In Her Own Right The Institute of Medicine's Guide to Women's Health Issues (1997) / Chapter Skim
Currently Skimming:
5 Health Through the Life Span: The Reproductive Years
5 Health Through the Life Span: The Reproductive Years
Pages 75-102
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 75... ...
Even within living American memory, the formal debut transformed upper-class schoolgirls into marriageable women in a whirl of balls and tea dances. Mere generations ago, an American boy graduated into long pants and an American girl put up her hair and dropped her hemline to mark the passage to man's and woman's estate.
|
From page 76... ...
Meanwhile, as they pass all these formal landmarks, American youth, as we have seen, also traverse, each at his or her own pace, an informal curriculum of adult behaviors that includes initiation into sexual activity, and, for far too many, into smoking, drinking, and drug use as well. At various points, young people also pass from the medical care arrangements that saw them through their growing-up years, either outgrowing their pediatricians or moving away to campus, military posting, or out-of-town work.
|
From page 77... ...
have seen perhaps the most drastic change in gender roles and attitudes in human history. Women on aircraft carriers, construction sites, and the Supreme Court; women as army generals, attorneys general, and surgeons general; women outnumbering men in newsrooms, elite medical schools, manufacturing plants; women entering every occupation from astronaut to zookeeper -- this social revolution closely followed two other revolutions, the technological one that culminated in the Pill and the judicial one that legalized abortion.
|
From page 78... ...
And that one, the Pill, requires daily attention and raises safety issues for some individuals. Of the other leading choices, the condom -- used by 16% of the partners of women who face unintended pregnancy -- is a crude and ancient device that requires discipline, interferes with pleasure, and depends for its effectiveness on users paying meticulous attention every single time.
|
From page 79... ...
As many as 8% seek to reverse the operation surgically, but only a minority of these attempts succeed.5 A DEARTH OF OPTIONS These figures, along with the problems that we have already seen facing teenagers who seek suitable contraception, certainly suggest that many Americans have contraceptive needs unmet by any available option. There are only four other readily available possibilities: withdrawal and abstinence, the choice of 5% each; the diaphragm, used by 4 to 6%; the IUD, the choice of 3%; and foams, jellies, creams, and suppositories, at about 1% each.6 A new category of long-lasting contraceptives, the subdermal (under-skin)
|
From page 80... ...
In short, "every method in use today has drawbacks," the committee concludes, "and collectively, current methods leave major gaps in the ability of people to control fertility safely, effectively, and in culturally acceptable ways throughout their reproductive life cycle."7 Americans face widely varying, and often changing, circumstances. Successful birth control requires contraceptives tailored to the individual's particular needs.
|
From page 81... ...
These gaps could be filled, in part, by developing new, safe, effective and acceptable methods for men, for breastfeeding women, for teenagers, for older women, and for those with particular health conditions."14 Far from welcoming exciting innovations to the market, though, the American public has actually seen contraceptive options contract in recent years, as manufacturers have withdrawn products, particularly IUDs, from sale in this country in the wake of the Dalkon Shield disaster, in which a combination of faulty design and corporate duplicity injured scores of thousands of women and resulted in a financial settlement in excess of $2 billion. In addition, "since the introduction of the pill and the IUD in the early 1960s, no fundamentally new contraceptive methods have been approved for use in the United States," the committee notes, although several have become available abroad.
|
From page 82... ...
In this country, most women consult obstetricians and gynecologists for contraceptive care; in the more successful countries, family doctors generally provide this service. Here family planning clinics serve those who cannot afford a private physician; in the more successful countries, they specialize in counseling first-time users of many social classes.
|
From page 83... ...
Any new techniques, however, must consider "both moral and physiological ideals, as well as psychological concerns," states ÉtienneÉmile Baulieu, M.D., Ph.D., of the Faculté de Médecine Paris-sud in France. "For centuries, abortion has been not only a morally difficult event for women, but also a physically painful and often dangerous procedure." Thus, any "medical means for pregnancy termination should diminish this threat to women's health" as well as "allow them to maintain their dignity."21 What's more, "the beginning of pregnancy is now understood to be a progression of steps" rather than a single event as formerly thought.
|
From page 84... ...
With RU 486 now licensed by Roussel to the Population Council, an American nonprofit organization, FDA approval is anticipated in 1997. "As a pharmacological class, the antiprogestins appear to have great potential as regulators of reproductive potential," the committee continues.28 In addition to facilitating first trimester abortions, possibilities include use as a "morning-after pill," to provide retroactive contraceptive protection; and to promote cervical ripening, whether for late-trimester abortions, termination of dead fetuses, or induced deliveries at full term.
|
From page 85... ...
Second only to the common cold and influenza in frequency, these two diseases account for almost 40% of infertility in this country.30 The total number of involuntarily childless couples has also doubled since 1965 to 1 million.31 Ninety percent of infertility arises from some cause that doctors can pinpoint, and half of couples receiving fertility treatment do succeed in conceiving at least once. Most of those go on to have a child.32 The hunt for an answer generally starts with the woman's doctor, either a family practitioner or a gynecologist, the specialty that does about 80% of basic infertility treatment.33 A urologist usually checks the man for problems.
|
From page 86... ...
Infertility research to date has concentrated mostly on the female system. Despite progress in recent years, "more needs to be known about the reproductive physiology of the male and about diagnosing and treating sperm deficiencies," Wymelenberg notes, as well as "the basic process of sperm movement through the female reproductive tract."34 Fertility treatment ranges from something as simple as determining the likely time of ovulation to immensely sophisticated in vitro fertilization (IVF)
|
From page 87... ...
Indeed, infertility patients come disproportionately from the well-off and well-educated. Though African Americans suffer infertility half again as often as whites, they seek treatment less often.
|
From page 88... ...
PREGNANCY AND BIRTH Despite American women's struggles to limit or enhance their fertility, the great majority, do, of course, at some point bear children. But the statistics describing the fate of our nation's newborns, like those concerning unwanted pregnancy, infertility, and abortion, indicate that this country, though possessing a concentration of medical talent, knowledge and resources unmatched in the history of the world, fails to afford to many of its citizens the simple, basic health services that can make a huge difference at an utterly crucial point in their lives.
|
From page 89... ...
places a child in the problematic category of low birth weight; and at less than 3 pounds, 5 ounces (1,500 grams) in the quite perilous one of very low birth weight.42 A baby born underweight, whatever the cause, lacks the benefit of adequate fetal growth and emerges from the engulfing nurturance of the womb less than optimally equipped to face the challenges of the airbreathing, mouth-feeding, microbe-infested outer world.
|
From page 90... ...
This country, meanwhile, countenances spending tens of thousands of dollars for infertility treatments and hundreds of thousands for high-tech rescues of grossly underweight and premature infants while many expectant mothers cannot obtain a couple of thousand dollars of preventative care that would help promote the safe delivery of a healthy child. If the nation increased access to prenatal care enough to reduce our rate of low birth weight by 2.5%, an IOM study found, our health care system could save $3 on later treatment of underweight infants for every $1 spent treating pregnant mothers.48 Indeed, infant mortality did drop by two-thirds between 1965 and 1980 before leveling off.
|
From page 91... ...
Research has shown that women who have had that procedure can safely try vaginal delivery for later births, and that the great majority of them can successfully deliver vaginally.53 Indeed, the American College of Obstetricians and Gynecologists, which encourages this approach, has issued guidelines for deciding who is eligible. Though the cesarean does improve survival chances of very small, high-risk babies and those presenting by the breech, this costly procedure is far more difficult and dangerous for the mother, exposing her to major abdominal surgery with its risks of infection and other complications.54 But the decision to use it may involve, as we will discuss in detail 91
|
From page 92... ...
Once again we are left to ponder the relative contributions of hormones and the stress of trying to fulfill demanding and often conflicting roles. With many mothers holding down tiring jobs both inside and outside the home, with highquality child care still an expensive and hard-to-find necessity, with growing numbers of women raising children on their own, the sources of depression, anxiety, substance abuse, and other mental disorders present little mystery.
|
From page 93... ...
Indeed, among women seeking alcohol treatment in this country, "the two phenomena go hand in hand," according to Fillmore.61 Liver disease also constitutes a more serious threat for women drinkers, and many more have unstable marriages, partners who themselves drink, or families unsympathetic to their treatment. Their self-esteem is lower than drinking men's, their child care responsibilities heavier, their families of origin more chaotic.
|
From page 94... ...
. really means the suppression of any kind of negative affect in a very simplified way." Though perhaps prevalent among men, and perhaps reflecting male coping styles, the rejection of one's own feelings of distress does not square with the "very high depression and anxiety scores" seen among chemically dependent women.65 Enabling, another key concept from alcohol recovery groups, is "getting picked up by a lot of drug programs and more generic programs" as well, Reed notes.
|
From page 95... ...
Public health campaigns have concentrated on exhorting people to insist on condoms, but the scanty research that exists on sexual practices among groups at high risk for HIV indicates that use is not generally a strictly individual decision, nor one that women can very often effectively influence. Rather, found IOM's Committee on Substance Abuse and 95
|
From page 96... ...
And in the life-and-death negotiations surrounding exposure to HIV, various subgroup customs severely increase women's already dangerous disadvantage. In certain cultures, Scrimshaw reports, including some prominent in the United States, a woman does not "have a choice on sex when 96
|
From page 97... ...
Or, ‘me uso anoche' [which means] ‘he used me last night,' is a euphemism for saying ‘we had sex last night.' "76 Women's " ‘permanent inequality' in status and power" separates many of them from their men and undermines their freedom of action, the AIDS committee observes.77 When sex is a masculine prerogative, tradition generally also dictates that "women should not initiate discussion of sexual practices or try to change their male partner's sexual behavior," the AIDS committee goes on.
|
From page 98... ...
With a support network "more constricted than that of other AIDS patients," this hapless soul must also contend with poverty that keeps her from both "obtaining the expensive drugs needed to treat AIDS" and "traveling long distances for the limited amount of care that may be available."82 For women, then, HIV and AIDS present dangers, issues, challenges, and needs quite unlike those facing men. Scientific assumptions based on masculine circumstances -- that an individual can control the terms of sexual contact, that the possibility exists of protecting oneself, that a support system will step in to provide care during illness -- are jeopardizing the health of countless women and their children.
|
From page 99... ...
Whatever health choices a woman made in the early stages of her life, as she moves into middle age, she will soon begin to see the rewards or errors of her ways.
|
From page 100... ...
47. Medical Professional Liability, Vol.
|
From page 101... ...
C HA P T E R 5 Health Through the Life Span: The Reproductive Years 70.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.