Current trends in women’s health care

Overview: health care evolution, promotion, and data-informed practice

Health care evolves as new information from research emerges and new treatments become available.
Organizations focused on health promotion and disease prevention set goals and objectives to guide the public in improving self-care and well-being.
United States statistics on morbidity and mortality are published yearly and scrutinized by researchers and health care providers to drive improvements.
Quality improvement initiatives are widely implemented to address poor outcomes.
Recognizing taboos and stigma related to reproductive health can improve outcomes for persons assigned female at birth (AFAB). As taboos are addressed and education is provided, persons AFAB continue to advocate for positive change and better health outcomes.

Healthy People 2030 and evidence-based care

Healthy People, established by the US Office of Disease Prevention and Health Promotion, reviews data on the nation's health to identify conditions negatively affecting the population and to create objectives to address them.
Healthy People 2030 is a set of evidence-based objectives aimed at improving health and wellness.
Evidence-based care means using research to guide decisions and interventions to provide the safest, most effective care.
Nurses and health care providers use these guidelines to ensure care is up to date.

Healthy People 2030 objectives: scope and areas

Objectives address health conditions including: addiction, heart disease, obesity, pregnancy, and sexually transmitted infections.
Objectives address health behaviors such as: child development, family planning, preventive care, vaccines, and violence prevention.
Populations covered include: children, adolescents, older adults, LGBTQIA+ persons, and persons with disabilities.
Settings covered include: global health, schools, hospitals, services, and workplaces.
Social determinants of health are addressed, including economics, education, health care access, neighborhoods, and communities.

AFAB-focused objectives and health education

Many objectives are dedicated to the health and wellness of persons AFAB, including pregnancy, childbirth, violence protection, and gender inequity.
Nurses use these objectives to educate people about health promotion and disease prevention.
Patient education based on these objectives can help prevent cervical cancer, heart disease, and adolescent pregnancies, elevating the health and wellness of persons AFAB.
Health status of women and children is a focus.
In 02/2021, the top three leading causes of death in the United States for persons AFAB were: Heart ext{ disease}, ext{ }Cancer, ext{ and }Stroke.
Behavioral and health data: 10\% of persons AFAB smoked cigarettes and 42.1\% were obese.
Persons AFAB have unique health issues including pregnancy, childbirth, menopause, osteoporosis, and physical violence.
Nurses must be aware of social disparities and varying access to health care when educating and caring for these patients.

Morbidity and mortality: definitions and use in epidemiology

Morbidity: describes a specific condition or disease affecting people.
Mortality: describes the number of deaths due to a specific condition or disease.
Both are usually reported as a ratio or rate and are used to evaluate population health and investigate causes of death or illness.

Maternal mortality and related statistics

Maternal mortality: death of a person while pregnant or within 42 days of birth or termination of pregnancy, not due to accident.
The maternal mortality rate in the United States for 2021 was 32.9 deaths per 100{,}000 births.
The World Health Organization reports higher maternal mortality in low-income countries.
Leading causes include: severe bleeding, infections, hypertension, preeclampsia, eclampsia, complications from delivery, and unsafe abortions.
In the United States, maternal mortality occurs 2.6\times more often in non-Hispanic Black persons than in non-Hispanic White persons (i.e., relative risk RR = 2.6).
Overall, the United States has the highest maternal mortality rate among developed countries.
Figure 1.2 summarizes maternal death by ethnicity.
Research from 2017–2019 (36 states) showed that more than 80\% of pregnancy-related deaths were preventable.
Table 1.1 lists causes of preventable maternal deaths (see below for percentages).

Major and minor causes of preventable maternal deaths (Table 1.1)

Mental health conditions (including suicide, overdose, poisoning related to substance use disorder): 22.7\%
Hemorrhage (excluding aneurysms or stroke): 13.7\%
Cardiac and coronary conditions (including coronary artery disease, pulmonary hypertension, congenital heart disease, and valve disease; excludes cardiomyopathy and pregnancy-related hypertension): 12.8\%
Hypertension-related conditions (hypertensive disorders of pregnancy): 6.5\%
Infection: 9.2\%
Embolism, thrombotic: 8.7\%
Cardiomyopathy: 8.5\%
Anaphylactoid syndrome of pregnancy (amniotic fluid embolism): 3.8\%
Injury, homicide, poisoning of unknown intent: 3.6\%
Cerebrovascular accident: 2.5\%
Cancer: 1.9\%
Metabolic/endocrine conditions: 1.2\%
Pulmonary conditions: 1.2\%
These are all considered preventable pregnancy-related deaths.

Fetal, infant, and childhood mortality and morbidity

Fetal mortality: intrauterine demise of a fetus at any gestational age; most states require reporting deaths occurring at or after 20 weeks of gestation.
US fetal mortality rate for 2020: 5.74 deaths per 1{,}000 for the population overall and 10.34 deaths per 100{,}000 Black people.
Top causes of fetal death: unknown cause; placental, cord, or membranes complications; maternal complications of pregnancy; maternal conditions unrelated to pregnancy; congenital malformations.
Infant mortality: death of an infant before the first birthday.
US infant mortality rate (02/2020): 5.4 deaths per 1{,}000 births; most common causes include birth defects, preterm birth/low birth weight, sudden infant death syndrome, injuries, and maternal pregnancy complications; infant mortality is higher among non-Hispanic Black people at 10.6\,per\,1{,}000 births.
Childhood mortality (death of a child under age 5): in 2021, the rate was 25.0\,deaths\,per\,100{,}000 people in the United States, with leading causes including accidents, congenital malformations and chromosomal abnormalities, and homicide.
WHO notes a worldwide reduction in childhood mortality from 12.8\times 10^6 deaths in 1990 to 5\times 10^6 deaths in 2021; global most common causes are congenital anomalies, injuries, and noncommunicable diseases.

Global and national context: Pakistan maternal mortality

Pakistan, the fifth most populous country, has a maternal mortality rate of 140 deaths per 100{,}000 births.
Cultural and religious practices influence maternal health; many Muslim women rely on faith-based health care providers rather than medically trained providers.
Pakistan is described as a patriarchal society; women often have limited autonomy in reproductive health decisions and transportation barriers can limit access to facilities.

Three delays model and implications for care

The three delays model explains how complications can be avoided by avoiding: (1) delays in deciding to seek care, (2) delays in reaching a health care facility, and (3) delays in receiving adequate medical care at the facility.
Nurses should consider the cultural background of pregnant patients when applying this model and addressing barriers to timely care.

Quality improvement and national call to action

Surgeon General's Call to Action to Improve Maternal Health (2020) emphasizes that everyone can contribute to reducing maternal mortality by:
- Recognizing the need to address mental and physical health across the life course, starting with young girls and adolescents through to childbearing age.
- Supporting healthy behaviors that improve women’s health (breastfeeding, smoking cessation, physical activity).
- Recognizing and addressing factors related to social determinants of health that affect overall health and well-being.
- Understanding maternal health disparities in the United States (geographic, racial, ethnic) and working to address them.
- Acknowledging that maternal age and chronic conditions such as hypertension, obesity, and diabetes are risk factors for poor maternal health.
Learn about early warning signs of potential health issues that can occur during pregnancy or in the year after delivery.
Work collaboratively to recognize and address the needs of women with disabilities within efforts to reduce maternal health disparities.
Nurses can help decrease maternal mortality by educating patients on these suggestions.

Destigmatizing topics in women’s health care

Many sensitive topics exist in women’s health care (abortion, birth control) due to religious influence, cultural norms, infertility expectations, and genital/modesty concerns.
Public and professional groups advocate for policy changes and improved public education to destigmatize these topics.
Example: Kenya’s menstrual hygiene management policy aims to debunk taboos by educating to de-stigmatize menstruation.
In the United States, access to reliable contraception and no out-of-pocket costs through insurance coverage are crucial to reducing unintended pregnancies and enabling safe, healthy pregnancies.
The (incorrectly named) American Care Act mentioned in the transcript likely refers to the Affordable Care Act (ACA), which requires insurance plans to cover contraception with no out-of-pocket costs, contributing to a decrease in teen pregnancies when contraception is accessible.

Teen health literacy and sex education at the policy level

Access to contraception correlates with reductions in teen pregnancies.
Some providers use the Five A’s model (Ask, Advise, Assess, Assist, Arrange, Follow-up) to ensure that conversations about sexual health and dysfunction are integrated into health care visits—reducing the burden on patients to initiate discussion.
Example: Teen Health Mississippi provides an educational platform addressing taboos surrounding birth control, including messages like: using birth control does not imply promiscuity.
Nurses can destigmatize taboos, educate patients, and connect them with resources.

Self-advocacy and patient-centered care

Women advocating for themselves is essential, as certain conditions (e.g., cardiovascular disease, cancer) may be diagnosed later in persons AFAB than in persons assigned male at birth.
Self-advocacy is the ability to ensure that a person’s preferences, needs, and values are respected in health care.
A cardiovascular health article suggested AFAB individuals should (a) listen to their bodies, (b) ensure their health care provider listens, (c) ask questions about treatment, and (d) seek support from friends, family, and health care groups.
Patients who self-advocate can improve quality of life and reduce disparities; nurses can support self-advocacy by encouraging questions and clarifying expectations for health treatment plans.

Generational shifts: new expectations in health care

New generations (born roughly 1981–1996) have distinct expectations for care:
- They want to be treated fairly and want informed consent, privacy, confidentiality, and involvement in decision-making.
- A survey of this cohort found that 93\% want a relationship with their provider, and 85\% felt health care providers cared about them only when they were ill.
- They desire holistic health support that addresses total well-being and personalized experiences.
Nurses are trained to listen, support patient decisions, and provide information for health promotion and disease prevention to meet these expectations.

Connections to foundational principles and real-world relevance

Evidence-based practice (Healthy People 2030) connects research to clinical decisions and outcomes.
Addressing social determinants of health is essential to reduce disparities and improve population health.
Ethical implications include patient autonomy, informed consent, privacy, and destigmatization of sensitive topics.
Public health data (morbidity, mortality, preventable deaths) guide policy, registration, and quality improvement initiatives.
Global perspectives (Pakistan, Kenya) illustrate how culture, religion, and health system structure influence maternal health and the importance of culturally competent care.

Practical implications for nursing and health care providers

Stay current with Healthy People 2030 objectives to guide patient education and care planning.
Incorporate family planning, violence prevention, and gender equity into patient education and health promotion activities.
Be vigilant for social disparities and barriers to care when educating and caring for AFAB patients; tailor interventions to reduce inequities.
Use the Three Delays Model to identify and mitigate barriers to timely care in pregnancy-related conditions.
Apply the Five A’s model in clinical encounters to ensure comprehensive discussions about sexual health and contraception.
Support self-advocacy by encouraging questions, validating patient concerns, and providing clear information about treatment options and outcomes.
Embrace the generational shift toward patient-centered, personalized care; build trust by fostering ongoing provider-patient relationships.

Key numerical references (for quick study recall)

Top causes of death for AFAB (2021): Heart\ disease,\ Cancer,\ Stroke
Smoking prevalence (AFAB): 10\%; Obesity prevalence (AFAB): 42.1\%
Maternal mortality (US, 2021): 32.9 deaths per 100{,}000 births
Maternal mortality disparity (Black vs White, non-Hispanic): relative risk RR = 2.6
Fetal mortality (2020): overall 5.74 deaths per 1{,}000; Black population 10.34 per 100{,}000
Infant mortality (02/2020): 5.4 per 1{,}000 births; Black, non-Hispanic: 10.6 per 1{,}000 births
Childhood mortality (2021): 25.0\,/\,100{,}000
Preventable maternal deaths: mental health 22.7\%; hemorrhage 13.7\%; cardiac/ischemic 12.8\%; infection 9.2\%; embolism 8.7\%; cardiomyopathy 8.5\%; hypertensive disorders 6.5\%; amniotic fluid embolism 3.8\%; injury/homicide/poisoning 3.6\%; stroke 2.5\%; cancer 1.9\%; metabolic/endocrine 1.2\%; pulmonary 1.2\%
Global childhood mortality (1990 → 2021): from 12.8\times 10^6 deaths to about 5\times 10^6 deaths annually
Pakistan maternal mortality: 140 deaths per 100{,}000 births
Three delays model: (1) decision to seek care, (2) reaching health facility, (3) receiving appropriate care
Teen pregnancy and contraception access links: decline in teen pregnancies with contraception access