Woman's health

(violence, menopause ,Brest Cancer,

and Reproductive health)
Physical examination and history taking .
Registered midwife Areej Faeq Abu-sharar
Major /Head of Midwifery Department at
Royall medical services Faculty of nursing
 The lecture objectives
 At the end of this lecture the students will be:
 Identify the meaning of women health .
 Define the violence, causes, risk factors.
 Define the menopause period, signs and symptoms and risk factors.
 Define the breast cancer, signs and symptoms and risk factors.
 Explain the nursing role(physical assessment) among these topics.
 Explain health promotion strategies.
 Women's health

 refers to the health of women, which differs from that of men in

many unique ways. Women's health is an example of population
health, where health is defined by the World Health Organization
as "a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity". Often treated as
simply women's reproductive health.
 Woman's health Key facts
According to WHO

 Worldwide, women live an average four years longer than men.

 In 2011, women's life expectancy at birth was more than 80 years in 46
countries, but only 58 years in the WHO African Region.
 Girls are far more likely than boys to suffer sexual abuse.
 Road traffic injuries are the leading cause of death among adolescent girls in
high- and upper-middle-income countries.
 Almost all (99%) of the approximate 287 000 maternal deaths every year occur in
developing countries.
 Globally, cardiovascular disease, often thought to be a "male" problem, is the
number one killer of women.
 Breast cancer is the leading cancer killer among women aged 20–59 years
worldwide.
 Infancy and childhood (0-9 years)

 Both death rates and the causes of death are similar for
boys and girls during infancy and childhood.
 Prematurity, birth asphyxia and infections are the main
causes of death during the first month of life, which is the
time of life when the risk of death is the highest.
 Pneumonia, prematurity, birth asphyxia and diarrhoea are
the main causes of death during the first five years of life.
Malnutrition is a major contributing factor in 45% of deaths
in children aged less than 5 years
 Adolescent girls (10-19 years)
 Mental health and injuries:
• Self-inflicted injuries, road traffic injuries and drowning are among the main
causes of death worldwide in adolescent girls.
• Depressive disorders and – in adolescents aged 15-19 years, schizophrenia –
are leading causes of ill health.
 HIV/AIDS
• In 2011, about 820 000 women and men aged 15-24 were newly infected with
HIV in low- and middle-income countries; more than 60% of them were
women.
• Globally, adolescent girls and young women (15-24 years) are twice as likely
to be at risk of HIV infection compared to boys and young men in the same
age group. This higher risk of HIV is associated with unsafe and often
unwanted and forced sexual activity.
Adolescent girls (10-19 years) /Adolescent
pregnancy
 Early childbearing increases risks for both mothers and their new-borns.
 progress has been made in reducing the birth rate among adolescents.
 more than 15 million of the 135 million live births worldwide are among
girls aged 15-19 years.
 Pregnant adolescents are more likely than adults to have unsafe
abortions.
 An estimated three million unsafe abortions occur globally every year
among girls aged 15-19 years.
 Unsafe abortions contribute substantially to lasting health problems
and maternal deaths.
 Complications from pregnancy and childbirth are an important cause of
death among girls aged 15–19 in low- and middle-income countries.
Adolescent girls (10-19 years) Con,

 Substance use
• Adolescent girls are increasingly using tobacco and alcohol, which risks compromising
their health, particularly in later life.
• In some places girls are using tobacco and alcohol nearly as much as boys
• in the WHO Region of the Americas, 23% of boys and 21% of girls aged 13-15 reported that
they used tobacco in the previous month.

 Nutrition
• In 21 out of 41 countries with data, more than one third of girls aged 15-19 years
are anaemic.
• Anaemia, most commonly iron-deficiency anaemia, increases the risk of
haemorrhage and sepsis during childbirth.
• Anaema causes cognitive and physical deficits in young children and reduces
productivity in adults. Women and girls are most vulnerable to anaemia due to
insufficient iron in their diets, menstrual blood loss and periods of rapid growth
 Maternal health
 Maternal deaths are the second biggest killer of women of
reproductive age.
 Every year, approximately 287 000 women die due to
complications in pregnancy and childbirth, 99% of them
are in developing countries.
 Despite the increase in contraceptive use over the past 30
years, many women in all regions still do not have access
to modern contraceptive methods.
 For example, in sub-Saharan Africa, one in four women
who wish to delay or stop childbearing does not use any
family planning method
 Tuberculosis

 Tuberculosisis often linked to HIV infection

and is among the five leading causes of
death, in low-income countries, among
women of reproductive age and among
adult women aged 20–59 years.
 Injuries
 Both self-inflicted injuries and road injuries figure
among the top 10 causes of death among adult
women (20-59 years) globally.
 In the WHO South-East Asia Region, burns are
among the top 10 leading causes of death among
women aged 15–44.
 Women suffer significantly more fire-related
injuries and deaths than men, due to cooking
accidents or as the result of intimate partner and
family violence.
 Cervical cancer

 Cervical cancer is the second most common type

of cancer in women worldwide, with all cases
linked to a sexually transmitted genital infection
with the human papillomavirus (HPV).
 Due to poor access to screening and treatment
services, more than 90% of deaths occur in women
living in low- and middle- income countries.
 Violence

 Violence against women is widespread around the world.

 Recent figures indicate that 35% of women worldwide have experienced
either intimate partner violence or non-partner sexual violence in their
lifetime.
 On average, 30% of women who have been in a relationship experienced
some form of physical or sexual violence by their partner.
 Globally, as many as 38% of murders of women are committed by an
intimate partner.
 Women who have been physically or sexually abused have higher rates of
mental ill-health, unintended pregnancies, abortions and miscarriages than
non-abused women.
 Violence
 Women exposed to partner violence are twice as likely to be depressed.
 almost twice as likely to have alcohol use disorders, and 1.5 times more
likely to have HIV or another sexually transmitted infection.
 42% of them have experienced injuries as a result.
 Increasingly in many conflicts, sexual violence is also used as a tactic of
war.
 Depression and suicide
 Women are more susceptible to depression and anxiety than men.
 Depression is the leading cause of disease burden for women in both high-income
and low- and middle-income countries.
 Depression following childbirth, affects 20% of mothers in low- and lower-middle-
income countries, which is even higher than previous reports from high-income
countries.
 Every year, an estimated 800 000 people die from suicide globally, the majority
being men.
 However, there are exceptions, for instance in China where the suicide rate in rural
areas is higher among women than men.
 Attempted suicide, which exceeds suicide by up to 20 times, is generally more
frequent among women than men and causes an unrecognized burden of disability.
 At the same time, attempted suicide is an important risk factor for death from
suicide and shows the need for appropriate health services for this group.
 Disabilities
 Disability – which affects 15% of the world’s
population – is more common among women than
men.
 Women with disabilities have poorer health
outcomes, lower education achievements, less
economic participation and higher rates of
poverty than women without disabilities.
 Adult women with disabilities are at least 1.5
times more likely to be a victim of violence than
those without a disability.
Chronic obstructive pulmonary disease
(COPD)
 Tobacco use and the burning of solid fuels for
cooking are the primary risk factors for chronic
obstructive pulmonary disease – a life-threatening
lung disease – in women.
 One third of all of the COPD deaths and disease
burden in women is caused by exposure to indoor
smoke from cooking with open fires or inefficient
stoves.
 Older women (60 years and over)

 Globally, men slightly outnumber women .

 Women tend to live longer than men, they represent a higher
proportion
 Older adults: 54% of people 60 years of age and older are women.
 Proportion that rises to almost 60% at age 75 and older, and to
70% at age 90 and older.
 No communicable diseases
 No communicable diseases, particularly cardiovascular
diseases and cancers, are the biggest causes of death
among older women. regardless of the level of economic
development of the country in which they live.
 Cardiovascular diseases account for 46% of older women’s
deaths globally,
 14% of deaths are caused by cancers – mainly cancers of
the lung, breast, colon and stomach.
 Chronic respiratory conditions, mainly COPD, cause
another 9% of older women’s deaths.
 Many of the health problems faced by women in older age
are the result of exposure to risk factors in adolescence
and adulthood, such as smoking, sedentary lifestyles and
unhealthy diets.
 Disability
Other health problems experienced by older women that:
 decrease physical and cognitive functioning include poor vision (including
cataracts), hearing loss, arthritis, depression and dementia.
 In many countries women are less likely to receive treatment or supportive aids
than men.
Older women experience more disability than men, reflecting
broader determinants of health such as:
 inequities in norms and policies that disadvantage women.
 changing household structures.
 higher rates of unpaid or informal sector work.
These factors combine to increase vulnerabilities, and reduce access to
needed and effective health services.
Life-Cycle Approach to Reproductive Health
Domestic Violence, Causes, Risk factors
and Assessment
 Domestic And Family Violence is an abuse of power ,mainly (but
not only) by men against women in a relationship or after
separation. It occurs when one partner attempts to physically
and/or psychologically dominate and control the other.
 Type of Domestic Violence?

 Physical abuse: Kicking, slapping, hitting, punching,

pushing, pulling, choking and property damage.
 Emotional abuse: Jealously , anger, intimidation, controlling,
neglect, humiliation, threats, isolation and verbal abuse.
 Social Abuse: Being stopped from meeting or seeing friends or
family, not allowed to leave the home.
 Sexual abuse: Forcing sexual acts, rape and having sex
without wanting to.
 Economic Abuse: Controlling access to money and other
resources, forced to live without money.
 Global Database on Violence against Women
in Jordan 2011
Prevalence Data on Different Forms of Violence against
Women:
 Lifetime Physical and/or Sexual Intimate Partner Violence
:24 %
 Physical and/or Sexual Intimate Partner Violence : 14 %
 Lifetime Non-Partner Sexual Violence :8 %
Menopause Definition According to
International Menopause Society
Menopause (natural menopause) – the term natural
menopause is defined as the permanent cessation of
menstruation resulting from the loss of ovarian follicular
activity. Natural menopause is recognized to have occurred
after 12 consecutive months of amenorrhea, for which there
is no other obvious pathological or physiological cause.
Menopause occurs with the final menstrual period (FMP)
which is known with certainty only in retrospect a year or
more after the event. [Source: WHO]
 World Menopause Awareness Day – 18th October 2016
Menopausal Symptoms
 Brest Cancer

According to the latest issued statistics (2011 National Cancer Registry

Report):
 Cancer is the second leading cause of death in Jordan after heart
disease.
 The total of new cancer cases registered in Jordan in 2011 was 6,971.
of them, 4,675 were Jordanian and 2,296 were non-Jordanian.
 In 2011, the number of new cancer cases among Jordanians decreased
by 246 cases, compared to 4,921 cases in 2010.
 The top three most common cancers among males in Jordan are: colo-
rectal (colon) cancer, lung cancer and U Bladder.
 The top three most common cancers among females in Jordan are:
breast cancer, colo-rectal (colon) cancer and thyroid.
Definition of Breast Cancer, Signs and
Symptoms and Risk Factors
What is breast cancer?
Breast cancer starts when cells in the breast begin to grow out of control. These
cells usually form a tumor that can often be seen on an x-ray or felt as a lump.
The tumor is malignant (cancerous) if the cells can grow into (invade)
surrounding tissues or spread (metastasize) to distant areas of the body. Breast
cancer occurs almost entirely in women, but men can get it, too.
Breast Mammogram & X -Ray

Non Malignant Malignant

 Health Promotion

 Family Planning and Reproductive Life Plan

 Weight Status
 Physical Activity
 Nutrient Intake
 Folate
 Substance or Alcohol use
 Sexually Transmitted Infections (STDs)
 Depression
 Health screening
Screening test 18–39 Ages 40–49 Ages 50–64 Ages 65 and older

Bone mineral if she is at Get this test

density test risk of at least once
(osteoporosis osteoporosis. at age 65 or
screening) older.

Breast cancer One each two One each two Once every
screening years years years
(mammogram)

Cervical one Time One each 5 One each two One every
cancer years ears years
screening
(Pap test
 Rferences
 Physical Activity Guidelines Advisory Committee. Physical
 Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S.
 Department of Health and Human Services, 2008.
 U.S. Department of Agriculture and U.S. Department of Health and Human
 Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010.
 Centers for Disease Control. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other
neural tube defects. MMWR 1992;41(No. RR-14);001
 www.who.int/entity/reproductivehealth/publications/violence/en/ - 42k
 www.who.int/entity/mediacentre/factsheets/fs239/en/ - 45k
 https://www.google.jo/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#
 Department of Statistics (2015). Jordan in Numbers 2015, Amman, Jordan
 Government of Jordan (2015). Jordan Position Paper on the Beijing +20 review and appraisal process. Amman, Jordan.
 Jordanian National Commission for Women. Jordan’s Fifth National Periodic Report to the CEDAW Committee – Summary.
Amman, Jordan
 Al Nsour, M. Al Kayyali, G. & Naffa, S. (2013). Overweight and obesity among Jordanian women and their social determinants.
EMHJ, 19(12), 1014-1019
 WHO (2007). Cross cutting gender issues in women’s health in the Eastern Mediterranean Region. Cairo, Egypt
 Department of Statistics (2012). DHS, Amman, Jordan
 The Demographic Opportunity in Jordan, A Policy Document. HPC Oct. 2009
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