Women's health

Renuka Shanmugalingam · Angela Makris

Madeleine M Cosgrave · Catherine A Brumby · Matthew A Roberts · Lawrence P McMahon

Aletta E Schutte · Markus Schlaich

Women's health is an essential aspect of global public health that is not only crucial for the individuals affected but also has far‐reaching implications for family dynamics, community cohesion, and overall economic stability. While, globally, complications during pregnancy and childbirth remain a leading cause of morbidity and mortality among women of reproductive age, women's health encompasses broad areas of health and wellbeing including non‐communicable diseases (NCDs), mental health, and gender‐based violence. In these areas important health disparities exist among women and between genders at local, national and global levels. Tackling these health gaps requires an appreciation of their historical, social, environmental and economic roots. This issue of the MJA is dedicated to women's health. Ramson and colleagues (https://doi.org/10.5694/mja2.52452) set the scene with a discussion on the opportunities afforded by maternal care contexts for addressing NCDs. Low‐ and middle‐income countries struggle with a mix of NCDs and other health challenges, with evidence indicating that women in these regions experience higher rates of multimorbidity compared with men. The authors explain that a life course approach to women's health, with a focus on addressing NCDs early, can improve maternal and child health outcomes, necessitating enhancements in sexual, reproductive, maternal, newborn and child health services. They propose that policy recommendations should include establishing standardised definitions for NCDs to improve data collection, focusing on primary prevention strategies, integrating care services, addressing inequalities, and providing global guidelines for the management of NCDs in maternity care. A noteworthy area of concern in Australian women's health is equitable access to contraception and family planning services, which is a particular challenge in rural and remote areas where health care services may be limited (https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ReproductiveHealthcare/Report/Chapter_2_‐_Enhancing_access_to_contraceptives). Research by Perkins and colleagues (https://doi.org/10.5694/mja2.52438) explored general practitioners’ views on postpartum contraception counselling and provision during postnatal checks. Three themes were generated: preferences for counselling timing, the provision of long‐acting reversible contraception (LARC), and opportunities for improving postpartum care. Participants expressed a desire to discuss contraception but had differing opinions on the timing of these discussions, often feeling that postpartum checks were not the ideal moment. While most recommended intrauterine devices (IUDs) and implants as preferred contraceptives, barriers such as long waiting times and insufficient training for IUD insertion limited their provision. Recommendations for improving postpartum contraception care included enhanced training opportunities, financial incentives for general practitioners, and multidisciplinary collaboration among health care professionals. A research article by Grzeskowiak and colleagues (https://doi.org/10.5694/mja2.52451) analysed the dispensing patterns of category X medications among women aged 15–49 years in Australia from 2008 to 2021 and their concurrent use of hormonal LARC and other contraceptives. LARC overlap with category X medications was only present for 13.2% of study participants, highlighting insufficient usage of effective contraceptive methods. The authors argue that strategies are required to enhance the uptake of LARCs among women using category X medications, including addressing barriers to LARC access, education on contraceptive options, and ongoing monitoring of contraceptive practices. Gender‐based violence is an ongoing societal challenge in Australia, with one in six Australian women experiencing physical or sexual violence since the age of 15 years (https://www.abs.gov.au/statistics/people/crime‐and‐justice/personal‐safety‐australia/2021‐22). In a research article, Galrao and colleagues (https://doi.org/10.5694/mja2.52436) aimed to determine the prevalence of intimate partner violence and reproductive coercion through standardised data collection in Australia. A cross‐sectional study was conducted with female clients aged 16 years and older attending a Perth sexual health clinic from March 2019 to March 2020, involving demographic data extraction and screening questionnaires. In this study, 2623 clients participated, with 17.3% reporting having experienced intimate partner violence (16.3%) or reproductive coercion (5.3%). The study revealed higher rates of both forms of abuse among specific demographics, including Australian‐born women and those with female partners, emphasising that clinicians should be open‐minded when assessing risk of abuse in order to identify and support affected individuals. In summary, women's health issues are influenced by various factors, both globally and within Australia. As we strive for gender equality and health equity, understanding the unique needs of women and the barriers many face is crucial in developing effective interventions and policies. There is a need for commitment from all stakeholders, including governments, health care providers, and communities, to advance women's health as a shared priority.

Francis Geronimo

General practitioners are well placed to facilitate discussions about contraception with women who have recently given birth

Jenna K Perkins · Sharon James · Danielle Mazza · Jessica R Botfield

Naomi CA Whyler · Sushena Krishnaswamy · Michelle L Giles

The proportion of births to Victorian women with obesity rose during 2010–2019, particularly in regional areas

Yvonne E Baker · Glyn Teale · Vidanka Vasilevski · Alemayehu Mekonnen · Linda Sweet

Improving their social and emotional wellbeing could help reduce the number of Aboriginal people in Australian prisons by reducing recidivism

Pat Dudgeon (Bardi) · Ee Pin Chang · Joan Chan · Carolyn Mascall · Gillian King (Noongar) · Jemma R Collova · Angela Ryder (Noongar)

Affordable and accessible testing to measure omega-3 levels is paramount to reduce preterm births

Joanna YX Fu · Carol A Wang · Elyse C Mead · Jason Phung · Maria Makrides · Craig E Pennell

Understanding trajectories of menstrual health throughout life is critical for effective public health interventions in women’s health

Courtney Munro · Sonia R Grover

This issue of the MJA has two pieces that reflect on medical leadership, the role of professional organisations, and the challenges that remain for women in leadership. In their perspective, Proimos and colleagues (doi: 10.5694/mja2.52244) discuss specifically the role of medical colleges and other member‐based medical organisations. This is not a problem that is unique to Australia: as the authors say, a recent report from the World Health Organization “showed women make up 70% of the global health workforce but only 25% of the leadership”. It is even worse for women from minority groups. And, as they note, although getting women into leadership is important for equity and social justice, more diversity, including having more women in leadership, also improves outcomes. So, who should take responsibility around barriers to women's leadership? As the authors argue, “The burden of addressing barriers on a woman's path to leadership should not sit with individuals but rather with changing the culture, organisations and systems where women work”. They go onto describe the Advancing Women in Healthcare Leadership (AWHL) initiative, which focuses on system‐level change. What happens next will be important in determining how the evidence‐based interventions they identified can be translated into outcomes. A second perspective in this issue by Wheeler and Govindasamy (doi: 10.5694/mja2.52242) looks at the flip side of women's leadership: that there is not just a glass ceiling for women in leadership, including medical leadership, but also a “glass cliff”. They define this concept as follows: “The glass cliff phenomenon, drawn from the glass ceiling concept, refers to the tendency for women and other minoritised people to be appointed to leadership positions in times of crisis, compared with periods of stability”. Such appointments are, as the authors say, “a poisoned chalice” since “when circumstances are bad … women and other minoritised people are often pushed forward as visible signals of change … these appointed leaders are expected to perform a miracle to turn the crisis around”. As in the previous article, the authors note that solutions must lie with organisations, not individuals. There must be “renewed focus on institutional changes that facilitate work–life integration and organisational inclusivity … [to] deliver the benefits of diverse leadership back to our health system”. First published online to coincide with International Women's Day 2024, these two articles are a stark reminder of how far we have to go. The stakes are high not just for gender equity: if we are serious about putting in place leadership that will improve health outcomes, more diverse and more female leaders are not just nice to have, they are essential.

Virginia Barbour

Paul P Glasziou · Jenny A Doust

Susan J de Jersey · Michael C d'Emden · Adrian G Barnett · H David McIntyre