In the early history of health sciences, the philosopher Aristotle believed that the women were the inverse of men and had suggested the superiority versus inferiority between the sexes. This hypothesis had influenced the ideology of women’s place in society as well as their health. It wasn’t until the mid 1980s that women were beginning to be seen as an independent group as opposed to a “sub-group” of men (King & Paul, 1996).
Another concept that influenced women’s healthcare was the diagnosis of hysteria. In its early conception, hysteria was defined as the idea of a woman’s uterus would wonder throughout her body causing mental and physical dysregulation. This idea continued to morph through the ages, from hysteria being define as “melancholic uterus” to the “workings of the devil” or other forms of demonization. The treatment for hysteria also morphed with the definition of the diagnosis, such as fumigating the uterus, expelling “semen” from the uterus by utilizing fingers to stimulate the internal organ. The concept of women being a sub-group of men had led philosophers and early physicians to believe that the cause of disease. However, at one point in the 18th century the concept of hysteria was separated from disease of the uterus and was suggested it had actually neurological origins and can impact any person (Tasca, Rapetti, Carta, & Fadda, 2012).
In the Victorian Era, Dr. Sigmund Freud had also studied the concept of hysteria and its relation to libidinal evolution. This lead him to the early theory of psychoanalysis with the concept of male and female hysteria involving stages of sexual conflict and fixations. Hysterical neurosis had remained in the Diagnostic and Statistical Manual until 1980 ((Tasca, Rapetti, Carta, & Fadda, 2012) however the ideology and the origination of the concept of hysteria and its relation to the “inferiority” of women still impact our health care systems and cultures.
Leading up to that ideology of woman being an independent group and other components of the Feminist Movement, the Women’s Health Movement (WHM) began to develop in the 1960s with the intention to “…improve health care for all women.” (Nichols, 2000).
Women’s Health Movement
In the Journal of Obstetric, Gynecologic, & Neonatal Nursing (JOGNN) Dr. Nichols, RNC, PhD, FAAN outlined the significant events in the WHM (adapted from Table 1, History of the Women’s Health Movement in the 20th Century; 2000).
The Doctors’ Case Against the Pill by Barbara Seaman was published. It brought the severity of the side effects of the birth control into awareness, resulting in the 1970 federal hearing on birth control pill safety.
Our Bodies, Ourselves was published.
The Commonwealth Fund conducted the first national survey of women’s health. Their latest survey was conducted in 1993.
“Rehabilitation of the female patient after myocardial infarction” (Boogaard) was published, suggesting that women have differing experiences than men and are not a subgroup of men.
The Congressional Caucus for Women’s Issues (CCWI) put into view the serious lack of research on women in the National Institutes of Health (NIH).
The Jacobs Institute of Women’s Health was founded to “…improve women’s health through research, dialogue, teaching, and information dissemination.”
The Office of Research on Women’s Health (ORWH) within NIH was established “… to ensure that women’s health research is part of the scientific framework at the NIH- and throughout the scientific community.”
The national nonprofit, Society for the Advancement of Women’s Health Research (SWHR) was founded to “…[address] unmet needs and research gaps in women’s health.”
Women’s Health Equity Act (WHEA) was introduced and later passed in 1991 increased awareness in women’s health issues.
Women’s Health Initiative (WHI) began the project of long-term studies on several chronic diseases in women of all backgrounds. It continues to provide research in other areas of women’s health.
The FDA pulled back the federal ban of women of childbearing years in Phase 1 and 2 drug trials from 1977 and developed new gender guidelines.
The NIH Revitalization Act was signed into law which “…directed the NIH to establish guidelines for inclusion of women and minorities in clinical research.”
The New Mothers’ Breastfeeding Promotion and Protection Act was introduced to amend the Civil Rights Act of 1964 to include breast feeding as an activity that cannot be discriminated against. This bill still remains in the House of Representatives and has been passed along through several subcommittees, last action was on April 17, 1998 in which it was referred to subcommittee on Early Childhood, Youth and Families.
The WHI studies continue to expand upon the original data collected along with newer cohorts. In the most recent WHI Annual Progress Report (February 28, 2020), of the number of women that remain in the studies have shown that:
- More women develop cardiovascular disease that can lead to death
- The older the women who are studied, the high percentages of developing cardiovascular disease, cancer, and hip fractures.
- American Indian/ Alaskan Natives have the highest percentage of cardiovascular disease.
- Asian/ Pacific Islanders and Non-Hispanic Whites have the highest percentage of cancer.
- American Indian/Alaskan Natives have a higher percentage of deaths from cardiovascular disease, cancer, or other known causes.
- There are higher incidences of breast cancer (invasive) in comparison to ovarian, endometrial, colorectal, leukemia, lung, Non-Hodgkin’s lymphoma, melanoma of the skin, and pancreas cancers.
- There are higher incidences of Coronary-Artery Bypass Grafting (CABTG) and Percutaneous Transluminal Coronary Angioplasty (PTCA) in comparison to other cardiovascular issues.
What are the implication of these studies?
From the WHI study we can learn about how women’s heart attack symptoms may differ from men’s symptoms:
according to the Mayo Clinic
- neck, jaw, shoulder, upper back or upper abdomen discomfort
- shortness of breath
- pain in one or both arms
- nausea or vomiting
- lightheadedness or dizziness
- unusual fatigue
- sudden cold sweat
- discomfort or tingling in the back, shoulder, arms, neck, or jaw
- chest pain or pressure
- shortness of breath
Prior to this information, women were often misdiagnosed or disregarded as being “hysterical” leading to health complications or premature death. We’re also finding the severity of the lack of health care resources that plague the American Indian/ Alaskan Native populations to the point that it impacts their life expectancy through disease.
Global focus on Women’s health and gender equality
In 2021 the World Health Organization (WHO) are turning to the future to set their sights on women’s health and gender equality. They stated that the agenda will revolve around these key areas:
“Bodily autonomy — enabling women and girls to make informed sexual, reproductive, and healthcare decisions—a human right for all.
Promoting equitable gender norms, including those that make violence against women and girls, including harmful practices such as early/forced marriage and female genital mutilation, unacceptable.
Financing universal health coverage and social protection to cover health costs, child care, paid parental, sick and family care leave and old age pension.
Valuing paid employment and unpaid care work equally and enabling men to share care work with women.
Addressing male bias in the development of vaccines, drugs, and diagnostics.
Strengthening health systems to include safe, decent working conditions for the majority female health workforce including eliminating sexual harassment and violence.
Investing in feminist movements, which have been instrumental in fostering progressive changes towards gender equality.
Ensuring women’s and feminist leadership in governments, health and development agencies, and other global organizations.”The Future we Expect: Women’s Health and Gender Equality; Joint News Release; June 28, 2021
Women’s health has come a long way from it origins, however it has a lot further to go. Newer research and the understanding of all women can provide insights in the hopes to expand upon the Women’s Health Movement and affect our laws to create equality and the availability of resources in health care.
UnWell Women: Misdiagnosis and Myth in a Man Made World by Elinor Cleghorn
The Future we Expect: Women’s Health and Gender Equality, the WHO Joint News Release, it also has other resources such as podcasts and videos
Women and Hysteria in the History of Mental Health, Tasca et al., 2012.
The Doctors’ Case Against the Pill by Barbara Seaman
This month’s blog post was written by our Chronic Illness specialist, Aarti S. Felder, MA, LCPC, BCN.