Ch 1 Intro to Women's Health Lecture Notes

Fundamentals of Health and Research Oversight

• Definition of Health

  • According to the World Health Organization (WHO), health is defined as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.

• National Institutes of Health (NIH)

  • The NIH serves as a major medical research organization within the federal government.

• Office of Research on Women's Health (ORWH)

  • Establishment: Founded in the 1980s as a department within the NIH.

  • Core Purpose: Advocates for women's health research, ensures NIH-funded studies include women's health issues, and analyzes biological differences between sexes.

  • Historical Context: Prior to the 1980s, medical research subjects were almost exclusively male, and findings were generalized to female populations. This exclusion caused a fundamental lack of scientific understanding regarding sex-specific differences in disease manifestation and progression.

  • 1960s Precursors: Inequities in women's health and medical research began receiving explicit national attention during the 1960s.

  • 1993 Inclusion Mandate: By 1993, federal mandates required the inclusion of women and racial minorities in all NIH-funded clinical trials.

  • Private Foundations: Private philanthropic organizations often step in to bridge funding gaps where federal initiatives fall short, such as funding research across five key components of women's health.

    • Obstretic care and maternal immunization: making pregnancy and delivery safer

    • Maternal health and nutrition: supporting healthier pregnancies and newborns

    • Gynecological and menstrual health: advancing tools and research to better diagnose, treat, and improve gynecological health and reduce infection risk

    • Contraceptive innovation: offering more accessible, acceptable and effective options

    • Sexually transmitted infections: improving diagnosis and treatment to reduce disproportionate burdens on women

The Office of Women's Health (OWH)

• Organizational Role and Structure

  • The Office of Women's Health (OWH) is distinct from the NIH's Office of Research on Women's Health (ORWH).

  • Establishment: Created in 1991.

  • Governance: Acts as the coordinating agency for women's health initiatives across all agencies within the United States Department of Health and Human Services (HHS), including the NIH, the Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC).

• Mission and Scope

  • Provides national leadership to advance the health of women and girls through targeted policy, public education, and scientific research.

  • Aims to close health disparities, promote health equity, and ensure federal health programs serve women across all stages of life.

  • Target areas include reproductive health, heart disease, oncology/cancer, healthy aging, and mental health.

• Historical and Modern Operations

  • Historically led public education campaigns to increase access to essential healthcare services, including prenatal care and early screenings for breast and cervical cancer.

  • Maintains public health resources covering pregnancy, menopause, autoimmune disorders, and mental health.

  • Recent Structural Challenges: In early 2025, Kaiser Health News reported that HHS removed or archived numerous OWH web pages, specifically those addressing reproductive health and sex-specific medical information. Political pressures and leadership shifts have presented significant barriers to the agency's operational effectiveness despite its critical mandate.

Legislative History of the Equal Rights Amendment (ERA)

• Origins and Early Congressional Path

  • Following the passage of the 19th Amendment granting women the right to vote, suffragists drafted and introduced the initial version of the Equal Rights Amendment (ERA).

  • After decades of annual submissions to Congress, the ERA gained widespread federal support in 1972, passing both the United States Senate and the House of Representatives with strong bipartisan support.

• Ratification Process and Resistance

  • Constitutional ratification required approval by $\frac{3}{4}$ of all states, representing $38$ out of $50$ states, within a strict legislative deadline.

  • Within the first year following congressional approval, $30$ states ratified the amendment.

  • The movement subsequently faced organized opposition led by conservative women's groups and the Moral Majority.

  • The ERA failed to achieve the required $38$ states before the 1982 deadline, meaning it is not a ratified amendment to the United States Constitution.

• 21st-Century Debates

  • Resolutions have been introduced in Congress to retroactively eliminate the 1982 deadline.

  • Three additional states voted to pass the ERA on state ballots, bringing ongoing political and legal debates surrounding constitutional equal rights into the modern era.

Waves of Feminism

• Definition of Feminism

  • A feminist is defined as any individual, regardless of gender, who advocates for women to possess equal political, economic, and social rights and opportunities to men.

• First Wave (Early 1800s – Early 1900s)

  • Focused primarily on female suffrage (the right to vote).

  • Introduced the initial Equal Rights Amendment.

  • Initiated early legal battles for access to birth control.

• Second Wave (Mid-1960s – 1980s)

  • Focused on personal, sexual, and financial autonomy.

  • Secured statutory rights for women to hold independent bank accounts and credit cards without male co-signers in the mid-1970s.

• Third Wave (1990s)

  • Characterized by significant statutory achievements, including mandates for institutional scientific inclusion, parental leave protections, and violence prevention legislation.

• Fourth Wave / Contemporary Era

  • Utilizes digital tools and social media platforms to organize public action against misogyny (the hatred of, contempt for, or prejudice against women and girls) and institutional patriarchy (a social system where men hold a disproportionatly large share of power and privilege).

Historical Timeline of Women's Health and Rights Movement

• 1800s – Late 19th Century

  • Maternal Mortality: In the 1800s, women faced a $2\text{\%}$ to $8\text{\%}$ probability of death during each individual pregnancy. While national rates have declined historically, maternal mortality in the United States remains higher than in many comparable developed nations, with Black women experiencing a disproportionately higher mortality risk.

  • 1830s – 1880s Reform: The women's health movement targeted restrictive garments like corsets due to documented internal organ compression, restricted breathing, and gastrointestinal issues.

  • Higher Education: Medical schools began admitting female students in small numbers in the 1840s.

  • Civil War & Nursing: Female volunteer caregiving during the Civil War drove the formal establishment of professional nursing schools in the 1870s. However, the operational hierarchy between male doctors and female nurses reinforced traditional household divisions of labor, maintaining males in authority positions and females in subordinate roles.

• 1890s – 1920s

  • 19th Amendment: Granted women full voting rights.

  • Contraception Access: The birth control movement emerged in opposition to federal bans. Contraceptives were eventually legalised under restricted conditions requiring a medical prescription and verified marital status.

  • Sheppard-Towner Act of 1921: Provided federal funding for maternal, prenatal, and child health care programs. Funding was permitted to lapse in 1929, resulting in the termination of the initiative.

• 1930s – 1950s

  • World War II Workforce Expansion: Female participation in the paid workforce expanded by $50\text{\%}$ during World War II. Following the return of military personnel, institutional policy pushed women to exit professional jobs and return to domestic roles.

• 1960s – 1970s

  • 1960: The Food and Drug Administration (FDA) approved the first oral contraceptive pill.

  • Civil Rights Act (Title VII): Prohibited employment discrimination on the basis of sex, race, color, national origin, and religion.

  • Title IX (1972): Mandated that educational institutions receiving federal funds provide equal financial and institutional support for male and female athletic programs.

  • Grassroots Advocacy: Organizations such as the National Organization for Women (NOW), the National Abortion Rights Action League (NARAL), and the Young Women's Christian Association (YWCA) challenged clinical practices from a feminist framework, targeting unnecessary hysterectomies, unindicated Cesarean sections, clinical approaches to postpartum depression, abortion access, and maternal autonomy in childbirth.

  • Inclusive Health Organizations: Minority women established distinct advocacy organizations to address unique demographic health needs, including the National Black Women's Health Project, the National Latino Women's Health Organization, the National Asian Women's Health Organization, and the Native American Women's Health Education and Resource Center.

• 1980s

  • Public Policy Shift: Establishment of the Office of Research on Women's Health (ORWH) to mandate clinical trial representation and promote female representation in scientific research professions.

  • Women's Health Equity Act: Passed to direct targeted federal funding toward research on contraception, infertility, breast cancer, ovarian cancer, HIV/AIDS, and osteoporosis.

• 1990s

  • NIH Revitalization Act of 1993: Formally mandated that women and racial minorities be included as human subjects in all research funded by the NIH.

  • Family and Medical Leave Act (FMLA) of 1993: Guaranteed qualifying employees up to 12 weeks of unpaid, job-protected leave for personal medical needs or to care for immediate family members, heavily impacting female workers who often fill eldercare and childcare roles.

  • Violence Against Women Act (VAWA) of 1994: Established systematic federal resources, legal remedies, and law enforcement guidelines to prevent and prosecute violent sex crimes against women.

Modern Status and Demographics in Medicine

• Scientific and Clinical Advances

  • The 21st century has seen notable developments in human genetics and clinical breakthroughs in treating HIV and AIDS.

• Physician Gender Disparities

  • Medical School Pipeline: Female students account for $55\text{\%}$ of current medical school enrollments.

  • Practicing Workforce: Female physicians account for only $38\text{\%}$ of actively practicing physicians nationwide.

  • Institutional Leadership: Women hold academic and institutional healthcare leadership roles at rates disproportionately lower than their male counterparts.

  • Compensation Disparity: A $29\text{\%}$ wage gap exists between male and female physicians across clinical specialties.