When you hear “women’s health,” your mind is likely drawn to maternal, sexual and reproductive health. But women’s health is shaped by so much more. It’s shaped by the environment they live in, the food they eat and the air they breathe. In short: women’s health is public health.
A frequently overlooked public health threat is noncommunicable diseases, or NCDs. NCDS—such as heart disease, cancer and diabetes—are responsible for two in every three deaths among women each year, and present the greatest threat to their health and well-being. Women and girls often also shoulder the indirect burden of NCDs as caregivers of sick family members, limiting their ability to earn or learn.
At the same time, NCDs and the behavioral and environmental factors that cause them—including tobacco, alcohol, poor diet and air pollution—are inextricably linked to maternal, sexual and reproductive health. For example, low-calcium diets, obesity, diabetes and hypertension increase the risk of developing pre-eclampsia and eclampsia—the second leading cause of maternal mortality.
To truly improve women’s health and well-being, we must hold governments accountable for addressing NCDs and their risk factors. Here are some of the key issues.
Cutting Tobacco. Every year, 2 million women die from tobacco use. While smoking rates among men are falling, those among women are rising. This should come as no surprise, given that the tobacco industry views women as an opportunity for market growth and targets them through advertisements that falsely link tobacco use to concepts of prestige, beauty and glamour—including as a method for weight control. Women account for about two-thirds of deaths from secondhand smoke, often because they lack the power to negotiate for smoke-free spaces, at work and even in their own homes.
Curbing tobacco use is an urgent women’s health issue, and one with proven solutions. Governments have an arsenal of policy levers at their disposal to reduce use and improve health, including tax increases on tobacco products, restrictions on tobacco marketing and bans on smoking in public places.
Curbing air pollution. Poor air quality claims an estimated 6.7 million lives each year, including 2.3 million lives lost due to household air pollution. Without access to clean fuels and technology for cooking, millions of households rely on traditional stoves and polluting fuels, and the smoke poses enormous risks to health for women, who are most often responsible for cooking, and their families.
Emerging research also emphasizes how poor air quality has adverse effects on pregnancy and child development. In a recent study, researchers found that poor air quality contributes to an estimated 350,000 pregnancy losses in South Asia each year. Researchers at my organization, Vital Strategies, recently published a comprehensive review of global evidence showing that that both ambient and household air pollution can increase the risk of prenatal and postnatal stunting.
The most impactful clean air solutions to promote women’s health will involve catalyzing government action to address leading sources of exposure for women, which includes efforts to promote clean household energy use.
Improving Food Systems. We are witnessing a global nutrition transition where hunger and obesity often coexist, traditional diets have been displaced, and people are increasingly pushed toward cheap ultra-processed foods and sugary drinks that saturate the market. More often than not, the face of malnutrition is female. Women and girls make up 60% of the world’s food insecure and hungry people, and the majority of the world’s overweight and obese people—in 2016, 15% of women were obese compared to 11% of men. Obesity in turn puts people at higher risk for diseases, including cardiovascular diseases—the world’s leading killer. Risks are compounded during pregnancy; obesity is associated with almost all pregnancy-related complications including gestational diabetes and preeclampsia.
There are tried and true steps that governments can take to address rising rates of obesity and accompanying levels of disease. Eliminating trans fat from the food supply is critical, as is helping people make informed and healthier choices by introducing front-of-package labels that warn shoppers–who are often women–against items high in salt, sugar and fat.
Counting Every Person. Throughout our lives, civil registration and vital statistics (CRVS) systems collect data on vital events, including births, deaths, marriages and divorces. On a national level, CRVS systems are crucial to helping governments identify and respond to the diseases that take the highest toll on a population. At an individual level, being counted means so much more. These legal documents can help women and girls claim the rights to which they are entitled. For example, where child marriage is still prevalent, birth certificates provide evidence of a girl’s age and can offer protection from early marriage and allow them to complete their education. And marriage certificates are crucial to defending women’s rights to child custody, property and inheritance.
But gender inequality often renders women—and their children—invisible. Globally, some 40% of deaths are unregistered or listed without a clear cause, while a quarter of the births of children under 5 remain unregistered. Women are much less likely than men to have their deaths registered, particularly because they are less likely to leave behind financial or material inheritance. In addition, stigma toward non-married women has been found to impede birth registration.
Investing in strengthening CRVS systems will have a significant effect on gender equality, particularly if the common barriers to registration that women face—including cost and distance—are identified and removed.
When we hear “women’s health,” we should picture everything from the food labels that warn us about the hidden, unhealthy ingredients in packaged food to the policies that ban smoking in public spaces to the birth certificates that grant girls access to education. For healthier women, we must mobilize behind this more holistic concept of women’s health and address these rising challenges.
About the Author: Christina Chang is the Executive Vice President and Deputy CEO of Vital Strategies, a global public healthorganization, working to address the inequities and challenges that exist in the global healthlandscape. Christina has significant experience advocating and expanding access to health care for women. Previously as Chief External Officer at Planned Parenthood New York, Christina oversaw the organization’s policy, and community organizing efforts to protect the sexual and reproductive services and information of all women. She also directed the advocacy and electoral activities of PPNYC’s Action Fund and PPNYC Votes PAC.