The US Food and Drug Administration, or FDA, published the “Guideline for the Study and Evaluation of Gender Differences in the Clinical Evaluation of Drugs,” henceforth “Study of Gender Differences,” in July 1993. The document defined acceptable practices for investigators studying new drugs. Prior to 1993, investigators excluded most women from clinical trials because in 1977, the FDA recommended that anyone who could possibly become pregnant be excluded from early phase drug research to minimize risk to a potential fetus. In 1997, the FDA reversed that guidance, advising investigators to include women in early phase drug research, a decision that reflected changing views about a woman’s ability to decide whether to participate in drug trials and furthering research on the effects of drugs on women.
In the 1973 case of Roe v. Wade, the US Supreme Court ruled that laws banning abortion violated the US Constitution. The Texas abortion laws, articles 1191–1194, and 1196 of the Texas penal code, made abortion illegal and criminalized those who performed or facilitated the procedure. Prior to Roe v. Wade, most states heavily regulated or banned abortions. The US Supreme Court decision in Roe v. Wade secured women's rights to terminate pregnancies for any reasons within the first trimester of pregnancy. It also sparked legal discussions of abortion, fetus viability and personhood, and the trimester framework, setting a landmark precedent for future cases including Webster v. Reproductive Health Services (1989), Planned Parenthood v. Casey (1992), and Stenberg v. Carhart (2000).
In 1901, physician William Henry Walling published the article, Some of the Uses of Electricity in Gynecology, in the January issue of the American Gynecological and Obstetrical Journal. Walling was a practicing gynecologist who studied electro-therapeutics, or the use of electricity in medicine for the treatment of disease, which was an emerging topic during the late 1800s. Walling stated that proper administration of electrical current to a woman’s vagina, uterus, bladder, or rectum could be therapeutic for gynecological diseases. He provides scientific explanations for some of his claims, but not for all. The article provides readers of the twenty-first century with context and historical examples of electrotherapy in women’s health, of what physicians understood about female reproductive anatomy, and of the standard of care in gynecology during the turn of the twentieth century.
In 1930, physician Joseph Colt Bloodgood founded the Amanda Sims Memorial Fund, or the ASMF, a United States cancer awareness organization that focused on spreading information about ways to detect and prevent cervical cancer in women, in Baltimore, Maryland. In partnership with nurse Florence Serpell Deakins Becker, Bloodgood promoted awareness of the early symptoms of cervical cancer among women and advocated for regular pelvic exams. The ASMF partnered with numerous women’s organizations throughout the United States, providing educational information to women of varying backgrounds. Though the ASMF existed for only five years, it was one of the first organizations to directly reach out to women to explain the importance of regular pelvic exams and early detection of cervical cancer, creating a platform for later organizations to continue that mission.
In Stuart v. Camnitz, the United States Court of Appeals for the Fourth Circuit affirmed the decision of a North Carolina District Court that declared a controversial ultrasound mandate for abortions unconstitutional in 2014. The ultrasound mandate was a part of the Woman’s Right to Know Act introduced in North Carolina in 2011, which placed several restrictions on abortion care providers in the state. If enforced, the ultrasound mandate would have required physicians to perform an ultrasound on every patient before an abortion and simultaneously describe the resulting image of the fetus regardless of whether the woman wanted to hear the description. The District Court ruled the mandate an unconstitutional violation of physicians’ free speech rights. The Fourth Circuit Court’s decision to affirm the District Court’s ruling established that the state could not compel healthcare providers to recite what the court called state ideology to patients against their medical judgment, which broke with precedent set by prior rulings by the Fifth and Eighth Circuit Courts in similar cases.
On 5 April 2018, the documentary Period. End of Sentence. premiered at the Cleveland International Film Festival in Cleveland, Ohio. In the documentary, Rayka Zehtabchi, the director of the film, documents the stigma surrounding menstruation in India and follows a group of women in Kathikhera, a rural village in the Hapur district of India, as they manufacture and distribute sanitary pads. A group of high school students at Oakwood High School in Los Angeles, California, raised money to produce the documentary after one student was inspired by her visit to the United Nations Commission on the Status of Women in New York City, New York, which focused on the stigma surrounding menstruation in low-income countries. Period. End of Sentence. draws attention to the obstacles impeding proper menstrual health management in low-income contexts by documenting the women of Kathikhera’s journey to manufacture and sell sanitary pads.
In July 2015, Marni Sommer and colleagues published “Comfortably, Safely, and Without Shame: Defining Menstrual Hygiene Management as a Public Health Issue,” hereafter “Defining MHM,” in American Journal of Public Health. The authors discuss that growing interest in the gender gap in education raised awareness about girls’ obstacles to managing menstruation, especially in low-income countries. Increased focus on MHM pushed menstruation to be redefined as a public issue rather than a private one. That transition made MHM the responsibility of national governments instead of just the responsibility of young girls, because it became more widely recognized that girls could only appropriately manage menstruation if they had access to the necessary resources through public infrastructure. “Defining MHM” outlines how defining MHM as a public health issue brought much-needed attention to the obstacles to MHM young girls face and emphasizes that other underrepresented public health issues could use similar tactics as the MHM movement to gain global attention and funding.
The North Carolina state legislature passed The Woman’s Right to Know Act in 2011, which places several restrictions on abortion care in the state. The Woman’s Right to Know Act, or the Act, imposes informed consent requirements that physicians must fulfill before performing an abortion as well as a twenty-four hour waiting period between counseling and the procedure for people seeking abortion, with exceptions for cases of medical emergency. Then-governor of North Carolina Beverly Perdue initially vetoed House Bill 854, which contained the Act, but the state legislature overrode her veto to pass the bill. In response to a lawsuit that the American Civil Liberties Union, or ACLU, and other organizations filed in 2011, a US district court judge blocked the law’s ultrasound mandate from going into effect and a later court case determined that the mandate was illegal. With the passage of the Act in North Carolina, the state passed several abortion regulations and mandated that abortion providers must inform women of specific details about their pregnancy before performing the abortion procedure.
In 1904, physician William Henry Walling published Sexology, a family medicine reference book. In his book, Walling proposed that his guidance would help people who were married or single and young or old, as well as anyone who wanted to conform to, what he claims are, gender expectations. Sexology discusses issues such as masturbation, abortion, pregnancy, labor, and marriage. Despite Walling’s limited scientific explanations and evidence for his medical claims, the Puritan Publishing Company printed and distributed the book, which received many positive reviews and endorsements from other physicians, college presidents, politicians, and religious leaders. However, in the twenty-first century, people may consider many of Walling’s claims to be sexist and oppressive toward women. Sexology provides readers with examples of historical medical misconceptions of male and female anatomy and provides context for the logic of reproductive medicine at the turn of the twentieth century.
Carol Downer was a reproductive health and abortion rights activist in the twentieth and twenty-first centuries in the US and other countries. During the late 1960s, many women reported knowing little about female anatomy and receiving little information from their physicians. Downer advocated for women’s reproductive anatomy education and encouraged women to not rely on the intervention of a medical doctor for all reproductive issues. Downer demonstrated how to perform a vaginal self-examination to many women and taught women around the world how to provide safer in-home abortions when abortions were illegal. Downer helped start clinics throughout California which provided some of the first legal abortions in the US. With her reproductive health activism, Downer spread reproductive health self-help tactics throughout the US and the world, thereby improving women’s access to health information.