Book Review

Taking Our Pulse: The health of America's women

N Engl J Med 1998; 338:1320April 30, 1998

Article

Taking Our Pulse: The health of America's women
By Iris F. Litt. 349 pp. Stanford, Calif., Stanford University Press, 1997. $45 (cloth); $19.95 (paper). ISBN: 0-8047-2828-3 (cloth); 0-8047-3137-3 (paper).

One consequence of the recent focus on women's health in the United States has been the widening of the definition of health to include social interactions, domestic issues, mental health, and reproductive function. Traditionally, women's-health research has dealt with either sex differences in specific conditions (e.g., heart disease) or the management of diseases that are unique to or more prevalent among women (e.g., breast cancer). More recently, clinicians wanting to address women's health needs fully have learned to assess risk factors for domestic violence, anxiety, and depression and to be proactive about reproductive health by, for example, improving the availability of emergency-contraceptive pills. The challenges facing women and those caring for them are the focus of Dr. Litt's comprehensive update on the health of America's women.

Written for students of medicine, nursing, nutrition, and women's studies, this book reviews the current knowledge of women's health. The first four chapters detail the four major life stages of women: adolescence, young adulthood, the perimenopausal years, and the older years. Chapters 5 through 10 discuss such health issues as pregnancy and its prevention, mental health, and violence against women through all life stages. The last four chapters address aspects of the medical care system of particular relevance to women.

The most insightful discussions in this book relate to adolescents. Litt's description of pubertal changes emphasizes the preparation necessary for developing independence. During adolescence, the main health preoccupations of young women relate to their attractiveness and their normality. For many girls, the stage is being set for mental-health problems later in life. Girls experience a higher incidence of sexual abuse than boys and are exposed to a school environment in which boys receive more encouragement. These issues notwithstanding, the greatest current threat to the long-term health of girls comes from increasing cigarette use.

The sections on reproductive health are particularly instructive. Litt draws on her extensive experience as an academic pediatrician to provide practical vignettes and clinical pearls about such issues as contraception and sexuality. The rate of adolescent pregnancy in the United States is the highest in the entire industrialized world. Remarkable accounts of teenage girls who fail to become pregnant after two or three instances of unprotected sex, become preoccupied with their reproductive ability, and then embark on a path to prove that they can conceive challenge our preconceptions of adolescent pregnancy and its prevention.

Litt argues effectively for more health care expenditures in the area of prevention. The life expectancy of women exceeds that of men by about seven years, yet little emphasis has been placed on prevention and the fears of older women, including the fear of dependency and of the loss of mobility. More than 60 percent of the deaths from Alzheimer's disease occur in women, and recent studies suggest estrogen levels may have a role.

As a woman in the “paid labor force,” I was particularly struck by Litt's observations of her own experiences. She notes, “The message has become more subtle, but it can still be heard all around us: `Venture into a man's world and you will be punished,' or `Leave your children at home without you and they will suffer.'” Instead, Litt cites Elizabeth Blackwell, who believed that female physicians “should be the `connecting link' between science and the everyday life of women,” and laments that only one fifth of practicing physicians are women. She sidesteps the debate about whether there should be specific women's-health specialty programs and proposes an increase in the numbers of women in clinical practice and academic medicine. Women doctors have been shown to spend more time with their patients, engaging them in more discussion without interruption, but they are unable to be role models in most medical schools because they are clustered in nontenured positions. As an example of how sex inequities can be remedied in academia, Litt (a journal editor herself) champions the cause of “blind” review of manuscripts to level the playing field for male and female researchers. When more women like Litt become successful in academic medicine, they will have the ability to improve the health of women in the United States and the careers of women in medicine.

Lori A. Bastian, M.D., M.P.H.
Duke University Medical Center, Durham, NC 27710