There is still a significant gap whereby women spend more of their lives in worse health

Over the past two centuries, we have seen an extraordinary increase in life expectancy for both men and women.

However, it is estimated that the average woman will spend nine more years in poor health, significantly affecting her productivity at home, at work, in the community, and thus reducing her earning potential. (1)

This gap stems from the combination of lower treatment effectiveness for women, worse benefits offered, and structural and systemic barriers that women face. Also, this is a conservative estimate given the historical scarcity of data on women’s health conditions, which underestimates the health burden of many conditions for women.

Taking action on the point would not only meet the moral imperative of improving the health and living conditions of millions of women, with positive effects in society for improving health in future generations, and the encouragement of healthy aging, but would also have a substantial impact in increasing the global economy.

Health equality implies access to the most appropriate forms of intervention and options for each individual, regardless of gender, sexual identity and orientation, age, ethnicity, religion, disability, education and income level. For women, this can start with better understanding, awareness and access to tools that will lead to better outcomes.

Better health correlates with economic prosperity, and it is also a matter of health equity and inclusion.

Women’s health is often simplified to include only the sexual and reproductive realm, but this definition is highly reductive because it does not take into account sex-specific conditions, such as issues related to the menstrual cycle, menopause, and general health conditions that may affect women with greater burden and prevalence. (2)
Regarding pregnancy, good women’s health during pregnancy helps the mother and baby, with benefits that extend beyond pregnancy and delivery, reducing the risk of complications that can result in chronic diseases.

Historically, men have led the studies of medicine and biology and have been the object of study (3), therefore, there has rarely been extensive research on sex-based differences.

Today we hope for the development of new research tools to better understand basic female biology, to classify symptoms and manifestations of disorders better, and to overcome the definition that they are “atypical,” as they are often labeled, suggesting bias in diagnostic criteria. (4)

At present, there are still important differences in the absorption or efficacy of drugs designed for use by both sexes but tested only in a male population, as in the case of therapies used for asthma and cardiovascular disease. The main treatment for asthma consists of inhaled therapy with bronchodilators and corticosteroids, but studies indicate that this treatment is 20% less effective in women than in men. (5, 6) But even in the case of new medical technologies, such as 3-D tablets for personalized therapies, with dosages tailored to the individual patient, medical research is based on 30-to 40-year-old white males.

Since health care was not designed for women, we, want to help change it and close the women’s health gap.

Another point to note is that research in the field of women’s health, focuses mainly on high-mortality diseases, such as oncological diseases, thus neglecting those that lead to disability, such as some debilitating gynecological diseases. The solution can only be to increase the pie of means available to cover the most neglected areas, such as menopause, premenstrual syndrome, endometriosis, and polycystic ovary syndrome.

Motherhood should also receive more attention, taking into account that its issues contribute to the overall suffering of women, up to the most severe cases of postpartum hemorrhage (PPH), which is the leading direct cause of preventable maternal mortality in low-income and lower-middle-income countries. In the past 30 years, only two new drugs have been developed that are effective in the management of postpartum hemorrhage. (7)

As noted above, the lack of data for everything related to women’s health also limits innovation and investment in the field. In the absence of relevant data, there is a potential underestimation of the severity of pathological conditions for the woman, in turn affecting the conditions of care and assistance she receives. One example is the potential gender bias against pain: that afferent to women is systematically under-investigated and treated with clinical and psychological implications and consequences. (8, 9, 10)

Women may also face obstacles to timely and accurate diagnosis.

A study conducted in Denmark over 21 years showed that women were diagnosed later than men for more than 700 diseases. For example, for cancer, the delay was two and a half years, while for diabetes it was four and a half years. (11)

Another example is that of endometriosis, a severely disabling disease that is still unrecognized and diagnosed late in many cases. The diagnostic delay, which in this case is estimated to average 10 years, besides being frustrating, obviously also has an impact on the woman’s quality of life, which is already challenged by the symptomatology. (12, 13)

Menopause, which is a physiological condition of all female individuals, is also poorly considered, although most women experience some symptoms at some point during the transition. In addition, some of the symptoms, such as mood swings or depression, are often associated with other diseases, resulting in misdiagnosis. (14)

Lack of data is also found in the area of pregnancy, resulting in inadequate health services both during pregnancy and immediately after.

Especially in low-income countries, it is not possible to trace the full picture of women’s needs, and so both pregnancy and childbirth become more dangerous for women, creating problems about which interventions to prioritize. WHO reports that every day in 2020, about 800 women died from foreseeable causes related to pregnancy and childbirth, which means one death every two minutes. Most of these deaths occur in the least developed countries. (15, 16)

The pathway of care and assistance starts with awareness of a health problem, and involves opportunities for access to preventive services and measures, timely and accurate diagnoses, and ends with effective treatments and functioning systems for follow-up and periodic monitoring. Unfortunately, inequalities are evident in every segment of this pathway, especially for women from disadvantaged groups, beyond gender. For example, in the U.S., Native American women and women of color incur up to four times the likelihood of dying from pregnancy-related causes than white women. (17) In India, an upper-caste woman is three times more likely to use prenatal care and five times more likely to have a skilled birth attendant than a lower-caste woman. (18) In the United Kingdom, ethnic minority women have a higher risk of postpartum hemorrhage. (19)

The first important role in spreading awareness and prevention comes from health education, starting precisely with education about the menstrual cycle, which cannot yet be treated as taboo, to help women learn more about their bodies. (20). In Italy, some research shows that the topic is still taboo. Not all women associate their periods with a feeling of “normality,” and some feel discomfort and embarrassment in dealing with the subject. The family plays an important role in clarifying doubts, with a substantial difference between the woman in the family who is the point of reference and the men who instead have a completely irrelevant role. Only 35% of women deal with the topic of menstruation frequently and only 14% of men do. (21)

Increased awareness affects not only women as patients, but also physicians, who are sometimes unaware of how some diseases may manifest themselves in women differently, and as a result are unable to provide adequate and effective care.

Barriers women also face relate to affordability for different types of treatments.

Healthcare costs and insurance premiums have historically been higher for women. In Svizzera, ad esempio, una donna di 31 anni paga in media il 37% in più rispetto a un uomo della stessa età, (22) in India, le assicurazioni private prevedono premi più alti per le donne. (23)

Sustainability should not only be limited to the cost of direct health services, but should also involve hygiene products such as menstrual pads and the cost of contraceptives. Women in developing areas do not use safe and effective family planning methods because there is a lack of access and support. (24)

Despite the fact that the EU considers the tampon tax to be a gender inequality issue, in Italy as of January 1, 2024, VAT on tampons has been raised from 5 percent to 10 percent. The European Parliament, as early as 2021, in a non-legislative resolution, called for different countries to eliminate the tax on feminine hygiene products by applying exemptions or 0% VAT rates on these essential goods. (25) In the same resolution, the Parliament encouraged different countries to ensure comprehensive sex education in primary and secondary schools in order to reduce sexual violence and sexual harassment, but Italy is one of the last countries where sex education is not compulsory at school, along with Bulgaria, Croatia, Hungary, Lithuania, Romania and Slovakia. (26)

We believe it is important to address these issues, to talk about them, to shed more and more light on some of the problems that are our starting point and motivation. Also on a broader level, involving not only an alarming health gap at the expense of women, but also a persistent economic, social and cultural gap. We need to involve and raise awareness of as many people as possible to challenge the status quo and tear apart the current glass ceiling.

Regarding pregnancy, we want to promote a more holistic and comprehensive woman-centered approach to improve symptom and pain management, prevent possible uncontrolled degeneration and subsequent complications, to the point of reducing all unnecessary treatments. The model should seek to improve the quality of care by emphasizing prevention and higher quality outcomes from different health care providers over the incentive of performing the most number of treatments. This would also provide faster diagnosis, even for the most complex cases.

Pregnancy represents an area in which it is necessary to build a modern, compassionate model of care for women that offers better outcomes than the system has shown to do so far.