“If you wished to know how civilized a culture is, look at how they treat its women.” – Bacha Khan

As a woman winemaker and entrepreneur, I’m not going to kick off Women’s History Month by highlighting women’s work and business. I know there are women making history in their fields every day, and that is certainly commendable and worthy of recognition.

But, what keeps me up at night is the state of women’s health in America. It is complex and multifaceted, influenced by various factors such as access to healthcare, socio-economic status, education, cultural attitudes, and government policies.

It keeps me up at night because my awareness to the many issues around women’s healthcare and wellbeing keeps getting blown up because of my own experiences – starting with childbirth, postpartum health, postpartum depression, mental health, issues around the pandemic, perimenopause and menopause. I am just one woman in one demographic and I have been affected by concerning healthcare issues over the past five years that have set off an alarm for me.

Which begged the questions: What about everybody else? How are other women doing? Why does the medical community focus so much on fertility in women’s healthcare but only now we’re beginning to have meaningful conversations about the multi-layered medical concerns around menopause?

Most women have no clue about perimenopause or when it creeps into the body, not recognizing symptoms that get assigned to other issues, or simply get ignored. Most women do not get any support and even get dismissed by their doctors when they discuss menopause symptoms. It’s exhausting and horrifying.

Gen X has been putting a hard stop to the disempowerment of women during menopause.

I am so passionate about this because young women, women in their 30’s, need to be aware of what’s ahead. Lifestyle awareness is critically important in the empowerment of long-term health outcomes by reducing serious health risks.

So, when researching the state of women’s health today in America, here are some key findings that need to be shared.

1. Access to Healthcare: While improvements have been made with the Affordable Care Act (ACA), access to healthcare remains a concern for many women, particularly those from marginalized communities, including low-income women, women of color, and rural women. Lack of access can lead to delays in preventive care, diagnosis, and treatment of health conditions.
   
2. Reproductive Health: Women’s reproductive health remains a significant focus, with debates over issues such as access to contraception, abortion rights, maternal mortality rates, and disparities in healthcare access for reproductive services. SIDE NOTE: notice menopause is not even mentioned.
   
3. Maternal Health: Maternal mortality rates in the United States are higher than in other developed countries, and there are significant racial disparities, with Black women being disproportionately affected. Efforts are being made to address these disparities through initiatives aimed at improving prenatal care, access to healthcare, and addressing racial biases in the healthcare system.
   
   SIDE NOTE: Postpartum depression (PPD) is a common mental health condition that can affect anyone. While it can feel hard or lonely, healing from PPD is possible.    
   
   About 1 in 8 women report symptoms of PPD in the year after giving birth. Everyone experiences PPD differently. Feeling sad, anxious, or overwhelmed are some of the signs. You might not feel connected to your baby, or you might not feel love or care for the baby. If these feelings last longer than two weeks, you may have PPD.  
   
4. Heart Disease: Heart disease is the leading cause of death for women in the United States, killing 310,661 women in 2021—or about 1 in every 5 female deaths.   But women are largely unaware of their risk for heart disease, which is more likely to kill them than all forms of cancer combined. According to the most recent American Heart Association survey, awareness that heart disease is the leading cause of death among women actually fell between 2009 and 2019, particularly among Black, Hispanic and younger women, for whom primary prevention may be most effective.
   
   SIDE NOTE: More research is showing that menopause is a leading cause for heart disease in women over age 40.  Menopause before 40 is tied to higher stroke risk. The importance of good health before menopause is critically important – and that means managing lifestyle and health habits to reduce future risks.
   
   Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital and a professor of medicine at Harvard Medical School in Boston, said women would benefit from intensifying cardiovascular prevention efforts in the years leading up to menopause.
   
   “That stage of life is a window of opportunity for making lifestyle changes,” said Manson, who also co-authored the 2020 AHA scientific statement that called on health care professionals to consider an aggressive prevention-based approach for women in midlife to decrease the chance of cardiovascular disease in the future.
   
   Research suggests the most effective ways to prevent heart disease include not smoking, being physically active, eating a healthy diet, addressing substance abuse, especially alcohol use, maintaining a healthy weight, getting enough sleep, and keeping cholesterol, blood pressure and blood glucose levels under control. But “very, very few people are good at following all of those,” Manson said.
   
5. Chronic Conditions: Women are more likely to suffer from chronic conditions such as autoimmune diseases, depression, and osteoporosis. Mental health issues, in particular, are receiving increased attention, with efforts to reduce stigma and improve access to mental healthcare.
   
   SIDENOTE: many symptoms experienced by women 35 and older are related to perimenopause and menopause, but there is no mention here.
   
   More than 1 in 5 women in the United States experienced a mental health condition in the past year, such as depression or anxiety. Many mental health conditions, such as depression and bipolar disorder, affect more women than men or affect women in different ways from men.
   
   According to the American Psychiatric Association:
   
   Research has identified disparities between women and men in regard to risk, prevalence, presentation, course, and treatment of mental disorders.
   
   Most racial/ethnic minority groups overall have similar—or in some cases, fewer—mental disorders than whites. However, the consequences of mental illness in minorities may be long lasting.
   
   Although Intimate Partner Violence (IPV) affects individuals across race/ethnicity, gender, and socioeconomic background, minority women experience IPV at disproportionately high rates.
   
   Bias against women has been documented for centuries around the globe, including in American culture specifically. These inequities continue to have harmful effects on women’s mental health.
   
6. Cancer: Breast and cervical cancers are significant concerns for women’s health. Screening programs and advancements in treatment have improved outcomes, but disparities in access to care still exist, particularly for underserved populations.
   
7. Sexual and Reproductive Rights: Access to comprehensive sexual education, contraception, and reproductive healthcare services continues to be a topic of debate. Women’s ability to make choices about their reproductive health is influenced by political and legal factors, which can vary significantly from state to state.
   
8. Lifestyle Factors: Obesity, smoking, and substance abuse, especially alcohol use, are significant health concerns for women in the United States. These lifestyle factors can increase the risk of various health conditions, including heart disease, diabetes, and certain cancers.
   
9. Preventive Care: Regular screenings and preventive care are essential for maintaining women’s health, including mammograms, Pap smears, and vaccinations. However, disparities in access to preventive services persist, contributing to health inequities.

While progress has been made in advancing women’s health in America, there are still significant challenges and disparities that need to be addressed to ensure equitable access to healthcare and improve health outcomes for all women. Ongoing efforts are required at the policy, community, and individual levels to address these issues comprehensively.

As we celebrate Women’s History Month, please also be aware that on March 10 — and throughout the month of March — local, state, federal, and national organizations come together to shed light on the impact of HIV and AIDS on women and girls and to show support for those at risk of and living with HIV. This year marks the 19th annual observance of National Women and Girls HIV/AIDS Awareness Day (NWGHAAD).

Please also be aware that from February 26 – March 3 – it is National Eating Disorders Awareness Week (NEDAW) which highlights the seriousness of eating disorders across the United States, particularly for women and girls of all ages. Throughout the week, the Office on Women’s Health (OWH) will join organizations, health professionals, and communities across the country to increase awareness of eating disorders and their associated impacts, disparities, resources, and treatment options.

This year’s theme, “Let’s Talk About It: Eating Disorders, Stigma, and Empowered Recovery,” focuses on understanding the facts around eating disorders, addressing common eating disorder stigma, raising awareness about disparities in diagnosis and treatment, highlighting best practices for improving quality of care, and empowering people when seeking support and recovery.

We need to better prioritize the health and wellbeing of ALL women. We need to listen better to women and respect women’s experiences and needs. Until we treat women’s health and wellbeing as a national priority, it seems superfluous to focus on anything else, really. Women’s healthcare is literally a life and death matter. At the very minimum, women’s healthcare is the foundation for feeling good, for feeling alive and for feeling capable of anything and everything. And that is really, really important.