Women’s History Month Shows Us How Our Health Care Past Can Inform the Future

As we celebrate Women’s History Month, I am mindful of the bold and courageous women who unlocked doors for other women to walk through. Women who took great risks to help other women gain their voice and their power. Women who brazenly took the first steps along a road untraveled, creating new pathways for others to follow with more ease. The history of women’s health care in the U.S., in particular, holds many insights for us as we honor innovation, self-advocacy and empowerment this month.

First Female Doctor was Shunned but Kept Going

On January 23, 1849, Elizabeth Blackwell became the first woman in the U.S. to graduate from medical school. Her application was initially considered a practical joke (literally) by reviewers. Elizabeth became a physician at a time when general society still found the idea of a “female doctor” absurd. Additionally, Rebecca Lee Crumple graduated in 1864 from the New England Female Medical College, becoming the first Black woman to earn a doctor of science degree. She would go on to write the Book of Medical Discourses.

Women also dominate the pharmacy and nursing fields. Approximately 61 percent of the 14,000 Doctor of Pharmacy degrees earned in the U.S. in 2016 were earned by women. Women also currently occupy about 75 percent of the pharmacist workforce compared to 8 percent in the 1960s. Among the more than two million registered nurses nationwide, about 90 percent are women.

First Women’s Suffrage Law Opened Doors

The first attempt to organize a national movement for women’s rights occurred in Seneca Falls, New York, in July 1848. Led by a young mother named Elizabeth Cady Stanton and the Quaker abolitionist Lucretia Mott, the effort resulted in the Seneca Falls Convention that outlined a women’s rights movement. Stanton’s “Declaration of Sentiments” echoed the Declaration of Independence in stating, “We hold these truths to be self-evident: that all men and women are created equal.” On December 10, 1869, Wyoming passed America’s first woman suffrage law, granting women the right to vote and hold office.

This was followed in 1896, when Mary Eliza Church Terrell founded the National Association of Colored Women (NACW), campaigning for Black women’s suffrage and civil rights. The efforts of these suffragettes and many others provided women with a voice to begin shaping workplace conditions, maternal and reproductive rights, and many of the precursors to today’s modern health care policies.

First Birth Control Clinic Provided Women with Health Options

On October 16, 1916, during World War I, Margaret Sanger, a nurse and writer on female sexuality, secretly opened the first birth control clinic in the U.S. Margaret also founded the American Birth Control League in 1921 – the precursor to today’s Planned Parenthood. Margaret advocated for women when contraception was illegal. Thanks to efforts from women like her, on March 9, 1960, the Food and Drug Administration (FDA) approved the world’s first commercially produced birth control pill.

Billie Jean King Broke Barriers in Sports

Billie Jean King is perhaps best known for the “Battle of the Sexes,” the 1973 tennis match where she beat Bobby Riggs, formerly a top-ranked men’s tennis player who claimed no female would ever beat him. This historical match was viewed by an estimated 90 million people globally in 1972 and showcased her fight for gender equality to the world. Equally significant, although perhaps lesser-known, was Billie Jean King’s tireless campaign resulting in the passage of Title IX, a federal law requiring colleges to invest in women’s athletic programs. Title IX transformed women’s athletics as the number of female high school, college and Olympic athletes skyrocketed. Today, over 200,000 women play college sports and over 3,000,000 girls participate in high school sports, enjoying better health, confidence and empowerment.

Women Finally Were Included in Clinical Research

In 1991, Dr. Bernadine Healy became the first female director of the National Institutes of Health (NIH) and launched the Women’s Health Initiative, one of the largest women’s health studies in the United States. Her understanding of the different ways disease and treatment affect men and women due to fundamental genomic, metabolic and hormonal differences in addition to average body size proved to the medical community that improvements to clinical research policy was necessary. In 1993, Congress wrote the NIH Inclusion Policy into federal law, mandating that women must be included in clinical research for new drugs. Five years later, the FDA’s Demographic Rule revised agency regulations to ensure that drug effectiveness data is presented by gender, age and race.

Affordable Care Act Supports Female-Centric Health Needs

The Affordable Care Act—the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010—provides for affordable preventive health care for women, including mammograms, cervical cancer screenings, prenatal care, and other services The law also recognizes the need to take into account the unique health needs of women throughout their lifespan.

Let’s Keep Moving Forward

These were remarkable strides. Today’s young women likely can’t imagine being denied entry to the voting booth, lacking women’s health resources, or being ridiculed for applying to medical school or competing on their HS track and field team. These milestones have dramatically improved how and why women receive medical care today, but we’re not done addressing major gaps in women’s health. Even today, just being female is enough to potentially harm your wallet, well-being and body:

Despite Progress, Health Care Disparities Persist

According to Health and Human Services’ Office on Women’s Health, not all women have benefited equally from recent improvements in the overall health of American women. Serious health disparities still exist, and minority women continue to lag behind white women in a number of areas, including quality of care, health care access, care timeliness and outcomes.

Black women continue to experience excess mortality, including shorter life expectancies[1] and higher rates of maternal mortality. [2] In fact, the U.S. has the highest maternal mortality rate among developed countries. Nearly 700 women die every year due to pregnancy-related complications. Consider also how rates of severe maternal morbidity and mortality among Black women are double to triple compared to those for white women.

Black women also continue to be disproportionately affected by chronic conditions, such as anemia, cardiovascular disease (CVD) and obesity, that are directly linked to inequities both within and outside of the health care system. 

Women’s Health Topics Still Involve Stigma and Shame

Many biologically rooted conditions and stages of a woman’s life – menstruation, sexual health, breastfeeding, postpartum depression – continue to be shrouded with stigma and shame, but in particular we need more research and education in the area of menopause. Despite living about 40 percent of our total lifespan in the post-menopausal state when medical needs change significantly, only 20 percent of OB/GYN residency programs in the U.S. offer menopause training. When they do, these courses are usually electives. Nearly 80 percent of medical residents say they feel “barely comfortable” discussing or treating menopause. Because every woman—i.e., half the world’s population—will eventually enter this stage of life, it’s essential that we begin to take seriously the need for much more education and public discourse about menopause symptoms and treatment options and reduce the stigma of conversation around this important life stage.

A Path for Our Next Generation

Women today are graduating from medical, nursing and pharmacy schools and attaining faculty positions in record numbers. However, there is still work to be done. For instance, women account for only 16 percent of medical school deans; 18 percent are department chairs. And even though women make up the vast majority of the nursing profession, gender imbalances mean that 78 percent of executive committee positions are held by men.

Opening up leadership opportunities in health care for women—who not only serve broadly in health care but also serve as the chief medical officers of their own families—is one way to improve economic and social health benefits in communities across the U.S.

While acknowledging how far we have come, we need to recognize we still have work ahead of us. Let’s address the holistic needs—medical, social and environmental—across every stage of a woman’s life. Let’s increase clinical trials and research in women’s health and improve health policy and societal issues. Let’s recognize that equity problems still persist and proactively address health care’s racial disparities. Let’s mentor, support and advocate for women so new health care policies lead to new clinical insights and action plans.

Together, let’s work to remove the barriers that hinder our progress and strive for a healthier tomorrow for everyone.

[1] National Center for Health Statistics. Health, United States, 2018. 2019. https://www.cdc.gov/nchs/data/hus/hus18.pdf 

[2] Centers for Disease Control and Prevention. Infographic: Racial/ethnic disparities in pregnancy-related deaths—United States, 2007–2016. 2020. Available at: https://www.cdc.gov/reproductivehealth/maternal-mortality/disparities-pregnancy-related-deaths/infographic.html Accessed May16, 2020