REFLEXIONES DE LA DIRECTORA FROM THE DIRECTOR
A new agenda for women's health in the Americas
Carissa F. Etienne
Director, Pan American Sanitary Bureau/Pan American Health Organization, Regional Office of the World Health Organization for the Americas, Washington, D.C., United States of America
There is no doubt that women in the Americas and worldwide have gained ground over the past few decades in many spheres. Health is no exception. Notable gains include a significant decline in preventable deaths and increased life expectancy for women, wider access to contraceptives, improved fertility control, better prenatal care, and earlier detection of breast and cervical cancer. This epidemiological transition has been slow and complex, however, and progress has been uneven on many issues that affect women's health. The lack of disaggregated health data, for example, continues to conceal disparities in areas such as deaths from cardiovascular diseases, diabetes, and traffic accidents. At the same time, certain topics that were considered taboo have become more visible, such as domestic violence, femicide, and health care for women having abortions.
To realize the full potential of social, economic, scientific, and technological change to advance women's well-being, the Pan American Health Organization (PAHO) is calling on its Member States to jointly develop a new women's health agenda for the Americas. This initiative seeks to align health needs with policies-connecting a transitioning epidemiology that presents both old and new challenges with legal, technical, and budgetary frameworks-to achieve appropriate, comprehensive care for the health problems that most afflict women. In the majority of the Region's countries, care for these needs is currently fragmented and poorly coordinated, resulting in inefficient and often ineffective efforts as well as wasted resources. A prioritized agenda would make it possible to sort out the problems, assess their real magnitude, and develop research and healthcare strategies to solve them. Because the social determinants of health are a major part of this picture, developing this new agenda will require a broad, intersectoral, interdisciplinary debate among countries, stakeholders, and civil society.
This special issue of the Pan American Journal of Public Health is intended to contribute to this multisector debate and the process of building a new women's health agenda for the Americas. The articles, submitted in response to a call for contributions, reflect leading experts' perceptions of women's health progress and unmet health needs, with a view to shaping how these are addressed in the post-2015 sustainable development agenda. This special issue takes a cross-disciplinary approach, presenting scientific evidence and analysis in a wide range of areas that affect women's health: maternal death, severe maternal morbidity (maternal near-miss), femicide, physical and sexual violence, regional and ethnic inequalities, quality of care, mental health, traditional midwives, HIV, aging, adolescence, suicide, obesity, breast cancer, and alcohol use.
In addition to contributing scientific evidence on these issues, this special issue also provides a basis for the PAHO women's health agenda initiative to promote future scientific research by analyzing co-authorship networks to identify researchers and research communities in women's health and sexual and reproductive health. Going forward, the initiative will also try to identify gaps in current research on these subjects as the basis for developing a prioritized research agenda. Part of this process will involve "listening to those in the field": PAHO's Latin American Center for Perinatology and Women's and Reproductive Health (CLAP/WR) plans to conduct a study based on the Delphi methodology to identify research priorities and needs in the delivery of services for women's care, as they are perceived by service providers and users in the Region. Prospective participants include representatives of ministries of health, health service providers, academia, and, importantly, civil society.
Evaluations following the 1994 International Conference on Population and Development in Cairo and recent assessments of the achievement of the Millennium Development Goals have shown both progress and persisting inequalities in women's health status overall and in women's access to quality health services in particular. For the post-2015 era, PAHO proposes a joint effort to break traditional paradigms and build a new women's health agenda that takes a comprehensive approach based on human rights and social determinants, and in which the health sector coordinates with other co-responsible sectors of government and society. The expected result is policies, strategies, and actions that respond more effectively and justly to the needs and rights of women. Only by guaranteeing women's human, health, and reproductive rights can we ensure that women and their families develop to their full potential, contribute fully to their societies, and live richer, fuller lives.
The Pan American Journal of Public Health recognizes with appreciation the contributions of the Guest Editors Leticia Artiles (Universidad de Ciencias Médicas de La Habana, Cuba); Francisco Becerra-Posada (Pan American Health Organization/World Health Organization, Washington, D.C., United States of America); Aníbal Faundes (Universidade Estadual de Campinas, São Paulo, Brasil); Suzanne Jacob Serruya (Centro Latinoamericano de Perinatología, Salud de la Mujer y Reproductiva, Organización Panamericana de la Salud/Organización Mundial de la Salud, Montevideo, Uruguay); Alejandra López Gómez (Instituto de Psicología de la Salud, Facultad de Psicología, Universidad de la República, Montevideo, Uruguay), and Raffaela Schiavon (International Pregnancy Advisory Services, Mexico D.F., Mexico).
Their contributions and dedication to this special issue on Women's Health in the Americas were extraordinary and helped make the manuscripts more interesting, more accurate, and more useful to our readers and all others who work to improve the health of the peoples of the Americas.