Chapter 1: Evolution of Women’s Health Care and Research

LEARNING OBJECTIVES

1. Outline changes in society that have altered women’s roles at home and in the workplace, education, careers, and sexuality, and explain the impact of these changes on women’s health and health care delivery.

2. Explain changing trends and significant health care and research advancements leading to decreased morbidity and mortality of women.

3. Describe the impact of actions taken by federal agencies, legislators, and pharmacy associations/organizations for women’s health care and research.

4. List at least two opportunities to further advance women’s health through practice, education, and advocacy.

INTRODUCTION

The history of modern women’s health is a complex story that involves significantly more than the advancement of medical theory. Improvements in women’s health are intimately linked to changing social and political norms that have laid the foundation for the current United States (US) women’s health movement. Without equal access to higher education, the right to vote and be elected to public office, and the ability to work outside the home, women would not be in a position to demand prescription coverage for contraception or adequate funding for breast cancer screening and treatment. Key events laid the groundwork for what is now known as women’s health. Initially in US legislation, sex and gender were considered binary—female or male and woman or man, respectively. However, today policy and health systems are becoming more inclusive of all woman-identified people (eg, transwoman, genderqueer, lesbian, bisexual, heterosexual woman). In this chapter, women will be used both as a historical and inclusive term.

Women’s health has no founding mothers like the United States had founding fathers.¹ Instead, the efforts of generations of women represent the collective “mothers” of women’s health. Women of the Revolutionary War era (1775-1783) were critical in laying the foundation for this movement. While their husbands, fathers, and brothers crafted arguments for independence, the women called for their inclusion in government and for better education. Although it would be nearly 150 years until women would obtain the right to vote, gains in education were achieved more rapidly, thanks to the reform efforts of both men and women. After the Revolutionary War, an educated citizenry was deemed critical to the success of the new nation, resulting in the establishment of new academies and seminaries for women. Although women were barred from attending coeducational institutions until Oberlin College opened in 1833, the new all-female academies were the beginnings of the education that women from the Revolutionary War era had demanded.² An educated citizenry has become even more critical today.

Many women who benefited from educational improvements played pivotal roles in the abolitionist and suffrage movements of the 18th and 19th centuries, with the latter continuing into the early part of the 20th century. These movements ultimately led to the 13th amendment to the US Constitution (ratified in 1865) banning slavery and the 19th amendment (ratified in 1920) giving women the right to ...