more_vertWhen, in 1976, Canadian Prime Minister Pierre Elliott Trudeau offered Monique Bégin a post in his Cabinet, which would make her one of the first female ministers in the country’s history, she turned him down. The offer was for a junior ministry in charge of a newly independent status of women portfolio—a post that nevertheless came with no budget, no staff, and no department, and “made no sense” for advancing women’s status, she recalls. “Trudeau told me I am the only person on earth who refused to be a minister”, she says.
Preference: Obstetrics and gynaecology and women's health
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[Comment] Canada’s vision for global health and gender equality
A global shift is happening. I see it wherever I go—coffee shops to cabinet meetings to international conferences. We have achieved a critical mass of activists and allies around the world who are fighting for women’s rights. The message is clear: the world is ready to make real progress on gender equality, and improve the lives of women and girls.
[Review] Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health
Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women’s, children’s, and adolescents’ health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000.
[World Report] Ireland to vote on a referendum to repeal the Eighth
Ireland has set a date for a referendum that could be decisive in women’s access to abortion. Anita Makri reports on the arguments on both sides of the debate.
Postpartum haemorrhage: A leading cause of maternal death
A woman bleeds to death after childbirth approximately every six minutes. Postpartum haemorrhage is the leading cause of maternal death worldwide, with the overwhelming majority of bleeding deaths occurring in low income countries. While the risk of death from postpartum hemorrhage in high income countries is vanishingly low, PPH is responsible for 100,000 deaths annually. These deaths occur due to a complex network of biological and socioeconomic factors, including changes to haemostasis and fibrinolysis during pregnancy.
‘The WOMAN Trial’ was an ambitious interventional trial collaborated on an epic scale, involving 20,060 women from 193 hospitals in 21 countries and thousands of doctors, midwives and nurses participated.
doctorportal learning in partnership with Osler have created ‘The WOMAN Trial’ module designed for clinicians who care for post –partum patients, and for whom haemorrhage is a life threatening event. Accredited for CPD by ACRRM, ACEM, CICM and ANZCA, the module is a well-structured, easy to understand, and step by step guide to understanding the WOMAN trial. The module covers:
- Study method
- Results
- Discussions
- Knowledge assessment
Sign up for ‘The Woman Trial’ module on doctorportal learning and understand the methodology, findings and prevention of post-partum haemorrhage deaths.
New studies give greater understanding on menopause
One year of hormone replacement therapy may be able to prevent development of depressive symptoms in women who are in the menopause transition, a study published online in JAMA Psychiatry has shown.
The double-blind, randomised controlled trial, conducted by University of North Carolina (UNC) School of Medicine found certain women would be more likely to experience the greatest mood benefit of hormone replacement therapy during the menopause transition, which are women early in the transition and women with a greater number of recent stressful life events.
Women are two to four times more likely to develop clinically significant depressive symptoms during the menopause transition, according to the study.
“We know that midlife for women, particularly in the transition to menopause, is a time of substantial elevations in risk for depression,” said Professor Susan Girdler, who helped lead the research.
“During the menopause transition, our risk for depression actually increases two to four times. And that’s true even for women who haven’t had a history of depression early in life.”
The participants were randomly selected and put into two separate groups. Over the course of a year, one group received transdermal estradiol on a daily basis, the other a placebo.
The study found more than 30 percent of the placebo group developed clinically significant depression. However, only 17 percent of women who received estradiol developed the same depression symptoms.
Other research published by The University of Illinois (UI) in the journal Sleep Medicine suggests addressing menopausal symptoms of hot flushes and depression may also address sleep disruptions.
The UI study also gives women hope that their sleep symptoms may not last past the menopausal transition, said Professor Rebecca Smith, from the Pathobiology Department at the University of Illinois. Professor Smith conducted the study with Professors Jodi Flaws and Megan Mahoney.
“Poor sleep is one of the major issues that menopausal women seek treatment for from their doctors,” Professor Mahoney said.
“It’s a huge health care burden, and it’s a huge burden on the women’s quality of life. Investigating what’s underlying this is very important.”
The study used data from the Midlife Women’s Health Study, which followed 776 women aged 45-54 in the greater Baltimore area for up to seven years.
The study found no correlation between the likelihood of reporting poor sleep before menopause, during menopause and after menopause. Meaning, for many women in the study, their reported sleep problems changed as they transitioned to different stages of menopause. For example, women who had insomnia during menopause were not more likely to have insomnia after menopause.
“That’s a hopeful thing for women who feel like their sleep has gone downhill since they hit the menopause transition: It might not be bad forever,” Professor Smith said.
“Your sleep does change, but the change may not be permanent.”
The researchers found that hot flushes and depression were strongly correlated with poor sleep across all stages of menopause.
Those two risk factors vary in reported frequency across menopausal stages, which might help explain why poor sleep also varies across the stages, the researchers said.
Professor Smith believes that the study has shown sleep disturbances in menopause are part of a bigger picture that doctors should be looking at.
“It indicates that when dealing with sleep problems, physicians should be asking about other symptoms related to menopause, especially looking for signs of depression and asking about hot flushes,” Professor Smith said.
MEREDITH HORNE
Tokophobia: what it’s like to have a phobia of childbirth
Catriona Jones, University of Hull; Franziska Wadephul, University of Hull, and Julie Jomeen, University of Hull
It’s very common for women to feel anxious about labour and birth. Worries about the pain of contractions, interventions and the uncertainty of the process are not unusual. But for some women, the fear of labour and birth can be so overwhelming that it overshadows their pregnancy and affects daily functioning.
This severe fear of birth is called tokophobia – which literally means a phobia of childbirth. And for some women, this also includes a dislike or disgust with pregnancy.
Tokophobia can be split into two types – primary and secondary. Primary tokophobia occurs in women who have not given birth before. For these women, a fear of birth tends to come from traumatic experiences in their past – including sexual abuse. It can also be linked to witnessing a difficult birth or listening to stories or watching programmes which portray birth as embarrassing or dangerous. Whereas women who suffer from secondary tokophobia, tend to have had a previous traumatic birth experience which has left them with a fear of giving birth again.
It is difficult to say how common tokophobia is. Research suggests that between 2.5% and 14% of women are affected by tokophobia. But some researchers believe this figure could be as high as 22%.
These figures vary so much because women with different levels of tokophobia were included in the research. So while some women may have relatively mild tokophobia, for others, the condition is much more severe. The figures may also include women who have anxiety and depression rather than tokophobia.
Not a happy occasion
Women with tokophobia come from a wide variety of backgrounds. It is difficult to predict who might be affected, although it is clear that women with tokophobia are also more likely to experience difficulties with anxiety and depression and other mental health problems.
Research suggests some women with the condition choose to avoid pregnancy altogether – or may consider a termination if they find themselves in that position. When pregnant, women with tokophobia may request a caesarean section to avoid the process of actually having to give birth.
Some women find pregnancy itself very difficult, particularly dealing with the growing bump and feeling the baby’s movements. Anxiety, insomnia, sleeplessness, eating disorders and antenatal depression or increased risk of postnatal depression, have all been identified as consequences of tokophobia.
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Some of the consequences for women with tokophobia – which emerge during labour – are longer labours. These are usually with an epidural and increased need for forceps or ventouse – this a cup-shaped suction device which is applied to the baby’s head to assist the birth. All of which can have implications for both the woman and her baby.
Afterwards some women with tokophobia may have a less satisfying bond with their babies. And a difficult experience of birth can make women more afraid of birth if they become pregnant again.
Tokophobia treatment
Anecdotal evidence indicates that clinical care for women with tokophobia is patchy. But the good news is that there is help out there for women with this condition. Some women find it helpful to talk through a previous experience of a traumatic birth, others might be reassured by information about labour and birth. Other women, however, may need more targeted treatment – a number of counselling approaches can be helpful.
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Many women also find it helpful to visit the maternity ward and talk to midwives and obstetricians during pregnancy. Some women find the condition can be very isolating, feeling that nobody else shares this intense fear. For these women, simply knowing that they are not alone, can be very comforting and helpful.
Overcoming a phobia
In Hull and East Riding of Yorkshire, where there is an established perinatal mental health service for women and their families, there has been a recognised need for a consistent approach to caring for and supporting women with tokophobia.
This has led to a group of practitioners, academics and patients to work together to explore the care and support available to these women – and to help address the gaps in service provision.
This pioneering work, which is at the forefront of tokophobia service provision and research in the UK, aims to ensure that women get the right support, and that their psychological and pregnancy needs are met.
Tokophobia can have debilitating effects on women and their families. Some women will avoid pregnancy, even though they might want to have children. For those who do become pregnant, the condition can overshadow pregnancy and affect the choices they make for labour and birth. This is why we need to work towards preventing tokophobia if possible – as well as providing effective treatment for women who suffer from this difficult condition.
Catriona Jones, Senior Research Fellow in Maternal and Reproductive Health, University of Hull; Franziska Wadephul, Research assistant, University of Hull, and Julie Jomeen, Professor of Midwifery and Dean in the Faculty of Health Sciences, University of Hull
This article was originally published on The Conversation. Read the original article.
[Correspondence] Women’s health in Israel
We congratulate The Lancet for its Health in Israel Series, which takes a broad and unprecedented look at Israeli health and health care, and applaud the effort to focus on women’s health. We read with interest the Viewpoint by Leeat Granek and colleagues (June 24, 2017, p 2575),1 in which the authors state that the health of women in Israel is affected by the political situation in Israel. Although it might be true, this statement needs more support.
AMA shines in Australia Day Honours
Former Australian Medical Association President Dr Mukesh Haikerwal has been awarded the highest honour in this year’s Australia Day awards by being named a Companion of the Order of Australia (AC).
He is accompanied by the current Editor-in-Chief of the Medical Journal of Australia, Laureate Professor Nick Talley, as well as longstanding member Professor Jeffrey Rosenfeld – who both also received the AC.
The trio top a long and impressive list of AMA members to receive Australia Day Honours this year.
AMA Federal Councillor, Associate Professor Julian Rait, received the Medal of the Order (OAM).
A host of other members honoured in the awards are listed below.
AMA President Dr Michael Gannon said the accolades were all well-deserved and made he made special mention of those receiving the highest Australia Day Honours.
“They have dedicated their lives and careers to helping others through their various roles as clinicians, researchers, teachers, authors, administrators, or government advisers – and importantly as leaders in their local communities,” Dr Gannon said.
“On behalf of the AMA, I pay tribute to all the doctors and other health professionals who were honoured today for their passion for their profession and their dedication to their patients and their communities.
“The great thing about the Honours is that they acknowledge achievement at the international, national, and local level, and they recognise excellence across all avenues of human endeavour.
“Doctors from many diverse backgrounds have been recognised and honoured again this year.
“There are pioneering surgeons and researchers, legends across many specialties, public health advocates, researchers, administrators, teachers, and GPs and family doctors who have devoted their lives to serving their local communities.
“The AMA congratulates all the doctors and other health advocates whose work has been acknowledged.
“We are, of course, especially proud of AMA members who are among the 75 people honoured in the medicine category.”
Dr Haikerwal, who was awarded the Officer in the Order of Australia (AO) in 2011, said this further honour was “truly mind-blowing” and another life-changing moment.
“To be honoured on Australia Day at the highest level in the Order of Australia is beyond imagination, beyond my wildest dreams and extremely humbling,” Dr Haikerwal said.
“For me to be in a position in my life and career to receive such an honour has only been made possible due to the unflinching support and unremitting encouragement of my closest circle, the people who have been with me through every step of endeavour, adversity, achievement, and success.”
CHRIS JOHNSON
AMA MEMBERS IN RECEIPT OF HONOURS
COMPANION (AC) IN THE GENERAL DIVISION
Dr Mukesh Chandra HAIKERWAL AO
Altona North Vic 3025
For eminent service to medical governance, administration, and technology, and to medicine, through leadership roles with a range of organisations, to education and the not-for-profit sector, and to the community of western Melbourne.
Professor Jeffrey Victor ROSENFELD AM
Caulfield North, Vic
For eminent service to medicine, particularly to the discipline of neurosurgery, as an academic and clinician, to medical research and professional organisations, and to the health and welfare of current and former defence force members.
Professor Nicholas Joseph TALLEY
Black Hill, NSW
For eminent service to medical research, and to education in the field of gastroenterology and epidemiology, as an academic, author and administrator at the national and international level, and to health and scientific associations.
OFFICER (AO) IN THE GENERAL DIVISION
Emeritus Professor David John AMES
East Kew, Vic
For distinguished service to psychiatry, particularly in the area of dementia and the mental health of older persons, as an academic, author and practitioner, and as an adviser to professional bodies.
Dr Peggy BROWN
Sanctuary Cove, Qld
For distinguished service to medical administration in the area of mental health through leadership roles at the state and national level, to the discipline of psychiatry, to education, and to health care standards.
Professor Creswell John EASTMAN AM
St Leonards, NSW
For distinguished service to medicine, particularly to the discipline of pathology, through leadership roles, to medical education, and as a contributor to international public health projects.
Professor Suzanne Marie GARLAND
Docklands, Vic
For distinguished service to medicine in the field of clinical microbiology, particularly to infectious diseases in reproductive and neonatal health as a physician, administrator, researcher and author, and to professional medical organisations.
Dr Paul John HEMMING
Queenscliff, Vic
For distinguished service to higher education administration, to medicine through contributions to a range of professional medical associations, and to the community of central Victoria, particularly as a general practitioner.
Professor Anthony David HOLMES
Melbourne, Vic
For distinguished service to medicine, particularly to reconstructive and craniofacial surgery, as a leader, clinician and educator, and to professional medical associations.
Dr Diana Elaine O’HALLORAN
Glenorie, NSW
For distinguished service to medicine in the field of general practice through policy development, health system reform and the establishment of new models of service and care.
MEMBER (AM) IN THE GENERAL DIVISION
Dr Michael Charles BELLEMORE
Croydon, NSW
For significant service to medicine in the field of paediatric orthopaedics as a surgeon, to medical education, and to professional medical societies.
Dr Colin Ross CHILVERS
Launceston, Tas
For significant service to medicine in the field of anaesthesia as a clinician, to medical education in Tasmania, and to professional societies.
Associate Professor Peter HAERTSCH OAM
Breakfast Point, NSW
For significant service to medicine in the field of plastic and reconstructive surgery as a clinician and administrator, and to medical education.
Professor Ian Godfrey HAMMOND
Subiaco, WA
For significant service to medicine in the field of gynaecological oncology as a clinician, to cancer support and palliative care, and to professional groups.
Dr Philip Haywood HOUSE
WA
For significant service to medicine as an ophthalmologist, to eye surgery foundations, and to the international community of Timor Leste.
Adjunct Professor John William KELLY
Vic
For significant service to medicine through the management and treatment of melanoma, as a clinician and administrator, and to education.
Dr Marcus Welby SKINNER
West Hobart, Tas
For significant service to medicine in the field of anaesthesiology and perioperative medicine as a clinician, and to professional societies.
Professor Mark Peter UMSTAD
South Yarra, Vic
For significant service to medicine in the field of obstetrics, particularly complex pregnancies, as a clinician, consultant and academic.
Professor Barbara S WORKMAN
East Hawthorn, Vic
For significant service to geriatric and rehabilitation medicine, as a clinician and academic, and to the provision of aged care services.
MEDAL (OAM) IN THE GENERAL DIVISION
Professor William Robert ADAM PSM
Vic
For service to medical education, particularly to rural health.
Dr Marjorie Winifred CROSS
Bungendore, NSW
For service to medicine, particularly to doctors in rural areas.
Associate Professor Mark Andrew DAVIES
Maroubra, NSW
For service to medicine, particularly to neurosurgery.
Dr David William GREEN
Coombabah, Qld
For service to emergency medicine, and to professional organisations.
Dr Barry Peter HICKEY
Ascot, Qld
For service to thoracic medicine.
Dr Fred Nickolas NASSER
Strathfield, NSW
For service to medicine in the field of cardiology, and to the community.
Dr Ralph Leslie PETERS
New Norfolk, Tas
For service to medicine, and to the community of the Derwent Valley.
Associate Professor Julian Lockhart RAIT
Camberwell, Vic
For service to ophthalmology, and to the development of overseas aid.
Mr James Mohan SAVUNDRA
South Perth, WA
For service to medicine in the fields of plastic and reconstructive surgery.
Dr Chin Huat TAN
Glendalough, WA
For service to the Chinese community of Western Australia.
Dr Karen Susan WAYNE
Toorak, Vic
For service to the community of Victoria through a range of organisations.
Dr Anthony Paul WELDON
Melbourne, Vic
For service to the community, and to paediatric medicine.
PUBLIC SERVICE MEDAL (PSM)
Dr Sharon KELLY
Yeronga, Qld
For outstanding public service to the health sector in Queensland.
Professor Maria CROTTY
Kent Town, SA
For outstanding public service in the rehabilitation sector in South Australia.
[Editorial] Year of reckoning for women in science
Gender equity in science is both a moral and necessary imperative. Although women make up more than half of graduates in the medical and life sciences and 70% of the global health workforce, they are vastly under-represented at senior levels: in the USA, for example, women comprise 45% of assistant professors in academic clinical sciences but only 35% of associate professors and just 22% of full professors. Numbers are similarly unbalanced for the basic medical sciences, demonstrating the “leaky pipeline” that wastes women’s education and potential, prevents needed diversity in workplaces, and restricts women’s goals and rights.