Women’s Health: Beyond Reproductive and Gynecological Care

Women's Health Series Part 1 of 3

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Women’s Health encompasses much more than just reproductive and gynecological health.

There’s a whole lot more to it.

It includes a wide array of physical and mental aspects that are essential for overall well-being.

In this article, I'll provide an overview of women’s health, setting the stage for the next two articles in this three-part women’s health series, which will explore market trends and policy issues.

Women’s Health is More than Reproductive Health

There’s a common misconception that women’s health is solely about a woman’s ability to have children. While this notion may be more of an outdated dogma than a misconception, it persists today. Why? Largely driven by a lack of funding and research into the broader facets of women’s health.

Recognizing that women comprise more than half the population and are uniquely affected by a wide range of conditions, from reproductive health to cardiovascular health, underscores the urgent need for more attention and investment. Here is a more comprehensive picture of women’s health:

  • Bone Health: 80% of those with osteoporosis are women.

  • Cardiovascular Health: to start, heart disease is the leading cause of death for women in the U.S. More specifically, though, conditions like preeclampsia increase the lifetime risk for cardiovascular disease. Preeclampsia is a pregnancy-related condition characterized by hypertension and end-organ damage.

  • Oncological Health: Women are uniquely affected by uterine, cervical, and ovarian cancer. These cancers haven’t fully benefited from the treatment progress seen in non-gynecological cancers (e.g., advancements in genetics and immunology).

  • Autoimmune Diseases: Women make up 75% of all Americans with autoimmune disorders.

  • Metabolic Health: Polycystic ovary syndrome (PCOS) is one of the most common metabolic disorders in women and is the leading cause of anovulatory infertility. The long-term health impacts of PCOS remain largely unknown due to a lack of research.

  • Gynecological Health: Uterine fibroids are the most common benign pelvic tumors in women, and when symptomatic, they significantly reduce quality of life. Additionally, endometriosis, affecting 10% of women, causes severe, life-impacting pain. The mainstay treatment is merely symptom management.

  • Reproductive Health: Infertility remains a significant problem for many women, and maternal morbidity and mortality, as I’ll discuss in the next section, remain high.

  • Brain Health: Nearly two-thirds of those with Alzheimer’s disease are women.

To visualize these diverse aspects of women’s health, Springboard Enterprises’ Women’s Health Innovation Program produced their Framework of Women’s Health, highlighting the various dimensions of women's health:

Women’s Health Research

As I hinted at above, the failure to invest adequately in research focused on sex-specific biology has delayed progress in fully understanding the basic pathophysiology that drives conditions unique to women.

In 2018, only 10% of NIH research funding was allocated to women's health research. Additionally, funding for research on reproductive-related conditions like preeclampsia, endometriosis, and fibroids is channeled through the National Institute of Child Health and Development (NICHD), which primarily focuses on childhood development and health. Unsurprisingly, only 8% of NICHD’s budget is spent on women’s health.

This lack of funding is a significant reason why the exact mechanism behind endometriosis remains largely unknown. Without a clear understanding of the mechanism, precise treatment cannot be administered, leaving women burdened by the disease.

Maternal Health and the Disparities that Persist

Maternal health receives significant attention since disparities in health outcomes in the U.S. are far from ideal. The maternal mortality rate for Black women remains more than 2.5 times higher than that of white women and nearly 4 times higher than that of Asian women. For American Indian and Alaska Native women, the numbers aren’t much better—the maternal mortality rate is 2 times higher than white women. Despite increased awareness of these disparities, they have not improved much over the years.

Source: CDC Provisional Maternal Mortality Rates

Overall, maternal mortality remains high in the U.S. The most recent data show an average maternal mortality rate of 22.3 deaths per 100,000 live births, which is substantially higher than peer countries. I should mention that one study published recently suggested the CDC’s maternal mortality data are overestimates, rooted in misclassifications of maternal deaths. The authors estimate the maternal mortality rate is closer to 10 deaths per 100,000 live births. However, this number is still higher than peer nations, and racial disparities still persist. Either way, it’s estimated that 4 of 5 maternal deaths may be preventable, such as by increased access to care.

This is a big challenge, though.

Geographic disparities also exist in maternal health. Women in rural areas face decreased access to hospitals offering labor and delivery services. And the this trend of inaccessibility is only worsening. From 2011 to 2021, 267 rural hospitals shut down their obstetrics services, which is about one in four rural hospitals nationwide. Further, 63 rural hospitals shuttered their obstetric services during the pandemic alone. Poor access to maternal care only increases the risk of complications.

Dashevsky’s Dissection

In my clinical practice, I’ve seen firsthand how women’s health issues extend far beyond reproductive capabilities. Conditions such as cardiovascular disease, osteoporosis, and autoimmune disorders uniquely affect women, highlighting the need for a comprehensive approach to healthcare.

Economically, prioritizing women’s health is a moral imperative and a significant opportunity. According to a McKinsey Report, closing the women’s health gap could boost the global economy by at least $1 trillion annually by 2040. This potential is driven by fewer health conditions, extended economic capacity, and increased productivity. The report emphasizes that focusing solely on reproductive health underestimates the broader impact of gynecological and sex-specific conditions that create a higher burden for women.

It’s also crucial for both the public and private sectors to invest in advancing women's health initiatives. Policies should support women’s health research, enhance access to gender-specific care, and create incentives for new financing models (I’ll explain more of this in Part 3 of the series). For example, increasing investments in under-researched conditions like endometriosis and menopause can unlock significant market potential and improve the quality of life for millions of women.

In summary, women’s health is a multifaceted issue encompassing far more than just reproductive and gynecological health. It includes a range of physical and mental health aspects crucial for overall well-being. Despite the significant impact of conditions like cardiovascular disease, osteoporosis, and autoimmune disorders on women, there is a persistent lack of funding and research into these areas. Addressing the disparities in maternal health, particularly among Black, American Indian and Alaska Native, and rural women, remains a critical challenge. Investing in women’s health not only improves quality of life but also presents a substantial economic opportunity, potentially boosting the global economy by at least $1 trillion annually by 2040. To close the women’s health gap, a coordinated effort involving public and private sectors is essential, focusing on research, equitable healthcare, and inclusive policy-making.

This article was part one of three in a series on Women’s Health. See below for the full series.

RESIDENCY REFLECTIONS

My reflections on medical training. Written for physicians, residents, and medical students.

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