women and health

Demographic transition

Epidemiological transition

• Causes of death move away from infectious disease (clean water, sanitation, vaccines) to more chronic disease: – Cardiovascular disease– Strokes– cancer

• This transition is at different stages in different parts of the world

Why women live longer

• Delay in cardiovascular disease – heart attack and stroke– Estrogen?– Iron and cell aging -- menstruation and meat

• Testosterone storm• Smoking• Stress handling• XX advantage

Why women live longer

Disposable males

• Castrati live longer• Female rats live longer– Better tissue repair– once ovaries removed, do not live longer

Missing girls

• Infantacide – a very old story– Delphi 200 BC: No more than 1% of 6000 families

had 2 daughters– Indian villages survey, early 1800s: 30 villages:

343 males, 54 females– New Dehli today: 821 females to 1000 males

Other murders

• Dowry deaths – 8000 per year?--the husband and/or in-laws have

determined that the dowry, a gift given from the daughter's parents to the husband, was inadequate and therefore attempt to murder the new bride to make the husband available to remarry or to punish the bride and her family

• Driven to suicide

Sex selective abortions

• Indian census statistics 1900 972 women per 1000 males

• 1994 929 per 1000• Delhi: 821 women per 1000 males

Sex selective abortions

• India: illegal since 1994• 5000 rupees = ~ 100 dollars• The end of infantacide?

• Female infanticide• Greece Delphi 200 BC• Indian villages survey, early 1800s: 30

villages: 343 males, 54 females• • Indian census statistics 1900 972 women per

1000 males• 1994 929 per 1000

Why?

• Lineage continuance• Girls have no property rights• Girls have to pay dowry – though illegal

since 1961• Boys work the fields and provide the

income

Asia: food for some

The wrong side of the power curve

• Information / education• Negotiation• Pregnancy and unsafe sex• Violence• Nutrition• Class matters -- poor women, high status

male• Suicide

Education

• Knowledge and power• Getting ahead independently of relationships• In all societies, child mortality is highest where

the women’s education is lowest.• 38 percent of girls in developing countries,

especially Asia, marry before the age of 18; 14% below the age of 15.

FGM

• Prevalence• What is the point?• What is the process?• What are the complications?

FGM effects

• Some will die of the procedure• Some will develop UTIs or reproductive tract

infections and sterility• Intercourse will be painful• Delivery – more episiotomies, more tears,

more arrests of labor, more C sections, more postpartum hemorrhage

• Fistulas

FGM effects: babies

• More likely to be stillborn• Morel likely to need recussitation• More likely to die in the neonatal period.

Sexuality and reproduction

• Takes one to tango– Leading cause of deaths worldwide 15-19 related

to sexuality• HIV• Maternal death• Unsafe abortion

• Leading cause of death globally age 15 – 49 is HIV

Maternal mortality

• 500, 000 deaths per year– Bacterial infection– Hemorrhage– Unsafe abortions– Preeclampsia– Obstructed labor

• Rate varies from an average of 9 per 100000 live births in developed countries, to 1200 in the worst countries

No Country for Pregnant Women

• Chad, Afghanistan, Sierra Leone, Niger:– 1 in 8 lifetime

• Europe– 1 in 16,400

• Ireland– 1 in 47,000

• US– 1 in 4800 (Right up there with Belarus and Serbia)

Maternal mortality

Maternal mortality

• Many easily preventable– Treatment of STIs– Available birth control– Safe abortion

• Prenatal care– Take a blood pressure– anemia

• Unattended deliveries

Maternal mortality

• Many who don’t die are injured– Urinary incontinence– Fecal incontinence– Fistula – abnormal connections

Maternal mortality – what works

• Training traditional birth attendants– Misprostol to expel placenta

• Regional hospitals with magnesium, antibiotics, supplies for cesarian section– Communication– Transport

What works

• Avoidance of unintended pregnancies• Avoidance of unsafe abortions• Avoidance of teen pregnancies• Prenatal care– Anemia– Nutritional support: vitamins, micronutrients– tetanus

• Mozambique: training assistant medical officers to becomes– Surgical technicians– Safely perform cesarians

Abortion safety

Abortion and the law

• Generally a safe procedure where it is legal• Lancet study: impartial?• Abortion in Kenya: illegal WHO: 300,000/yr– Misprostol in the cities– Herbs, trauma, back alley abortions– 17,600 deaths in E. Africa

Abortion

Maternal mortality US

US maternal mortality – going up

• Older age, higher risk: obesity, HBP, diabetes• Blacks 4 times the rate of whites• C-sections – 30 percent of births in NYC• We have much higher rates of maternal death

than Europeans– Access to care?– Access to family planning?– A marker of class