Progress in Women's Health: 1985–2015

Abstract

This year, 2015, marks the 30th anniversary of the landmark 1985 Report of the Public Health Service Task Force on Women's Health Issues. 1,2 The recommendations in this landmark report caused health researchers, service organizations, policy makers, pharmaceutical companies, health-care providers, and others to better recognize the need to focus on the health of women, at both the individual and community levels. This recognition has triggered advances in the health of women. 2 A look back during the past 30 years reminds us how far we have come. In the years before the report's 1985 release, progress in recognizing the importance of focusing on women's health had been relatively slow. In 1984, only about 60% of mothers reported breastfeeding. 3 Today, 77% of mothers initiate breast-feeding after birth, and 49% are still breastfeeding six months after birth. 4 In 1985, before the advent of antiretroviral therapy, women infected with human immunodeficiency virus (HIV) had a 25%-30% chance of transmitting the virus to their newborn babies. Today, HIV-infected women who take antiretroviral medication during pregnancy can reduce the risk of HIV transmission to their babies to ,2%. 5 In 1985, the teen birth rate stood at 51.0 per 1,000 teenage girls. 6 Today, that rate stands at 29.4 per 1,000 teenage girls, 7 partly due to the development of more effective and better tolerated reversible contraceptive methods. These newer methods have been a major advance for all women of reproductive age, from both a clinical and cultural perspective. An important shift has been recognizing that a woman's health involves more than just her reproductive functioning, and that specific health conditions can behave differently in women than in men. One year after the 1985 report, the U.S. Department of Health and Human Services took an important step when the National Institutes of Health established a policy of including more women in clinical research. 8 This policy required researchers to study how medications, procedures, and diseases affected women differently from men. Similarly, in 1998, the U.S. Food and Drug Administration published a rule requiring manufacturers to provide, prior to license approval, data on the safety and effectiveness of drugs and medical devices by sex, as well as by age and race. 9 Because of these and other forward-thinking policies , important distinctions affecting the health and well-being of women have continued to be identified by researchers, clinicians, and public health professionals. Research has highlighted sex differences in mental health and the greater burden that women face from several types of mental illness. For example, major depressive disorders affect women twice as often as they affect men. 10 We are still learning more about the differences between men and women in outcomes from heart attack, stroke, and other conditions. We have learned, for example, that because a woman can experience the symptoms of a heart attack differently than a man does, she may go undiagnosed or be mis-diagnosed. 11 In the early days of the HIV epidemic, researchers and health educators viewed women simply as "little men." Over time, however, researchers realized that women had different risk factors for HIV infection and needed different risk-reduction interventions than those targeted to men. In the past 30 years, we have learned that this paradigm applies to other health conditions and risk factors as well. 2 The overall health of American women has improved since the 1985 report, but not all women have benefited equally. Women from racial/ ethnic minority groups have experienced improvements in the rates of leading causes of death, 12,13 but serious