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In H Per In Right The Institute of Medicine's Guide to Women's Health Issues By Bery' Lieff Benderly for the Institute of Medicine NATIONAL ACADEMY PRESS Washington, D.C. ~ 997

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National Academy Press 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congres- sional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. This project was supported in part by a grant from the Johnson & Johnson Family of Companies. Library of Congress Cataloging-in-Publication Data Benderly, Beryl Lieff. In her own right: the Institute of Medicine's guide to women's health / by Beryl LieffBenderly for the Institute of Medicine Council. p. cm. Includes bibliographical references and index. ISBN 0-309-05327-7 1. Women Health and hygiene United States. 2. Women's health services United States. I. National Research Council (U.S.) II. Title. [DNLM: 1. Women's Health United States. 2. Women's Health Services. 3. Women's Rights United States. WA 309 B458i 1996] RA564.85.B46 1996 613'.0424 dc20 DNLM/DLC for Library of Congress Copyright 1997 by the National Academy of Sciences. All rights reserved. Printed in the United States of America 96-26155 CIP Cover: Madge Tennent. Local Color, 1934. Oil on canvas. The National Museum of Women in the Arts. On loan from the Tennent Art Foundation. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logo-type by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemusseen in Berlin.

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........... - - .. .-: . :-L ::: ::: ~ -:-. :: ~2::::-::-. .-:-::::::::::::::::::-::::-:. d-, --:: :-- : :~. ....... :. T--:-. ~. -: ; -: '----:- - - .... :.:. : ....... -;---- -:-:-.-.:.:.:.:.:.: --::~--. ... d- .-:::: Contents :: .. Why Another Book on Women's Health? 2 Gender Differences in Health 3 Roots of Difference 3 15 35 4 Health Through the Life Span: The First Two Decades 53 5 Health Through the Life Span: The Reproductive Years 75 6 Health Through the Life Span: Menopause and Beyond 105 7 Eating for a Healthy Life 8 Women in the Health Care System 9 Research on Women, Women in Research 10 Looking Ahead References Index . . . 119 153 179 209 213 217

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.-::--- - : ::::-::-: 2 ~. - 2 2~ - -. ~-: :- ---:- - -:--:- -:-:----:-:-:-:-:----:-:-: :: Acknowledgments The Institute of Medicine acknowledges with gratitude the contributions of the many people who have lent their efforts and expertise to this project during its planning and inception, writing, and production. Among these people are the speakers at the Institute's 1992 annual meet- ing and the 1991 Symposium on Nutrition, Women, and Their Health; the author, Beryl Lieff Benderly, who organized and made more acces- sible a vast amount of material; the editor, Roseanne Price, who helped refine the text; past and present Institute staff, including Enriqueta Bond, under whose stewardship as executive officer the project was conceived and largely executed; Karen Hein, IOM's current executive officer, who has seen it to its completion; and Judith Auerbach, Sue Barron, Conrad Baugh, Claudia Carl, Lou Cranford, Michael Edington, Polly Harrison, Chris Howson, Sandra Matthews, Patty Olender, Janet Stoll, Carol Suitor, Paul Thomas, Betsy Turvene, Catherine Woteki, and Allison Yates; and the staff at the National Academy Press Dawn Eichenlaub, Barbara Kline Pope, Estelle Miller, Francesca Moghari, Brooke O'Donnell, and Sally Stanfield who have applied their art and craft to the book's design and publication. All of these people have helped to shape the volume you now hold in your hands. Finally, the Institute is especially grateful to the Johnson & Johnson Family of Companies for the financial support that made this project a reality. IV

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In Her Own phi

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