In Her Own Right The Institute of Medicine's Guide to Women's Health Issues (1997) / Chapter Skim
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4 Health Through the Life Span: The First Two Decades
4 Health Through the Life Span: The First Two Decades
Pages 53-72
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From page 53... ...
Did she bear children as a young woman, in middle age, or not at all? Did she receive hormone treatment at meno The discussion of the life-span perspective as it applies to women's health derives from the IOM report In Her Lifetime: Female Morbidity and Mortality in Sub-Saharan Africa.
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From page 54... ...
The capacity to conceive, carry, birth, and nurse healthy babies, or to efficiently avoid doing so, focused interest -- as an expectant mother's belly draws attention from her arms, legs, even her face -- on a single, transitory aspect of her being, to the near exclusion of many more enduring features. Unlike the older, pregnancy-centered view, the newer life span perspective regards a woman's experience as happening first and foremost to her, not to or because of or for the benefit of anyone else.
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From page 55... ...
Other such crucial points occur at various stages of the life span. Discovering when, and which, events trigger harmful consequences, and what factors affect the organism's susceptibility or resistance, and how adverse effects can be overcome today constitutes "one of the key issues for clinicians and researchers," the IOM report notes.1 Because the sensitive period concept arose first in animal studies, it "has traditionally been associated with the prenatal period and infancy"; experience has proven it "applicable to all stages of development," however.2 As we journey through American women's lives, we will see this concept's explanatory power again and again.
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From page 56... ...
But even as infectious disease has been largely conquered, significant -- and possibly growing -- numbers of children still succumb to mental, emotional, and behavioral disorders, including some, like learning disabilities and attention deficits, only relatively recently identified and understood. During the preschool and elementary years, these afflictions strike fewer girls than boys, although girls at every age face a higher risk of sexual abuse -- at least twice as high, according to studies.4 As if to illustrate the sensitive period concept, in fact, childhood referrals for psychiatric and psychological help peak at certain ages -- around 4 and then again between 7 and 9.
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From page 57... ...
"The girls get the territories that are left over from what the boys have grabbed," Maccoby goes on. "The boys get the big areas for their ball games, and the girls are on the edges," jumping rope or skipping across hopscotch boards, or bouncing their small pink balls to counting rhymes.8 Hours and years at the line of scrimmage or in the batter's box or under the hoop teach boys the skills and satisfactions of strenuous physical activity.
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From page 58... ...
Also crucial to the experience, Conger believes, is a highly variable factor: "how nearly optimal the young person's development has been during earlier age periods." A child who had "trusting, secure relationships with caretakers during infancy and early childhood and who is able to achieve competency in physical, cognitive and social skills and a positive sense of self during middle childhood, will be better prepared to weather the demands of puberty and adolescence than one who has not." But these days, alas, a decent childhood is far from a foregone conclusion. "One of the tragedies of our time," Conger goes on, "is the mounting number of children who have been denied both of these essential psychological building blocks, and who in all too many instances have also been denied basic health and neurobiological integrity, whether as a result of maternal drug use, malnutrition, exposure to toxic environmental agents or physical abuse and neglect."9 But ready or not, girls must face puberty whenever it happens, ushering many of them into a period of turmoil and complex new vulnerabilities.
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From page 59... ...
The advent of safe and reliable contraception has also somewhat evened the sexual balance by lessening the risks of unregulated intercourse. "Nevertheless," Maccoby insists, "our modern societies, not just America but other industrialized ones, are probably unique in the whole history of human societies in the lack of protection that we provide young women." Unlike traditional systems that build protections into the very fabric of social life, today "the burden of regulating sexuality is placed primarily on young women.
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From page 60... ...
. many girls" -- stripped of the protection of now-outdated codes and armed only with persuasive powers relatively ineffective on boys -- "are unprepared to handle the pressure from males."16 But given that the pressures continue, "it shouldn't come as a surprise to us that adolescence is the time at which we begin to see incidence of depression," Maccoby concludes.17 Sexual abuse is a very real danger to girls of this age.
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From page 61... ...
A generation or two ago, a "good" girl could safeguard her reputation and hold boys at bay by "playing the field" -- dating a number of people, none of whom could claim sufficient intimacy or commitment to demand sexual favors. In today's much more permissive climate, though, with sexual activity early in a relationship essentially taken for granted, many girls paradoxically feel their "sexual space" much more severely limited than their mothers ever did.
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From page 62... ...
To distinguish mere faddists from the truly disordered, psychiatrists added a final criterion: "A minimum average of two binge eating episodes per week for at least three months."23 This frightening condition is "one of the few psychiatric illnesses that in and of its own pathology results in death."24 Sufferers can plunge to a half or even a third of their normal weight. Vomiting can so deplete their bodies' potassium that they go into fatal cardiac arrhythmias.
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From page 63... ...
Since 1955, the average age when white girls begin has fallen more than 5 years, to about 12 or 13.30 (See Table 4-1.) That figure, however, is the only teen smoking statistic that has fallen recently.
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From page 64... ...
Data are from the Youth Risk Behavior Survey, 1990, in Luis G Escobedo, Stephen Marcus, Deborah Holtzman, and Gary Giovino, "Sports Participation, Age at Smoking Initiation, and the Risk of Smoking among U.S.
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From page 65... ...
"What is most striking, however, is the nature of the trade-off." Reasons for smoking are "transient in nature and closely linked to specific developmental tasks -- for example, to assert independence and achieve perceived adult status, or to identify with and establish social bonds with peers who use tobacco."33 But the results, of course, are potentially permanent -- nicotine addiction and its life-shortening risks. In addition to all the health dangers that cigarettes entail, both for the girl herself and for any children she might bear or raise while a smoker, they expose her to yet another serious peril.
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From page 66... ...
The African American teen pregnancy rate, though considerably higher than the white, does not suffice as an explanation. On their own, and despite a continuing fall in overall adult birth rate, white American teens conceive twice as often as comparable Canadians, citizens of the country closest to our own culturally, geographically, and in terms of pregnancy rates.39 Americans under 15 are at least 5 times as likely to give birth as girls in any other developed country.40 66
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From page 67... ...
Nor does Medicaid cover family planning for childless or nonpregnant poor women. American religious, political, and educational leaders, as well as ordinary citizens, loudly and continually bemoan our nation's dismal record of "children having children." But while their counterparts in other countries "concentrate on preventing teen pregnancy," Wymelenberg observes, the American system "concentrates on preventing teen sex."44 Countries that accept both the existence of teen sexuality and the need to provide effective protection against its likely outcome succeed much better than we do in reducing teenage conception.
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From page 68... ...
Our decentralized, locally controlled school system gives such groups greater power than their counterparts have in the centralized, federally controlled educational systems in Europe. Although many people, both within and without the religious community, believe teenage chastity a highly desirable method of preventing youthful pregnancy, experts agree on neither the feasibility of that goal nor the best way of attaining it.
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From page 69... ...
African American girls with their sights set on finishing their education are likelier than either white girls or other blacks to use effective forms of contraception.47 But even if an American teenager determines to use birth control, she has few options that meet her needs. The most efficacious types, the Pill, the diaphragm, and the intrauterine device, are far better suited to an older woman in a stable, monogamous, predictable sexual relationship than to a young girl whose sexual encounters are likely to be sporadic or unplanned.
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From page 70... ...
Almost no one starts smoking or using illicit drugs after age 18 or 20, for example. Avoiding sexually transmitted diseases will safeguard both her fertility and her life.
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From page 71... ...
28. Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths, 116.
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