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Gender, Women and Health in the Americas
edited by E. Gómez Gómez
PAHO Scientific Publication, No. 541
PAHO 1993, xix + 280 pages [E, S from PAHO]
ISBN 92 75 11541 9
Sw.fr. 56.-/US $50.40; in developing countries: Sw.fr. 39.20
Order no. 1610541
A multi-authored analysis of the ways in which factors linked to gender affect the health of women in Latin American and North American countries. Designed to highlight health-related inequalities between the sexes, the book goes beyond the traditionally restricted concern with reproductive and maternal functions to consider factors influencing the health of women at all stages in their life cycle, from infancy to old age. The contribution of women to health care is also considered.
The book contains 26 contributions presented in five parts. Contributions in the first part provide a conceptual overview of the ways in which women, health, and development are interrelated. The second and most extensive part offers a wide-ranging analysis of the impact of factors related to gender on such health problems as excessive female mortality in children, maternal mortality, domestic violence, the epidemiology of AIDS in women, gender-related patterns of cancer and other chronic diseases, and the incidence of mental disorders, alcohol abuse, and addiction to psychoactive drugs in women.
The impact of medical technology on the health care of women is covered in the third part, which draws lessons from a study of the link between toxic shock syndrome and the use of tampons, and assesses the implications of new techniques for assisted reproduction. The remaining parts examine the impact of legislation, in Canada, Latin American, and in international law, on women's health, and explore the role of women in health development in the formal health sector, within the family, and in organized social activism.
Investing in Women's Health: Central and Eastern Europe
WHO Regional Publications, European Series, No. 55
1995, xvi + 44 pages [E]
ISBN 92 890 1319 2
Sw.fr. 11.-/US $9.90; in developing countries: Sw.fr. 7.70
Order no. 1310055
Summarizes the findings from studies of women's health status conducted in 11 pilot countries and one pilot city in central and eastern Europe. By presenting and comparing country-specific data, the report aims to show how recent dramatic changes in these countries have influenced women's health, to identify the most important gender-specific problems, and thus to provide the basis for the development of policies that address the needs of women. The report represents the first overview and comparative analysis of women's health in countries of central and eastern Europe and the newly independent states of the former USSR.
The report has five main sections. Baseline information is provided in the first, which presents statistical data on health conditions in central and eastern Europe and compares them with data from other European countries. The second section, on women in the social structure, explores the impact on women of the economic crisis, the limited availability of food and other essential services, the erosion of maternity and child care benefits, and the double burdens of paid employment and household work.
The third section considers how the conditions faced in the daily lives of women are shaped by cultural and structural opportunities. An extremely high rate of maternal mortality, mainly linked to abortions, points to the consequences of inadequate family planning services and the absence of personal control over reproductive health. Other problems discussed include conditions that discourage healthy eating patterns, the growth of prostitution, and a lack of sex education and services for treating sexually transmitted diseases. The remaining sections explore the impact of dangerous and deteriorating environments, including work conditions in jobs where women are concentrated, and review the status of health services for women.
Midlife and Older Women in Latin America and the Caribbean
PAHO 1989, x + 424 pages [E, S from PAHO]
ISBN 92 75 12021 8
Sw.fr. 50.-/US $45.00; in developing countries: Sw.fr. 35.-
Order no. 1630002
A multi-authored study of the special health and social problems faced by older women living in Latin America and the Caribbean. As the book points out, their problems of poverty, bad health, and social isolation deserve special attention, not only because more women than men survive to old age, but also because they reach that vulnerable stage of life having already faced a lifetime of difficulties and discrimination related to their sex.
The first half of the book consists of a background paper prepared expressly for the Consulting Group Meeting on Midlife and Older Women, co-sponsored by PAHO and the American Association of Retired Persons. The paper, which provides a comprehensive summary of the situation in the entire Region of the Americas, draws a portrait of a group of women diverse in social and cultural background but united by problems inherent to being female and middle-aged or elderly in male-dominated and youth-oriented societies. The paper also focuses on the one problem which unites women from all these societies: the traditional focus on health problems of women in their reproductive years and the tremendous lack of attention given to health problems of elderly women. Other papers explore the condition of older women in specific countries from the perspectives of health, social and psychological well-being, and economic status.
"The authors of this powerful and moving book
call for urgent attention to be paid to the suffering and deprivation of middle-aged and
older women born to a lifetime of subordination. Through the work of PAHO, the care of the
elderly is at last being forced on the political agendas of Latin American
- The Lancet
Nations for Mental Health:
A Focus on Women
1997, ix + 57 pages [E]
Sw.fr. 12.-/US $10.80; in developing countries: Sw.fr. 8.40
Order no. 1930123
Describes a series of practical initiatives for addressing the mental health needs of women and improving the treatment and prevention of common disorders. The document is an outgrowth of the new WHO Nations for Mental Health project, which seeks to mobilize social, economic, and political support for combatting the growing problems of mental disorders and substance abuse. The project gives particular attention to the needs of underserved populations in developing countries.
The document has nine sections. The first reviews data indicating the magnitude of mental health problems that are especially common in women and often inadequately treated. These include depression, anxiety, psychological distress, sexual violence such as rape and forced prostitution, domestic violence, and substance abuse. Section two shows how these problems can be addressed, at the policy level, through a comprehensive plan of action ranging from changes in national legislation and the criminal justice system to support for grassroots initiatives. Policies are discussed in greater detail in section three, which explains how legislation can be used to combat discrimination against women, in health, education, and employment, and thus improve their mental health.
Against this background, the remaining sections present examples of projects designed to change factors in the social and physical environment that are known to have an adverse effect on women's mental health. Projects are suggested to improve the skills and attitudes of primary health care workers, to reach women at the workplace, to improve the management of domestic violence by the criminal justice system, and to ensure that women have access to support services. Additional projects cover the use of grassroots initiatives and the media to promote the mental health of women.
Nations for Mental Health:
Gender Differences in the Epidemiology of Affective Disorders and Schizophrenia
M. Piccinelli and F. Gomez Homen
1997, xix + 142 pages [E]
Sw.fr. 23.-/US $20.70; in developing countries: Sw.fr. 16.10
Order no. 1930118
A critical analysis of epidemiological evidence aimed at determining whether differences exist between men and women in the frequency of depression, major depression, bipolar disorder, and schizophrenia. The analysis also considered evidence that gender-specific factors might influence and predict symptom patterns, co-morbidity, clinical course, outcome, and response to treatment. Throughout, particular attention is given to methodological problems, including differences in study design, diagnostic criteria, and statistical methods, that help explain discrepancies in the literature and aid the critical interpretation of results. Close to 400 studies were critically assessed.
Affective disorders and schizophrenia are considered in separate sections. For affective disorders, the authors found consistent and convincing evidence that rates of major depression are higher in women compared to men, and that women also face a higher lifetime morbidity risk for depression. Age at first onset of depression was determined to be similar in men and women. Concerning the important question of whether rates of major depression are increasing, the analysis found evidence for higher cumulative rates at an earlier age of onset in younger birth cohorts, but could not reach firm conclusions. In seeking explanations for the observed gender differences in depression, the authors considered the possible role of genetic factors, reproductive hormones and other biological factors, life events and social support, gender differences in coping style, and findings from neuropsychology. Several promising lines for further investigation were identified.
For schizophrenia, the authors found convincing evidence that age of onset is earlier in men than in women, and that women respond better to medication and tend to have a better clinical outcome. The study found no consistent pattern of gender differences in incidence rates or in lifetime morbidity risk for schizophrenia. Weaknesses in the available evidence were identified, together with priority areas for further study.
Research on the Menopause in the 1990s
Report of a WHO Scientific Group
WHO Technical Report Series, No. 866
1996, vii + 106 pages [E, F*, S*]
ISBN 92 4 120866 X
Sw.fr. 20.-/US $18.00; in developing countries: Sw.fr. 14.-
Order no. 1100866
An expert assessment of what is known about the menopause, its immediate and long-term effects on health, and the possibilities for their treatment and prevention. Noting the many methodological problems surrounding research on the menopause, the report makes a special effort to separate those areas where firm conclusions can be reached from those where questions remain and further research is needed. Particular attention is given to the risks and benefits of hormone therapy.
The report has twelve sections. Methodological problems are addressed in the first, which considers the strengths and weaknesses of various investigative approaches and explains why certain designs are more likely to yield reliable results. Subsequent sections review the demography of the menopause and summarize what is known about the endocrinology of the normal menopause. A section on symptoms and their treatment underscores the importance of distinguishing between symptoms that result from loss of ovarian function and symptoms that arise from the ageing process or from the socio-environmental stress of the mid-life years.
The most extensive sections attempt to resolve some of the controversy surrounding the use of hormone therapy to reduce the risks of osteoporotic fractures and cardiovascular diseases while also answering the question of whether hormone therapy increases the risk of breast cancer, endometrial cancer, and other gynaecological cancers. Information ranges from advice on calcium and vitamin D supplementation for the prevention of osteoporosis, to estimates of the increase in relative risk of breast cancer among women using estrogens alone for different lengths of time.
The report concludes with a balanced discussion of strategies for managing the health consequences of the menopause, emphasizing the need for a clear distinction between short-term therapeutic and long-term preventive goals, since the risks and benefits of the two types of therapy are very different.
Women, Aging and Health
Achieving Health Across the Life Span
prepared by R. Bonita for the Third Meeting of the
Global Commission on Women's Health
1996, iii + 55 pages [E]
Sw.fr. 12.-/US $10.80; in developing countries: Sw.fr. 8.40
Sets out a conceptual framework, supported by specific lines of action, that can guide efforts to improve the health of aging women in developed and developing countries alike. Global in its approach, the report identifies certain health needs shared by all aging women, discusses their determinants, and then shows how these needs can be met through cost-effective strategies. Throughout the report, numerous facts, figures, and practical examples are used to illustrate both the great scope for improving the health of aging women and the feasibility of twenty-two precise strategies for action.
The most extensive section identifies health priorities for aging women in three main areas: major preventable causes of morbidity and mortality, major chronic disabling conditions, and mental health. Conditions discussed include cardiovascular diseases and cancers of the lung, cervix, and breast; trachoma, tuberculosis, and tropical diseases; musculoskeletal conditions, osteoporosis, urinary incontinence, and sensory impairment; and depression and dementia. Noting that many of these conditions are caused by the same factors, the report stresses the need for broad, population-based strategies that address common causes.
The determinants of older women's health are considered in the final section, which assesses the economic, social, cultural, and political factors which influence health and affect the quality of women's life as they age.
Women and Tobacco
C. Chollat-Traquet et al
1992, xi + 128 pages [C, E, F, R, S]
ISBN 92 4 156147 5
Sw.fr. 26.-/US $23.40; in developing countries: Sw.fr. 18.20
Order no. 1150373
Explores the many special issues that surround the impact of tobacco use on the health and well-being of women. Noting that most tobacco control programmes fail to address the distinct needs of women, the book concentrates on the identification of gender-specific factors that help explain why girls and women smoke and how tobacco damages their health. The book, which uses data from a wide range of sources, makes a special effort to cover all dimensions of the problem, ranging from conditions in developing countries that deter female smoking to the reasons why women may find it more difficult to quit than men. The impact of the tobacco industry's efforts to recruit female smokers is also considered.
The report gives detailed country-specific statistics revealing changing trends in female tobacco use and related morbidity and mortality. Data linking female smoking to a greatly increased risk of eight forms of cancer and six other major diseases soundly refute the myth that women are somehow immune to the adverse effects of tobacco. Additional effects on reproductive health, on physical appearance, and on the health of children are also clearly demonstrated in this comprehensive report.
"... lucid and succinct ... should be on
the shelf of every teaching practice ... excellent..."
British Journal of General Practice
"... extremely informative ... a useful
resource for libraries in colleges of nursing..."
"... fascinating ... should be read by all
policy makers, legislators, health professionals, health education officers, and opinion
makers in the women's movement..."
Women, Health and Development in the South-East Asia Region
SEARO Regional Health Paper, No. 22
1992, ix + 90 pages [E]
ISBN 92 9022 191 7
Sw.fr. 7.-/US $6.30; in developing countries: Sw.fr. 4.90
Order no. 1580022
Analyses trends in the health and social status of women in South-East Asian countries, which account for one quarter of the world's population and more than half of the world's poor. The contribution of women to health care and socioeconomic development is also critically assessed, with particular attention given to the consequences of the worldwide economic recession. By comparing the situation in different countries, the book aims to identify priority needs and help policy-makers determine the best ways to improve women's health and strengthen their role in development.
The book has five chapters. The first traces events, at the global level, that have focused attention on the importance of women and called for urgent action to meet their special health needs. The second chapter uses statistical data to provide an overview of changes in the health situation of women throughout the region. Apart from surveying key indicators of health status, the chapter explores the impact of such factors as education and literacy, remunerative employment, poverty, social status, and access to health services and family planning. Observations include a direct link between declining health services and increased rates of maternal, infant and child mortality, decreases in per capita food supplies in certain regions, and increasing child malnutrition.
The third chapter provides succinct profiles of the health situation of women in each country of the region, highlighting facts and figures indicative of future trends. The remaining chapters summarize recent activities and programmes focused on women's needs, and identify priorities for future action, including the growing problems of HIV infection and AIDS. The concluding chapter notes the alarming discrepancy between the scale of unmet needs and the availability of resources.
Women's Health: Across Age and Frontier
1992, vi + 107 pages [E, F]
ISBN 92 4 156152 1
Sw.fr. 20.-/US $18.00; in developing countries: Sw.fr. 14.-
Order no. 1150379
A visual presentation of selected facts and figures that document the inferior health status of women and illustrate the many gender-specific factors that contribute to health problems and undermine the ability of women to improve their lives. Facts and figures are used to demonstrate the complex determinants of female health status in different countries and at different stages throughout the lifespan, moving from discrimination against the female fetus to the health problems of elderly women.
The book has eight chapters. The first illustrates the inferior status of women as demonstrated by sex-specific differences in education, income, participation in the labour force, wages earned, and other socioeconomic determinants. The second chapter, concerned with infancy and childhood, reveals early discrimination against females as seen through gender differences in aborted fetuses, feeding practices, nutritional status, incidence rates of selected diseases, and death rates among 2-5-year-olds. A chapter devoted to health status during adolescence presents data on the reproductive health, including rates of sexually transmitted diseases, of adolescent girls and on differences in alcohol and drug use in young men and women.
Other chapters consider health risks linked to the type and amount of work done by women, the determinants of morbidity and mortality during pregnancy and childbirth, and the complex problems that underlie sex-specific differences in major diseases and infections. The concluding chapters document the seriousness of violence against women and the prevalence of mental disorders, and discuss the emerging health problems of elderly women.
"... of wide interest to health care workers and
researchers ... an invaluable resource..."
Women's Health and Human Rights
The Promotion and Protection of Women's Health through International Human Rights Law
1994, vii + 62 pages [E, F, S from PAHO]
ISBN 92 4 156166 1
Sw.fr. 14.-/US $12.60; in developing countries: Sw.fr. 9.80
Order no. 1150412
Explores the ways in which international treaties on human rights can be used as a mechanism for improving the health of women. Arguing that the inferior health status of women can be viewed as a violation of international agreements, the book aims to identify the specific rights, embodied in these treaties, that affect women's health and can thus be used as a lever to press for conditions conducive to greater equality and better health. Throughout the book, a special effort is made to point out the many new lines of action that arise when the health risks associated with women's low status are viewed as a violation of international human rights agreements.
The first chapter describes the evolution of international human rights relevant to women's health and shows how specific universal and regional international instruments can provide a framework for understanding the nature of State obligations to improve women's health. Evidence of the pervasive neglect of women's health is reviewed in the second chapter, which points to a number of health risks, present from birth through old age, that are uniquely experienced by women and closely linked to society's tendency to "devalue" their importance. Chapter three considers the key questions of how compliance with a right is determined and how breach of the right can be established. The fourth and most extensive chapter summarizes each of the main health-related rights of women embodied in the international treaties and explains how these rights can be invoked to provide relief, remedy, and preventive interventions. The remaining chapters discuss some of the judicial processes available to promote women's health and issue a call for greater initiative in the use of these mechanisms.
"... excellent ... gathers in one place all the
relevant international statements that offer guidance concerning fundamental human rights
that are related to health care for women ... a valuable resource ... a challenge and an
Journal of Law, Medicine and Ethics
"... a useful attempt to place current issues
about women's health across the world within the framework of the language and law of
Towards a Better World
Report of the First Meeting of the Global Commission on
1994, v + 42 pages [E, F]
Sw.fr. 10.-/US $9.00; in developing countries: Sw.fr. 7.-
Order no. 1930071
Explores the impact of global political, economic, and social trends on the health of women throughout their lifespan. Based on discussions and debates during the first meeting of the Global Commission on Women's Health, the report aims to identify the most important health problems of women, assess their causes, and propose actions that can be expected to bring real improvements. Particular attention is given to the need for a holistic approach to women's health that goes beyond the traditional concern with reproductive functions.
The report has three parts. The first provides an overview of recent economic, political, social, and technological changes that have had both positive and negative consequences for women's health. Part two, which summarizes the Commission's discussions, identifies six areas that illustrate the main risk factors leading to morbidity and mortality in women. These are nutrition, reproductive health, the health consequences of violence, aging, lifestyle-related health conditions, and the work environment. The final part provides an overview of achievements and opportunities, concentrating on progress made since the declaration of the United Nations Decade for Women in 1975.
Women's Health Western Pacific Region
This publication is a compilation of country reports in the Western Pacific Region, depicting the status of women's health and covering topics such as gender, domestic violence, reproductive health, safe pregnancy, safe motherhood, unsafe abortion and women and HIV/AIDS.