Robin N. Fiore, PhDRobin N. Fiore, PhDFlorida Atlantic Florida Atlantic

UniversityUniversity

Ethics, Advocacy, and Ethics, Advocacy, and Women’s HealthWomen’s Health

Women’s Health Women’s Health Movement Movement

Goal: women’s empowermentGoal: women’s empowerment Education Education Policy Advocacy Policy Advocacy Service ProvisionService Provision Critique of SexismCritique of Sexism

EducationEducation

Self HelpSelf Help Boston Women’s Health CollectiveBoston Women’s Health Collective Our Bodies, OurselvesOur Bodies, Ourselves1969 1969

FFWHC Federation of Feminist FFWHC Federation of Feminist Women’s Health CentersWomen’s Health Centers

Policy AdvocacyPolicy Advocacy

Barbara Seaman Barbara Seaman

The Doctors’ Case Against the PillThe Doctors’ Case Against the Pill 1969 1969

Belita Cowan Belita Cowan

DES -Advocates for Medical Information DES -Advocates for Medical Information (AMI) 1971(AMI) 1971

NWHN National Women’s Health NWHN National Women’s Health Network Network

Provision of ServicesProvision of Services

““Jane” – abortion referral and Jane” – abortion referral and provisionprovision

Lay provision of artificial Lay provision of artificial insemination for Lesbians insemination for Lesbians

Independent research on Independent research on contraceptivescontraceptives

Critique of SexismCritique of Sexism

WHM analyzed sexism and racism WHM analyzed sexism and racism in the ways in which health care is in the ways in which health care is

delivered,delivered, with respect to access to high quality with respect to access to high quality

health care services, health care services, with respect to women’s control of with respect to women’s control of

resources and their ability to resources and their ability to influence medical decision-making influence medical decision-making and researchand research

Snapshot of Women’s Snapshot of Women’s HealthHealth

US women rank 16th in life expectancy US women rank 16th in life expectancy U.S. infant mortality ranks between U.S. infant mortality ranks between

17th and 20th 17th and 20th teen pregnancy rate is 2nd highest in teen pregnancy rate is 2nd highest in

the West the West AIDS is the leading cause of death AIDS is the leading cause of death

among women of reproductive age among women of reproductive age time from AIDS diagnosis to death is time from AIDS diagnosis to death is

shorter in women than for menshorter in women than for men

National Women’s Law National Women’s Law CenterCenter

Making the Grade on Women’s Making the Grade on Women’s Health: A National and State Health: A National and State by State Report Cardby State Report Card

Florida DemographicsFlorida Demographics

Women and AgingWomen and Aging

59% of persons over 6559% of persons over 65 72% of the poor elderly 72% of the poor elderly 45% of 45% of

elderly women live below the poverty elderly women live below the poverty lineline

1/3 more years beyond normal 1/3 more years beyond normal retirement age years (20 v 15 years)retirement age years (20 v 15 years)

half as likely to have pensions (24% half as likely to have pensions (24% women/46% men)women/46% men)

Pensions half as muchPensions half as much

Gender and CareGender and Care

Men get care from spouses: Men get care from spouses: 12million women are in-home 12million women are in-home caregivers, many over age 70caregivers, many over age 70

Caregiving exacerbates morbidity in Caregiving exacerbates morbidity in women – less attention to caregiver’s women – less attention to caregiver’s needsneeds

Women more likely to outlive Women more likely to outlive spouses, must pay for home carespouses, must pay for home care

Disability Free YearsDisability Free Years

Men at 65: Life expectancy 80 (15 Men at 65: Life expectancy 80 (15 years)years)

Age at disability 74Age at disability 74 Years of disability 6Years of disability 6

Women at 65: Life expectancy 84 (19 Women at 65: Life expectancy 84 (19 years)years)

Age at disability 76Age at disability 76 Years of disability 8Years of disability 8

Medicare and Women’s Medicare and Women’s NeedsNeeds

Health Insurance and Medicare Health Insurance and Medicare covers12% more per year per male covers12% more per year per male beneficiarybeneficiary

emphasizes good emphasizes good hospitalhospital coverage coverage (men use 5% more hospital care, ¾ of (men use 5% more hospital care, ¾ of nursing home patients are women)nursing home patients are women)

Undercovers chronic disease – women Undercovers chronic disease – women have more chronic diseases of aginghave more chronic diseases of aging

Undercovers adaptive aids, home care Undercovers adaptive aids, home care (2/3 of home care consumers are (2/3 of home care consumers are women)women)

JAMA 1994 Survey of JAMA 1994 Survey of Family CaregiversFamily Caregivers

34% provided majority of care for 34% provided majority of care for patientspatients

31% lost all or most of savings; 6% lost 31% lost all or most of savings; 6% lost househouse

29% lost major income source29% lost major income source 20% caregiver quit work20% caregiver quit work 12% stress impairs other family 12% stress impairs other family

membersmembers 6% delayed medical care for others6% delayed medical care for others

Feminization of PovertyFeminization of PovertyCreation of permanent class of poor Creation of permanent class of poor

elderly women due to burden of elderly women due to burden of caregiving:caregiving:

lost work hourslost work hours interrupted work historyinterrupted work history decreased job rankdecreased job rank decreased pensions and Social Securitydecreased pensions and Social Security decreased consumer savingsdecreased consumer savings excess morbidity cost of caregivingexcess morbidity cost of caregiving

The Next GenerationThe Next Generation

3 out of 5 Palm Beach County 3 out of 5 Palm Beach County students in grades 6-12 responded students in grades 6-12 responded that someone lives in their homes that someone lives in their homes who needs help caring for themselveswho needs help caring for themselves

Of those, 9 out of 10 said they assist Of those, 9 out of 10 said they assist in that care and that it adversely in that care and that it adversely affects their homework, or causes affects their homework, or causes them to miss school activitiesthem to miss school activities

Accomplishments of WHM Accomplishments of WHM Abortion remains legal, though Abortion remains legal, though

limitedlimited Informed consent for breast biopsies, Informed consent for breast biopsies,

c-sectionsc-sections Protection from unnecessary medical Protection from unnecessary medical

procedures, sterilization abuse, and procedures, sterilization abuse, and medical experimentationmedical experimentation

Right to know RX side effects and Right to know RX side effects and contraindications contraindications

Allocation of more federal $$$$ to Allocation of more federal $$$$ to research on women’s health issues research on women’s health issues

Challenges for FutureChallenges for Future

Dignified, affordable, Dignified, affordable, accessible, primary and accessible, primary and maternal health care for poor maternal health care for poor womenwomen

AIDS and HIV prevention and AIDS and HIV prevention and carecare

Long Term Care Long Term Care

Florida Bioethics Florida Bioethics NetworkNetwork

University of Miami/FBN Annual University of Miami/FBN Annual Clinical Ethics ConferenceClinical Ethics Conference

April 8, 2005April 8, 2005

Wyndham Miami Beach ResortWyndham Miami Beach Resort

www.miami.edu/ethicswww.miami.edu/ethics