Challenges and Advances in the Inclusion of Women in Health:

An appeal to self-Defence and empowerment

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In the field of health, the phrase "knowledge is power" resonates deeply, especially when it comes to understanding the complexities of women's health. However, until a few decades ago, women were significantly underrepresented in clinical research, leaving a large gap in understanding their unique health needs.

For a long time, medical research has predominantly focused on male subjects, leading to a biased understanding of health and treatment outcomes. This disparity stemmed from a variety of factors, including outdated beliefs about the role of women in society as well as concerns about potential hormonal fluctuations that could complicate the study's results. Consequently, many medications and treatments have been developed with limited data on their effectiveness and safety for women.

A landmark event that highlights the need to include women in clinical research occurred with the use of real menstrual blood for menstrual studies. Before this, much of the understanding of menstrual health was based on opinion and speculation rather than hard scientific evidence. The inclusion of menstrual blood in the research marked a significant step in recognising and addressing women's specific health needs.

You've probably noticed that in sanitary pads ads, a blue liquid is used instead of blood. You might think this is because it's not appropriate to show blood in an ad. However, this is not the reason. Are you ready? The truth is that the pads are not tested with blood, and the advert only reflects this reality. The first study to compare the absorption of different menstrual products using real human blood instead of water or saline solution was published in August 2023. It looks like you weren't the one who bought the wrong pads after all; it the pads that weren't well tested to your reality! What a bummer, right?

This pioneering study sought to demystify and destigmatize heavy menstrual bleeding, which affects around a third of women. It provided valuable insights into the performance of various menstrual products in real-world scenarios using a more accurate and relevant testing methodology. By incorporating real human blood, the study advanced our understanding of menstrual product absorption and paved the way for more informed choices and discussions about menstrual health.

1993: A Pivotal Moment in the Inclusion of Women in Clinical Research

Until the early 1990s, women's participation in clinical trials was limited, or even non-existent, due to a series of historical and social factors. Safety concerns, such as potential effects on menstrual cycles and pregnancy, were often cited as justifications for excluding women from medical studies. Furthermore, there was a widespread view that women's hormonal and biological variations made study results more complex and difficult to interpret.

However, as awareness of gender disparities in clinical research increased, political and social pressures began to emerge to ensure more equitable representation of women in medical studies. A significant milestone in this movement occurred in 1993, when the United States National Institutes of Health enacted the Policy on the Inclusion of Women in Clinical Trials, which quickly spread throughout the world.

This policy required that women be included in all clinical trials funded by the National Institutes of Health unless there were valid scientific justifications for their exclusion. This change represented a fundamental turning point, highlighting the importance of including women in clinical research and setting a precedent for similar policies around the world. 

Continuous Challenges and the Way Forward

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Despite the advances, we still fight for true gender equality in clinical research. Women remain underrepresented in many studies, especially on issues such as reproductive health and autoimmune disorders. This lack of representation can lead to misdiagnosis and inappropriate treatments.

In light of this disparity, it is crucial that we become active in our health journey, asking the right questions in the search for solutions and demanding better clarification and representation. It is important to find out how any treatment affects women, especially the women in our community. Everyone’s participation can ensure that their health needs are met and that medical interventions are based on inclusive and robust data.

Furthermore, the push for inclusivity extends beyond gender to encompass diverse populations, including people of different ages, races, ethnicities, and socioeconomic backgrounds. Embracing diversity in clinical research and care not only enhances our understanding of health disparities, but also promotes a more inclusive and equitable healthcare system.

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When reflecting on the progress made since 1993 in the inclusion of women in clinical research, it is clear that there is still a lot of work to be done. By advocating for greater representation, challenging prejudices and actively participating in their health journey, women can pave the way for a future in which health is truly adapted to their needs. In the search for optimal health and well-being, knowledge really is power, and it is time for women to take advantage of this power and drive positive changes in the health field.

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References:

Clue. (n.d.). Why Women and People with Cycles Are Underrepresented in Health Research. Retrieved from: https://helloclue.com/articles/culture/why-women-and-people-with-cycles

DeLoughery E, Colwill AC, Edelman A, et al. (2024)BMJ Red blood cell capacity of modern menstrual products: considerations for assessing heavy menstrual bleeding. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/37550075/

Frick, C., Rumgay, H., Vignat, J., Ginsburg, O., Nolte, E., Bray, F., et al. (2023). Quantitative estimates of preventable and treatable deaths from 36 cancers worldwide: a population-based study. Retrieved from: https://www.thelancet.com/action/showPdf?pii=S2214-109X%2823%2900406-0

Lopes, L. (2022). Como a histórica falta de mulheres em ensaios clínicos afeta a saúde delas. Retrieved from: https://revistagalileu.globo.com/Ciencia/Saude/noticia/2022/03/como-historica-falta-de-mulheres-em-ensaios-clinicos-afeta-saude-delas.html

National Institutes of Health (NIH). (1993). NIH Revitalization Act of 1993. Retrieved from: https://grants.nih.gov/grants/olaw/pl103-43.pdf

Silva,M. O., Saúde e Bem-Estar das Mulheres: Um Potencial a Alcançar. (2022). Retrieved from: https://www.saudes.pt/media/1067/estudo-2022.pdf