ovum or ova (egg or eggs) from ...
(IVF) procedures were carried out, with 47,090 live births resulting. In 2013 these numbers had increased to 160,521 and 53,252. However, about a half of IVF pregnancies result in multiple-birth deliveries, which in turn are associated with an increase in both morbidity
A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are asso ...
and mortality of the mother and the infant. Causes for this include increased maternal blood pressure, premature birth
Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is betwee ...
and low birth weight. In addition, more women are waiting longer to conceive and seeking ART.
Child marriage
Child marriage
Child marriage is a practice involving a marriage or domestic partnership, formal or informal, that includes an individual under 18 and an adult or other child.*
*
*
*
Research has found that child marriages have many long-term negative co ...
(including union or cohabitation
Cohabitation is an arrangement where people who are not legally married live together as a couple. They are often involved in a Romance (love), romantic or Sexual intercourse, sexually intimate relationship on a long-term or permanent basis. ...
)[ is defined as ]marriage
Marriage, also called matrimony or wedlock, is a culturally and often legally recognised union between people called spouses. It establishes rights and obligations between them, as well as between them and their children (if any), and b ...
under the age of eighteen and is an ancient custom. In 2010 it was estimated that 67 million women, then, in their twenties had been married before they turned eighteen, and that 150 million would be in the next decade, equivalent to 15 million per year. This number had increased to 70 million by 2012. In developing countries one third of girls are married under age, and 1:9 before 15. The practice is commonest in South Asia (48% of women), Africa (42%) and Latin America
Latin America is the cultural region of the Americas where Romance languages are predominantly spoken, primarily Spanish language, Spanish and Portuguese language, Portuguese. Latin America is defined according to cultural identity, not geogr ...
and the Caribbean
The Caribbean ( , ; ; ; ) is a region in the middle of the Americas centered around the Caribbean Sea in the Atlantic Ocean, North Atlantic Ocean, mostly overlapping with the West Indies. Bordered by North America to the north, Central America ...
(29%). The highest prevalence is in Western and Sub-Saharan Africa. The percentage of girls married before the age of eighteen is as high as 75% in countries such as Niger
Niger, officially the Republic of the Niger, is a landlocked country in West Africa. It is a unitary state Geography of Niger#Political geography, bordered by Libya to the Libya–Niger border, north-east, Chad to the Chad–Niger border, east ...
. Approximately one in five young women in the Middle East and North Africa
The Middle East and North Africa (MENA), also referred to as West Asia and North Africa (WANA) or South West Asia and North Africa (SWANA), is a geographic region which comprises the Middle East (also called West Asia) and North Africa together ...
were married before becoming eighteen, and one in twenty-five married before turning fifteen. In Egypt
Egypt ( , ), officially the Arab Republic of Egypt, is a country spanning the Northeast Africa, northeast corner of Africa and Western Asia, southwest corner of Asia via the Sinai Peninsula. It is bordered by the Mediterranean Sea to northe ...
, 17% of women in the 20–24 age group, 13% in Morocco
Morocco, officially the Kingdom of Morocco, is a country in the Maghreb region of North Africa. It has coastlines on the Mediterranean Sea to the north and the Atlantic Ocean to the west, and has land borders with Algeria to Algeria–Morocc ...
, 28% in Iraq
Iraq, officially the Republic of Iraq, is a country in West Asia. It is bordered by Saudi Arabia to Iraq–Saudi Arabia border, the south, Turkey to Iraq–Turkey border, the north, Iran to Iran–Iraq border, the east, the Persian Gulf and ...
, 8% in Jordan
Jordan, officially the Hashemite Kingdom of Jordan, is a country in the Southern Levant region of West Asia. Jordan is bordered by Syria to the north, Iraq to the east, Saudi Arabia to the south, and Israel and the occupied Palestinian ter ...
, 6% in Lebanon
Lebanon, officially the Republic of Lebanon, is a country in the Levant region of West Asia. Situated at the crossroads of the Mediterranean Basin and the Arabian Peninsula, it is bordered by Syria to the north and east, Israel to the south ...
, and 3% in Algeria
Algeria, officially the People's Democratic Republic of Algeria, is a country in the Maghreb region of North Africa. It is bordered to Algeria–Tunisia border, the northeast by Tunisia; to Algeria–Libya border, the east by Libya; to Alger ...
were married or engaged before turning 18. Most child marriage involves girls. For instance in Mali
Mali, officially the Republic of Mali, is a landlocked country in West Africa. It is the List of African countries by area, eighth-largest country in Africa, with an area of over . The country is bordered to the north by Algeria, to the east b ...
the ratio of girls to boys is 72:1, while in countries such as the United States the ratio is 8:1. Marriage may occur as early as birth, with the girl being sent to her husbands home as early as age seven.
There are a number of cultural factors that reinforce this practice. These include the child's financial future, her dowry
A dowry is a payment such as land, property, money, livestock, or a commercial asset that is paid by the bride's (woman's) family to the groom (man) or his family at the time of marriage.
Dowry contrasts with the related concepts of bride price ...
, social ties and social status, prevention of premarital sex
Premarital sex is sex before marriage. It is an act of sex between two people who are not married to each other. Premarital sex is considered a sin by a number of religions and also considered a moral issue which is taboo in many cultures.
S ...
, extramarital pregnancy and STIs. The arguments against it include interruption of education and loss of employment prospects, and hence economic status, as well as loss of normal childhood and its emotional maturation and social isolation. Child marriage places the girl in a relationship where she is in a major imbalance of power and perpetuates the gender inequality that contributed to the practice in the first place.[ Also in the case of minors, there are the issues of human rights, non-consensual sexual activity and ]forced marriage
Forced marriage is a marriage in which one or more of the parties is married without their consent or against their will. A marriage can also become a forced marriage even if both parties enter with full consent if one or both are later force ...
and a 2016 joint report of the WHO and Inter-Parliamentary Union places the two concepts together as Child, Early and Forced Marriage (CEFM), as did the 2014 Girl Summit (see below). In addition the likely pregnancies at a young age are associated with higher medical risks for both mother and child, multiple pregnancies and less access to care[ with pregnancy being amongst the leading causes of death amongst girls aged 15–19. Girls married under age are also more likely to be the victims of ]domestic violence
Domestic violence is violence that occurs in a domestic setting, such as in a marriage
Marriage, also called matrimony or wedlock, is a culturally and often legally recognised union between people called spouses. It establishes r ...
.
There has been an international effort to reduce this practice, and in many countries eighteen is the legal age of marriage. Organizations with campaigns to end child marriage include the United Nations[ and its agencies, such as the ]Office of the High Commissioner for Human Rights
The Office of the United Nations High Commissioner for Human Rights (OHCHR) is a department of the United Nations Secretariat that works to promote and protect human rights that are guaranteed under international law and stipulated in the Univers ...
, UNFPA,[ UNICEF][ and WHO. Like many global issues affecting women's health, poverty and gender inequality are root causes, and any campaign to change cultural attitudes has to address these.][ Child marriage is the subject of international conventions and agreements such as The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW, 1979) (article 16)][ and the ]Universal Declaration of Human Rights
The Universal Declaration of Human Rights (UDHR) is an international document adopted by the United Nations General Assembly that enshrines the Human rights, rights and freedoms of all human beings. Drafted by a UN Drafting of the Universal D ...
[ and in 2014 a summit conference ( Girl Summit) co-hosted by UNICEF and the UK was held in London (see illustration) to address this issue together with FGM/C. Later that same year the General Assembly of the ]United Nations
The United Nations (UN) is the Earth, global intergovernmental organization established by the signing of the Charter of the United Nations, UN Charter on 26 June 1945 with the stated purpose of maintaining international peace and internationa ...
passed a resolution, which '' inter alia''
Amongst non-governmental organizations
A non-governmental organization (NGO) is an independent, typically nonprofit organization that operates outside government control, though it may get a significant percentage of its funding from government or corporate sources. NGOs often focus ...
(NGOs) working to end child marriage are Girls not Brides, Young Women's Christian Association (YWCA), the International Center for Research on Women (ICRW) and Human Rights Watch
Human Rights Watch (HRW) is an international non-governmental organization that conducts research and advocacy on human rights. Headquartered in New York City, the group investigates and reports on issues including War crime, war crimes, crim ...
(HRW). Although not explicitly included in the original Millennium Development Goals, considerable pressure was applied to include ending child marriage in the successor Sustainable Development Goals adopted in September 2015, where ending this practice by 2030 is a target of SDG 5 Gender Equality (see above).[ While some progress is being made in reducing child marriage, particularly for girls under fifteen, the prospects are daunting. The indicator for this will be the percentage of women aged 20–24 who were married or in a union before the age of eighteen. Efforts to end child marriage include legislation and ensuring enforcement together with empowering women and girls.][ To raise awareness, the inaugural UN International Day of the Girl Child in 2012 was dedicated to ending child marriage.][
]
Menstrual cycle
Women's menstrual cycles, the approximately monthly cycle of changes in the reproductive system, can pose significant challenges for women in their reproductive years (the early teens to about 50 years of age). These include the physiological changes that can effect physical and mental health, symptoms of ovulation
Ovulation is an important part of the menstrual cycle in female vertebrates where the egg cells are released from the ovaries as part of the ovarian cycle. In female humans ovulation typically occurs near the midpoint in the menstrual cycle and ...
and the regular shedding of the inner lining of the uterus (endometrium
The endometrium is the inner epithelium, epithelial layer, along with its mucous membrane, of the mammalian uterus. It has a basal layer and a functional layer: the basal layer contains stem cells which regenerate the functional layer. The funct ...
) accompanied by vaginal bleeding (menses or menstruation
Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and Mucous membrane, mucosal tissue from the endometrium, inner lining of the uterus through the vagina. The menstrual cycle is characterized ...
). The onset of menstruation (menarche
Menarche ( ; ) is the first menstrual cycle, or first menstruation, menstrual bleeding, in female humans. From both social and medical perspectives, it is often considered the central event of female puberty, as it signals the possibility of fe ...
) may be alarming to unprepared girls and mistaken for illness. Menstruation can place undue burdens on women in terms of their ability to participate in activities, and access to menstrual aids such as tampons
A tampon is a menstrual product designed to absorb blood and vaginal secretions by insertion into the vagina during menstruation. Unlike a pad, it is placed internally, inside of the vaginal canal. Once inserted correctly, a tampon is held ...
and sanitary pads. This is particularly acute amongst poorer socioeconomic groups where they may represent a financial burden and in developing countries where menstruation can be an impediment to a girl's education.[ In the ]Middle East and North Africa
The Middle East and North Africa (MENA), also referred to as West Asia and North Africa (WANA) or South West Asia and North Africa (SWANA), is a geographic region which comprises the Middle East (also called West Asia) and North Africa together ...
, period poverty and stigma have an influence on girls' education and general well-being. Misinformation and a lack of fundamental knowledge cause girls to miss school during their menstrual cycle and contribute to the prevailing stigma around getting your period.
Equally challenging for women are the physiological and emotional changes associated with the cessation of menses (menopause
Menopause, also known as the climacteric, is the time when Menstruation, menstrual periods permanently stop, marking the end of the Human reproduction, reproductive stage for the female human. It typically occurs between the ages of 45 and 5 ...
or climacteric). While typically occurring gradually towards the end of the fifth decade in life marked by irregular bleeding the cessation of ovulation and menstruation is accompanied by marked changes in hormonal activity, both by the ovary
The ovary () is a gonad in the female reproductive system that produces ova; when released, an ovum travels through the fallopian tube/ oviduct into the uterus. There is an ovary on the left and the right side of the body. The ovaries are end ...
itself ( oestrogen and progesterone
Progesterone (; P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the progestogens and is the ma ...
) and the pituitary gland ( follicle stimulating hormone or FSH and luteinizing hormone or LH). These hormonal changes may be associated with both systemic sensations such as hot flashes and local changes to the reproductive tract such as reduced vaginal secretions and lubrication. While menopause may bring relief from symptoms of menstruation and fear of pregnancy it may also be accompanied by emotional and psychological changes associated with the symbolism of the loss of fertility and a reminder of aging and possible loss of desirability. While menopause generally occurs naturally as a physiological process it may occur earlier ( premature menopause) as a result of disease or from medical or surgical intervention. When menopause occurs prematurely the adverse consequences may be more severe.[
]
Other issues
Other reproductive and sexual health issues include sex education
Sex education, also known as sexual education, sexuality education or sex ed, is the instruction of issues relating to human sexuality, including human sexual anatomy, Human sexual activity, sexual activity, sexual reproduction, safe sex, birth ...
, puberty
Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a female, the testicles i ...
, sexuality
Human sexuality is the way people experience and express themselves sexually. This involves biological, psychological, physical, erotic, emotional, social, or spiritual feelings and behaviors. Because it is a broad term, which has varied ...
and sexual function. Women also experience a number of issues related to the health of their breasts and genital tract
The reproductive system of an organism, also known as the genital system, is the biological system made up of all the anatomical organs involved in sexual reproduction. Many non-living substances such as fluids, hormones, and pheromones are al ...
, which fall into the scope of gynaecology
Gynaecology or gynecology (see American and British English spelling differences) is the area of medicine concerned with conditions affecting the female reproductive system. It is often paired with the field of obstetrics, which focuses on pre ...
.
Non-reproductive health
Women and men have different experiences of the same illnesses, especially cardiovascular disease, cancer, depression and dementia. Women are also more prone to urinary tract infections than men.[
]
Cardiovascular disease
Cardiovascular disease
Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina, heart attack), heart failure, hypertensive heart disease, rheumati ...
is the leading cause of death (35%) amongst women globally. The onset occurs at a later age in women than in men. For instance the incidence of stroke in women under the age of 80 is less than that in men, but higher in those aged over 80. Overall the lifetime risk of stroke in women exceeds that in men. The risk of cardiovascular disease amongst those with diabetes and amongst smokers is also higher in women than in men. Many aspects of cardiovascular disease vary between women and men, including risk factors, prevalence, physiology, symptoms, response to intervention and outcome. Among women in the Middle East
The Middle East (term originally coined in English language) is a geopolitical region encompassing the Arabian Peninsula, the Levant, Turkey, Egypt, Iran, and Iraq.
The term came into widespread usage by the United Kingdom and western Eur ...
, cardiovascular disease-related morbidity
A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are asso ...
and death are increasing. At the same time, awareness and education on the disease, as well as research, are lacking in the region.
Cancer
Women and men have approximately equal risk of dying from cancer
Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...
, which accounts for about a quarter of all deaths, and is the second leading cause of death. However the relative incidence of different cancers varies between women and men. Globally the three most common types of cancer of women in 2020 were breast
The breasts are two prominences located on the upper ventral region of the torso among humans and other primates. Both sexes develop breasts from the same embryology, embryological tissues. The relative size and development of the breasts is ...
, lung
The lungs are the primary Organ (biology), organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the Vertebral column, backbone on either side of the heart. Their ...
and colorectal cancers. These three account for 44.5% of all cancer cases in women. Other types of cancers specifically affecting women include ovarian, uterine ( endometrial and cervical) cancers.
While cancer death rates rose rapidly during the twentieth century, the increase was less and happened later in women due to differences in smoking
Smoking is a practice in which a substance is combusted, and the resulting smoke is typically inhaled to be tasted and absorbed into the bloodstream of a person. Most commonly, the substance used is the dried leaves of the tobacco plant, whi ...
rates. More recently cancer death rates have started to decline as the use of tobacco becomes less common. Between 1991 and 2012, the death rate in women declined by 19% (less than in men). In the early twentieth century death from uterine ( uterine body and cervix
The cervix (: cervices) or cervix uteri is a dynamic fibromuscular sexual organ of the female reproductive system that connects the vagina with the uterine cavity. The human female cervix has been documented anatomically since at least the time ...
) cancers was the leading cause of cancer death in women, who had a higher cancer mortality than men. From the 1930s onwards, uterine cancer deaths declined, primarily due to lower death rates from cervical cancer following the availability of the Papanicolaou (Pap) screening test. This resulted in an overall reduction of cancer deaths in women between the 1940s and 1970s, when rising rates of lung cancer led to an overall increase. By the 1950s the decline in uterine cancer left breast cancer as the leading cause of cancer death until it was overtaken by lung cancer in the 1980s. All three cancers (lung, breast, uterus) are now declining in cancer death rates, but more women die from lung cancer every year than from breast, ovarian, and uterine cancers combined. Overall about 20% of people found to have lung cancer are never smokers, yet amongst nonsmoking women the risk of developing lung cancer is three times greater than amongst men who never smoked.
In addition to mortality, cancer is a cause of considerable morbidity in women. Women have a lower lifetime probability of being diagnosed with cancer (38% vs 45% for men), but are more likely to be diagnosed with cancer at an earlier age.
Breast cancer
Breast cancer is most common type of cancer among women. Globally, it accounts for 25% of all cancers. It is also among the ten most common chronic diseases of women, and a substantial contributor to loss of quality of life
Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...
. In 2016, breast cancer was the most common cancer diagnosed among women in both developed and developing countries, accounting for nearly 30% of all cases, and worldwide accounts for one and a half million cases and over half a million deaths, being the fifth most common cause of cancer death overall and the second in developed regions. In the Middle East and North Africa
The Middle East and North Africa (MENA), also referred to as West Asia and North Africa (WANA) or South West Asia and North Africa (SWANA), is a geographic region which comprises the Middle East (also called West Asia) and North Africa together ...
, there were 95,000 cases of breast cancer
Breast cancer is a cancer that develops from breast tissue. Signs of breast cancer may include a Breast lump, lump in the breast, a change in breast shape, dimpling of the skin, Milk-rejection sign, milk rejection, fluid coming from the nipp ...
in 2019. The countries with the highest age-standardized prevalence rates per 100,000 females in the region were Bahrain
Bahrain, officially the Kingdom of Bahrain, is an island country in West Asia. Situated on the Persian Gulf, it comprises a small archipelago of 50 natural islands and an additional 33 artificial islands, centered on Bahrain Island, which mak ...
, Qatar
Qatar, officially the State of Qatar, is a country in West Asia. It occupies the Geography of Qatar, Qatar Peninsula on the northeastern coast of the Arabian Peninsula in the Middle East; it shares Qatar–Saudi Arabia border, its sole land b ...
, and Lebanon
Lebanon, officially the Republic of Lebanon, is a country in the Levant region of West Asia. Situated at the crossroads of the Mediterranean Basin and the Arabian Peninsula, it is bordered by Syria to the north and east, Israel to the south ...
. Geographic variation in incidence is the opposite of that of cervical cancer, being highest in Northern America and lowest in Eastern and Middle Africa, but mortality rates are relatively constant, resulting in a wide variance in case mortality, ranging from 25% in developed regions to 37% in developing regions, and with 62% of deaths occurring in developing countries.[
]
Cervical cancer
Globally, cervical cancer is the fourth most common cancer amongst women. It is particularly common in women with lower socioeconomic status
Socioeconomic status (SES) is a measurement used by economics, economists and sociology, sociologsts. The measurement combines a person's work experience and their or their family's access to economic resources and social position in relation t ...
, living in low-and middle-income countries who have reduced access to health care. Customs and cultural practices that involve child
A child () is a human being between the stages of childbirth, birth and puberty, or between the Development of the human body, developmental period of infancy and puberty. The term may also refer to an unborn human being. In English-speaking ...
and forced marriage
Forced marriage is a marriage in which one or more of the parties is married without their consent or against their will. A marriage can also become a forced marriage even if both parties enter with full consent if one or both are later force ...
, higher rates of parity, polygamy
Polygamy (from Late Greek , "state of marriage to many spouses") is the practice of marriage, marrying multiple spouses. When a man is married to more than one wife at the same time, it is called polygyny. When a woman is married to more tha ...
and exposure to STIs from multiple sexual contacts of male partners further increase the chances of cervical cancer. In developing countries, cervical cancer accounts for 12% of cancer cases amongst women and is the second leading cause of death, where about 85% of the global burden of over 500,000 cases and 250,000 deaths from this disease occurred in 2012. The highest incidence occurs in Eastern Africa, where with Middle Africa, cervical cancer is the commonest cancer in women. The case fatality rate of 52% is also higher in developing countries than in developed countries (43%), and the mortality rate varies by 18-fold between regions of the world.[
Cervical cancer is associated with ]human papillomavirus
Human papillomavirus infection (HPV infection) is caused by a DNA virus from the ''Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and r ...
(HPV), which has also been implicated in cancers of the vulva
In mammals, the vulva (: vulvas or vulvae) comprises mostly external, visible structures of the female sex organ, genitalia leading into the interior of the female reproductive tract. For humans, it includes the mons pubis, labia majora, lab ...
, vagina
In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular sex organ, reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The #Vag ...
, anus
In mammals, invertebrates and most fish, the anus (: anuses or ani; from Latin, 'ring' or 'circle') is the external body orifice at the ''exit'' end of the digestive tract (bowel), i.e. the opposite end from the mouth. Its function is to facil ...
, and oropharynx
The pharynx (: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the esophagus and trachea (the tubes going down to the stomach and the lungs respectively). It is found in vertebrates and invertebrates, though its ...
. Almost 300 million women worldwide have been infected with HPV, one of the commoner sexually transmitted infection
A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is Transmission (medicine), spread by Human sexual activity, sexual activity, e ...
s, and 5% of the 13 million new cases of cancer in the world have been attributed to HPV.[ In developed countries, screening for cervical cancer using the ]Pap test
The Papanicolaou test (abbreviated as Pap test, also known as Pap smear (AE), cervical smear (BE), cervical screening (BE), or smear test (BE)) is a method of cervical screening used to detect potentially precancerous and cancerous processes i ...
has identified pre-cancerous changes in the cervix, at least in those women with access to health care. Also an HPV vaccine
Human papillomavirus (HPV) vaccines are vaccines intended to provide acquired immunity against infection by certain types of human papillomavirus. The first HPV vaccine became available in 2006. Currently there are six licensed HPV vaccines: ...
programme is available in 45 countries. Screening and prevention programmes have limited availability in developing countries although inexpensive low technology programmes are being developed, but access to treatment is also limited. If applied globally, HPV vaccination at 70% coverage could save the lives of 4 million women from cervical cancer, since most cases occur in developing countries.
Ovarian cancer
Ovarian cancer is the eighth most common cancer globally. It is predominantly a disease of women in industrialized countries and death from ovarian cancer is more common in North America and Europe than in Africa and Asia. Because it is largely asymptomatic in its earliest stages and lacks an effective screening programme, more than 50% of women have stage III or higher cancer (spread beyond the ovaries) by the time they are diagnosed, with a consequent poor prognosis.
Mental health
Almost 25% of women will experience mental health
Mental health is often mistakenly equated with the absence of mental illness. However, mental health refers to a person's overall emotional, psychological, and social well-being. It influences how individuals think, feel, and behave, and how t ...
issues over their lifetime. Women are at higher risk than men from anxiety
Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...
, depression, and psychosomatic complaints. Globally, depression is the leading disease burden. In the United States, women have depression twice as often as men. The economic costs of depression in American women are estimated to be $20 billion every year. The risks of depression in women have been linked to changing hormonal environment that women experience, including puberty, menstruation, pregnancy, childbirth and the menopause. Women also metabolise drugs used to treat depression differently to men. Suicide rates are less in women than men (<1% vs. 2.4%),[ but are a leading cause of death for women under the age of 60. In the United Kingdom, the Women's Mental Health Taskforce was formed aiming to address differences in mental health experiences and needs between women and men.
]
Dementia
The prevalence of Alzheimer's disease
Alzheimer's disease (AD) is a neurodegenerative disease and the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems wit ...
in the United States is estimated at 5.1 million, and of these two thirds are women. Furthermore, women are far more likely to be the primary caregivers of adult family members with dementia, so that they bear both the risks and burdens of this disease. The lifetime risk for a woman of developing Alzheimer's disease is twice that of men. Part of this difference may be due to life expectancy, but changing hormonal status over their lifetime may also play a par as may differences in gene expression. Deaths due to dementia are higher in women than men (4.5% of deaths vs. 2.0%).
Bone health
Osteoporosis
Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in Bone fracture, fracture risk.
It is the most common reason f ...
ranks sixth amongst chronic diseases of women in the United States, with an overall prevalence
In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...
of 18%, and a much higher rate involving the femur
The femur (; : femurs or femora ), or thigh bone is the only long bone, bone in the thigh — the region of the lower limb between the hip and the knee. In many quadrupeds, four-legged animals the femur is the upper bone of the hindleg.
The Femo ...
, neck
The neck is the part of the body in many vertebrates that connects the head to the torso. It supports the weight of the head and protects the nerves that transmit sensory and motor information between the brain and the rest of the body. Addition ...
or lumbar spine
The lumbar vertebrae are located between the thoracic vertebrae and pelvis. They form the lower part of the back in humans, and the tail end of the back in quadrupeds. In humans, there are five lumbar vertebrae. The term is used to describe t ...
amongst women (16%) than men (4%), over the age of 50. Osteoporosis is a risk factor for bone fracture
A bone fracture (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a ''c ...
and about 20% of senior citizens who sustain a hip fracture
A hip fracture is a break that occurs in the upper part of the femur (thigh bone), at the femoral neck or (rarely) the femoral head. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually ...
die within a year. The gender gap is largely the result of the reduction of estrogen
Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...
levels in women following the menopause
Menopause, also known as the climacteric, is the time when Menstruation, menstrual periods permanently stop, marking the end of the Human reproduction, reproductive stage for the female human. It typically occurs between the ages of 45 and 5 ...
. Hormone Replacement Therapy
Hormone replacement therapy (HRT), also known as menopausal hormone therapy or postmenopausal hormone therapy, is a form of hormone therapy used to treat symptoms associated with female menopause. Effects of menopause can include symptoms such ...
(HRT) has been shown to reduce this risk by 25–30%, and was a common reason for prescribing it during the 1980s and 1990s. However the Women's Health Initiative
The Women's Health Initiative (WHI) was a series of clinical studies initiated by the U.S. National Institutes of Health (NIH) in 1991, to address major health issues causing morbidity and mortality in postmenopausal women. It consisted of three ...
(WHI) study that demonstrated that the risks of HRT outweighed the benefits has since led to a decline in HRT usage.
Anaemia
Anaemia is a major global health problem for women. Women are affected more than men, in which up to 30% of women being found to be anaemic and 42% of pregnant women. Anaemia is linked to a number of adverse health outcomes including a poor pregnancy outcome and impaired cognitive function
Cognitive skills are skills of the mind, as opposed to other types of skills such as motor skills, social skills or life skills. Some examples of cognitive skills are literacy, self-reflection, logical reasoning, abstract thinking, critical th ...
(decreased concentration and attention). The main cause of anaemia is iron deficiency
Iron deficiency, or sideropenia, is the state in which a body lacks enough iron to supply its needs. Iron is present in all cells in the human body and has several vital functions, such as carrying oxygen to the tissues from the lungs as a key ...
. In United States women iron deficiency anaemia (IDA) affects 37% of pregnant women, but globally the prevalence is as high as 80%. Anaemia affects over one-third of the population in the Middle East and North Africa
The Middle East and North Africa (MENA), also referred to as West Asia and North Africa (WANA) or South West Asia and North Africa (SWANA), is a geographic region which comprises the Middle East (also called West Asia) and North Africa together ...
, caused by iron deficiencies or a combination of other factors, with women making up the bulk of those affected. In Saudi Arabia, 40% of women in the 15–49 age range suffer from anaemia. IDA starts in adolescence, from excess menstrual blood loss, compounded by the increased demand for iron in growth and suboptimal dietary intake. In the adult woman, pregnancy leads to further iron depletion.
Violence
Women experience structural
A structure is an arrangement and organization of interrelated elements in a material object or system, or the object or system so organized. Material structures include man-made objects such as buildings and machines and natural objects such as ...
and personal violence differently than men. The United Nations has defined violence against women as;
Violence against women may take many forms, including physical, sexual, emotional and psychological
Psychology is the scientific study of mind and behavior. Its subject matter includes the behavior of humans and nonhumans, both consciousness, conscious and Unconscious mind, unconscious phenomena, and mental processes such as thoughts, feel ...
and may occur throughout the life-course. Structural violence may be embedded in legislation or policy, or be systematic misogyny
Misogyny () is hatred of, contempt for, or prejudice against Woman, women or girls. It is a form of sexism that can keep women at a lower social status than Man, men, thus maintaining the social roles of patriarchy. Misogyny has been wide ...
by organisations against groups of women. Perpetrators of personal violence include state actors, strangers, acquaintances, relatives and intimate partners and manifests itself across a spectrum from discrimination
Discrimination is the process of making unfair or prejudicial distinctions between people based on the groups, classes, or other categories to which they belong or are perceived to belong, such as race, gender, age, class, religion, or sex ...
, through harassment
Harassment covers a wide range of behaviors of an offensive nature. It is commonly understood as behavior that demeans, humiliates, and intimidates a person, and it is characteristically identified by its unlikelihood in terms of social and ...
, sexual assault
Sexual assault is an act of sexual abuse in which one intentionally Physical intimacy, sexually touches another person without that person's consent, or Coercion, coerces or physically forces a person to engage in a sexual act against their w ...
and rape
Rape is a type of sexual assault involving sexual intercourse, or other forms of sexual penetration, carried out against a person without consent. The act may be carried out by physical force, coercion, abuse of authority, or against a person ...
, and physical harm to murder ( femicide). It may also include cultural practices such as female genital cutting.[
Non-fatal violence against women has severe implications for women's physical, mental and reproductive health, and is seen as not simply isolated events but rather a systematic pattern of behaviour that both violates their rights but also limits their role in society and requires a systematic approach.
The World Health Organization (WHO) estimates that 35% of women in the world have experienced physical or sexual violence over their lifetime and that the commonest situation is intimate partner violence. 30% of women in relationships report such experience, and 38% of murders of women are due to intimate partners. These figures may be as high as 70% in some regions.][ Risk factors include low educational achievement, a parental experience of violence, childhood abuse, gender inequality and cultural attitudes that allow violence to be considered more acceptable.][
The COVID-19 epidemic made gender-based violence more common in Arab countries and worsened already-existing health disparities between the sexes. Yet millions of women in the ]Middle East and North Africa
The Middle East and North Africa (MENA), also referred to as West Asia and North Africa (WANA) or South West Asia and North Africa (SWANA), is a geographic region which comprises the Middle East (also called West Asia) and North Africa together ...
did not receive enough attention when it came to the provision of enhanced protection from gender-based violence.
Violence was declared a global health priority by the WHO at its assembly in 1996, drawing on both the United Nations Declaration on the elimination of violence against women (1993) and the recommendations of both the International Conference on Population and Development (Cairo, 1994) and the Fourth World Conference on Women (Beijing, 1995) This was followed by its 2002 World Report on Violence and Health, which focusses on intimate partner and sexual violence. Meanwhile, the UN embedded these in an action plan when its General Assembly passed the Millennium Declaration in September 2000, which resolved '' inter alia'' "to combat all forms of violence against women and to implement the Convention on the Elimination of All Forms of Discrimination against Women". One of the Millennium Goals (MDG 3) was the promotion of gender equality and the empowerment of women, which sought to eliminate all forms of violence against women as well as implementing CEDAW.[ This recognised that eliminating violence, including discrimination was a prerequisite to achieving all other goals of improving women's health. However it was later criticised for not including violence as an explicit target, the "missing target".][ In the evaluation of MDG 3, violence remained a major barrier to achieving the goals. In the successor Sustainable Development Goals, which also explicitly list the related issues of discrimination, child marriage and genital cutting, one target is listed as "Eliminate all forms of violence against all women and girls in the public and private spheres" by 2030.][
]UN Women
The United Nations Entity for Gender Equality and the Empowerment of Women, also known as UN Women, is a United Nations entity charged with working for gender equality and the empowerment of women. UN Women is charged with advocating for the righ ...
believe that violence against women "is rooted in gender-based discrimination and social norms and gender stereotypes that perpetuate such violence", and advocate moving from supporting victims to prevention, through addressing root and structural causes. They recommend programmes that start early in life and are directed towards both genders to promote respect and equality, an area often overlooked in public policy
Public policy is an institutionalized proposal or a Group decision-making, decided set of elements like laws, regulations, guidelines, and actions to Problem solving, solve or address relevant and problematic social issues, guided by a conceptio ...
. This strategy, which involves broad educational and cultural change, also involves implementing the recommendations of the 57th session of the UN Commission on the Status of Women
The Commission on the Status of Women (CSW or UNCSW) is a functional commission of the United Nations Economic and Social Council (ECOSOC), one of the United Nations System#Six principal organs, principal organs of the United Nations. CSW has bee ...
(2013).[ To that end the 2014 UN International Day of the Girl Child was dedicated to ending the cycle of violence.][ In 2016, the World Health Assembly also adopted a plan of action to combat violence against women, globally.][
]
Women in health research
Changes in the way research ethics
Research ethics is a discipline within the study of Ethics, applied ethics. Its scope ranges from general scientific integrity and scientific misconduct, misconduct to the treatment of human and animal subjects. The social responsibilities of sc ...
was visualised in the wake of the Nuremberg Trials #REDIRECT Nuremberg trials
{{redirect category shell, {{R from other capitalisation{{R from move ...
(1946), led to an atmosphere of protectionism of groups deemed to be vulnerable that was often legislated or regulated. This resulted in the relative underrepresentation of women in clinical trials
Clinical trials are prospective biomedical or behavioral research studies on human subject research, human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel v ...
. The position of women in research was further compromised in 1977, when in response to the tragedies resulting from thalidomide
Thalidomide, sold under the brand names Contergan and Thalomid among others, is an oral administered medication used to treat a number of cancers (e.g., multiple myeloma), graft-versus-host disease, and many skin disorders (e.g., complication ...
and diethylstilbestrol
Diethylstilbestrol (DES), also known as stilbestrol or stilboestrol, is a nonsteroidal estrogen medication, which is presently rarely used. In the past, it was widely used for a variety of indications, including pregnancy support for those with ...
(DES), the United States Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respo ...
(FDA) prohibited women of child-bearing years from participation in early stage clinical trials. In practice this ban was often applied very widely to exclude all women. Women, at least those in the child-bearing years, and female animals were also deemed unsuitable research subjects due to their fluctuating hormonal levels during the menstrual or other reproductive cycles. However, research has demonstrated significant biological differences between the sexes in rates of susceptibility, symptoms and response to treatment in many major areas of health, including heart disease and some cancers. These exclusions pose a threat to the application of evidence-based medicine
Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. It means integrating individual clinical expertise with the best available exte ...
to women, and compromise to care offered to both women and men.
The increasing focus on Women's Rights
Women's rights are the rights and Entitlement (fair division), entitlements claimed for women and girls worldwide. They formed the basis for the women's rights movement in the 19th century and the feminist movements during the 20th and 21st c ...
in the United States during the 1980s focused attention on the fact that many drugs being prescribed for women had never actually been tested in women of child-bearing potential, and that there was a relative paucity of basic research into women's health. In response to this the National Institutes of Health
The National Institutes of Health (NIH) is the primary agency of the United States government responsible for biomedical and public health research. It was founded in 1887 and is part of the United States Department of Health and Human Service ...
(NIH) created the Office of Research on Women's Health (ORWH) in 1990 to address these inequities. In 1993 the National Institutes of Health Revitalisation Act officially reversed US policy by requiring NIH funded phase III clinical trials to include women. This resulted in an increase in women recruited into research studies. The next phase was the specific funding of large scale epidemiology studies and clinical trials focussing on women's health such as the Women's Health Initiative
The Women's Health Initiative (WHI) was a series of clinical studies initiated by the U.S. National Institutes of Health (NIH) in 1991, to address major health issues causing morbidity and mortality in postmenopausal women. It consisted of three ...
(1991), the largest disease prevention study conducted in the US. Its role was to study the major causes of death, disability and frailty in older women. Despite this apparent progress, women remain underrepresented. In 2006 women accounted for less than 25% of clinical trials published in 2004, A follow-up study by the same authors five years later found little evidence of improvement. Another study found between 10 and 47% of women in heart disease clinical trials, despite the prevalence of heart disease in women. Lung cancer is the leading cause of cancer death amongst women, but while the number of women enrolled in lung cancer studies is increasing, they are still far less likely to be enrolled than men.
One of the challenges in assessing progress in this area is the number of clinical studies that either do not report the gender of the subjects or lack the statistical power
In frequentist statistics, power is the probability of detecting a given effect (if that effect actually exists) using a given test in a given context. In typical use, it is a function of the specific test that is used (including the choice of tes ...
to detect gender differences. These were still issues in 2014, and further compounded by the fact that the majority of animal studies also exclude females or fail to account for differences in sex and gender. for instance despite the higher incidence of depression amongst women, less than half of the animal studies use female animals. Consequently, a number of funding agencies and scientific journals are asking researchers to explicitly address issues of sex and gender in their research. Some countries address the underrepresentation of women in research studies by the establishment of centers of excellence focusing on women's health research and running large scale clinical trials
Clinical trials are prospective biomedical or behavioral research studies on human subject research, human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel v ...
such as the Women's Health Initiative
The Women's Health Initiative (WHI) was a series of clinical studies initiated by the U.S. National Institutes of Health (NIH) in 1991, to address major health issues causing morbidity and mortality in postmenopausal women. It consisted of three ...
.
A related issue is the inclusion of pregnant women in clinical studies. Since other illnesses can exist concurrently with pregnancy, information is needed on the response to and efficacy of interventions during pregnancy, but ethical issues relative to the fetus, make this more complex. This gender bias is partly offset by the initiation of large scale epidemiology studies of women, such as the Nurses' Health Study (1976), Women's Health Initiative
The Women's Health Initiative (WHI) was a series of clinical studies initiated by the U.S. National Institutes of Health (NIH) in 1991, to address major health issues causing morbidity and mortality in postmenopausal women. It consisted of three ...
and Black Women's Health Study.
Women have also been the subject of neglect in health care research, such as the situation revealed in the Cartwright Inquiry in New Zealand
New Zealand () is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and List of islands of New Zealand, over 600 smaller islands. It is the List of isla ...
(1988), in which research by two feminist journalists revealed that women with cervical abnormalities were not receiving treatment, as part of an experiment. The women were not told of the abnormalities and several later died.
The Women's Health Care Market is today a major pharmaceutical industry, projected to double in size within the five years from 2019 to 2024 and reach USD 17.8 billion. The by far most valued company worldwide whose leading products are in Women's Health is Bayer
Bayer AG (English: , commonly pronounced ; ) is a German multinational pharmaceutical and biotechnology company and is one of the largest pharmaceutical companies and biomedical companies in the world. Headquartered in Leverkusen, Bayer' ...
(Germany) with the focus area of Contraception.
National and international initiatives
In addition to addressing gender inequity in research, a number of countries have made women's health the subject of national initiatives. For instance in 1991 in the United States, the Department of Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the US federal government created to protect the health of the US people and providing essential human services. Its motto is ...
established an Office on Women's Health (OWH) with the goal of improving the health of women in America, through coordinating the women's health agenda throughout the department, and other agencies. In the twenty first century the Office has focussed on underserviced women.[ Also, in 1994 the ]Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the National public health institutes, national public health agency of the United States. It is a Federal agencies of the United States, United States federal agency under the United S ...
(CDC) established its own Office of Women's Health (OWH), which was formally authorised by the 2010 Affordable Health Care Act (ACA).[
Internationally, many ]United Nations
The United Nations (UN) is the Earth, global intergovernmental organization established by the signing of the Charter of the United Nations, UN Charter on 26 June 1945 with the stated purpose of maintaining international peace and internationa ...
agencies such as the World Health Organization
The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
(WHO), United Nations Population Fund
The United Nations Population Fund (UNFPA) is a United Nations System, UN agency aimed at improving reproductive health, reproductive and maternal health worldwide. Its work includes developing national healthcare strategies and protocols, incr ...
(UNFPA) and UNICEF
UNICEF ( ), originally the United Nations International Children's Emergency Fund, officially United Nations Children's Fund since 1953, is an agency of the United Nations responsible for providing Humanitarianism, humanitarian and Development a ...
maintain specific programs on women's health, or maternal, sexual and reproductive health.[ In addition the United Nations global goals address many issues related to women's health, both directly and indirectly. These include the 2000 ]Millennium Development Goals
In the United Nations, the Millennium Development Goals (MDGs) were eight international development goals for the year 2015 created following the Millennium Summit, following the adoption of the United Nations Millennium Declaration. These w ...
(MDG) and their successor, the Sustainable Development Goals
The ''2030 Agenda for Sustainable Development'', adopted by all United Nations (UN) members in 2015, created 17 world Sustainable Development Goals (SDGs). The aim of these global goals is "peace and prosperity for people and the planet" – wh ...
adopted in September 2015, following the report on progress towards the MDGs (''The Millennium Development Goals Report 2015'').[ For instance the eight MDG goals, eradicating extreme poverty and hunger, achieving universal primary education, promoting gender equality and empowering women, reducing child mortality rates, improving maternal health, combating HIV/AIDS malaria and other diseases, ensuring environmental sustainability, and developing a global partnership for development, all impact on women's health, as do all seventeen SDG goals, in addition to the specific SDG5: Achieve gender equality and empower all women and girls.][
]
Goals and challenges
Research is a priority in terms of improving women's health. Research needs include diseases unique to women, more serious in women and those that differ in risk factors between women and men. The balance of sex and/or gender in research studies needs to be balanced appropriately to allow analysis that will detect interactions between sex and/or gender and other factors. Gronowski and Schindler suggest that scientific journals make documentation of sex a requirement when reporting the results of animal studies, and that funding agencies require justification from investigators for any sex inequity in their grant proposals, giving preference to those that are inclusive. They also suggest it is the role of health organisations to encourage women to enroll in clinical research
Clinical research is a branch of medical research that involves people and aims to determine the effectiveness (efficacy) and safety of medications, devices, diagnostic products, and treatment regimens intended for improving human health. The ...
. However, there has been progress in terms of large scale studies such as the WHI, and in 2006 the Society for Women's Health Research founded the Organization for the Study of Sex Differences and the journal ''Biology of Sex Differences'' to further the study of sex differences.
Research findings can take some time before becoming routinely implemented into clinical practice
''Clinical Practice'' is a bimonthly peer-reviewed open access medical journal. It covers good clinical practice and health care. The journal was established in 2004 as ''Therapy'' by Future Drugs Ltd, obtaining its current name in 2012 when it wa ...
. Clinical medicine needs to incorporate the information already available from research studies as to the different ways in which diseases affect women and men. Many "normal" laboratory values have not been properly established for the female population separately, and similarly the "normal" criteria for growth and development. Drug dosing needs to take sex differences in drug metabolism into account.
Globally, women's access to health care remains a challenge, both in developing and developed countries. In the United States, before the Affordable Health Care Act came into effect, 25% of women of child-bearing age lacked health insurance
Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
. In the absence of adequate insurance, women are likely to avoid important steps to self care such as routine physical examination, screening and prevention testing, and prenatal care. The situation is aggravated by the fact that women living below the poverty line
The poverty threshold, poverty limit, poverty line, or breadline is the minimum level of income deemed adequate in a particular country. The poverty line is usually calculated by estimating the total cost of one year's worth of necessities for ...
are at greater risk of unplanned pregnancy, unplanned delivery and elective abortion
Abortion is the early termination of a pregnancy by removal or expulsion of an embryo or fetus. Abortions that occur without intervention are known as miscarriages or "spontaneous abortions", and occur in roughly 30–40% of all pregnan ...
. Added to the financial burden in this group are poor educational achievement, lack of transportation, inflexible work schedules and difficulty obtaining child care, all of which function to create barriers to accessing health care. These problems are much worse in developing countries. Under 50% of childbirths in these countries are assisted by healthcare providers (''e.g.'' midwives, nurses, doctors) which accounts for higher rates of maternal death, up to 1:1,000 live births. This is despite the WHO setting standards, such as a minimum of four antenatal visits.[ A lack of healthcare providers, facilities, and resources such as formularies all contribute to high levels of morbidity amongst women from avoidable conditions such as obstetrical fistulae, sexually transmitted infections and cervical cancer.
These challenges are included in the goals of the Office of Research on Women's Health, in the United States, as is the goal of facilitating women's access to careers in ]biomedicine
Biomedicine (also referred to as Western medicine, mainstream medicine or conventional medicine) . The ORWH believes that one of the best ways to advance research in women's health is to increase the proportion of women involved in healthcare and health research, as well as assuming leadership in government, centres of higher learning, and in the private sector
The private sector is the part of the economy which is owned by private groups, usually as a means of establishment for profit or non profit, rather than being owned by the government.
Employment
The private sector employs most of the workfo ...
. This goal acknowledges the glass ceiling that women face in careers in science and in obtaining resources from grant funding to salaries and laboratory space. The National Science Foundation
The U.S. National Science Foundation (NSF) is an Independent agencies of the United States government#Examples of independent agencies, independent agency of the Federal government of the United States, United States federal government that su ...
in the United States states that women only gain half of the doctorates
A doctorate (from Latin ''doctor'', meaning "teacher") or doctoral degree is a postgraduate academic degree awarded by universities and some other educational institutions, derived from the ancient formalism '' licentia docendi'' ("licence to teach ...
awarded in science and engineering, fill only 21% of full-time professor positions in science and 5% of those in engineering, while earning only 82% of the remuneration their male colleagues make. These figures are even lower in Europe.
See also
* European Institute of Women's Health
* Gynaecology
Gynaecology or gynecology (see American and British English spelling differences) is the area of medicine concerned with conditions affecting the female reproductive system. It is often paired with the field of obstetrics, which focuses on pre ...
* Gender discrimination
* Health equity
* Men's health
''Men's Health'' (''MH''), published by Hearst Communications, Hearst, is the world's largest men's magazine brand, with 35 editions in 59 countries; it is the bestselling men's magazine on American newsstands.
Started as a men's health magazin ...
* Reproductive Health Supplies Coalition
* Social determinants of health
The social determinants of health (SDOH) are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions (such as the dist ...
* Women and smoking
* Women in medicine
* Gender bias in medical diagnosis
Women's health by country
* Women's health in China
* Women's health in Ethiopia
* Women's health in India
Publications
* '' Global Library of Women's Medicine''
* '' Health Care for Women International''
* '' Journal of Women's Health''
* '' Our Bodies, Ourselves''
* '' Women & Health''
* '' Women's Health Issues''
Notes
References
Bibliography
Symposia and series
*
*
*
Articles
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
* , in
*
*
*
*
*
* , in
*
*
*
* , in
*
* , in
* , in
*
* , in
*
*
*
*
*
* }
*
*
*
*
* , in
Reproductive and sexual health
* , in
*
*
*
*
*
*
*
*
*
*
*
*
Maternal health
*
*
*
*
*
Books
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Chapters
* , in
* , in
* , in
* , in
Reports and documents
*
*
*
*
*
*
*
*
*
*
United Nations reports
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Websites
*
*
*
*
*
News
*
*
*
*
*
*
*
*
Women's health research
*
*
*
*
*
*
*
Organizations
* see American Congress of Obstetricians and Gynecologists
*
*
*
*
**
*
*
* see Human Rights Watch
Human Rights Watch (HRW) is an international non-governmental organization that conducts research and advocacy on human rights. Headquartered in New York City, the group investigates and reports on issues including War crime, war crimes, crim ...
*
* see Overseas Development Institute
ODI Global (formerly Overseas Development Institute) is a global affairs think tank, founded in 1960. Its mission is "to inspire people to act on injustice and inequality through collaborative research and ideas that matter for people and the ...
* see Save the Children
The Save the Children Fund, commonly known as Save the Children, is an international non-governmental organization. It was founded in the UK in 1919; its goal is to improve the lives of children worldwide.
The organization raises money to imp ...
*
= Women's health providers
=
*
*
*
= United Nations Web sites
=
*
*
*
*
*
*
*
*
*
*
*
*
*
*
WHO
*
** , in
**
**
**
**
**
**
= CDC
=
*
** , in
** , in
Further reading
*
External links
Women’s Health: Why do women feel unheard?
at the NIHR Evidence website.
*
{{DEFAULTSORT:Women's Health
Feminism and health
Maternal health