HEALTH ISSUES OF WOMEN

MARCH 10, 2022

Presented by: Sadia Rana, Hajirah Younas, Iqra Yaseen, Nazia Riaz
 GENDER STUDIES

WOMEN’S HEALTH ISSUES

1. PREAMBLE

Breast cancer, maternal conditions, and cervical cancer are the causes of death that have the strongest
effect in lowering female global life expectancy in comparison with male global life expectancy.

Some of the differences in life expectancy between men and women are due to biological sex
differences. Some causes of death occur in one sex only; for example, those related to sexual and
reproductive anatomy (e.g., cervical cancer in women or prostate cancer in men). Other conditions can
occur in both women and men, but their prevalence is influenced by biological sex differences; for
example, death rates from ischemic heart disease are thought to be lower in women, partly because of
higher levels of the hormone estrogen whereas TB infection rates may be higher in men, partly due to
immunological reasons. For some conditions, death rates are similar in men and women if they are
exposed to the same risk, but risk exposures differ as a result of gender-related factors, such as occupation
(e.g., road injury). Gender can also influence health outcomes through differences in health literacy,
availability of and access to health information and services, and provider knowledge and attitude. The
exact contributions of sex and gender to health disparities are often hard to separate because they do not
operate independently. The maternal mortality ratio is the other hand, is the number of maternal deaths
per 100,000 live births. The maternal mortality ratio is used as a criterion for the quality of medical care
in a country. The global rate is 211 maternal deaths per 100,000 live births.

India is the top country in the number of female deaths in the world. As of 2020, several female
deaths in India were 22,514.99 thousand cases which accounts for 17.00% of the world's number of
female deaths. The top 5 countries (others are China, the United States of America, Nigeria, and the
Russian Federation) account for 46.59% of it. The world's total number of female deaths was estimated at
132,416.63 thousand cases in 2020. 94% of all maternal deaths occur in low and lower-middle-income
countries. 810 women approximately die every day from preventable causes related to pregnancy and
childbirth (WHO).

Historically, women have also been the primary health care providers and health decision-makers for
their families. Nearly two-thirds of women polled in a recent national survey indicated that they alone
were responsible for health care decisions within their family, and 83 percent had sole or shared
responsibility for financial decisions regarding their family’s health. Women are also the primary
caregivers for ill or disabled family members. Of the estimated Percent of Americans who are informal
caregivers, an estimated 72 percent are women—many of them sandwiched between caring for an ailing
relative and caring for their children.

2. BARRIERS TO WOMEN’S HEALTH CARE

2.1. MEDICAL RESEARCH

Until recently, medical research has largely ignored many health issues important to women, and
women have long been under-represented in clinical trials. In the past, research on women’s health
focused on diseases that affect fertility and reproduction, while many studies on other diseases focused on
men. At present, most women receive diagnoses and treatment based on what has worked for men.
However, the efforts of women’s health advocates and the unveiling of inequities in medical research

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have led to a broadened research agenda. This research is beginning to yield insights into the health-
related similarities and differences between men and women.

2.2. HEALTH CARE PRACTICES

When women try to meet their needs for reproductive health care and other health care services, they
often face fragmentation in the health care system itself. Furthermore, women make more visits to the
doctor than do men. Women are highly interested in and Informed about, health care issues. However,
reliable information about health care has not been widely available. National studies have indicated that
women may not be as satisfied with the information they receive from their health care providers as are
men or with the level of communication with their providers.

Furthermore, several studies have found that health care providers treat women differently than they
do men. Compared with the treatment given to men, health providers may give women less thorough
evaluations for similar complaints, minimize their symptoms, provide fewer intentions for the same
diagnoses, prescribe some types of medications more often, or provide less explanation in response to
questions.

3. PRIORITY WOMEN'S HEALTH ISSUES

3.1. HEART DISEASES

Heart disease is the number one killer of American women. Although it is typically viewed as a
man’s disease, more women die of heart disease each year than do men. On average, women develop
heart disease later in life than do men. In addition, women are more likely to have other co-existing,
chronic conditions that may mask their symptoms of heart disease than are men.

Symptoms of a heart attack in women may also differ from those in men, which can lead to a
misdiagnosis of the disease in women. Women who recover from a heart attack are more likely to have a
stroke or to have another heart attack than are men. 42 percent of women die within a year following a
heart attack compared to 24 percent of men. The overall prevalence of CAD was 26.9%: 23.7% (17.8%-
30.9%) in men vs 30.0% (23.4-37.5%) in women (2005)

3.2. MALNUTRITION

Malnutrition, defined as ill-health caused by deficiencies of calories, protein, vitamins, and minerals
interacting with infections and other poor health and social conditions, saps the strength and well-being of
millions of women and adolescent girls around the world. Malnutrition poses a variety of threats to
women. It weakens women’s ability to survive childbirth, makes them more susceptible to infections, and
leaves them with fewer reserves to recover from illness. HIV-infected mothers who are malnourished may
be more likely to transmit the virus to their infants and to experience a more rapid transition from HIV to
full-blown AIDS.

Globally, 50 percent of all pregnant women are anemic, and at least 120 million women in less
developed countries are underweight. Research shows that being underweight hinders women’s
productivity and can lead to increased rates of illness and mortality. In some regions, the majority of
women are underweight: In South Asia, for example, an estimated 60 percent of women are
underweight.

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Since the 1970s, the rate of obesity among females has increased by more than one-fourth to a rate of
36 percent. Much of this rising rate is attributed to the increasing lack of physical activity and overeating.
Being overweight increases women's risks of heart disease, diabetes, high blood pressure, arthritis, and
some types of cancer.

Iron Deficiency and Anemia, Iron deficiency, and anemia are the most prevalent nutritional
deficiencies in the world. The body uses iron to produce hemoglobin, a protein that transports oxygen
from the lungs to other tissues in the body via the bloodstream, and anemia is defined as having a
hemoglobin level below a specific level (less than 12 grams of hemoglobin per decilitres of blood [g/dl]
in nonpregnant women; less than 10 g/dl in pregnant women). Most women who develop anemia in less
developed countries are not consuming enough iron-rich foods or are eating foods that inhibit the
absorption of iron. However, malaria can also cause anemia and is responsible for much of the endemic
anemia in some areas. Other causes of anemia include hookworm and schistosomiasis, HIV/AIDS, other
micronutrient deficiencies, and genetic disorders.

 Anemia affects about 43 percent of women of reproductive age in less developed countries.

3.3. CANCER

The uncontrolled cell division is cancer that leads to weight loss, loss of appetite, and obstruction with
much more, and its metastasis can cause secondary tumors.

i. lung cancer has been the leading cause of cancer death among women in the United States. Over
the past 10 years, the mortality rate from lung cancer has declined in men but has continued to
rise in women. These alarming trends are under-recognized by women, and they are due almost
exclusively to increased rates of cigarette smoking in women.
ii. At present, breast cancer (Breast cancer happens when cells in your breast grow and divide in an
uncontrolled way, creating a mass of tissue called a tumor. Signs of breast cancer can include
feeling a lump in your breast, experiencing a change in the size of your breast, and seeing
changes to the skin on your breasts. Mammograms can help with early detection) is the second
leading cancer killer of American women. The incidence of breast cancer rose steadily from 194
to 1990, then stabilized at approximately 110 cases per 100,000 women. Every year, one million
women are diagnosed with breast cancer. Breast cancer is the most common cancer among
females and it is estimated that over 1.38 million women according to 2008, WHO (2015). At
some stage of life, 1 in 9 Pakistani women has become patients of breast cancer (2015).
iii. Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the
uterus that connects to the vagina. Various strains of the human papillomavirus (HPV), a sexually
transmitted infection, play a role in causing most cervical cancer. The prevalence of cervical
cancer has risen in Pakistan where almost 20 women fall victim to cervical cancer daily, making
it one of the top 10 countries with the highest female mortality rates. Some half-a-million women
will die due to cervix carcinoma by 2030, according to WHO, and more than 98% of these deaths
are likely to occur in developing countries like Pakistan
iv. Ovarian cancer is a group of diseases that originates in the ovaries or the related areas of the
fallopian tubes and the peritoneum (CDC). Although the incidence of ovarian cancer is lower,
ovarian cancer is the deadliest of all cancers of the female reproductive system. Symptoms often
appear only in the very advanced stages of the disease. There will be around 13,770 deaths due

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to ovarian cancer in 2021. The chance of developing ovarian cancer at some time is about 1 in
78. The chance of dying from it is about 1 in 108. Around 50% of cases affect those aged 63
years and over.

3.4. STROKE

A stroke is usually caused by a clot that stops the flow of blood to an area of the brain. Stroke can
cause paralysis, loss of speech, and poor memory. Stroke is the third leading cause of death for American
women, and it kills more than twice as many women each year as breast cancer. It is the most common
cause of adult disability in this country.

Women account for 43 percent (or 240,000) of the 550,000 strokes that occur each year and 61
percent of stroke deaths (97,227 of 159,791 annual deaths).

The prevalence of stroke is 1.2% in the province of KP. Obesity, hypertension, smoking, and
Diabetes Mellitus are the commonly associated risk factors of stroke. Higher age, urban area,
unemployment, and lower formal education are significantly associated with stroke

3.5. HIV/AIDS

Long considered a man’s disease, HIV/AIDS is a public health problem among women. It is the fifth
leading cause of death among women ages 25 to 44 and the third leading cause of death among African
American women in this age group.

Most Pakistani women have no proper access to medical facilities due to gender-based
discrimination. More than half of the population is based on women. Sexually transmitted diseases and
breast cancer has become a very common disease among women in Pakistan. In rural areas of Pakistan,
socio-economic conditions are responsible for the poor health of women. Estimated HIV/AIDS in a study
in 2013, positive adults aged 15-49 years in Pakistan to be 73,000, 8,900 being women. The general
population prevalence was estimated as 0.1% and high-risk population prevalence as 1-2%

The most common mode of HIV infection among adult and adolescent women is through
heterosexual contact, followed by intravenous drug use. Significant gender differences are manifest
throughout the illness as well as in the mode of infection. These differences indicate the need for gender-
sensitive treatment and prevention strategies to stem the spread of AIDS.

3.6. AUTOIMMUNE DISEASES

Autoimmune diseases arise when, for unknown reasons, a person’s body declares war on itself,
producing antibodies that attack healthy tissue.

About 75 percent of autoimmune diseases occur in women, including systemic lupus erythematosus
(SLE), Sjogren’s syndrome, rheumatoid arthritis, scleroderma, diabetes Type I, multiple sclerosis, and
autoimmune thyroid disease. When considered as individual conditions, autoimmune diseases are not
very common. However, taken together as a group, they represent the fourth-largest cause of disability
among women in the United States. These diseases remain misunderstood and misdiagnosed.

3.7. MENTAL ILLNESS

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One in 10 Americans experiences an episode of depression each year. Major depression affects
approximately twice as many women as men. An estimated 12 percent of women in the United States
experience major depression during their lifetimes, compared with 7 percent of men; and 4.2 percent of
women. Women are 2 to 3 times more likely to have certain types of anxiety disorders, including anxiety,
panic, and phobic disorders.

At least 90 percent of all cases of eating disorders occur in women. In addition, a high correlation
appears to exist between eating disorders and depression and between eating disorders and substance
abuse. The most prevalent forms are anorexia and bulimia nervosa. Eating disorders were more than twice
as prevalent among females (3.8%) than males (1.5%)

Depression has been recognized as a major public health problem evidenced by its ranking of the
fourth position among the global burden of diseases. Many believe it will occupy the second position
by the year 2020. 340 million people above the age of 18 suffer from depressive disorders that contribute
to a high suicide rate.

Postpartum depression: Many new mothers find themselves sad, angry, and irritable, and experience
crying spells soon after giving birth. These feelings — sometimes called the baby blues — are normal and
generally subside within a week or two. But more-serious or long-lasting depressed feelings may indicate
postpartum depression, particularly if signs and symptoms include:

 Crying more often than usual

 Low self-esteem or feeling like you're a bad mom
 Anxiety or feeling numb
 Trouble sleeping, even when your baby is sleeping
 Problems with daily functioning

3.8. SMOKING

Smoking during pregnancy substantially increases health risks to the developing fetus. It is the
leading cause of premature births, and it greatly increases the risks of mental retardation, miscarriage, low
birth weight, and other serious health conditions in infants. The smoking rate among women with children
under the age of 2 was 26.6 percent. This statistic indicates that some women may abstain from smoking
during pregnancy, but resume smoking after their child is born. Approximately 1.5 million women die
every year from tobacco use.

Children who have been exposed to second-hand cigarette smoke are at increased risk of Sudden
Infant Death Syndrome (SIDS); recurring ear infections; and severe respiratory illnesses such as
bronchitis, pneumonia, and asthma.

3.9. VIOLENCE

Violence is a major public health problem for American women. More than 4.5 million women are
victims of violence each year. Of these women, nearly two of every three are attacked by a relative or
someone they know. Women are 6 times more likely to be abused by someone they know than are men
and 10 times more likely to be victims of sexual assault. It is estimated that 10 to 20 percent (or one to
two young women in 10) are the victims of sexual abuse. In 1997, homicide was the second leading cause

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of death among women ages 15 to 24 and the sixth leading cause of death among women ages 25 to 44. It
is the leading cause of occupational deaths in women.

Researchers are increasingly concerned that violence may also be an important hidden cause of
maternal mortality. The prevalence of violence during pregnancy appears to range from 4 percent to 8
percent. Applying these percentages to the 3.9 million U.S. women who delivered live-born infants in
1995 yields the conclusion that l52, 000 to 325,000 women experienced violence during their
pregnancies. Thus, violence may be a more common problem for pregnant women than preeclampsia,
gestational diabetes, or placenta Previa.

3.10. REPRODUCTIVE HEALTH

Women’s reproductive capacity plays an important role in shaping their lives and health experiences.
Over 80 percent of all American women have had a child by the age of 45, and the average woman has
2.2 children. While motherhood is a defining feature of adult life for many women, most spend the
greater part of their reproductive years trying to avoid pregnancy. Sixty-four percent of women ages 15 to
44 use some form of contraception.

Gynecological health is not only an important component of women’s health during their
reproductive years but throughout their lives. The average woman spends a third of her life beyond
menopause. While many older women mistakenly believe that regular gynecological exams are no longer
necessary, this is precisely the point in life when they are at higher risk for cancers of the reproductive
system and other gynecological problems such as uterine prolapse.

Younger women are particularly at risk for reproductive health problems associated with sexually
transmitted diseases (STDs). Two-thirds of all STD cases occur among individuals younger than 25
years, and one in four teenagers’ contracts an STD each year. Women are more susceptible biologically to
becoming infected with STDs than are men, and younger women are more at risk than their older
counterparts due to differences in their cervical anatomy.

Pelvic inflammatory disease (PID), In turn, PID leads to infertility in 20 percent of cases, chronic
pelvic pain in 18 percent of cases, and ectopic pregnancy in 9 percent of cases. In addition to the direct
health problems caused by STD infection, high rates of STD infection in adolescent women contribute to
an increased susceptibility to HIV.

Gynecological problems are common among women of reproductive age. More than 4.5 million
women ages 18 to 50 report at least one chronic gynecological condition each year. Half of all women
who menstruate experience some pain during menstruation, and 10 percent of them suffer from pain so
severe (dysmenorrhea) that it interferes with their daily routine. Nearly two in five women between the
ages of it and 50 experience some symptoms of premenstrual syndrome (PMS)—10 percent with
symptoms severe enough to disrupt their usual activities.

As many as 10 percent of American women have endometriosis, which can cause chronic pain and
infertility. Between l0 and 20 percent of women have uterine fibroids (non-cancerous growths in the
uterus). Other causes include cancer, excessive bleeding, and pain. One woman in three over the age of 60
has had a hysterectomy, and it is the second most commonly performed surgical procedure in the nation.

3.11. FERTILITY AND INFERTILITY

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The main symptom of infertility is the inability to get pregnant. A menstrual cycle that's too long (35
days or more), too short (less than 21 days), irregular or absent can mean that you're not ovulating

 Infertility is one of the primary reasons for divorce among couples. (International Journal of
Reproductive Biomedicine, 2020)
 Up to 60% of infertile individuals reported psychiatric symptoms with significantly higher levels
of anxiety and depression than fertile individuals. (Clinical Therapeutics, 2014)
 Nearly 41% of infertile women have depression. (BMC Women’s Health, 2004)
 Almost 87% of infertile women have anxiety. (BMC Women’s Health, 2004)
 Women who get pregnant via IVF have a higher chance of giving birth prematurely. (Ultrasound
in Obstetrics & Gynecology, (2017)

Polycystic ovary syndrome (PCOS), PCOS causes a hormone imbalance, which affects ovulation. PCOS
is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It's
the most common cause of female infertility. It is the major endocrinopathy among reproductive-aged
women, is not yet perceived as an important health problem in the world. It affects 4%–20% of women of
reproductive age worldwide (2020).

3.12. ENVIRONMENTAL HEALTH

Environmental factors contribute substantially to the cause of many diseases in women. Adverse
environmental conditions range from water, air, and soil pollution to contamination through the
workplace. Occupational hazards include exposure to lead, chemicals, pesticides, tobacco smoke, and
continuous noise. Home and community environmental factors-from radon, lead-based paints,
electromagnetic fields, food, and cosmetics to heatstroke, hypothermia, and violence-affect women's
health. How environmental factors may disrupt women's endocrine, reproductive, central nervous, and
immune systems and cause-specific diseases such as cancer, autoimmune diseases, endometriosis, and
osteoporosis are only beginning to be understood. Endocrine-disrupting chemicals (EDCs) are the agents
known to cause several harmful effects to the reproductive system of women and wildlife. There is a wide
range of chemicals, developed for commercial use mainly in agriculture, which may cause endocrine
disruption

3.13. CHRONIC DISABLING CONDITIONS

In part, because they live longer than men, women are more likely to be affected by such chronic
disabling conditions as diabetes, osteoporosis, osteoarthritis, obesity, urinary incontinence, Alzheimer's
disease, fibromyalgia, and chronic fatigue syndrome. These conditions not only limit function but over
time they may be life-threatening. Each of these disorders is characterized by a long trajectory of
increasing impairment. Chronic illnesses exert an untoward effect not only upon the person experiencing
them but also upon family members and other caregivers. More research is needed to determine whether
specific gender-related factors contribute to the increased incidence of these illnesses in women.

Diabetes mellitus: Diabetes is a chronic (long-lasting) health condition that affects how your body
turns food into energy. Most of the food you eat is broken down into sugar (also called glucose) and
released into your bloodstream. When your blood sugar goes up, it signals your pancreas to release
insulin. Insulin acts like a key to let the blood sugar into your body’s cells for use as energy

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An estimated 16 million Americans have diabetes. However, only 10.3 million cases are diagnosed,
of which 8.1 million are women. There are currently over 199 million women living with diabetes and
this total is projected to increase to 313 million by 2040. Diabetes is the ninth leading cause of death in
women globally, causing 2.1 million deaths each year

Diabetes can be controlled through a proper diet, weight loss, exercise, or the use of medications.
Left untreated, diabetes can lead to severe vision loss, heart disease, stroke, kidney disease, amputation of
the lower limbs, and even death.

Osteoporosis is a disorder characterized by the thinning and increasing brittleness of bones, a

condition that can lead to bone fracture.

Approximately 60 percent of a woman's final bone mass is acquired by the time she is 18, and peak
bone density is achieved by age 35. To build and maintain healthy bones, girls and women of all ages
need to consume calcium-rich foods, get regular exercise, and avoid tobacco and the excessive
consumption of alcohol or caffeine. Further treatment strategies include the use of calcium and vitamin D
supplements, estrogen replacement therapy at menopause, and no hormonal medication to stem the bone
loss.

The prevalence of osteoporosis among women over 50 is estimated to be about 49% [65]. About one-
tenth of women over the age of 60, one-fifth of women over the age of 70, two-fifths of women over the
age of 80, and two-thirds of women over the age of 90 worldwide have osteoporosis

Dementia is a syndrome in which there is deterioration in cognitive function beyond what might be
expected from the usual consequences of biological aging. Dementia affects over 850,000 people in the
UK and 44 million worldwide. It is estimated that 61% of people with dementia are women and 39% are
men. This is likely to reflect the fact that women live longer than men and age is the biggest known risk
factor for the condition

Urinary incontinence (the unintentional loss of urine) affects 13 million Americans-11 million of
them women. Although half of all elderly people experience episodes of incontinence, it is not
exclusively a problem among the elderly. One in four women ages 30 to 59 experiences urinary
incontinence. Women are most likely to develop this problem during pregnancy, childbirth, and physical
activity or after menopause due to weakened pelvic muscles or pelvic trauma. Incontinence is treatable in
8 out of 10 cases. However, fewer than half of the people who experience this problem discuss it with a
health care professional.

Nearly 26.4 million of the 42.7 million Americans with arthritis are women. It is the most common
and disabling chronic condition reported by women. An estimated 4 .6 million American women (or 4 .6
percent of this population) report that arthritis limits their daily activities. The term arthritis commonly
refers to a group of more than 100 diseases of the muscles, tendons, joints, bones, or nerves. These
conditions range from mild to severe. Arthritis most commonly causes pain or stiffness in the joints of the
hands, feet, knees, and hips. Risk factors include increasing age, injury, obesity, and genetic
predisposition. Estrogen helps keep inflammation in check, which is why younger women have less
arthritis than men – but when levels plummet with menopause, arthritis often arrives. Treatment for
arthritis includes medication, exercise, use of heat or cold on the affected area, weight control, and
surgery. Today 6 million Canadians have arthritis – that’s 1 in 5.

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Fibromyalgia: The American College of Rheumatology reports fibromyalgia affects 3 million to 6

million Americans. An estimated 80 percent of sufferers are women, most of whom are of childbearing
age. Fibromyalgia is a common disorder characterized by widespread musculoskeletal pain; fatigue; and
multiple tender points in the neck, spine, shoulders, and hips. People with fibromyalgia may also
experience sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety, and other symptoms.

Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) is characterized by persistent and
debilitating fatigue and additional nonspecific symptoms such as sore throat, headache, tender muscles,
joint pain, difficulty thinking, and loss of short-term memory. Estimates show that CFIDS affects as many
as 500,000 persons in the United States. Approximately 80 percent of those diagnosed with the syndrome
are women.

4. DISEASE PREVENTION/HEALTH PROMOTION

Most of the health care burden in the United States stems from chronic illness, more than half of
which may be related to lifestyle and behavioral factors. An estimated 47 percent of premature deaths in
the United States could be prevented by modifying lifestyle behaviors (including tobacco use, diet,
physical activity, the use of helmets and seatbelts, sexual behavior, and alcohol and drug abuse). An
estimated 20 percent of these premature deaths could be prevented by reducing environmental risks.
Developing effective strategies to change behavior as well as women-focused programs that promote
health are critical to improving the quality and length of life.

4.1. Policy Options

The Millennium Development Goals established by the UN member states in 2000 challenge nations
to create effective interventions to improve women’s and adolescent girls’ nutrition. Taking such action
not only improves the health of girls and women today but also has far-reaching intergenerational effects
that can help countries develop.

Preventing malnutrition requires a political commitment. Public health systems need to prevent and treat
micronutrient deficiencies, encourage households to meet the dietary needs of women and adolescent
girls throughout their lives, and ensure their access to high-quality health services, clean water, and
adequate sanitation. Policymakers should also address women’s low social status and ensure that girls
have access to education — which should include nutrition information. Such policy measures can help
increase women’s age at first pregnancy, an important determinant of maternal health and child survival,
and can encourage women to space their births.

5. SPECIAL POPULATIONS
5.1. MINORITY WOMEN

Many women of color continue to suffer disproportionately from premature death, disease, and
disabilities. In 1997, life expectancy was 79.4 for white women, 74.9 for African American women, and
75.7 for all other minority women. Women of color also have a greater prevalence of such chronic
illnesses as cardiovascular disease, lupus, certain types of cancer, and diabetes as well as certain
infectious diseases like hepatitis, tuberculosis, and AIDS.

Women of color are more likely to live in poverty than are white women-a factor which is strongly
linked to a greater frequency and severity of illness and premature death. Limited access to health care

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and lower utilization rates for many preventive health services are more prevalent among women of color
than among white women. These disparities are due to the legacies of discrimination; the dearth of
minority health care providers; and the systemic, cultural, social, and economic barriers to health care that
confront minority women.

5.2. ADOLESCENT GIRLS

Adolescence represents a dynamic, developmental period of life. Young women make important
choices about lifestyle behaviors, including diet; physical activity; sexual activity; and the use of tobacco,
alcohol, and other drugs. All of these decisions can influence their health and well-being throughout
adulthood. The leading cause of death among adolescent girls is unintentional injury. Physical and sexual
abuse is experienced by more than one in five high school-age girls, and the proportion of these girls who
show signs of depression is one in four. Surveys indicate that 28 percent of high school girls think they
are overweight, 60 percent report trying to lose weight, and 8 percent regularly binge and purge.

An estimated 37 percent of teen girls smoked in the last month, 48 percent report frequent drinking,
and 15 percent rarely or never use a seat belt. Youth and young adults under the age of 24 comprise the
least medically served age group in this country. An estimated one in seven adolescents ages 10 to 18
years and 27 percent of those ages 19 to 24 have no health insurance. Much more lack access to
affordable, comprehensive, and confidential services that are targeted to their needs.

5.3. INCARCERATED WOMEN

Although women account for only 6.5 percent of all prisoners nationwide, they are the fastest-
growing incarcerated population in the United States. During 1998, the number of women under the
jurisdiction of state or federal prison authorities reached a total of 84,427, outpacing the rise in the
number of men for the third consecutive year. In addition, 63,791 women were held daily in jails and
737,958 female juvenile arrests were made in midyear 1998. Women in prison have different health care
needs than male prisoners. These differences result from several factors: women's relatively complex
reproductive systems, their status as pregnant women and mothers, their caregiving responsibility for
children who are minors, their increasingly high-risk illicit drug behavior, their increased rates of HIV
positivity, and their history of physical and sexual abuse.

6. ACTIONS BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

(DHHS) TO PROMOTE WOMEN'S HEALTH

As part of its overall mission to promote and protect the nation's health and to provide essential
human services, DHHS is pursuing a comprehensive agenda to improve women's health. Through its
agencies and offices, and in coordination with other governmental, national, and international
organizations, DHHS

 promotes the health of women across the lifespan

 empowers women to make informed choices about their health
 Translates policy decisions into effective women's health programs.

DHHS funding for women's health totaled just under $5 billion in FY 1999, an increase of more than
$2 billion in just five years. These funds support health care services for women, the development of

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innovative educational programs for the public and health care professionals, intensified research, and
other specific initiatives targeted to women.

7. ORGANIZATIONS FOR WOMEN

International Women’s Health Coalition (IWHC), an international organization, founded in 1984,

promotes sexual and reproductive rights and health among women and girls worldwide, especially in
Africa, Asia, and Latin America. The IWHC advocates for national and international policies that benefit
women and girls in these areas. It also provides education and training to local activists and community
leaders and issues grants to local women’s and youth organizations. In its first 25 years, the IWHC
assisted in the creation of more than 75 such organizations in 10 countries.

To address the lack of focus on women’s health issues within local health care systems and, more
broadly, within underserved Pakistani communities, GHETS (Global Health through Education,
Training, and Service) established a collaboration with Ziauddin Medical University (ZMU) in Karachi
and the associated Sikandrabad squatter community, the Women’s Health in Pakistani Squatter
Settlements (WHIPSS) program. For the last five years, ZMU has trained Female Health Volunteers
(FHV) who in turn provide information on immunization, breastfeeding, family planning, and control of
common childhood diseases to local women through health centers in Sikandrabad.

Through this network of FHVs, WHIPSS implemented the GHETS Women’s Health Learning
Package (WHLP) to bolster the training of this visible, female-friendly healthcare workforce. The FHVs
also provided additional training on topics such as violence against women and sexual and reproductive
health. This GHETS project was particularly successful because it provided support for a crucial women’s
resource within underserved settlements while fostering sensitivity to improving the quality of life for
Pakistani women.

World Bank currently assists Pakistan through three health projects the Family Health, Second
Family Health, and Northern Health Program projects that together cover Pakistan's four provinces and
territories. The Bank also supports the country's population welfare (family planning) program through
the nationwide Population Welfare Program and Social Action Program projects. In mid-1997 the Bank
and the government restructured the first four projects to speed progress and improve the limited
managerial capacity of the implementing agencies.

The Family Health Project (US$45.0 million original IDA credit, US$8.4 million of which was
canceled during project restructuring) assists the provinces of Northwest Frontier and Sindh and the
Federally Administered Tribal Areas. Its main objective is to improve the population's health status,
especially for women and children, by strengthening the delivery of health services and improving
institutional capacity through staff and management development. The project, approved in 1991,
represented the Bank's first assistance to Pakistan in the health sector. Although some gains have been
made toward the project's main objective, women's low status and lack of empowerment; absenteeism
among government health workers; and weak distribution systems for medicines, contraceptives, and
supplies have slowed implementation. Both provinces were successful in implementing the staff
development component. Sindh developed a strong partnership with Aga Khan University, which
supported the effort through a technical assistance contract.

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The Second Family Health Project was approved in 1993 to assist the provinces of Punjab and
Balochistan and the Islamabad Capital Territory. Balochistan was able to implement the health services
component more rapidly and to maintain higher levels of utilization of IDA credit, in part because its
program was smaller and management practices were relatively streamlined. Serious organizational
problems plagued the project in Punjab, including limited management capacity and lack of commitment.
These issues were resolved during restructuring, and the project is now being carried on with new vigor

Budgets have become better aligned with needs, and a larger share of government health expenditure
is devoted to primary health services, including community-based and preventive services. More women
health care providers have been hired and trained, and the promising Lady Health Workers Program has
begun providing the kind of community-based outreach that has proved successful in improving health in
programs across the world. The government's planning capacity has improved, and decentralization of
decision-making to the provincial and local levels is underway. With special assistance from the KfW, a
list of essential drugs has been introduced in the various government health facilities. Provincial and area
departments of health are working to strengthen the links between community-level workers, primary-
care facilities, and referral facilities, for more complicated procedures. A participatory development
program was launched to encourage the provision of health services by NGOs. These are all promising
steps, but the successes are fragile, and much remains to be done, especially toward involving the private
sector more effectively.

The population's awareness of family planning methods is high, except in some of the more
remote areas. Demand for family planning is increasing faster than contraceptive use rates, creating a
significant level of unmet need for family planning services. Although about 60 percent of women in the
reproductive age group want no more children, only 24 percent of women in this age group are using
some form of contraception. The reasons are complex and include limited access, the low status of
women, low educational levels, and high infant mortality.

To help meet the demand, the Bank is financing part of the government's program through the
Population Welfare Program Project (US$65.1 million IDA credit, US$29.1 million of which was
canceled following restructuring), approved in 1995. The project has achieved its goal of increasing
demand for family planning services but much more needs to be done to expand the delivery of services
through both public and private providers and to strengthen institutional development and management
capacity. In addition, the Bank is facilitating greater cooperation between health and population welfare
agencies to expand the coverage of services.

The Northern Health Program Project, financed in part by an IDA credit of US$20 million and
by the KfW, aims at improving and expanding access to health services for more than 2 million women
and children in the Northern Areas and in Azad Jammu and Kashmir, where health status and services are
substantially worse than elsewhere in Pakistan. The project design was tailored to the regions' extreme
poverty and limited infrastructure and the harsh geography and climate in some areas. Given the situation
of isolated settlements in rough terrain, and limited transportation and communication options the only
way to provide sustainable services is by developing partnerships between the government, communities,
and NGOs, and this is a central strategy of the project. In the Northern Areas, the project involves the
assistance of the Aga Khan Development Network, an NGO that has been providing health care in this
region since the mid-1960s. The Network will work in partnership with government teams to build on the
health services that it has already established.

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The Social Action Program Project II (US$250 million IDA credit, approved in 1998) will
continue to support the government's program through 2003. The government recognizes that it must
improve the delivery of key health services such as those targeted specifically to women and children
while undertaking organizational change and improving management capacity. This project will
consolidate gains already made in expanding the coverage and improving the quality of primary health
care services. Partnerships with NGOs and the private sector remain an important part of the overall
strategy.

In August 2020 the World Health Assembly adopted the Global Strategy for cervical cancer elimination.
To eliminate cervical cancer, all countries must reach and maintain an incidence rate of below four per
100 000 women. Achieving that goal rests on three key pillars and their corresponding targets:

 Vaccination: 90% of girls fully vaccinated with the HPV vaccine by the age of 15;
 Screening: 70% of women screened using a high-performance test by the age of 35, and again by
the age of 45;
 Treatment: 90% of women with pre-cancer treated and 90% of women with invasive cancer
managed

Acid Survivors Foundation, Pakistan, provides medical, psychosocial, and legal support to the
victims of acid attacks in the country, to ensure their physical reconstruction and reintegration into
mainstream society. It was founded in 2006 with the support of UK-based Acid Survivors Trust
International.

Aurat Foundation is a national, non-profit, non-governmental organization working for women's

empowerment. The organization was created in 1986 and deals with a wide spectrum of women's welfare
issues in rural and urban areas all across Pakistan. It is also known as the Aurat Publication and
Information Service Foundation. The organization also manages a USAID-funded Gender Equity
Program.

The Services for Community Development Foundation is an NGO based in West Karachi that serves
to alleviate the problems of women. The foundation deals with issues that include women's education,
lack of sanitation and hygiene, a shortage of food and jobs, sectarian problems, and a lack of investment.
The organization's motto is "service, awareness, and development." It aims to better the lives of girls
and women, with a focus on the Lasi Goth area in Karachi.

The Social Action Program Project and other ongoing efforts are providing a platform for improving
the health status of Pakistan's population in the twenty-first century. Sustained government commitment,
increased involvement by NGOs and the private sector, and assistance from development partners will be
key ingredients in achieving this goal.

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