Women’s Health Review

- Determinants of Women’s health

o Biological determinants
 Iron deficiency (menstruation)
 Pregnancy complications
 Increased susceptibility to STIs
 Health conditions specific to women (ovarian cancer etc)
o Social determinants
 Male preference in some societies – female abortion
 Young female children fed less nutritious foods than male children
 Low social status linked to physical and sexual abuse (also depression)
 Household roles can lead to issues such as respiratory disease associated with
poor ventilation in the home
 Poverty, lack of education, low social status limit access to health care
 Dowry deaths
- Burden of Health
o Leading causes of deaths for females 15-49
 HIV/AIDS, Maternal disorders, Self-harm, TB, Road injury, Ischemic heart
disease, Stroke, Lower respiratory infection, Diarrheal diseases, malaria
o Sex-selective abortion
 Practice more common in Asian countries, China, and India
 It is important to understand consequences of sex-selective abortion including
factors such as marriage patterns, shared mates, social/health/behavioural
problems such as HIV/AIDS, prostitution, kidnappings, rapes, murder, decline in
fertility etc.
o FGM
 Four types, form of child abuse (see Simpson et al., 2012), carried out on girls 4-
14yrs old, instruments may not be clean
 Illegal in Canada
 Approx. 125 million women worldwide have had some form of cutting
 Can initially lead to shock, infection, hemorrhaging, pelvic inflammatory disease,
increased risk for HIV/Hep B
 Long term problems include retention of urine, infertility, obstructed labor
(which may also lead to infant resuscitation following birth)
 FGC is performed due to many reasons. Traditional practices is a large factor
along with religious requirements in certain areas. It can also be considered a
means by which to ensure virginity at time of marriage, preventative for
promiscuous behaviours, and to increase marriage prospects – refer to Simpson
article for further information
 Many health consequences exist related to FGC and no known health benefits.
o STI’s
 Women are biologically more susceptible
 Risk factors: young age, sex with high risk partners, inability to use condoms
  Untreated STI’s can lead to other health concerns such as Pelvic inflammatory
disease, chronic pain, ovarian abscesses, ectopic pregnancy, and infertility
 Chlamydia is 9x more prevalent in women and is common in low-income
countries
 HPV is associated with cervical cancer (cervical cancer causes approx. 275,000
deaths per year)
 Largest burden of STI is in 15-44yr olds with women having larger share of
disease. HIV/AIDS is leading cause of death and DALYs in 15-44yr old women
globally
o Violence against Women
 10-50% of women globally have been abused physically
 Risk factors: low SES, young age of partner, proximity to alcohol, gender
inequality
 Often stigmatized, and stats are difficult to obtain as a result
 In conflict zones sexual violence (rape) is used as “tool of war”
 Can lead to significant mental health concerns, unwanted pregnancy, STI, death
 According to WHO 1 in 3 women will experience physical and/or sexual violence
by a partner or sexual violence by non-partner
 South-asian and African regions have highest percentages of intimate partner
violence reported. American countries follow
o Maternal Mortality & Morbidity
 In 2013 there were 289,000 maternal deaths reported by UN
 These include deaths during pregnancy, childbirth, until 42 days after birth
 60% of all maternal deaths occur in 10 countries (refer to slide)
 Women in high income countries have significantly lower chance of maternal
death
 28% of maternal deaths are typically from obstructed labor and 72% are from
direct causes (refer to Callister article for more information)
 Direct causes can include hemorrhage, eclampsia, obstructed labor
 Indirect causes can include malaria, anemia, HIV/AIDS, FGC, abortion etc.
 Maternal mortality is higher in rural and poor areas
 Skilled birth attendants can significantly reduce the likelihood of maternal death
 Only 46% of women in low-income countries benefit from skilled care during
childbirth
 Poverty, distance, lack of information and education, inadequate services,
cultural practices are all factors that prevent women from receiving adequate
care during pregnancy and childbirth
 Sub-Saharan Africa and South Asia have highest maternal mortality rates
globally
 Leading causes of maternal death are hemorrhage, hypertensive disorders,
sepsis, abortion complications, embolism/clots
o Unsafe Abortions
 Only about 60% of abortions performed worldwide are considered ‘safe’
 Unsafe abortions contribute to approx. 13% of maternal deaths
  Over 22 million unsafe abortions performed every year
 Central Africa, Eastern Africa, South America have highest numbers of unsafe
abortion
o Obstetric Fistula
 Medical condition where hole opens between bladder and vagina or rectum and
vagina. Effects 50-100,000 women globally every year
 Women are stigmatized and often abandoned as a result of condition
 Risk factors include those related to obstructed delivery
 Fistula can also be caused by sexual violence/rape
 Lack of access to emergency obstetric care contributed to prevalence rates
- Cost & Consequences
o Isolation and stigmatization
o Family left without primary caregiver
o Puts newborn at greater risk of death
o Economic costs can be substantial
o Cost of violence can lead to increased mental health needs which are expensive to treat
o Costs are not well documented and further research is necessary
o Refer to program briefs in textbook
- Addressing future challenges
o For traditional practices such as FGC efforts must focus on local beliefs and cultural
practice
o Promotion of female empowerment and education are key
o Culturally competent nursing care is key when discussing issues related to sensitive
women’s health topics
o In matters of violence against women there is limited evidence overall about what
works to minimize or eliminate
o Support and shelter are key interventions needed for victims of violence
o Appropriate training of healthcare workers, police, judges etc. are required to
appropriately support victims
o Changing cultural norms related to value, worth of women is key
o Prevention strategies are necessary to reduce STI incidence worldwide
o Proper training for healthcare workers and access to appropriate services key
o Reducing maternal mortality requires addressing barriers that limit access to quality
maternal health services
o Skilled birth attendants are necessary along with emergency obstetrical care
o Refer to program brief “maternal mortality in Tamil Nadu, India”
o Three delays play key role in maternal mortality rates and need to be addressed – refer
to slides/textbook
o