Ayollar salomatligi - Womens health - Wikipedia

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Ayollar salomatligi
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Reproduktiv bo'lmagan sog'liq Ayollarga nisbatan zo'ravonlik Oiladagi zo'ravonlik Shaxsiy sheriklarning zo'ravonligi Misogyny Jinsiy shilqimlik Jinsiy tajovuz Zo'rlash Femitsid Jinsiy kamsitish Yuqumli bo'lmagan kasalliklar Saraton O'pka saratoni Ko'krak bezi saratoni Bachadon saratoni Endometriyal saraton Serviks saratoni Papanikolau testi Tuxumdon saratoni Yurak-qon tomir kasalliklari Dementia Altsgeymer kasalligi Suyak salomatligi Osteoporoz Kestirib sinishi Anemiya Boshqalar Ruhiy salomatlik Tashvish Depressiya Asosiy depressiv buzilish Siydik chiqarish yo'llari Uretra Siydik yo'li infektsiyasi Siydik chiqarishning buzilishi
Ijtimoiy-madaniy omillar Qashshoqlik Kamchilik Jinsiy tenglik Sog'liqni saqlash tizimidagi tengsizlik Sog'liqni saqlashdagi gender tengsizligi Sog'liqni saqlashning ijtimoiy omillari Reproduktiv adolat Ayollarning imkoniyatlarini kengaytirish
Siyosat, tadqiqot va targ'ibot Birlashgan Millatlar Ayollarga nisbatan zo'ravonlikni yo'q qilish to'g'risidagi konventsiya Ayollarga nisbatan zo'ravonlikni yo'q qilish to'g'risidagi deklaratsiya Xalqaro qiz bola kuni Ayollarning maqomi bo'yicha komissiya BMT Ayollari Qo'shma Shtatlar Ayollar salomatligi bo'yicha tadqiqotlar idorasi Ayollar salomatligi tashabbusi Xalqaro ayollar tadqiqotlari markazi Hamshiralarning sog'lig'ini o'rganish Qora ayollarning sog'lig'ini o'rganish Kartriyat bo'yicha so'rov Ayollar sog'lig'ini o'rganish bo'yicha jamiyat
Mamlakatlar bo'yicha ayollar salomatligi Xitoyda ayollar salomatligi Efiopiyada ayollar salomatligi Hindistonda ayollar salomatligi (Oilani rejalashtirish ) Qo'shma Shtatlarda tug'ilishni nazorat qilish

Ayollar salomatligi ayollar salomatligini anglatadi, bu erkaklarnikidan ko'pgina o'ziga xos jihatlari bilan farq qiladi. Ayollarning sog'lig'i bunga misoldir aholi salomatligi, bu erda sog'liq Jahon Sog'liqni saqlash tashkiloti "kasallik yoki zaiflikning yo'qligi emas, balki to'liq jismoniy, ruhiy va ijtimoiy farovonlik holati" sifatida. Ko'pincha oddiy ayollar kabi muomala qilinadi reproduktiv salomatlik, ko'plab guruhlar "Ayollar salomatligi" deb yaxshiroq ifoda etilgan ayollarning umumiy sog'lig'iga tegishli bo'lgan yanada kengroq ta'rifni ta'kidlaydilar. Ushbu farqlar yanada kuchaymoqda rivojlanayotgan davlatlar bu erda sog'lig'i o'zlarining xavf-xatarlari va tajribalarini o'z ichiga olgan ayollar uchun yanada yomonlashadi.

Garchi ayollar sanoati rivojlangan mamlakatlar toraytirdik gender farqi yilda umr ko'rish davomiyligi va hozirgi paytda erkaklarnikiga qaraganda uzoqroq yashaydilar, sog'liqning ko'plab sohalarida ular ilgari va og'irroq kasalliklarga duch kelishadi, natijalari yomonroq. Gender muhim bo'lib qolmoqda sog'liqni ijtimoiy belgilovchi omil, chunki ayollarning sog'lig'iga nafaqat ularning biologiyasi, balki kabi sharoitlar ham ta'sir qiladi qashshoqlik, ish bilan ta'minlash va oiladagi vazifalar. Ijtimoiy va iqtisodiy qudrat kabi ko'p jihatdan ayollar uzoq vaqtdan beri noqulay ahvolga tushib qolishgan, bu ularning hayot ehtiyojlariga, shu jumladan hayot ehtiyojlariga kirishini cheklaydi Sog'liqni saqlash va rivojlanayotgan mamlakatlarda bo'lgani kabi, ahvolga tushib qolish darajasi qanchalik katta bo'lsa, sog'liqqa shunchalik yomon ta'sir qiladi.

Ayollarning reproduktiv va jinsiy salomatlik erkaklar sog'lig'iga nisbatan aniq farqga ega. Hatto ichida rivojlangan mamlakatlar homiladorlik va tug'ish bo'lgan ayollar uchun katta xavf bilan bog'liq onalar o'limi rivojlanayotgan va rivojlangan mamlakatlar o'rtasida katta bo'shliqlar mavjud bo'lib, yiliga chorak milliondan ortiq o'limni hisobga oladi. Birgalikda kasallik kabi boshqa reproduktiv bo'lmagan kasalliklardan yurak-qon tomir kasalliklari o'limga ham hissa qo'shadi kasallanish homiladorlik, shu jumladan preeklampsi. Jinsiy yo'l bilan yuqadigan infektsiyalar ayollar va chaqaloqlar uchun jiddiy oqibatlarga olib keladi, bilan onadan bolaga yuqish kabi natijalarga olib keladi o'lik tug'ilish va yangi tug'ilgan chaqaloqlarning o'limi va tos a'zolarining yallig'lanish kasalligi olib boradi bepushtlik. Bundan tashqari, boshqa ko'plab sabablarga ko'ra bepushtlik, tug'ilishni nazorat qilish, rejalashtirilmagan homiladorlik, noaniq jinsiy faoliyat va kirish uchun kurash abort ayollar uchun boshqa yuklarni yaratish.

O'limning asosiy sabablari darajasi, yurak-qon tomir kasalliklari, saraton va o'pka kasalligi, ayollar va erkaklarda o'xshash, ayollar turli xil tajribaga ega. O'pka saratoni saraton kasalligining boshqa barcha turlarini ortda qoldirib, ayollarda saraton kasalligi o'limining etakchi sababi bo'lib, keyingi o'rinda turadi ko'krak bezi saratoni, kolorektal, tuxumdon, bachadon va bachadon bo'yni saraton. Esa chekish bu o'pka saratonining asosiy sababidir, chekmaydigan ayollar orasida saraton kasalligi xavfi chekmaydigan erkaklarga qaraganda uch baravar ko'pdir. Shunga qaramay, ko'krak bezi saratoni rivojlangan mamlakatlarda ayollarda eng keng tarqalgan saraton bo'lib qolmoqda va eng muhimlaridan biri hisoblanadi surunkali kasalliklar bachadon bo'yni saratoni rivojlanayotgan mamlakatlarda eng keng tarqalgan saraton kasalligidan biri bo'lib qolmoqda inson papilloma virusi (HPV), muhim jinsiy yo'l bilan yuqadigan kasallik. HPV vaktsinasi bilan birga skrining ushbu kasalliklarni nazorat qilishni va'da qiladi. Ayollar uchun boshqa muhim sog'liq muammolari orasida yurak-qon tomir kasalliklari, depressiya, dementia, osteoporoz va anemiya. Xotin-qizlarning sog'lig'ini yaxshilashga to'sqinlik qiladigan narsa bu ularning tadqiqotlarda kam ishtirok etishidir tengsizlik tashkil etish orqali Qo'shma Shtatlarda va boshqa g'arbiy davlatlarda hal qilinmoqda mukammallik markazlari ayollar salomatligi bo'yicha tadqiqotlar va keng ko'lamda klinik sinovlar kabi Ayollar salomatligi tashabbusi.

Ta'riflar va ko'lam

Ayollarning sog'lig'i va kasalliklari tajribasi erkaklarnikidan farq qiladi, bu o'ziga xos biologik, ijtimoiy va xulq-atvor sharoitlari bilan bog'liq. Biologik farqlar fenotiplar uchun uyali biologiya va manifest noyob xatarlar yomon sog'liqni rivojlantirish uchun.^[1] The Jahon Sog'liqni saqlash tashkiloti (JSST) sog'liqni saqlashni "nafaqat jismoniy, ruhiy va ijtimoiy farovonlik holati, balki kasallik yoki zaiflikning yo'qligi" deb ta'riflaydi.^[2] Ayollarning sog'lig'i bunga misoldir aholi salomatligi, aniq belgilangan aholi salomatligi.^[3]

Ayollarning sog'lig'i "bo'shliqlar bilan patchwork yorgan" deb ta'riflangan.^[4] Garchi ayollarning sog'lig'i bilan bog'liq ko'plab muammolar ular bilan bog'liq bo'lsa-da reproduktiv salomatlik, shu jumladan onalik va bola sog'liq, jinsiy a'zolar salomatligi va ko'krak sog'lig'i va endokrin (gormonal ) sog'liqni saqlash, shu jumladan hayz ko'rish, tug'ilishni nazorat qilish va menopauza, "Ayollar salomatligi" o'rniga "Ayollar salomatligi" o'rnini bosgan holda, ayollar sog'lig'ining barcha jihatlarini o'z ichiga olgan ayollar salomatligini yanada kengroq tushunishga undaydi.^[5] JSST reproduktiv salomatlikka ortiqcha urg'u barcha ayollar uchun sifatli tibbiy xizmatdan foydalanish imkoniyatini ta'minlash uchun asosiy to'siq bo'ldi deb hisoblaydi.^[1] Kabi erkaklar va ayollarga ta'sir qiladigan sharoitlar yurak-qon tomir kasalliklari, osteoporoz, shuningdek, ayollarda boshqacha namoyon bo'ladi.^[6] Ayollarning sog'lig'i muammolari, shuningdek, ayollarning biologiyasiga bevosita bog'liq bo'lmagan muammolarga duch keladigan tibbiy vaziyatlarni, masalan, tibbiy davolanish uchun jinsi bo'yicha farqlanishini va boshqalarni o'z ichiga oladi. ijtimoiy-iqtisodiy omillar.^[6] Ayollarning sog'lig'i keng tarqalganligi sababli alohida tashvishga solmoqda kamsitish dunyodagi ayollarga qarshi, ularni tashlab ahvolga tushgan.^[1]

Kabi bir qator sog'liqni saqlash va tibbiy tadqiqotlar himoyachilari Ayollar sog'lig'ini o'rganish bo'yicha jamiyat Amerika Qo'shma Shtatlarida ayollar va erkaklar o'rtasidagi biologik jinsiy farqlar mavjud bo'lgan joylarni o'z ichiga olgan inson anatomiyasiga xos bo'lgan muammolarni emas, balki ushbu kengroq ta'rifni qo'llab-quvvatlang. Ayollar sog'liqni saqlashga ko'proq muhtoj va sog'liqni saqlash tizimidan erkaklarnikiga qaraganda ko'proq foydalanadilar. Buning bir qismi ularning reproduktiv va jinsiy salomatligi ehtiyojlari bilan bog'liq bo'lsa-da, ular surunkali reproduktiv bo'lmagan sog'liq muammolariga ega. yurak-qon tomir kasalliklari, saraton, ruhiy kasallik, diabet va osteoporoz.^[7] Yana bir muhim istiqbol - bu voqealarni butun boshidan kechirish hayot davrasi (yoki hayotiy yo'nalish ), dan bachadonda qarish uchun ayollarning o'sishi, rivojlanishi va sog'lig'i. The hayot yo'nalishi Jahon sog'liqni saqlash tashkilotining asosiy strategiyalaridan biridir.^[8][9][10]

Global istiqbol

Kasallikning sezgirligi va alomatlaridagi gender farqlari va sog'liqni saqlashning ko'plab sohalarida davolanishga javoban, a global istiqbol.^[11][12] Mavjud ma'lumotlarning aksariyati olingan rivojlangan mamlakatlar, shunga qaramay rivojlangan va o'rtasida aniq farqlar mavjud rivojlanayotgan davlatlar ayollarning roli va sog'lig'i nuqtai nazaridan.^[13] Global nuqtai nazar "butun dunyodagi barcha insonlar uchun sog'liqni saqlashni yaxshilash va salomatlik tengligini ta'minlashga ustuvor ahamiyat beradigan o'rganish, tadqiq etish va amaliyot uchun maydon" sifatida belgilanadi.^[14][15][16] 2015 yilda Jahon sog'liqni saqlash tashkiloti ayollar sog'lig'ining saraton, reproduktiv salomatlik, onalar salomatligi, inson immunitet tanqisligi virusi (OIV), jinsiy yo'l bilan yuqadigan infektsiyalar, zo'ravonlik, ruhiy salomatlik, yuqumli bo'lmagan kasalliklar, yoshlar va qarilik.^[17]

O'rtacha umr ko'rish

Ayollarning umr ko'rish davomiyligi erkaklarnikidan kattaroq va irqiy va geografik mintaqalarga qaramasdan, ular umr bo'yi o'lim ko'rsatkichlari pastroq. Tarixiy jihatdan, ayollar o'lim darajasi, asosan, onalar o'limi (tug'ruqdagi o'lim). Sanoati rivojlangan mamlakatlarda, ayniqsa eng rivojlangan mamlakatlarda, jinslar o'rtasidagi farq kamayib, quyidagilarga qarab bekor qilindi sanoat inqilobi.^[6] Ushbu farqlarga qaramay, sog'liqni saqlashning ko'plab sohalarida ayollar ilgari va og'irroq kasalliklarga duch kelishadi va natijalari yomonroq bo'ladi.^[18]

Ushbu farqlarga qaramay, Qo'shma Shtatlarda o'limning asosiy sabablari boshchiligidagi erkaklar va ayollar uchun juda o'xshash yurak kasalligi, bu o'limning to'rtdan bir qismini tashkil qiladi, undan keyin saraton, o'pka kasalligi va qon tomir. Ayollarda o'lim darajasi pastroq bo'lsa-da bexosdan shikastlanish (pastga qarang) va o'z joniga qasd qilish, ular bilan kasallanish darajasi yuqori dementia (Gronovski va Shindler, I-jadval).^[6][19]

Rivojlangan va rivojlanayotgan mamlakatlar o'rtasidagi ayollarning umr ko'rish davomiyligining asosiy farqlari tug'ish yillarida bo'ladi. Agar ayol ushbu davrdan omon qolsa, keyingi mintaqalarda bu ikki mintaqa o'rtasidagi farqlar sezilarli darajada kamayadi yuqumli bo'lmagan kasalliklar (NCD) butun dunyo bo'ylab ayollarning o'limining asosiy sabablariga aylanib bormoqda, yurak-qon tomir o'limlari keksa yoshdagi ayollarda 45% o'limni, so'ngra saraton (15%) va o'pka kasalliklari (10%) ni tashkil qiladi. Bular rivojlanayotgan mamlakatlar resurslariga qo'shimcha yuklarni keltirib chiqaradi. Turmush tarzini o'zgartirish, shu jumladan parhez, jismoniy faollik va madaniy omillar, ayollarning tanasining kattaligini qo'llab-quvvatlash, muammolarning ko'payishiga yordam beradi. semirish va diabet ushbu mamlakatlardagi ayollar orasida va yurak-qon tomir kasalliklari va boshqa NCDlar xavfini oshirish.^[11][20]

Ijtimoiy jihatdan chetda qolgan ayollar yoshroq yoshda o'lish ehtimoli ko'proq bo'lmagan ayollarga qaraganda.^[21] Giyohvand moddalarni suiiste'mol qilish bilan og'rigan, uysiz, jinsiy aloqa bilan shug'ullanadigan va / yoki qamoqqa tashlangan ayollarning hayoti boshqa ayollarga qaraganda ancha qisqa.^[21] Har qanday yoshda, bir-birini qoplaydigan, tamg'alangan guruhlardagi ayollar o'lish ehtimoli o'sha yoshdagi odatdagi ayollarga qaraganda taxminan 10-13 baravar ko'pdir.^[21]

Ijtimoiy va madaniy omillar

Logotipi Barqaror rivojlanish maqsadi 5: Gender tengligi

Ayollar salomatligi, boshqalar qatori, keltirilgan bilimlarning keng doirasiga to'g'ri keladi Jahon Sog'liqni saqlash tashkiloti, bu jinsga muhim ahamiyatga ega sog'liqni ijtimoiy belgilovchi omil.^[22] Ayollarning sog'lig'iga ularning biologiyasi ta'sir etsa, ularga ijtimoiy sharoitlari ham ta'sir qiladi, masalan qashshoqlik, ish bilan ta'minlash va oilaviy majburiyatlar va bu jihatlarni soya qilmaslik kerak.^[23][24]

Xotin-qizlar an'anaviy ravishda iqtisodiy va ijtimoiy holat va kuch, bu esa o'z navbatida ularning hayot ehtiyojlariga bo'lgan ehtiyojini kamaytiradi Sog'liqni saqlash. G'arbiy mamlakatlarda so'nggi paytlarda yaxshilanishga qaramay, ayollar erkaklar bilan bog'liq ahvolda qolmoqda.^[6] Sog'liqni saqlashdagi gender farqi yanada keskinroq rivojlanayotgan davlatlar bu erda ayollar nisbatan kam ta'minlangan. Jinsiy tengsizlikka qo'shimcha ravishda, ayol bo'lish bilan bog'liq bo'lgan o'ziga xos kasallik jarayonlari mavjud bo'lib, ular profilaktika va sog'liqni saqlashda muayyan muammolarni keltirib chiqaradi.^[18]

Sog'liqni saqlash xizmatidan foydalanganidan keyin ham ayollar kamsitilgan,^[25] bu jarayon Iris Young kirish to'siqlarini "tashqi chiqarib tashlash" dan farqli o'laroq "ichki chiqarib tashlash" deb atadi. Ushbu ko'rinmaslik, hokimiyatning tengsizligi tufayli yomon ahvolga tushib qolgan guruhlarning shikoyatlarini samarali ravishda yashiradi va adolatsizlikni yanada kuchaytiradi.^[26]

Xulq-atvorning farqlari ham rol o'ynaydi, bunda ayollarda kam xavflilik, shu jumladan kamroq tamaki, alkogol va giyohvand moddalarni iste'mol qilish, shu bilan bog'liq kasalliklardan o'lish xavfini kamaytiradi. o'pka saratoni, sil kasalligi va siroz. Ayollar uchun past bo'lgan boshqa xavf omillariga quyidagilar kiradi avtoulovlarda sodir bo'lgan baxtsiz hodisalar. Kasbdagi farqlar ayollarga kamroq ta'sir ko'rsatdi ishlab chiqarish jarohatlari, garchi bu o'zgarishi mumkin bo'lsa, urushda jarohat olish yoki o'lim xavfi kabi. Umuman olganda, bunday jarohatlar ayollarning o'limining 3,5 foiziga yordam berdi, 2009 yilda AQShda bu ko'rsatkich 6,2 foizni tashkil qildi. O'z joniga qasd qilish darajasi ayollarda ham kam.^[27][28]

Sog'liqni saqlashga ijtimoiy nuqtai nazar, gender sog'liqni saqlashning ijtimoiy hal qiluvchi omilidir, degan e'tirof bilan birlashganda, dunyo bo'ylab mamlakatlarda ayollarga tibbiy xizmat ko'rsatishni xabardor qiladi. Kabi ayollar sog'liqni saqlash xizmatlari Leyxardt 1974 yilda tashkil etilgan Ayollar jamoat salomatligi markazi^[29] va Avstraliyada tashkil etilgan birinchi ayollar sog'liqni saqlash markazi bo'lib, ayollarning sog'liqni saqlashga xizmat ko'rsatishga yondashuvining namunasidir.^[30]

Ayollarning sog'lig'i - bu ko'pchilik tomonidan hal qilingan muammo feministlar, ayniqsa qaerda reproduktiv salomatlik tashvishlanmoqda va xalqaro sog'liqni saqlashni yaxshilashga qaratilgan kun tartibining qabul qilinishida xalqaro ayollar harakati mas'ul bo'lgan.^[31]

Biologik omillar

Ayollar va erkaklar ularning farq qiladi xromosoma bo'yanish, oqsil gen mahsulotlari, genomik imprinting, gen ekspressioni, signalizatsiya yo'llari va gormonal muhit. Bularning barchasi olingan ma'lumotlarni ekstrapolyatsiya qilishda ehtiyot bo'lishni talab qiladi biomarkerlar bir jinsdan ikkinchisiga.^[6] Ayollar hayotning ikki chekkasida ayniqsa zaifdirlar. Yosh ayollar va o'spirinlar jinsiy yo'l bilan yuqadigan yuqumli kasalliklar, homiladorlik va xavfli abort qilish xavfiga duchor bo'lishadi, keksa yoshdagi ayollar ko'pincha kam manbalarga ega va erkaklarga nisbatan noqulay ahvolda, shuningdek demans va suiiste'mol qilish xavfi va umuman sog'lig'i yomon.^[17]

Reproduktiv va jinsiy salomatlik

Logotipi Ming yillik rivojlanish maqsadi 5: Onalik va reproduktiv salomatlikni yaxshilash

Ayollar ko'payish va jinsiy aloqalar bilan bog'liq ko'plab noyob sog'liq muammolarini boshdan kechirmoqdalar va bu reproduktiv yoshdagi ayollar (15–44 yosh) boshidan kechirgan sog'liq muammolarining uchdan bir qismi uchun javobgardir, ulardan xavfli jinsiy aloqa, ayniqsa, rivojlanayotgan mamlakatlarda xavfli xavf tug'diradi. .^[17] Reproduktiv salomatlik ko'plab muammolarni o'z ichiga oladi, shu jumladan ko'payish bilan bog'liq tuzilmalar va tizimlarning salomatligi va vazifalari, homiladorlik, tug'ish va bola tarbiyasi, shu jumladan tug'ruqdan oldin va perinatal parvarish.^[32][33] Jahon ayollari sog'lig'i nafaqat rivojlangan mamlakatlarga qaraganda, balki reproduktiv salomatlikka juda katta e'tibor beradi yuqumli kasalliklar kabi bezgak homiladorlik va yuqumli bo'lmagan kasalliklar (NCD). Tabiiy kambag'al mintaqalarda ayollar va qizlar duch keladigan ko'plab muammolar rivojlangan mamlakatlarda nisbatan noma'lum, masalan ayollarning jinsiy a'zolarini kesish va keyinchalik tegishli diagnostika va klinik manbalardan foydalanish imkoniyati yo'q.^[11]

Onalar salomatligi

Doya o'qitish Papua-Yangi Gvineya

Onalar salomatligi klinikasi Afg'oniston

Homiladorlik sezilarli darajada taqdim etadi sog'liq uchun xavf, hatto rivojlangan mamlakatlarda ham, va erishilgan yutuqlarga qaramay akusherlik fan va amaliyot.^[34] Onalar o'limi ning asosiy muammosi bo'lib qolmoqda global sog'liq va a deb hisoblanadi qo'riqchi hodisasi sog'liqni saqlash tizimlarining sifatini baholashda.^[35] O'smir homiladorlik mo'ljallangan yoki ko'zda tutilmagan, yoki nikohda yoki ittifoqda bo'ladimi yoki yo'qmi, ma'lum bir muammoni anglatadi. Homiladorlik qizning hayotida jismoniy, hissiy, ijtimoiy va iqtisodiy jihatdan katta o'zgarishlarga olib keladi va uning katta yoshga o'tishini xavf ostiga qo'yadi. O'smir homiladorlik, ko'pincha, qizning tanlovi etishmasligidan kelib chiqadi. yoki suiiste'mol qilish. Bolalar nikohi (pastga qarang) dunyo miqyosida katta hissa qo'shmoqda, chunki 15-19 yoshdagi qizlarning 90% tug'ilishi nikohda sodir bo'ladi.^[36]

Onalik o'limi

2013 yilda dunyoda taxminan 289,000 ayol (kuniga 800) homiladorlik bilan bog'liq sabablarga ko'ra vafot etdi, rivojlangan va rivojlanayotgan mamlakatlar o'rtasida katta farqlar mavjud.^[11][37] G'arbiy mamlakatlarda onalar o'limi tobora pasayib bordi va yillik hisobotlar va sharhlarning mavzusini tashkil qiladi.^[38] Shunga qaramay, 1987-2011 yillarda Qo'shma Shtatlarda onalar o'limi 10000 tirik tug'ilishga 7,2 dan 17,8 o'limga ko'tarildi, bu o'z aksini topdi Onalar o'limi darajasi (MMR).^[38] Aksincha, dunyo bo'ylab har bir tug'ilish uchun 1000 gacha bo'lgan ko'rsatkichlar qayd etilgan,^[11] eng yuqori stavkalar bilan Afrikaning Sahroi osti qismi va Janubiy Osiyo, bu o'limning 86% ni tashkil qiladi.^[39][37] Ushbu o'limlar kamdan-kam hollarda tekshiriladi, ammo Jahon sog'liqni saqlash tashkiloti ushbu infratuzilma, o'quv va sharoitlar mavjud bo'lgan taqdirda, bu o'limlarning aksariyati tug'ruqdan keyingi 24 soat ichida sodir bo'lishining oldini olish mumkin deb hisoblaydi.^[40][37] Tabiiy resurslari kam bo'lgan ushbu mamlakatlarda onalar salomatligi qashshoqlik va cheklangan malakali kadrlarga qo'shimcha ravishda yo'llar, sog'liqni saqlash muassasalari, uskunalar va jihozlarga ta'sir ko'rsatadigan qashshoqlik va salbiy iqtisodiy omillar ta'sirida yanada yomonlashmoqda. Boshqa muammolar jinsiy aloqaga madaniy munosabat, kontratseptsiya, bolalar nikohi, uyda tug'ilish tibbiy favqulodda vaziyatlarni aniqlash qobiliyati. Ushbu onalar o'limining bevosita sabablari qon ketish, eklampsi, to'siq qilingan mehnat, sepsis va malakasiz abort. Bunga qo'chimcha bezgak va OITS homiladorlikni murakkablashtirish. 2003-2009 yillarda qon ketish o'limning asosiy sababi bo'lib, rivojlanayotgan mamlakatlarda o'limning 27% va rivojlangan mamlakatlarda 16% ni tashkil etdi.^[41][42]

Reproduktiv bo'lmagan sog'liq onalar sog'lig'ining muhim predmeti bo'lib qolmoqda. Qo'shma Shtatlarda onalar o'limining asosiy sabablari yurak-qon tomir kasalliklari (o'limning 15%), endokrin, nafas olish va oshqozon-ichak kasalliklari, infektsiya, qon ketishi va homiladorlikning gipertonik kasalliklari (Gronovski va Shindler, II-jadval).^[6]

2000 yilda Birlashgan Millatlar yaratilgan Ming yillik rivojlanish maqsadi (MRM) 5^[43] onalar salomatligini yaxshilash.^[44] Maqsad 5A 1990 yildan 2015 yilgacha ikkitadan foydalanib, onalar o'limini to'rtdan uch qismga kamaytirishga intildi ko'rsatkichlar, 5.1 MMR va 5.2 malakali sog'liqni saqlash xodimlari (shifokor, hamshira yoki akusher) ishtirok etgan etkazib berish nisbati. Dastlabki hisobotlarda MRM 5 barcha MRMlar orasida eng past natijalarga erishganligi ko'rsatilgan.^[45][46] 2015 yildagi maqsadli kunga kelib MMR atigi 45% ga kamaydi, 380 dan 210 gacha, aksariyati 2000 yildan keyin sodir bo'ldi. Ammo bu yaxshilanish barcha mintaqalarda sodir bo'ldi, ammo Janubiy Osiyo guvoh bo'lishiga qaramay, eng yuqori MMR Afrika va Osiyoda edi. eng katta pasayish, 530 dan 190 gacha (64%). Eng kichik pasayish rivojlangan mamlakatlarda kuzatildi, 26 dan 16 gacha (37%). Yordam bilan tug'ilish nuqtai nazaridan bu ulush dunyo miqyosida 59 dan 71% gacha ko'tarildi. Raqamlar rivojlangan va rivojlanayotgan mintaqalar uchun o'xshash bo'lishiga qaramay, ikkinchisida Janubiy Osiyodagi 52% dan 100% gacha bo'lgan farqlar mavjud. Sharqiy Osiyo. Rivojlanayotgan mamlakatlarda homiladorlik paytida o'lish xavfi rivojlangan mamlakatlarga qaraganda o'n to'rt baravar yuqori bo'lib qolmoqda, ammo MMR eng yuqori bo'lgan Afrikaning Saxara mintaqasida bu xavf 175 baravar yuqori.^[39] MRM maqsadlarini belgilashda malakali yordam bilan tug'ilish asosiy strategiya sifatida qaraldi, shuningdek, parvarish qilish imkoniyatining ko'rsatkichi va o'lim ko'rsatkichlarini yaqindan aks ettiradi. Rivojlanayotgan mamlakatlarning qishloq joylarida (56 ga nisbatan 87 foizga nisbatan) 31 foizga pastroq bo'lgan mintaqalarda aniq farqlar mavjud, ammo Sharqiy Osiyoda farq yo'q, ammo 52 foiz farq Markaziy Afrika (32 va 84%).^[37] 2015 yilda MRM kampaniyasining yakunlanishi bilan 2030 yilgacha yangi maqsadlar belgilanadi Barqaror rivojlanish maqsadlari kampaniya.^[47][48] Onalar salomatligi "Sog'liqni saqlash" 3-maqsadi ostida joylashtirilgan bo'lib, uning maqsadi dunyoda onalar o'limining koeffitsientini 70 dan past darajaga tushirishdir.^[49] Ushbu maqsadlarga erishish uchun ishlab chiqilayotgan vositalar orasida JSST tomonidan xavfsiz tug'ilishni tekshirish ro'yxati ham mavjud.^[50]

Onalar sog'lig'ini yaxshilash, tug'ruq paytida professional yordamdan tashqari, muntazam ravishda tug'ruqdan oldin parvarish qilish, asosiy shoshilinch akusherlik yordami, shu jumladan, antibiotiklar, oksitotsitlar, antikonvulsanlar, qo'lda olib tashlash qobiliyati a saqlanib qolgan platsenta, bajaring asbobli etkazib berish va tug'ruqdan keyingi parvarish.^[11] Tadqiqotlar shuni ko'rsatdiki, bemorlar va jamoat ta'limi, tug'ruqdan oldin parvarish qilish, shoshilinch akusherlik (shu jumladan kirish imkoniyatiga ega bo'lish) yo'naltirilgan dasturlar eng samarali dastur hisoblanadi. sezaryen bo'limlari ) va transport.^[41] Umuman olganda, ayollar sog'lig'ida bo'lgani kabi, onalar sog'lig'ini hal qilish uchun ham MRMning boshqa ko'plab maqsadlarini qamrab oladigan keng nuqtai nazarni talab qiladi, masalan, qashshoqlik va holat, va o'limning ko'p qismi bevosita tug'ruqdan oldin davrda sodir bo'lishini hisobga olib, tavsiya etilgan intrapartum parvarish (etkazib berish) asosiy strategiya bo'lishi kerak.^[39] Jahon sog'liqni saqlash tashkiloti tomonidan 2016 yil noyabr oyida tug'ruqdan oldin parvarish qilish bo'yicha yangi ko'rsatmalar chiqarildi.^[51]

Homiladorlikning asoratlari

Homiladorlik va tug'ruq paytida yuzaga keladigan o'limdan tashqari, homiladorlik ko'plab sog'liq muammolariga olib kelishi mumkin, shu jumladan akusherlik fistulalari, tashqi homiladorlik, erta mehnat, homiladorlik qandli diabet, giperemeziya gravidarum, shu jumladan gipertenziv holatlar preeklampsi va anemiya.^[34] Jahon miqyosida homiladorlikning asoratlari onalar o'limini sezilarli darajada uzaytirmoqda, homiladorlik bilan bog'liq 9,5 million holat va 1,4 millionga yaqin sog'inish (hayotga tahlikali og'ir asoratlardan xalos bo'lish). Homiladorlikning asoratlari jismoniy, ruhiy, iqtisodiy va ijtimoiy bo'lishi mumkin. Hisob-kitoblarga ko'ra, har yili 10-20 million ayol homiladorlik yoki etarli darajada parvarish qilish asoratlari natijasida jismoniy yoki aqliy nogironlikni rivojlantiradi.^[39] Binobarin, xalqaro agentliklar akusherlik yordami standartlarini ishlab chiqdilar.^[52]

Akusherlik oqma

Ayollar Efiopiya fistula kasalxonasi

Yaqinda o'tkazib yuborilgan voqealar, akusherlik fistulalari (OF), shu jumladan vesikovajinal va rektovaginal fistula, eng jiddiy va fojiali biri bo'lib qolmoqda. Tuzatish operatsiyasi mumkin bo'lsa-da, ko'pincha u mavjud emas va OF butunlay oldini olish mumkin deb hisoblanadi. Agar tuzatilgan bo'lsa, keyingi homiladorlik uchun sezaryen kerak bo'ladi.^[53] Rivojlangan mamlakatlarda odatiy bo'lmagan bo'lsa-da, dunyoda har yili 100000 ga yaqin holatlar ro'y beradi va hozirgi kunda 2 millionga yaqin ayollar ushbu kasallik bilan yashamoqda, bu kasallik Afrikada va Osiyoning ayrim qismlarida eng yuqori ko'rsatkichga ega.^[39][53][54] Uzoq muddatli natijalar to'siq qilingan mehnat aralashuvisiz, homilaning davomiy bosimi tug'ilish kanali atrofdagi to'qimalarning qon bilan ta'minlanishini cheklaydi, natijada homila o'limi, nekroz va chiqarib yuborish. Keyinchalik shikastlangan tos a'zolarida siydik yoki najasni yoki ikkalasini ham qin orqali bog'langan holda chiqarib yuboradigan aloqa (fistula) rivojlanadi. siydik va najasni tutmaslik, qin stenoz, asab buzilishi va bepushtlik. Ayollardan qochib, og'ir ijtimoiy va ruhiy oqibatlarga olib kelishi mumkin. Xizmatdan foydalanish imkoniyati etishmasligidan tashqari, sabablarga yoshlik va to'yib ovqatlanmaslik.^[11][55][53] The UNFPA OF-ning oldini olishni ustuvor vazifaga aylantirdi va yillik hisobotlarni chiqaradigan Fistulani tugatish kampaniyasining etakchi agentligi hisoblanadi^[56] va Birlashgan Millatlar Tashkiloti 23 mayni quyidagicha kuzatmoqda Xalqaro akusherlik fistulasini tugatish kuni har yil.^[57] Oldini olish o'spirin homiladorligi va bolani nikohidan voz kechish, etarli ovqatlanish va malakali yordam, shu jumladan sezaryen bilan ta'minlanish imkoniyatini o'z ichiga oladi.^[11]

Jinsiy salomatlik

Kontratseptsiya

Oilani rejalashtirish uyushmasi: Kuala-Terengganu, Malayziya

Homilador bo'lishni va qachon bo'lishini aniqlash qobiliyati ayolning avtonomligi va farovonligi uchun juda muhimdir va kontratseptsiya vositasi qizlarni va yosh ayollarni erta homiladorlik xavfidan va katta yoshdagi ayollarni kutilmagan homiladorlik xavfidan himoya qilishi mumkin. Kontratseptsiya vositalaridan etarli foydalanish ko'p homiladorlikni cheklashi, xavfli abortga bo'lgan ehtiyojni kamaytirishi va onalar va bolalar o'limini va kasallanishini kamaytirishi mumkin. Biroz kontratseptsiyaning to'siq shakllari kabi prezervativ, shuningdek, jinsiy yo'l bilan yuqadigan kasalliklar va OIV infeksiyasi xavfini kamaytiradi. Kontratseptsiya vositalaridan foydalanish ayollarga reproduktiv va jinsiy salomatligi to'g'risida ma'lumotli qaror qabul qilishga imkon beradi, vakolatlarni oshiradi va ta'lim, martaba va jamoat hayotida ishtirok etish imkoniyatlarini oshiradi. Ijtimoiy darajada kontratseptsiya vositalaridan foydalanish nazoratning asosiy omili hisoblanadi aholining o'sishi, natijada iqtisodiyotga, atrof-muhitga va mintaqaviy rivojlanishga ta'sir qiladi.^[58][59] Binobarin, Birlashgan Millatlar Tashkiloti kontratseptsiya vositalaridan foydalanish imkoniyatini ko'rib chiqadi a inson huquqi bu markaziy jinsiy tenglik va ayollarning imkoniyatlarini kengaytirish hayotni saqlab qolish va qashshoqlikni kamaytirish,^[60] tug'ilishni nazorat qilish 20-asrda sog'liqni saqlash sohasidagi 10 ta eng katta yutuqlar qatoriga kiritilgan.^[61]

Ayollarning homiladorlik ustidan nazoratini optimallashtirish uchun madaniy jihatdan mos bo'lgan kontratseptsiya bo'yicha tavsiyalar va vositalar har kimga keng, oson va arzon narxlarda taqdim etilishi zarur. jinsiy faol jumladan, o'spirinlar. Dunyoning ko'p joylarida kontratseptsiya va oilani rejalashtirish xizmatlaridan foydalanish juda qiyin yoki umuman mavjud emas, hatto rivojlangan mamlakatlarda ham madaniy va diniy an'analar kirish uchun to'siqlar yaratishi mumkin. Xabar berishlaricha, etarli miqdorda kontratseptsiya vositalaridan foydalanish ayollar tomonidan 1990-2014 yillarda sezilarli darajada o'sgan va mintaqaviy o'zgaruvchanlik bilan. Garchi global foydalanish 55% atrofida bo'lsa-da, Afrikada 25% gacha bo'lishi mumkin. Dunyo bo'ylab 222 million ayol kirish huquqiga ega emas yoki cheklangan kontratseptsiya. Mavjud ma'lumotlarni talqin qilishda ba'zi ehtiyotkorlik zarur kontratseptsiya vositalarining tarqalishi ko'pincha "hozirgi kunda reproduktiv yoshdagi barcha ayollar orasida har qanday kontratseptsiya usulidan foydalanadigan ayollarning foizlari (ya'ni, 15 yoshdan 49 yoshgacha bo'lganlar, agar boshqacha ko'rsatilmagan bo'lsa), turmush qurgan yoki kasaba uyushmasida bo'lganlar. "Kasaba uyushmasi" guruhiga bir xonadonda sherigi bilan yashaydigan va mamlakatning nikoh qonunlari yoki urf-odatlariga binoan turmush qurmagan ayollar kiradi. "^[62] Ushbu ta'rif yanada cheklovchi tushunchaga ko'proq mos keladi oilani rejalashtirish, ammo jinsiy aloqada bo'lgan yoki bo'lishi mumkin bo'lgan, homiladorlik xavfi ostida bo'lgan va turmush qurmagan yoki "uyushma" bo'lmagan barcha boshqa ayollar va qizlarning kontratseptsiya ehtiyojlarini qondirmaydi.^{[37][63][58][59]}

MRM 5 bilan bog'liq uchta maqsad - bu o'smirlarning tug'ilish darajasi, kontratseptiv vositalarning tarqalishi va oilani rejalashtirishga bo'lgan ehtiyoj (bu erda tarqalish + qondirilmagan ehtiyoj = umumiy ehtiyoj), bular BMTning Aholishunoslik bo'limi tomonidan kuzatilgan. Iqtisodiy va ijtimoiy masalalar bo'limi.^[64] Kontratseptiv vositalardan foydalanish 5.3-indikator sifatida 5B-maqsad (reproduktiv salomatlikka universal kirish) ning bir qismi edi.^[65] 2015 yilda MDM5 bahosi shuni ko'rsatdiki, juftliklar orasida dunyo bo'ylab foydalanish 55% dan 64% gacha o'sgan. ning eng katta o'sishlaridan biri bilan Afrikaning dengiz osti mintaqasi (13 dan 28% gacha). Xulosa, qondirilmagan ehtiyoj butun dunyo bo'ylab bir oz pasaygan (15 dan 12% gacha).^[37] 2015 yilda ushbu maqsadlar 5.6-maqsadga muvofiq SDG5 (gender tengligi va imkoniyatlarini kengaytirish) tarkibiga kirdi: Jinsiy va reproduktiv salomatlik va reproduktiv huquqlarga umumiy kirishni ta'minlash, bu erda 5.6.1 ko'rsatkichi - bu o'zlarini xabardor qiladigan 15-49 yoshdagi ayollarning ulushi. jinsiy aloqalar, kontratseptiv vositalardan foydalanish va reproduktiv salomatlikni saqlash bo'yicha qarorlar (31-bet).^[66]

Rivojlanayotgan va rivojlangan mintaqalardagi ko'plab ayollar uchun kontratseptsiya vositalaridan foydalanishda muhim to'siqlar mavjud. Bularga sog'liqni saqlash xizmatlaridan foydalanish sifati va sifati bilan bog'liq bo'lganlardan tashqari qonunchilik, ma'muriy, madaniy, diniy va iqtisodiy to'siqlar kiradi. Diqqatning katta qismi o'spirin homiladorligining oldini olishga qaratilgan. The Chet elda rivojlanish instituti (ODI) ikkala tomonda ham bir qator asosiy to'siqlarni aniqladi ta'minot va talab tomoni shu jumladan, ijtimoiy-madaniy qadriyatlarni ichki tartibga solish, oila a'zolarining bosimi va kognitiv to'siqlar (bilim etishmasligi).^[67][68] Rivojlangan mintaqalarda ham ko'plab ayollar, ayniqsa ular ahvolga tushgan, moliyaviy va geografik bo'lishi mumkin bo'lgan, ammo diniy va siyosiy kamsitishlarga duch kelishi mumkin bo'lgan kirishda jiddiy qiyinchiliklarga duch kelishi mumkin.^[69] Ayollar, shuningdek, nuqsonli kabi kontratseptsiyaning xavfli shakllariga qarshi kampaniyalar o'tkazdilar intrauterin vositalar (IUD) lar, xususan Dalkon Shild.^[70]

Abort

Abort qilish huquqi uchun ayollar namoyishi, Dublin, 2012 yil

Abort qilish - bu o'z-o'zidan tugashi bilan taqqoslaganda, homiladorlikning qasddan bekor qilinishi (tushish ). Abort qilish ayollarning nazorati va ularning ko'payishini tartibga solish nuqtai nazaridan kontratseptsiya bilan chambarchas bog'liq va ko'pincha shunga o'xshash madaniy, diniy, qonunchilik va iqtisodiy cheklovlarga duch keladi. Kontratseptsiya vositalaridan foydalanish imkoniyati cheklangan joylarda ayollar abortga murojaat qilishadi. Natijada, abort qilish stavkalari kontratseptsiya uchun qondirilmagan ehtiyojlarni baholash uchun ishlatilishi mumkin.^[71] Ammo mavjud protseduralar butun tarix davomida ayollar uchun katta xavf tug'dirgan va rivojlanayotgan mamlakatlarda ham, yoki qonuniy cheklovlar ayollarni izlashga majbur qiladigan joylarda ham mavjud. yashirin muassasalar.^[72][71] Xavfsiz abortdan foydalanish imkoniyati quyi ijtimoiy-iqtisodiy guruhlarga va muhim to'siqlarni keltirib chiqaradigan yurisdiktsiyalarga ortiqcha yuklarni yuklaydi. Ushbu masalalar ko'pincha siyosiy va feministik kampaniyalarning mavzusi bo'lib kelgan, bu erda turli xil qarashlar axloqiy qadriyatlarga qarshi turadi.

Jahon miqyosida 2005 yilda 87 million istalmagan homiladorlik bo'lgan, shundan 46 millioni abortga murojaat qilgan, ulardan 18 millioni xavfli deb topilgan, natijada 68 ming kishi o'lgan. Ushbu o'limlarning aksariyati rivojlanayotgan dunyoda sodir bo'lgan. Birlashgan Millatlar Tashkiloti xavfsiz abort qilish va abortdan keyin parvarish qilish imkoniyatiga ega bo'lgan holda ularni oldini olish mumkin deb hisoblaydi. Abort qilish darajasi rivojlangan mamlakatlarda pasaygan bo'lsa-da, rivojlanayotgan mamlakatlarda emas. 2010-2014 yillarda 15-44 yoshdagi 1000 ayolga 35 ta abort, jami yilda 56 million abort bo'lgan.^[41] Qo'shma Shtatlar sog'liqni saqlash xodimlari uchun abort va abortdan keyingi yordamni yanada qulayroq va xavfsizroq ta'minlash bo'yicha tavsiyalar tayyorladi. Abortdan keyingi parvarishning ajralmas qismi etarli kontratseptsiya bilan ta'minlashni o'z ichiga oladi.^[73]

Jinsiy yo'l bilan yuqadigan infektsiyalar

Ayollar uchun muhim jinsiy salomatlik muammolari Jinsiy yo'l bilan yuqadigan infektsiyalar (STI) va ayol jinsiy a'zolarini kesish (FGC). Jinsiy yo'l bilan yuqadigan jinsiy yo'l bilan yuqadigan kasalliklar jinsiy salomatlikning global ustuvor yo'nalishi hisoblanadi, chunki ular ayollar va chaqaloqlar uchun jiddiy oqibatlarga olib keladi. Onadan bolaga yuqish jinsiy yo'l bilan yuqadigan yuqumli kasalliklar olib kelishi mumkin o'lik tug'ilish, yangi tug'ilgan chaqaloqlarning o'limi, kam vaznli va erta tug'ilish, sepsis, zotiljam, neonatal kon'yuktivit va konjenital deformatsiyalar. Sifilis homiladorlik natijasida yiliga 300000 dan ortiq homila va neonatal o'lim, 215000 go'dak esa erta tug'ilish, kam vaznli yoki tug'ma kasallik tufayli o'lim xavfi ortadi.^[74]

Kabi kasalliklar xlamidiya va gonoreya sabablarining muhim sabablari hamdir tos a'zolarining yallig'lanish kasalligi (PID) va undan keyingi bepushtlik ayollarda. Kabi ba'zi bir STIlarning yana bir muhim natijasi jinsiy gerpes va sifiliz yuqtirish xavfini oshiradi OIV uch baravar ko'payadi va uning uzatilishiga ta'sir qilishi mumkin.^[75] Dunyo bo'ylab ayollar va qizlarga katta xavf tug'diradi OIV / OITS. STI o'z navbatida bog'liqdir xavfli ko'pincha jinsiy faoliyat nomuvofiq.^[74]

Ayollarning jinsiy a'zolarini buzish

Jamiyat yig'ilishida tug'ruq uchun FGK xavfini tushuntirib beradigan an'anaviy afrikalik akusher

Ayollarning jinsiy a'zolarini buzish (shuningdek, ayollarning jinsiy a'zolarini kesish deb ataladi) Jahon sog'liqni saqlash tashkiloti (JSST) tomonidan "qisman yoki to'liq olib tashlash bilan bog'liq barcha protseduralar tashqi ayol jinsiy a'zolari, yoki tibbiy bo'lmagan sabablarga ko'ra ayol jinsiy a'zolariga boshqa shikast etkazish ". Ba'zan uni ayol deb ham atashgan sunnat, garchi bu atama chalg'ituvchi bo'lsa ham, chunki bu sunnatga o'xshashdir sunnat terisi erkak jinsiy olatidan.^[76] Binobarin, buzilish atamasi ushbu harakatning og'irligi va uning inson huquqlarining buzilishi sifatida o'rnini ta'kidlash uchun qabul qilingan. Keyinchalik, o'zgartirish uchun dialogga to'sqinlik qiladigan madaniy sezgirlikni oldini olish uchun qisqartirish atamasi ilgari surildi. Ushbu nuqtai nazarni tan olish uchun ba'zi idoralar ayollarning jinsiy a'zolarini buzish / kesish (FMG / C) dan foydalanadilar.^[76]

Bu bugungi kunda tirik bo'lgan 200 milliondan ortiq ayollar va qizlarga ta'sir ko'rsatdi. Amaliyot Afrika, Yaqin Sharq va Osiyodagi 30 ga yaqin mamlakatda to'plangan.^[77] FGC ko'plab diniy e'tiqodlarga, millatlarga va ijtimoiy-iqtisodiy sinflarga ta'sir qiladi va juda ziddiyatli. FGKni oqlash uchun ilgari surilgan asosiy dalillar gigiena, unumdorlik, saqlash iffat, muhim o'tish marosimi, turmush qurishi va erkak sheriklarning jinsiy zavqini kuchaytirishi.^[11] Chiqarilgan to'qima miqdori sezilarli darajada farq qiladi, bu JSST va boshqa organlarni FGKni to'rt turga bo'lishiga olib keladi. Ular qisman yoki to'liq olib tashlashdan iborat klitoris bilan yoki bo'lmagan holda prepuce (klitoridektomiya ) I turida, qo'shimcha ravishda olib tashlash uchun labia minora, eksizatsiyasi bilan yoki bo'lmasdan labia majora (II tip) qin teshigining torayishiga qadar (introitus ) labiyadagi qolgan to'qimalarni tikish orqali qoplama muhrini yaratish bilan siydik yo'li va introitus, klitoris bilan yoki olib tashlanmasdan (infibulyatsiya ). Ushbu turdagi siydik va hayz ko'rish qonini chiqarishga imkon beradigan kichik teshik hosil bo'ladi. 4-toifa boshqa barcha protseduralarni, odatda nisbatan kichik o'zgarishlarni o'z ichiga oladi pirsing.^[78]

An'anaga ega bo'lgan madaniyatlar tomonidan himoya qilingan bo'lsa-da, FGC ko'plab tibbiy va madaniy tashkilotlar tomonidan keraksiz va zararli ekanligi sababli qarshi chiqmoqda. Qisqa muddatli sog'liqqa ta'sir qon ketishi, infektsiya, sepsis va hatto o'limga olib kelishi mumkin, uzoq muddatli ta'sirlar esa disparuniya, dismenoreya, vaginit va sistit.^[79] Bundan tashqari, FGK homiladorlik, tug'ruq va tug'ruq paytida asoratlarni keltirib chiqaradi. Chandiqli to'qimalarni ochish uchun malakali xodimlar tomonidan qaytarilish (defibulyatsiya) talab qilinishi mumkin.^[80] Ushbu amaliyotga qarshi bo'lganlar orasida mahalliy aholi ham bor oddiy guruhlar, milliy va xalqaro tashkilotlar, shu jumladan JSST, YuNISEF,^[81] UNFPA^[82] va Xalqaro Amnistiya.^[83] FGKni taqiqlash bo'yicha qonunchilik harakatlari kamdan-kam hollarda muvaffaqiyatli bo'lmadi va afzal ko'rilgan usul bu ta'lim va vakolatlarni kengaytirish va sog'likka salbiy ta'sirlari to'g'risida ma'lumot berishdir. inson huquqlari jihatlari.^[11]

Rivojlanishga erishildi, ammo 14 yoshdan kichik qizlar kesilganlarning 44 millionini tashkil qiladi, ayrim mintaqalarda esa 11 yosh va undan kichik yoshdagi qizlarning 50 foizi kesilgan.^[84] FGC ni tugatish Mingyillik Rivojlanish Maqsadlariga erishishda zarur bo'lgan maqsadlardan biri hisoblanadi,^[83] Birlashgan Millatlar Tashkiloti FGC-ni tugatishni Barqaror rivojlanish maqsadlarining maqsadi deb e'lon qildi va 6-fevral kuni 17-Afrika mamlakatlari va 15 yoshdan 5 milliongacha bo'lgan qizlarga e'tiborni qaratib, Xalqaro xotin-qizlar tanosillarini buzish uchun nol bag'rikenglik kuni deb nomlandi. 19, aks holda 2030 yilga qadar kesiladi.^[84][85]

Bepushtlik

Qo'shma Shtatlarda bepushtlik 1,5 million juftga ta'sir qiladi.^[86][87] Ko'p juftliklar izlaydilar reproduktiv texnologiya (ART) bepushtlik uchun.^[88] Qo'shma Shtatlarda 2010 yilda 147 260 ekstrakorporal urug'lantirish (IVF) protseduralari o'tkazildi, natijada 47090 tirik tug'ilish.^[89] 2013 yilda bu raqamlar 160,521 va 53,252 gacha o'sdi.^[90] Biroq, IVF homiladorlikning taxminan yarmi natijaga olib keladi ko'p tug'ilish etkazib berishlar, bu esa o'z navbatida ikkalasining ortishi bilan bog'liq kasallanish onaning va go'dakning o'limi. Buning sabablari orasida onaning qon bosimining ko'tarilishi, erta tug'ilish va kam vazn. Bundan tashqari, ko'proq ayollar homilador bo'lishlarini kutishadi va ARTni izlaydilar.^[90]

Bolalar nikohi

Poster addressing the 2014 London Qizlar sammiti dealing with FGM and Child Marriage

Bolalar nikohi (including union or birgalikda yashash )^[91] sifatida belgilanadi nikoh under the age of eighteen and is an ancient custom. In 2010 it was estimated that 67 million women, then, in their twenties had been married before they turned eighteen, and that 150 million would be in the next decade, equivalent to 15 million per year. This number had increased to 70 million by 2012. In developing countries one third of girls are married under age, and 1:9 before 15.^[92] The practice is commonest in South Asia (48% of women), Africa (42%) and lotin Amerikasi va Karib dengizi (29%). The highest prevalence is in Western and Sub-Saharan Africa. The percentage of girls married before the age of eighteen is as high as 75% in countries such as Niger (Nour, Table I).^[11][92] Most child marriage involves girls. Masalan Mali the ratio of girls to boys is 72:1, while in countries such as the United States the ratio is 8:1. Marriage may occur as early as birth, with the girl being sent to her husbands home as early as age seven.^[11]

There are a number of cultural factors that reinforce this practice. These include the child's financial future, her mahr, social ties and social status, prevention of nikohgacha jinsiy aloqa, extramarital pregnancy and STIs. The arguments against it include interruption of education and loss of employment prospects, and hence economic status, as well as loss of normal childhood and its emotional maturation and social isolation. Child marriage places the girl in a relationship where she is in a major imbalance of power and perpetuates the gender inequality that contributed to the practice in the first place.^[93][94] Also in the case of minors, there are the issues of human rights, non-consensual sexual activity and majburiy nikoh and a 2016 joint report of the WHO and Inter-Parliamentary Union places the two concepts together as Child, Early and Forced Marriage (CEFM), as did the 2014 Girl Summit (see below).^[95] In addition the likely pregnancies at a young age are associated with higher medical risks for both mother and child, multiple pregnancies and less access to care^[96][11][93] with pregnancy being amongst the leading causes of death amongst girls aged 15–19. Girls married under age are also more likely to be the victims of oiladagi zo'ravonlik.^[92]

There has been an international effort to reduce this practice, and in many countries eighteen is the legal age of marriage. Organizations with campaigns to end child marriage include the United Nations^[97] and its agencies, such as the Inson huquqlari bo'yicha Oliy komissarning idorasi,^[98] UNFPA,^[99] UNICEF^[91][93] and WHO.^[95] Like many global issues affecting women's health, poverty and gender inequality are asosiy sabablar, and any campaign to change cultural attitudes has to address these.^[100] Child marriage is the subject of international conventions and agreements such as The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW, 1979) (article 16)^[101] va Inson huquqlari umumjahon deklaratsiyasi^[102] and in 2014 a summit conference (Qizlar sammiti ) co-hosted by UNICEF and the UK was held in London (see illustration) to address this issue together with FGM/C.^[103][104] Later that same year the Bosh assambleya ning Birlashgan Millatlar passed a resolution, which boshqalar bilan bir qatorda^[105]

Urges all States to enact, enforce and uphold laws and policies aimed at preventing and ending child, early and forced marriage and protecting those at risk, and ensure that marriage is entered into only with the informed, free and full consent of the intending spouses (5 September 2014)

Orasida nodavlat tashkilotlar (NGOs) working to end child marriage are Girls not Brides,^[106] Yosh ayollar nasroniylar uyushmasi (YWCA), Xalqaro ayollar tadqiqotlari markazi (ICRW)^[107] va Human Rights Watch tashkiloti (HRW).^[108] Although not explicitly included in the original Millennium Development Goals, considerable pressure was applied to include ending child marriage in the successor Sustainable Development Goals adopted in September 2015,^[105] where ending this practice by 2030 is a target of SDG 5 Gender Equality (see above).^[109] While some progress is being made in reducing child marriage, particularly for girls under fifteen, the prospects are daunting.^[110] The indicator for this will be the percentage of women aged 20–24 who were married or in a union before the age of eighteen. Efforts to end child marriage include legislation and ensuring enforcement together with empowering women and girls.^{[92][93][95][94]} To raise awareness, the inaugural UN Xalqaro qiz bola kuni^[a] in 2012 was dedicated to ending child marriage.^[112]

Menstrüel tsikl

Women's menstrual cycles, the approximately monthly cycle of changes in the reproductive system, can pose significant challenges for women in their reproductive years (the early teens to about 50 years of age). These include the physiological changes that can effect physical and mental health, symptoms of ovulyatsiya and the regular shedding of the inner lining of the uterus (endometrium ) accompanied by vaginal bleeding (menses or hayz ko'rish ). The onset of menstruation (menarx ) may be alarming to unprepared girls and mistaken for illness. Menstruation can place undue burdens on women in terms of their ability to participate in activities, and access to menstrual aids such as tamponlar va sanitariya tagliklari. This is particularly acute amongst poorer socioeconomic groups where they may represent a financial burden and in developing countries where menstruation can be an impediment to a girl's education.^[113]

Equally challenging for women are the physiological and emotional changes associated with the cessation of menses (menopauza or climacteric). While typically occurring gradually towards the end of the fifth decade in life marked by tartibsiz qon ketish the cessation of ovulation and menstruation is accompanied by marked changes in hormonal activity, both by the tuxumdon itself (oestrogen va progesteron ) va gipofiz gland (follicle stimulating hormone or FSH and luteinizan gormon or LH). These hormonal changes may be associated with both systemic sensations such as issiq chaqnashlar and local changes to the reproductive tract such as reduced vaginal secretions and lubrication. While menopause may bring relief from symptoms of menstruation and fear of pregnancy it may also be accompanied by emotional and psychological changes associated with the symbolism of the loss of fertility and a reminder of aging and possible loss of desirability. While menopause generally occurs naturally as a physiological process it may occur earlier (erta menopauza ) as a result of disease or from medical or surgical intervention. When menopause occurs prematurely the adverse consequences may be more severe.^[114][115]

Boshqa masalalar

Other reproductive and sexual health issues include jinsiy tarbiya, balog'at yoshi, jinsiylik va sexual function.^[116][117] Women also experience a number of issues related to the health of their breasts va genital trakt, which fall into the scope of ginekologiya.^[118]

Non-reproductive health

Women and men have different experiences of the same illnesses, especially cardiovascular disease, cancer, depression and dementia,^[119] and are more prone to siydik yo'li infektsiyalari erkaklarga qaraganda.^[1]

Yurak-qon tomir kasalliklari

Yurak-qon tomir kasalliklari is the leading cause of death (30%) amongst women in the United States, and the leading cause of chronic disease amongst them, affecting nearly 40% (Gronowski and Schindler, Tables I and IV).^[6][7][119] The onset occurs at a later age in women than in men. For instance the incidence of stroke in women under the age of 80 is less than that in men, but higher in those aged over 80. Overall the lifetime risk of stroke in women exceeds that in men.^[27][28] The risk of cardiovascular disease amongst those with diabetes and amongst smokers is also higher in women than in men.^[6] Many aspects of cardiovascular disease vary between women and men, including risk factors, prevalence, physiology, symptoms, response to intervention and outcome.^[119]

Saraton

Women and men have approximately equal risk of dying from saraton, which accounts for about a quarter of all deaths, and is the second leading cause of death. However the relative incidence of different cancers varies between women and men. In the United States the three commonest types of cancer of women in 2012 were o'pka, ko'krak va kolorektal cancers. In addition other important cancers in women, in order of importance, are tuxumdon, bachadon (shu jumladan endometrial va bachadon bo'yni cancers (Gronowski and Schindler, Table III).^[6][120] Similar figures were reported in 2016.^[121] While cancer death rates rose rapidly during the twentieth century, the increase was less and later in women due to differences in chekish stavkalar. More recently cancer death rates have started to decline as the use of tobacco becomes less common. Between 1991 and 2012, the death rate in women declined by 19% (less than in men). In the early twentieth century death from uterine (uterine body va bachadon bo'yni ) cancers was the leading cause of cancer death in women, who had a higher cancer mortality than men. From the 1930s onwards, uterine cancer deaths declined, primarily due to lower death rates from cervical cancer following the availability of the Papanicolaou (Pap) screening test. This resulted in an overall reduction of cancer deaths in women between the 1940s and 1970s, when rising rates of lung cancer led to an overall increase. By the 1950s the decline in uterine cancer left breast cancer as the leading cause of cancer death till it was overtaken by lung cancer in the 1980s. All three cancers (lung, breast, uterus) are now declining in cancer death rates (Siegel va boshq. Figure 8),^[121] but more women die from lung cancer every year than from breast, ovarian, and uterine cancers combined. Overall about 20% of people found to have lung cancer are never smokers, yet amongst nonsmoking women the risk of developing lung cancer is three times greater than amongst men who never smoked.^[119]

In addition to mortality, cancer is a cause of considerable morbidity in women. Women have a lower lifetime probability of being diagnosed with cancer (38% vs 45% for men), but are more likely to be diagnosed with cancer at an earlier age.^[7]

Ko'krak bezi saratoni

Breast cancer is the second most common cancer in the world and the most common among women. It is also among the ten most common chronic diseases of women, and a substantial contributor to loss of hayot sifati (Gronowski and Schindler, Table IV).^[6] Globally, it accounts for 25% of all cancers. In 2016, breast cancer is the most common cancer diagnosed among women in both developed and developing countries, accounting for nearly 30% of all cases, and worldwide accounts for one and a half million cases and over half a million deaths, being the fifth most common cause of cancer death overall and the second in developed regions. Geographic variation in incidence is the opposite of that of cervical cancer, being highest in Northern America and lowest in Eastern and Middle Africa, but mortality rates are relatively constant, resulting in a wide variance in case mortality, ranging from 25% in developed regions to 37% in developing regions, and with 62% of deaths occurring in developing countries.^[17][122]

Serviks saratoni

Globally, cervical cancer is the fourth commonest cancer amongst women, particularly those of lower ijtimoiy-iqtisodiy holat. Women in this group have reduced access to health care, high rates of child and forced marriage, tenglik, ko'pxotinlilik and exposure to STIs from multiple sexual contacts of male partners. All of these factors place them at higher risk.^[11] In developing countries, cervical cancer accounts for 12% of cancer cases amongst women and is the second leading cause of death, where about 85% of the global burden of over 500,000 cases and 250,000 deaths from this disease occurred in 2012. The highest incidence occurs in Sharqiy Afrika, where with Middle Africa, cervical cancer is the commonest cancer in women. The o'lim darajasi of 52% is also higher in developing countries than in developed countries (43%), and the mortality rate varies by 18-fold between regions of the world.^{[123][17][122]}

Cervical cancer is associated with inson papillomavirusi (HPV), which has also been implicated in cancers of the vulva, qin, anus va oropharynx. Almost 300 million women worldwide have been infected with HPV, one of the commoner jinsiy yo'l bilan yuqadigan infektsiyalar, and 5% of the 13 million new cases of cancer in the world have been attributed to HPV.^[124][75] In developed countries, skrining for cervical cancer using the Pap test has identified pre-cancerous changes in the cervix, at least in those women with access to health care. Shuningdek, HPV vaktsinasi programme is available in 45 countries. Screening and prevention programmes have limited availability in developing countries although inexpensive low technology programmes are being developed,^[125] but access to treatment is also limited.^[123] If applied globally, HPV vaccination at 70% coverage could save the lives of 4 million women from cervical cancer, since most cases occur in developing countries.^[6]

Tuxumdon saratoni

By contrast, ovarian cancer, the leading cause of reproductive organ cancer deaths, and the fifth commonest cause of cancer deaths in women in the United States, lacks an effective screening programme, and is predominantly a disease of women in industrialised countries. Because it is largely asymptomatic in its earliest stages, more than 50% of women have stage III or higher cancer (spread beyond the ovaries) by the time they are diagnosed, with a consequent poor prognosis.^[121][6]

Ruhiy salomatlik

Almost 25% of women will experience ruhiy salomatlik issues over their lifetime.^[126] Women are at higher risk than men from tashvish, depressiya va psixosomatik complaints.^[17] Globally, depression is the leading disease burden. In the United States, women have depression twice as often as men. The economic costs of depression in American women are estimated to be $20 billion every year. The risks of depression in women have been linked to changing hormonal environment that women experience, including puberty, menstruation, pregnancy, childbirth and the menopause.^[119] Women also metabolise drugs used to treat depression differently to men.^[119][127] Suicide rates are less in women than men (<1% vs. 2.4%),^[27][28] but are a leading cause of death for women under the age of 60.^[17] In the United Kingdom, the Women's Mental Health Taskforce was formed aiming to address differences in mental health experiences and needs between women and men.^[128]

Dementia

Ning tarqalishi Altsgeymer kasalligi in the United States is estimated at 5.1 million, and of these two thirds are women. Furthermore, women are far more likely to be the primary caregivers of adult family members with depression, so that they bear both the risks and burdens of this disease. The lifetime risk for a woman of developing Alzheimer's disease is twice that of men. Part of this difference may be due to life expectancy, but changing hormonal status over their lifetime may also play a par as may differences in gene expression.^[119] Deaths due to dementia are higher in women than men (4.5% of deaths vs. 2.0%).^[6]

Bone health

Osteoporoz ranks sixth amongst chronic diseases of women in the United States, with an overall tarqalishi of 18%, and a much higher rate involving the suyak suyagi, bo'yin yoki lumbar spine amongst women (16%) than men (4%), over the age of 50 (Gronowski and Schindler, Table IV).^[6][7][129] Osteoporosis is a risk factor for suyak sinishi and about 20% of senior citizens who sustain a hip fracture die within a year.^{[6] [130]} The gender gap is largely the result of the reduction of estrogen levels in women following the menopauza. Gormonlarni almashtirish terapiyasi (HRT) has been shown to reduce this risk by 25–30%,^[131] and was a common reason for prescribing it during the 1980s and 1990s. Ammo Ayollar salomatligi tashabbusi (WHI) study that demonstrated that the risks of HRT outweighed the benefits^[132] has since led to a decline in HRT usage.

Anemiya

Anemiya is a major global health problem for women.^[133] Women are affected more than men, in which up to 30% of women being found to be anaemic and 42% of pregnant women. Anaemia is linked to a number of adverse health outcomes including a poor pregnancy outcome and impaired cognitive function (decreased concentration and attention).^[134] The main cause of anaemia is temir tanqisligi. In United States women temir tanqisligi anemiyasi (IDA) affects 37% of pregnant women, but globally the prevalence is as high as 80%. IDA starts in adolescence, from excess menstrual blood loss, compounded by the increased demand for iron in growth and suboptimal dietary intake. In the adult woman, pregnancy leads to further iron depletion.^[6]

Zo'ravonlik

Women experience tizimli va personal violence differently than men. The United Nations has defined violence against women as;^[135]

" any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life." (United Nations, Declaration on the Elimination of Violence against Women, 1993)

Violence against women may take many forms, including physical, jinsiy, hissiy va psixologik and may occur throughout the life-course. Structural violence may be embedded in legislation or policy, or be systematic noto'g'ri fikr by organisations against groups of women. Perpetrators of personal violence include state actors, strangers, acquaintances, relatives and yaqin sheriklar and manifests itself across a spectrum from kamsitish, orqali ta'qib qilish, jinsiy tajovuz va zo'rlash, and physical harm to murder (femitsid ). It may also include cultural practices such as female genital cutting.^[136][137]

Non-fatal violence against women has severe implications for women’s physical, mental and reproductive health, and is seen as not simply isolated events but rather a systematic pattern of behaviour that both violates their rights but also limits their role in society and requires a systematic approach.^[138]

The World Health Organization (WHO) estimates that 35% of women in the world have experienced physical or sexual violence over their lifetime and that the commonest situation is intimate partner violence. 30% of women in relationships report such experience, and 38% of murders of women are due to intimate partners. These figures may be as high as 70% in some regions.^[139] Risk factors include low educational achievement, a parental experience of violence, childhood abuse, gender inequality and cultural attitudes that allow violence to be considered more acceptable.^[140]

Violence was declared a global health priority by the WHO at its assembly in 1996, drawing on both the United Nations Declaration on the elimination of violence against women (1993)^[135] and the recommendations of both the Aholi va rivojlanish bo'yicha xalqaro konferentsiya (Cairo, 1994) and the Ayollar bo'yicha to'rtinchi Butunjahon konferentsiyasi (Beijing, 1995)^[141] This was followed by its 2002 World Report on Violence and Health, which focusses on intimate partner and sexual violence.^[142] Meanwhile, the UN embedded these in an action plan when its Bosh assambleya o'tdi Ming yillik deklaratsiyasi in September 2000, which resolved boshqalar bilan bir qatorda "to combat all forms of violence against women and to implement the Convention on the Elimination of All Forms of Discrimination against Women".^[143] Lardan biri Ming yillik maqsadlari (MDG 3) was the promotion of gender equality and the empowerment of women,^[144] which sought to eliminate all forms of violence against women as well as implementing CEDAW.^[101] This recognised that eliminating violence, including discrimination was a prerequisite to achieving all other goals of improving women's health. However it was later criticised for not including violence as an explicit target, the "missing target".^[145][85] In the evaluation of MDG 3, violence remained a major barrier to achieving the goals.^[31][37] In the successor Sustainable Development Goals, which also explicitly list the related issues of discrimination, child marriage and genital cutting, one target is listed as "Eliminate all forms of violence against all women and girls in the public and private spheres" by 2030.^{[109][146][139]}

BMT Ayollari believe that violence against women "is rooted in gender-based discrimination and social norms and gender stereotypes that perpetuate such violence", and advocate moving from supporting victims to prevention, through addressing root and structural causes. They recommend programmes that start early in life and are directed towards both genders to promote respect and equality, an area often overlooked in davlat siyosati. This strategy, which involves broad educational and cultural change, also involves implementing the recommendations of the 57th session of the UN Ayollarning maqomi bo'yicha komissiya^[147] (2013).^{[148][149][150]} To that end the 2014 UN International Day of the Girl Child was dedicated to ending the cycle of violence.^[112] In 2016, the World Health Assembly also adopted a plan of action to combat violence against women, globally.^[151]

Women in health research

Ayollar salomatligi tashabbusi logotip

Changes in the way research ethics was visualised in the wake of the Nürnberg sud jarayoni (1946), led to an atmosphere of protectionism of groups deemed to be vulnerable that was often legislated or regulated. This resulted in the relative underrepresentation of women in klinik sinovlar. The position of women in research was further compromised in 1977, when in response to the tragedies resulting from talidomid va dietilstilbestrol (DES), the United States Oziq-ovqat va dori-darmonlarni boshqarish (FDA) prohibited women of child-bearing years from participation in early stage clinical trials. In practice this ban was often applied very widely to exclude all women.^[152][153] Women, at least those in the child-bearing years, were also deemed unsuitable research subjects due to their fluctuating hormonal levels during the menstrual cycle. However, research has demonstrated significant biological differences between the sexes in rates of susceptibility, symptoms and response to treatment in many major areas of health, including heart disease and some cancers. These exclusions pose a threat to the application of dalillarga asoslangan tibbiyot to women, and compromise to care offered to both women and men.^[6][154]

The increasing focus on Ayollar huquqlari in the United States during the 1980s focused attention on the fact that many drugs being prescribed for women had never actually been tested in women of child-bearing potential, and that there was a relative paucity of basic research into women's health. Bunga javoban Milliy sog'liqni saqlash institutlari (NIH) created the Office of Research on Women's Health (ORWH)^[155] in 1990 to address these inequities. In 1993 the National Institutes of Health Revitalisation Act officially reversed US policy by requiring NIH funded phase III clinical trials to include women.^[119] This resulted in an increase in women recruited into research studies. The next phase was the specific funding of large scale epidemiology studies and clinical trials focussing on women's health such as the Ayollar salomatligi tashabbusi (1991), the largest disease prevention study conducted in the US. Its role was to study the major causes of death, disability and frailty in older women.^[156] Despite this apparent progress, women remain underrepresented. In 2006 women accounted for less than 25% of clinical trials published in 2004,^[157] A follow up study by the same authors five years later found little evidence of improvement.^[158] Another study found between 10–47% of women in heart disease clinical trials, despite the prevalence of heart disease in women.^[159] Lung cancer is the leading cause of cancer death amongst women, but while the number of women enrolled in lung cancer studies is increasing, they are still far less likely to be enrolled than men.^[119]

One of the challenges in assessing progress in this area is the number of clinical studies that either do not report the gender of the subjects or lack the statistik kuch to detect gender differences.^[157][160] These were still issues in 2014, and further compounded by the fact that the majority of animal studies also exclude females or fail to account for differences in sex and gender. for instance despite the higher incidence of depression amongst women, less than half of the animal studies use female animals.^[119] Consequently, a number of funding agencies and scientific journals are asking researchers to explicitly address issues of sex and gender in their research.^[161][162]

A related issue is the inclusion of pregnant women in clinical studies. Since other illnesses can exist concurrently with pregnancy, information is needed on the response to and efficacy of interventions during pregnancy, but ethical issues relative to the fetus, make this more complex. This gender bias is partly offset by the initiation of large scale epidemiology studies of women, such as the Nurses' Health Study (1976),^[163] Ayollar salomatligi tashabbusi^[164] va Black Women's Health Study.^[165][6]

Women have also been the subject of abuse in health care research, such as the situation revealed in the Kartriyat bo'yicha so'rov yilda Yangi Zelandiya (1988), in which research by two feminist journalists^[166] revealed that women with bachadon bo'yni abnormalities were not receiving treatment, as part of an experiment. The women were not told of the abnormalities and several later died.^[167]

National and international initiatives

Logo of UN Barqaror rivojlanish maqsadlari

In addition to addressing gender inequity in research, a number of countries have made women's health the subject of national initiatives. For instance in 1991 in the United States, the Sog'liqni saqlash va aholiga xizmat ko'rsatish boshqarmasi tashkil etilgan Office on Women's Health (OWH) with the goal of improving the health of women in America, through coordinating the women's health agenda throughout the Department, and other agencies. In the twenty first century the Office has focussed on underserviced women.^[168][169] Also, in 1994 the Kasalliklarni nazorat qilish va oldini olish markazlari (CDC) established its own Office of Women's Health (OWH), which was formally authorised by the 2010 Affordable Health Care Act (ACA).^[170][171]

Internationally, many Birlashgan Millatlar kabi agentliklar Jahon Sog'liqni saqlash tashkiloti (WHO), Birlashgan Millatlar Tashkilotining Aholi jamg'armasi (UNFPA)^[172] va UNICEF^[173] maintain specific programs on women's health, or maternal, sexual and reproductive health.^[1][174] In addition the United Nations global goals address many issues related to women's health, both directly and indirectly. These include the 2000 Mingyillik rivojlanish maqsadlari (MDG)^[143][43] and their successor, the Barqaror rivojlanish maqsadlari adopted in September 2015,^[47] following the report on progress towards the MDGs (The Millennium Development Goals Report 2015).^[175][37] For instance the eight MDG goals, eradicating extreme poverty and hunger, achieving universal primary education, promoting gender equality and empowering women, reducing child mortality rates, improving maternal health, combating HIV/AIDS malaria and other diseases, ensuring environmental sustainability, and developing a global partnership for development, all impact on women's health,^[43][11] as do all seventeen SDG goals,^[47] in addition to the specific SDG5: Achieve gender equality and empower all women and girls.^[109][176]

Goals and challenges

Women receiving health education in India

Ayollar ichida Nepal o'rganish oral health

Research is a priority in terms of improving women's health. Research needs include diseases unique to women, more serious in women and those that differ in risk factors between women and men. The balance of gender in research studies needs to be balanced appropriately to allow analysis that will detect interactions between gender and other factors.^[6] Gronowski and Schindler suggest that ilmiy jurnallar make documentation of gender a requirement when reporting the results of animal studies, and that funding agencies require justification from investigators for any gender inequity in their grant proposals, giving preference to those that are inclusive. They also suggest it is the role of health organisations to encourage women to enroll in klinik tadqiqotlar. However, there has been progress in terms of large scale studies such as the WHI, and in 2006 the Society for Women's Health Research founded the Organization for the Study of Sex Differences and the journal Jinsiy farqlar biologiyasi to further the study of jinsiy farqlar.^[6]

Research findings can take some time before becoming routinely implemented into clinical practice. Clinical medicine needs to incorporate the information already available from research studies as to the different ways in which diseases affect women and men. Ko'pchilik "normal" laboratory values have not been properly established for the female population separately, and similarly the "normal" criteria for growth and development. Drug dosing needs to take gender differences in drug metabolism into account.^[6]

Globally, women's access to health care remains a challenge, both in developing and developed countries. In the United States, before the Affordable Health Care Act came into effect, 25% of women of child-bearing age lacked tibbiy sug'urta.^[177] In the absence of adequate insurance, women are likely to avoid important steps to self care such as routine physical examination, screening and prevention testing, and prenatal care. The situation is aggravated by the fact that women living below the qashshoqlik chegarasi katta xavf ostida rejalashtirilmagan homiladorlik, unplanned delivery and elective abort. Added to the financial burden in this group are poor educational achievement, lack of transportation, inflexible work schedules and difficulty obtaining child care, all of which function to create barriers to accessing health care. These problems are much worse in developing countries. Under 50% of childbirths in these countries are assisted by healthcare providers (masalan. doyalar, nurses, doctors) which accounts for higher rates of maternal death, up to 1:1,000 live births. This is despite the WHO setting standards, such as a minimum of four antenatal visits.^[178] A lack of healthcare providers, facilities, and resources such as formulalar all contribute to high levels of morbidity amongst women from avoidable conditions such as obstetrical fistulae, sexually transmitted diseases and cervical cancer.^[6]

These challenges are included in the goals of the Office of Research on Women's Health, in the United States, as is the goal of facilitating women's access to careers in biotibbiyot. The ORWH believes that one of the best ways to advance research in women's health is to increase the proportion of women involved in healthcare and health research, as well as assuming leadership in government, oliy ta'lim markazlari va xususiy sektor.^[156] This goal acknowledges the shisha shift that women face in careers in science and in obtaining resources from grant funding to salaries and laboratory space.^[179] The Milliy Ilmiy Jamg'arma in the United States states that women only gain half of the doktorantlar awarded in science and engineering, fill only 21% of full-time professor positions in science and 5% of those in engineering, while earning only 82% of the remuneration their male colleagues make. These figures are even lower in Europe.^[179]

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