CHAPTER 1: Historical Roots of Women’s Healthcare

Introduction What it means to be female in American society has changed over time. The relationship among women, their bodies, and what is considered “healthy” is grounded in assumptions and sociocultural contexts.

Child and Adolescent Health Principles of “scientific motherhood” were promoted in the early 20th century. Sheppard-Towner Maternity and Infancy Act (1921) – Appropriated federal funds for maternal and child healthcare for low-income families. Lewis Terman and healthcare in public schools (1910s–1920s).

Adolescent Growth and Development 1930s: “Wonder drugs” were administered to girls during puberty to keep their adult height within socially acceptable norms. – These treatments often caused severe medical problems later in life. Average age at which children develop secondary sex characteristics has been declining for the past 50 years.

Sexuality and Sex Education Separate curricula were developed for each gender. Contrary to pre-1920s beliefs, sexual curiosity and sexual experimentation came to be considered a normal part of healthy female development. Routine pelvic exams for women were recommended before marriage.

Sexuality and Sex Education Sex education programs were gradually incorporated in colleges and universities and then into public high schools. 20th century: – Abstinence-only programs taught in schools – Objections to mandatory HPV vaccines

The Birth Control Movement Margaret Sanger: – Activist for contraception Birth control was controversial and not often discussed. Common hormonal methods: – Birth control pill (approved in 1960) – Depo-Provera (approved in 1992)

The Women’s Health Movement 1960s and 1970s: Women’s individual struggles as women seen as forms of societal oppression – Encompasses psychological, economic, sexual struggles Direct roots in women’s liberation Advocacy, education, and alternative healthcare organizations sought to increase women’s control over their own bodies.

Pregnancy and Childbirth Medicalization of pregnancy and childbirth – Debates over “natural childbirth” vs. “medicated childbirth” 21 st century: childbirth remains primarily a medical event. – >99% of American births are taking place in hospitals. – Rate of Cesarean deliveries is rising.

Abortion, Sterilization Abuse, and Reproductive Rights Roe v. Wade and abortion reform in 1960s – More than a medical or public health issue, but a “collective problem for all women” Racism affects reproductive rights. – Minority women are more likely than White women to be sterilized.

Sexual Assault and the Anti-Rape Movement Before mid-1960s, physicians ignored problem of sexual abuse. 1970s: Rape was argued as a “political crime against women.” Early 1990s: Rape became a “bridge issue” that brought together women from a variety of political and racial backgrounds.

Gender Equality and Medical Research Gender disparities in medical research Public Health Service Task Force on Women’s Health Issues (1983) – Studied disease risks unique to women – Assessed women’s health across lifetime Push for more women’s health research at NIH Creation of Office on Women’s Health (1991)

Gender Equality and Medical Research The mission of the Office on Women’s Health is: – To improve the health of American women by advancing and coordinating a comprehensive women’s health agenda throughout HHS to address health care prevention and service delivery, research, public and health care professional education, and career advancement for women in the health professions and in scientific careers (2001)