Sexuality, Gender, and Women's Health

This issue again begins with a formal commentary, this time by Heidi Siller and Margarethe Hochleitner, sparked by Piotr and Pawet Żuk's article recently published in our journal. The Żuk article is entitled, “Women's Health as an Ideological and Political Issue: Restricting the Right to Abortion, Access to In Vitro Fertilization Procedures and Prenatal Testing in Poland.”The comments highlight why women's health issues are so closely tied to our sexuality, not only in Europe but everywhere on the globe. We are hoping to make commentary a regular feature of Health Care for Women International, thus I remind readers that your comments and letters to the editor are welcome additions to what we publish.

Sexuality resurfaces as Eleonora C. V. Costa, Joana Silva, and M. Gra¸ca Pereira study how mental health problems contribute to women's AIDS risk, and when

Elisabeth Chop and colleagues examine food insecurity in the context of studying adherence to antiretroviral therapy among women living with HIV. In the Costa study, the authors learn women with PTSD take more risks in sexual behavior. In the Chop study, food-insecure women living with HIV often engage in transactional sex and sex work to obtain resources and food for themselves and their families. Both mental illness and food insecurity function as barriers to women's health, yet it is women's sexuality that seems to determine their circumstances.

Perhaps it is gender, even more than sexuality, that contributes to women's health issues. We publish two studies whose authors tested theoretical models to predict who adopts cancer screenings. Wei-Chen Tung and colleagues were informed about cervical cancer screening decisions by Korean American women regarding the PAP test and Shayesteh Shirzadi et al. learned what determines women's choices concerning the adoption of mammogram screening for breast cancer from women in Iran. While the Wei-Chen Tung and the Shirzadi researchers used different theoretical models (Wei-Chen Tung used TTM approach; Shirzadi employed the Health Belief model), what both groups of researchers had in common was the recognition that decision making processes are dynamic as are the barriers that women perceive regarding cancer screening. I was pleased to read each conclusion and I noted how study results could be used to predict what information should be shared with patients as their circumstances change. Health behavior is dynamic. The variables that may be used to explain changes are social as well as physical. Of course, why women do what they do changes as their situations change. I think it is time to stop telling patients that health education will fix what is wrong with women's health. Some health educators may think we don't do what's good for us because we need more education, but while education is a factor, living in crisis might be more predictive of who acts on the content of health education. As educators, we need to recognize that Shirzadi and colleagues were told by many women that they have problems with more priority than performing a mammography test. I suspect these problems are gender based.

The fact that health education isn't enough is also evident in research by Marván, Chrisler, Gorman, and Barney. In their innovative study, they employ a cross cultural semantic analysis of how young women view menarche. In their conclusion, they suggest words like “scary,” “embarrassing,” “confusing,” “nerve-wracking,” and “strange” remain in descriptions of menarche despite health education. My view is health education must be broadened to include more than the physical changes. It is wrong for educators to tell young women that physical changes that occur in the context of puberty should not be viewed negatively. Most life changes in life are scary, confusing, and strange, including those we look forward to experiencing. What we should emphasize are the social roles that gender will play in women's lives, and how these roles may also be scary, confusing, and strange.

Finally, David W. Sibbritt and colleagues show us that gender-based issues can be studied using health-related datasets that are abundant throughout the world. Now we publish their research about how gender contributes to women's tiredness in Australia.

Please, as always, read and learn, and if the work is inspirational, send me your comments.