Robin N. Fiore, PhD Florida Atlantic University

1. Robin N. Fiore, PhDFlorida Atlantic University Ethics, Advocacy, and Women’s Health

2. Women’s Health Movement • Goal: women’s empowerment • Education • Policy Advocacy • Service Provision • Critique of Sexism

3. Education • Self Help • Boston Women’s Health Collective • Our Bodies, Ourselves1969 • FFWHC Federation of Feminist Women’s Health Centers

4. Policy Advocacy • Barbara Seaman The Doctors’ Case Against the Pill 1969 • Belita Cowan DES -Advocates for Medical Information (AMI) 1971 NWHN National Women’s Health Network

5. Provision of Services • “Jane” – abortion referral and provision • Lay provision of artificial insemination for Lesbians • Independent research on contraceptives

6. Critique of Sexism WHM analyzed sexism and racism • in the ways in which health care is delivered, • with respect to access to high quality health care services, • with respect to women’s control of resources and their ability to influence medical decision-making and research

7. Snapshot of Women’s Health • US women rank 16th in life expectancy • U.S. infant mortality ranks between 17th and 20th • teen pregnancy rate is 2nd highest in the West • AIDS is the leading cause of death among women of reproductive age • time from AIDS diagnosis to death is shorter in women than for men

8. National Women’s Law Center Making the Grade on Women’s Health: A National and State by State Report Card

11. Florida Demographics

14. Women and Aging • 59% of persons over 65 • 72% of the poor elderly  45% of elderly women live below the poverty line • 1/3 more years beyond normal retirement age years (20 v 15 years) • half as likely to have pensions (24% women/46% men) • Pensions half as much

15. Gender and Care • Men get care from spouses: 12million women are in-home caregivers, many over age 70 • Caregiving exacerbates morbidity in women – less attention to caregiver’s needs • Women more likely to outlive spouses, must pay for home care

16. Disability Free Years Men at 65: Life expectancy 80 (15 years) • Age at disability 74 • Years of disability 6 Women at 65: Life expectancy 84 (19 years) • Age at disability 76 • Years of disability 8

17. Medicare and Women’s Needs • Health Insurance and Medicare covers12% more per year per male beneficiary • emphasizes good hospital coverage (men use 5% more hospital care, ¾ of nursing home patients are women) • Undercovers chronic disease – women have more chronic diseases of aging • Undercovers adaptive aids, home care (2/3 of home care consumers are women)

18. JAMA 1994 Survey of Family Caregivers • 34% provided majority of care for patients • 31% lost all or most of savings; 6% lost house • 29% lost major income source • 20% caregiver quit work • 12% stress impairs other family members • 6% delayed medical care for others

19. Feminization of Poverty Creation of permanent class of poor elderly women due to burden of caregiving: • lost work hours • interrupted work history • decreased job rank • decreased pensions and Social Security • decreased consumer savings • excess morbidity cost of caregiving

20. The Next Generation • 3 out of 5 Palm Beach County students in grades 6-12 responded that someone lives in their homes who needs help caring for themselves • Of those, 9 out of 10 said they assist in that care and that it adversely affects their homework, or causes them to miss school activities

21. Accomplishments of WHM • Abortion remains legal, though limited • Informed consent for breast biopsies, c-sections • Protection from unnecessary medical procedures, sterilization abuse, and medical experimentation • Right to know RX side effects and contraindications • Allocation of more federal $$$$ to research on women’s health issues

22. Challenges for Future • Dignified, affordable, accessible, primary and maternal health care for poor women • AIDS and HIV prevention and care • Long Term Care

23. Florida Bioethics Network University of Miami/FBN Annual Clinical Ethics Conference April 8, 2005 Wyndham Miami Beach Resort www.miami.edu/ethics