The History of Women’s Health
The history of women’s health is intertwined with the history of women in health.
Women’s health is a complex and multifaceted topic that has evolved over time as scientific and medical knowledge advanced and as cultural, social, and political attitudes towards women changed. Exploring the fascinating history of women’s health and highlighting some of the key milestones and challenges that have shaped women’s health practices over time will help inform the future. The roots of women’s health span across many diverse cultures. This article covers some of the first recorded health practices specific to women, followed by a look at how the U.S. and Western world understood women’s health.
One of the most prominent issues that can be explored through history are sexual and reproductive rights. Society has come a long way from using crocodile dung as contraception, yet there is still plenty of room for innovation and it’s exciting to see the landscape continuing to evolve today.
Women’s health practices and beliefs varied widely across ancient civilizations. One of the oldest mentions of women’s health dates back to ancient Egypt: the Kahun Gynaecological Papyrus is a large manuscript dating from 1850–1700 BC and includes 34 paragraphs that detail medical problems related to women’s health. Women were believed to have a special connection to the divine and were granted access to female healers and midwives who provided specialized care during pregnancy and childbirth. The Kahun Papyrus contains many accounts of women’s health symptoms, how the physician should care for the patients presenting these symptoms, and the recommended treatments. Treatments included “fumigation, massage, and medicines” that came in liquids or pessaries, prosthetic devices inserted into the vagina for structural and pharmaceutical purposes. These are still used today. It was a common belief in ancient Egypt that many illnesses resulted from the conditions of the womb and in fact the Kahun Papyrus has the first known descriptions of “female hysteria.”
In ancient Greece, on the other hand, women were viewed as inferior to men and were not allowed to participate in medical education or practice. A large portion of what we know about women’s health from this time comes from the Hippocratic corpus, which is a large body of medical treatises including seven focused specifically on gynecological issues. The content today seems quite shocking but many of the ideas resulted from societal assumptions. For example, it states that if a woman was having trouble breathing, it was because she either exerted herself or did not eat enough, causing her uterus to rise up in her body and suffocate her. The most common cure for illnesses in women, typically referred to as “female hysteria” (which included everything from fever to back pain to an inability to sleep), was to calm the uterus in order to keep it in place. Ancient Greeks believed the cure was either intercourse or ideally pregnancy.
Did you know? It was the Greek philosopher Aristotle who was the first to propose using natural chemicals as spermicides.
Before the common era, there were various religions, including some that worshipped moon goddesses and followed a matriarchal system. However, these localized religions declined as larger religious movements expanded. A patriarchal society emerged, having a direct impact on women’s health.
Women still persisted in their studies: Christian monasteries became institutions where nuns could continue learning about the human body and herbal remedies. They wrote manuscripts about the effects of certain plants, animals, and mineral medicines.
Female midwives and healers oversaw and performed most of the actual care for women. However, the increasing power of the church led to a negative view of women and their bodies. Menstruation and childbirth were believed to be evidence of women’s inherent sinfulness. Many women (especially young women and widows) were cast as scapegoats during the witch hunts of the late 15th century. Governments started to ban women physicians due to fears of witchcraft, and the number of midwives declined rapidly. The study of women’s physiology and understanding of women’s health suffered from the superstitions and frenzy around witch hunts.
Did you know? In the Middle Ages, women tended to have fewer periods due to the frequency of childbearing, and used scraps of fabric or even a certain kind of absorbent bog moss to manage menstruation. Both women and men typically ate a diet designed to balance the four bodily humors of “ black and yellow bile, blood, and phlegm” and avoided the sin of gluttony. Certain foods, such as meat, were believed to increase blood flow and affect fertility.
Beginning in the 18th century, advances in medical knowledge and technology led to new understandings of women’s health and greater medical intervention in women’s lives. Many of the treatments during this time were often ineffective, painful, and even dangerous. For example, bloodletting, leeches, and purging were commonly used to treat women’s ailments such as menstrual cramps and “hysteria.”
In the 18th century, hysteria slowly became associated with mechanisms in the brain rather than the uterus. Physician George Beard cataloged a 75-page list of possible symptoms of hysteria, claiming that almost any ailment could fit the diagnosis.
The mid-19th century saw a rise in the women’s health movement which focused on improving women’s access to education, medical care, and contraception. Gynecology was becoming a more popular area of study within the medical field and much of the focus centered around “reducing women to their sex organs.”
In the late 19th century, the development of antiseptic techniques and anesthesia made surgery safer and more accessible, including for women during childbirth. In addition, the use of the microscope and the development of germ theory led to a greater understanding of infectious diseases, which helped to improve public health practices.
There was substantial progress towards improving women’s access to medical education in the 19th century. Elizabeth Blackwell became the first woman doctor of medicine in modern times. She was the first woman to receive an M.D. degree from an American medical school and in 1875, she was appointed professor of gynecology at the London School of Medicine for Women. In her book “Pioneer Work in Opening the Medical Profession to Women“, she encouraged education for women in medicine.
Another 19th century physician who helped women become accepted as medical professionals was Marie Elizabeth Zakrzewska. The German-born American physician was the founder of the New England Hospital for Women and Children. She studied midwifery at the Charité Hospital in Berlin, one of the biggest university hospitals in Europe.
Mary Putnam Jacobi was another esteemed 19th century American medical physician, teacher, scientist, writer, and suffragist. She was the first woman to study medicine at the University of Paris, and disparaging anecdotal evidence and traditional approaches, she demanded rigorous scientific research on every question of the day. Her scientific rebuttal of the popular idea that menstruation made women unsuited to education was influential in the fight for women’s educational opportunities.
At the turn of the 20th century, women’s health continued to be subject to myths and misconceptions, with little scientific understanding of female physiology and reproductive health. Despite the advances of the women’s health pioneers in the 19th century, women were still largely excluded from medical education and were often seen as frail and prone to illness.
The first nursing schools, formed in the late 1800s, included both men and women but by the early 1900s, there was a push to professionalize the field, efforts that were often led by women active in the suffragette movement. Over the course of the 20th century, nursing became professionalized and a predominantly female field. As such, it has retained less status and lower pay than other male-dominated medical professions.
Some key statistics regarding women’s health from the year 1900 include:
- 30 percent of infants in America’s major cities died before their first birthdays.
- The average life expectancy for an American woman was 48.3 years (48.7 years if she was white and 33.2 years if she was Black).
- Infectious diseases, including pneumonia, influenza, tuberculosis, and syphilis, were the leading causes of death for men, women, and children.
- The maternal mortality rate was 6–9 deaths per 1,000 live births.
- Nearly all births (90 percent) took place at home. Some were unattended; others were attended by midwives or doctors who were often poorly trained.
- Only 10 percent of the nation’s physicians attended college.
- 6 percent of physicians were women.
Average life expectancy in 1900: white men 46.6 years, black men 32.5, white women 48.7, black women 33.5
During this decade, as women continued to advocate for greater access to healthcare and reproductive rights, women’s health received more attention when Dr. Rosalie Morton challenged the norm to deny medical women any active role in World War I efforts in July 1915. This led to the establishment of the American Women’s Hospitals committee — you can actually view a fascinating report from this organization from 1917 here.
In October 1916, Margaret Sanger opened one of the first birth control clinics in the United States in Brooklyn, New York. During this time both birth control and abortion were illegal although women still sought means to control unwanted pregnancies and visited the clinic to learn about birth control. The clinic was open for only ten days before being shut down. Despite being short-lived, America’s first birth control clinic provided educational resources to women in New York and raised awareness of the birth control movement in the US through media exposure.
In the United Kingdom, Marie Stopes was one of the pioneers in the field of family planning. She published her book “Wise Parenthood” in 1918, making it available to the general public and explaining how contraception worked. This book helped many women make their own decisions and control their own fertility.
In 1913, Dr. Albert Salomon, a German surgeon, x-rayed 3000 breast specimens obtained from the morgue and discovered microcalcifications associated with known breast cancer pathology. This was the first mammogram, offering a new tool for breast cancer screening.
The most important development relating to women’s health in the 1920s had nothing directly to do with health at all: the 19th amendment, granting women the right to vote, was certified on August 26, 1920. One of the leaders of the women’s suffrage movement was nurse activist Lillian Wald, whose first legislative victory after winning the vote was the creation of the Sheppard-Towner Act to provide health education and home nursing to poor and rural mothers and babies. (Unfortunately, Congress cancelled the program in 1929.)
Dr. George Papanicolaou, known as Dr. Pap, discovered that he could make cytological examinations of vaginal smears of animals to study their sex cycle and in the 1920s he began to use the same technique on his wife Mary. Through his examinations, he was able to detect precancerous cells, leading to the development of the Pap smear, a screening test for cervical cancer.
In 1921, a young surgeon named Frederick Banting figured out how to remove insulin from a dog’s pancreas; with their murky liquid they kept another dog with diabetes alive for 70 days. After refining the process, in January 1922 a 14-year-old dying from diabetes in a Toronto hospital became the first person to receive an injection of insulin, leading to a lifesaving treatment for this women’s health issue.
During the Great Depression of the 1930s, many women faced economic hardship; because women’s health depends directly on living and working conditions, the poor housing, unhealthy diets, long hours and lack of child care led to ill health.
This decade also saw the development of the first oral contraceptive, Enovid, a mix of the hormones progesterone and estrogen, although it would not be widely available until the 1960s. Diaphragms, also known as “womb veils,” became a popular method of birth control in 1938.
After the criminalization of abortion, the practice went underground, resulting in high death tolls. In 1930, according to the Guttmacher Institute, illegal abortion was the cause of death for almost one out of every five recorded maternal deaths that year, though there were likely many more unrecorded mortalities.
The 1940s saw significant advances in medical research and technology, with the development of antibiotics and the first successful blood transfusion. Women also played a critical role in healthcare during World War II, serving as nurses and healthcare workers.
In 1942, the Birth Control Federation of America organization changed its name to Planned Parenthood Federation of America and in 1941 the National Council of Negro Women becomes the first national women’s organization to officially endorse the practice of contraception.
Various forms of tampons, although available in the 1920s and 1930s, were not widely used until the 1940s.
Cultural ideas about the previously taboo topic of infertility were also changing. There were new medical treatments including the examination of women’s fallopian tubes and ovaries and testing hormone levels. Because many patients still struggled to get pregnant, medical providers and psychological researchers contributed theories about mental causes of infertility. Some theorized that women’s unconscious hatred of their husbands or fear of sex might trigger spasms in the vaginal muscles or fallopian tubes, making conception impossible.
In the 1950s there were significant advances in birth control; Dr. Margaret Sanger, now in her 80s, organized support for research to create the first birth control pill in 1950. In 1953 biologists John Rock and Gregory Pincus teamed up to develop the birth control pill, funded by two million dollars from philanthropist Katharine Dexter McCormick. Because state laws prohibiting contraceptive research made it extremely difficult to set up trials, Rock and Pincus controversially first tested the drug on male and female patients at the Worcester State Psychiatric Hospital in Massachusetts and then on poor women in Puerto Rico.
In 1900, 90 percent of all births occurred at home, whereas by 1950, 90 percent of all births occurred in the hospital. Surgical procedures such as cesarean births and episiotomies also became far safer.
Throughout most of history, medical research and practice had been based on a male-centric view of science. Then in the 1950s and 1960s, thousands of pregnant women took the experimental drug thalidomide and gave birth to babies with horrible limb deformities. This caused researchers to adopt an even more cautious approach to female participation in clinical trials.
The 1960s were marked by the growth of the women’s liberation movement, which challenged traditional gender roles and advocated for greater access to reproductive healthcare. In 1965, the Supreme Court ruled in Griswold v. Connecticut that married couples have a Constitutional right to privacy that includes the right to use birth control; millions of unmarried women, however, were still denied birth control. Conversely in 1969 medical journalist Barbara Seaman’s book, “The Doctor’s Case Against the Pill,” laid out testimony and research showing that the high doses of estrogen in the early Pill put women at risk of blood clots, heart attacks, strokes, and cancer.
In 1965 the U.S. Agency for International Development’s population and reproductive health program began with the goal of reducing birth rates in developing countries.
The FDA approved intrauterine devices (IUDs) in 1968, bringing early versions called the Lippes Loop and Copper 7 to market. Within a few years, more than 10 percent of U.S. women using contraception had IUDs.
This decade also saw the establishment of the National Institute of Child Health and Human Development, founded in 1962, to investigate human development throughout the entire life process, with a focus on understanding disabilities and important events that occur during pregnancy.
In the 1970s, the women’s health movement gained momentum, with the establishment of women’s health clinics and the development of new treatments for breast cancer and other conditions.
The ’70s also highlighted important issues around race and gender in healthcare. Toni Cade Bambara’s essay “The Pill: Genocide or Liberation?” was released in 1970 and called attention to controversies with contraception in communities of color. The Indian Health Services sterilized thousands of Native American women in the 1970s, contributing to a significant drop in Native women’s average birth rate. Between 1972–1973 the coercive sterilization of African American sisters Minnie Lee and Mary Alice Relf, aged 14 and 12, sparked a lawsuit and a national campaign to end sterilization abuse. The Committee to End Sterilization Abuse (CESA) was founded a year later to combat coercive sterilization of women of color.
In 1970, Congress passed Title X of the Public Health Service Act, creating a federal grant program dedicated solely to providing low-income individuals with comprehensive family planning services, including contraceptives, and related preventive health services. In 1972 the Supreme Court in Eisenstadt v. Baird legalized birth control for unmarried people. It wasn’t until 1978 that the Supreme Court in Carey v. Population Services held that states cannot constitutionally place any restrictions on the advertisement, sale, and distribution of contraceptives to individuals of any age.
The FDA suspended the sale of the Dalkon Shield IUD after four years on the market in 1974, after multiple users developed severe infections and at least seven women died. Although other IUD designs were not implicated, in subsequent years most IUDs were slowly taken off the U.S. market due to the escalating costs of lawsuits.
In 1975 Loretta Lynn released her controversial country music hit “The Pill.”
During the 1980s, a boom in women’s magazines expanded and reshaped the market. The magazines provided a space for women to explore ideas and concerns about their bodies within a community of others with similar worries searching for the same information.
In 1980 the Surgeon General’s Report on Women and Smoking documented the growing number of women smokers and warned that if the trend was not reversed, smoking related diseases in women will reach epidemic proportions. In 1987 lung cancer surpassed breast cancer as the leading cause of cancer death in women.
Throughout the 1980s, there were a series of regulatory advancements to protect and serve women’s health. This included the establishment of the National Black Women’s Health project in 1981 designed to improve the health of Black women by providing wellness education and services, health information, and advocacy; consolidated programs for to support maternal, infant, child, and adolescent health via the Maternal and Child Health Services Block Grants in 1981; the establishment of the Public Health Service’s Task Force on Women’s Health in 1983; the National Institutes of Health established a policy to increase participation in women’s health research in 1986; and in 1989 Women’s Health Equity Act introduced to call for increased focus on women’s health through research, services, and prevention activities.
Launched in 1983, the Komen Race for the Cure to raise money for breast cancer research, education, screening and treatment programs began as a single 5k event in Dallas, Texas. Additional developments in breast cancer treatment occurred in 1985 when the lumpectomy was declared just as effective as mastectomies when combined with radiation therapy.
In the 1990s the world seemed to finally recognize that women’s health is more than just breast cancer and reproductive health care, and that we need to evaluate other diseases to which women are prone through a gender-specific lens. In 1990 Dr. Antonia Novello was confirmed as the First Woman Surgeon General of the United States, and she was also the first minority to be appointed to this position. In 1991, the Office on Women’s Health was established within the US Department of Health and Human Services to better coordinate women’s health activities, programs, and research.
Between 1991 and 1992, there were advances in birth control including the FDA approval of two long acting reversible contraception (LARC), Norplant and Depo Provera. LARCs were lauded because they are highly effective in preventing pregnancy, last for an extended period of time, and work without user action. However, there was controversy because, similar to involuntary sterilization, doctors, judges and policymakers have at times coercively used LARCs against people of color, low-income people, immigrants, and disabled people.
Five important laws were introduced between 1992 and 1994:
- Mammography Quality Standards Act to set national standards and a uniform system of quality control for mammography clinics across the country.
- Infertility Prevention Act to provide additional funds to establish screening, treatment, counseling, and follow-up services for sexually transmitted diseases that could lead to infertility in women if left undiagnosed and/or untreated.
- NIH Revitalization Act to require the inclusion of women and members of racial and ethnic minority groups in all federally-funded population-based studies.
- Family and Medical Leave Act to provide employees with the right to take up to 12 weeks of unpaid leave for family or medical reasons without the threat of having to leave their job permanently.
- Violence Against Women Act to define new federal crimes of violence against women and enhanced penalties to combat sexual assault and domestic violence.
In 1994 the DNA sequences of two genetic mutations linked to breast cancer were discovered, BRCA1 and BRCA2, leading to the possibility of genetic testing for high-risk women.
The first guidelines for including women’s health issues in medical school curriculum was published shockingly recently, in 1996.
The 2000s saw the development of new vaccines for HPV and shingles, as well as new treatments for osteoporosis and other conditions. This decade also saw increased attention to the issue of maternal health, with the establishment of the Millennium Development Goals, which aimed to reduce maternal mortality rates worldwide.
Rapid expansion in availability, safety, and effectiveness led to the FDA approving new birth control options: the IUD called Mirena in 2000, the hormonal patch Ortho Evra in 2001, the vaginal ring Nuvaring in 2001, a method of transcervical female sterilization called Essure in 2002, a single-rod implant named Implanon in 2006, and an improved female condom FC2 in 2009. These safe, convenient, reversible, and highly effective contraceptives allowed women to plan with high confidence when and when not to get pregnant.
In 2006 the FDA approved over-the-counter sales of the emergency contraception Plan B for people aged 18 and over.
During this decade the CDC released the findings of an STD study that estimated one in four young women between the ages of 14 and 19 in the United States was infected with at least one of the most common sexually transmitted diseases (human papillomavirus, chlamydia, herpes simplex virus type 2, or trichomoniasis). The study was the first to examine the national prevalence of common STDs among adolescent women in the United States.
The 2010s were marked by the development of new screening technologies, treatments for breast cancer and other conditions, and expanded access to reproductive healthcare, although towards the tail end of the decade some of these advances retracted as the political climate shifted.
In 2010, the Affordable Care Act was passed, requiring insurance plans to cover preventive services such as mammograms and Pap smears without cost-sharing.
In 2012, the FDA approved the first extended cycle oral contraceptive designed to reduce the frequency of menstrual periods, offering a new option for women who experience heavy or painful periods.
The use of telemedicine also expanded during this decade, with more healthcare providers offering virtual consultations and remote monitoring services. This decade also saw the approval of the first drug for the treatment of postpartum depression.
The COVID-19 pandemic in the early part of the decade had an obvious and significant impact on women’s health, with disruptions to routine healthcare services, increased rates of mental health issues, and concerns about the safety and efficacy of vaccines for pregnant and breastfeeding women. However, the pandemic also spurred new developments in telemedicine and virtual care, allowing for more convenient and accessible healthcare services for women.
Recent years have also seen increased attention to women’s reproductive health, with new research on the safety and effectiveness of long-acting reversible contraceptives and expanded access to over-the-counter emergency contraception.
The issue of maternal mortality continued to be a concern, with efforts to reduce maternal mortality rates through improved access to prenatal care and childbirth education. The maternal mortality rate increased during the COVID pandemic from 20.1 deaths per 100,000 live births in 2019 to 23.8 in 2020. In 2021, the Black Maternal Health Momnibus Act was introduced in the US Congress, which includes a comprehensive set of policies aimed at improving maternal health outcomes for Black women.
In 2022 the U.S. Supreme Court, in Dobbs v. Jackson Women’s Health Organization, overturned Roe v. Wade (1973) and Planned Parenthood v. Casey (1992), returning abortion rights to the states.
Women’s health has come a long way since the days of “female hysteria” being blamed for many health conditions, with new technologies and treatments offering new options for women, expanded access to healthcare services, and increased attention to the unique healthcare needs of women. However, there are still many challenges to be addressed, including the persistent disparities in healthcare access and outcomes for women from marginalized communities. By continuing to invest in research, education, and healthcare policy, we work towards a future where all women have access to high-quality, comprehensive healthcare services.