More than the Sum of Her (Reproductive) Parts

Women and men are different -- disease impacts them differently and health systems respond differently. Understanding those differences will help us deliver treatment and prevention options that take those differences into account.
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Say the words "women's' health" in a conversation and inevitably the listeners' mind likely wanders toward sex. It's not because of inherent sexism, but it's because the global health agenda has programmed us to think of women's health as narrowly focused on sexual and reproductive health.

A woman is more than just her reproductive organs. But public policy doesn't always take that into consideration.

Last September, on the 20-year anniversary of the historic Beijing World Conference on Women, the United Nations held a meeting to discuss progress to date and steps needed to achieve the Sustainable Development Goal (SDG) of gender equality. The Global Leaders' Meeting on Gender Equality and Women's Empowerment sought concrete new commitments and financial contributions to eliminate gender inequality and discrimination against women.

Out of that meeting global governments committed $25 billion and 88 UN Member States, as well as regional organizations, civil society groups, and private sector groups, made public commitments. Unfortunately, despite the stated purpose of eliminating gender inequality, over and over the public statements almost exclusively focused on sexual and reproductive health.

For many years this focus, particularly in emerging economies, was essential in stemming the tide of maternal mortality and morbidity. But the women's health landscape has changed. Non-communicable diseases (NCDs), like cardiovascular disease, cancer, chronic respiratory disease and diabetes, have emerged as the leading killers of women. In fact, NCDs account for seven of the top 10 killers of women, and 18 million women annually die from them.

The global burden of disease from NCDs is clear. But it has not led to changes in the way we analyze, categorize and fund women's health. To have an impact on the future health, wellbeing and longevity of women, the global health agenda must shift its focus from sex organs to the whole woman, and the barrage of illnesses that are killing her.

In addition to no longer being an accurate focus, the current framework is discriminatory. An agenda with an almost exclusive focus on women of childbearing age effectively discriminates against and excludes those women who do not have or want children, or are no longer of reproductive age.

A further bias in our current system is the lack of gendered analyses of healthcare data. We are beginning to understand that health systems respond differently to women and men and that disease impacts women and men differently. But that wasn't always the case. For many years it was assumed that data and studies involving only men would be equally relevant for women.

Consequently, in some cases, the clinical definition of disease symptoms are based exclusively on characteristics of those reported in men. This can lead to warning signs in women being ignored, unrecognized or misdiagnosed because they fall outside of the defined parameters for symptoms -- parameters that were defined for men.

Or consider that women have historically been under-represented in clinical trials. Because of the assumption that men and women would respond consistently, gender diversity has not been prioritized in research studies, and sex-specific findings and outcomes have not been regularly reported.

This has the potential to be extremely detrimental to women's health. In the U.S., between 1997 and 2000, 10 drugs were withdrawn from the market because of life-threatening health effects; eight of the drugs posed greater health risks for women than for men.

Women and men are different -- disease impacts them differently and health systems respond differently. Understanding those differences will help us deliver treatment and prevention options that take those differences into account.

Data informs public policy. Poorly reported data can lead to ineffective, or even dangerous, public policy. In order to have effective public policy, we must take a gendered approach to collecting, analyzing and reporting health data, and ensure that sufficient numbers of women are included in scientific studies.

True gender equality and women's empowerment can only take place when women's health means more than just sexual and reproductive health, and the differences between women and men are accounted for and captured in our health systems.

Simply put, we need a broader, integrated agenda for women's health.

Women are more than the sum of their parts, reproductive or otherwise, and global health policymakers must acknowledge this. The lives of millions of women are counting on them.

Professor Robyn Norton is the Principal Director of The George Institute for Global Health. She is the lead author of a new report "Women's Health: A New Global Agenda" that was released at the House of Lords at a meeting of the All Party Parliamentary Group on Global Health this week. The paper is a joint effort of the Oxford Martin School and The George Institute.

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