Women’s health: local and global matters of great significance

A life cycle approach is important, as is acknowledging the importance of socio-cultural and lifestyle factors

Women’s health, in its broadest sense, encompasses all aspects of their health and wellbeing. From this perspective, this issue of the MJA includes a wide selection of articles covering key issues in women’s health, both locally and globally. The topics covered are diverse, and include pregnancy and reproductive health, as well as health and wellbeing at various stages of a woman’s life cycle. Taking a life course perspective of women’s health clarifies links between their socio-cultural background, reproductive health, lifestyle, and chronic disease risk.1 Significant events across the lifespan, including birthweight and age of menarche, have been identified as likely markers of cardiovascular disease risk,2 pre-menopausal breast cancer risk,3 and diabetes4 in women.

Most women in high and middle income countries will come into contact with health systems and health professionals while they are pregnant, but in Australia there is a confusing plethora of models of care. In some models the care is fragmented, as women move between primary and secondary care, private and public services, and medical and midwifery providers. Outcomes of pregnancy are important indicators of health for women and their families, so it is essential that women have access to a model of care that provides them with the best possible outcomes in every respect.

The narrative review by Homer5 examines the evidence in favour of continuity of care models in which a midwife is the primary maternity caregiver. The evidence, much of which is from Australia, is very clearly in favour of such models. Women report high levels of satisfaction with the midwife’s holistic approach to care during pregnancy and the postnatal period; the maternal and perinatal outcomes are the same as for other medical models, and are achieved with less intervention and at lower cost. The considerable high level evidence from randomised clinical trials now forms the basis of guidelines that advocate this approach for low or normal risk women. Why is it then so difficult for many women to choose this evidence-based model of midwifery care during pregnancy? Only a minority of women can access this form of care, and maternity hospitals appear reluctant to recognise the evidence. Inter-professional rivalries, lack of collaborative leadership models, and inaccurate citing of evidence all block further development, and the translation of the available evidence into practice is held up. As Homer remarks, it really needs to be asked whether it is ethical to deny women access to a model of care that is so strongly supported by the evidence.

Further assessment of how effectively these models work for women with higher risks during pregnancy is required, and one of the greatest challenges is ensuring that all health professionals involved in maternity care work collaboratively to achieve the best outcomes. It makes sense that women at higher psycho-social risk would benefit from greater continuity. Whether or not such models lead to better medium and long term psychological and emotional outcomes for all women needs to be determined, but there is potential for significant benefits for the entire family if the model enhances their wellbeing in the postnatal period and beyond. The likelihood that this outcome of pregnancy will impact on women later in life should be obvious to all.

In their later years, non-communicable diseases (NCDs) pose one of the greatest threats to women’s health globally. NCDs such as cardiovascular disease, cancer, diabetes, and chronic respiratory diseases currently account for around 18 million deaths in women annually, and it is estimated that this will rise by 17% over the next decade.6 The perspective article on global women’s health by Davidson and colleagues7 identifies that much of the increased risk has been attributed to socio-cultural factors, although lifestyle factors, such as unhealthy diet, alcohol consumption and smoking, physical inactivity, and obesity, also play pivotal roles.6 Davidson and colleagues argue that the ramifications of the burden of NCDs for women, their families and the global community is significant, and will lead to escalating health care costs, lost productivity, and adverse social and economic outcomes for families.7

Importantly, the perspective article by Teede and colleagues8 explains how biological differences, gender roles, and social marginalisation affect women, and mean that their risk behaviours are not the same as those of men, with consequences for the success of health-related interventions. From this perspective, more targeted health programs for women and health models of care are likely to better promote the wellbeing of women generally, as well as during pregnancy. This approach should help reduce the impact of modifiable risk factors and the burden of chronic disease, and enhance the development of comprehensive evidence-based policy and practice that improve women’s health.

There is increasing evidence that women’s health needs, both locally and globally, are best served by interventions tailored to their specific needs, acknowledging the links between socio-cultural background, reproductive health, lifestyle and chronic disease risk. Improving health outcomes for women, during pregnancy and at other stages of their life cycle, requires health service providers to recognise this, and to use the evidence to inform their provision of care that is both effective and acceptable to women.