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Championing Women's Health as Female Leaders Reach New Heights

      On January 20, 2021, Kamala Devi Harris became the first woman and person of color to hold the office of the United States Vice President. Days later on January 26, 2021, Janet Louise Yellen was sworn in as the first woman to serve as the Secretary of the Treasury of the United States. And the Biden Administration has made historic nominations as well: Deb Haaland, first female Native American woman nominated for Secretary of the Interior and Rachel Levine, the first transgender woman to be nominated for Assistant Health and Human Services Secretary. What's more is that, for the first time in history, we have two women presiding over the House and Senate dais. Breaking glass ceilings, I hope that these incredible women will not be the “last” to serve in the most prominent leadership posts for our nation. It is an exciting time for many of us who remember, as young children, President John F. Kennedy signing into law the Equal Pay Act.
      In fact, during my life it has been inspiring to see so many women be the “first:” Colonel Pearl Eleanor Tucker, the first aerospace nurse (1964); Representative Patsy Takemoto Mink, the first woman of color elected to the U.S. House of Representatives (1965); Representative Shirley Chisholm, the first Black woman elected to the U.S. House of Representatives and to run for President (1969); Sandra Day O'Connor, the first woman to serve on the U.S. Supreme Court (1981); Sally Ride, the first American woman in space (1983); Geraldine Ferraro, the first female vice-presidential nominee (1984); Janet Reno, the first female attorney general (1993); Madeleine Albright, the first female secretary of state (1997); Condoleezza Rice, the first Black woman to serve as Secretary of State (2005); Representative Nancy Pelosi, the first female speaker of the House (2007); and Hilary Clinton, the first woman to receive the presidential nomination from a major political party (2016).
      While these trailblazers have paved the way for others, and as we look to the horizon for the woman who will be the “first” President of the United States, some of this excitement is overshadowed by disparities that we know still exist for women. With respect to the pandemic, COVID-19 has impacted women more than their male counterparts, economically, socially, and physically. The shocking statistic that came out at the end of 2020 from the Bureau of Labor Statistics (BLS) and analyzed by the National Women's Law Center showed women accounted for 100% of the labor market's December losses, and over the course of the year, more than five million women lost their jobs (). Demonstrating a more disparate reality, women of color were disproportionally hit hardest. While the overall unemployment rate for women was 6.3% in December 2020 (

      Bureau of Labor Statistics (2021, January 8). The Employment Situation — February 2021. https://www.bls.gov/news.release/pdf/empsit.pdf

      ), Black women had an 8.4% unemployment rate and it was 9.1% for Latina women ().
      As nurses, we know that economic stability is a key area of the social determinants of health (). Yet, this is just one of many inequities faced by women and particularly women of color. We know that disease progression, symptoms clusters, stress-related disorders, and autoimmune diseases look different for many health conditions in women. But it was not until the early 2000s, that more research came out looking at the differences between women and men suffering heart attacks (

      National Institutes of Health (2007, December). Heart Attack Symptoms in Women — Are they Different? https://www.nih.gov/news-events/news-releases/heart-attack-symptoms-women-are-they-different

      ). Women are exposed to more violence and sexual assaults. Native American women are so disproportionately impacted (

      National Coalition Against Domestic Violence. (2016). Domestic violence against American Indian and Alaska Native women. www.ncadv.org (https://assets.speakcdn.com/assets/2497/american_indian_and_alaskan_native_women__dv.pdf)

      ) that the 2013 Violence Against Women Act Reauthorization specifically included provisions to extend tribal special domestic violence criminal jurisdiction (

      Department of Justice (2015). Violence Against Women Act (VAWA) Reauthorization 2013. https://www.justice.gov/tribal/violence-against-women-act-vawa-reauthorization-2013-0

      ).
      Still, as primary care givers, women bear increased physical and emotional stress— often hidden but not invisible— during the pandemic and affecting so many nurses themselves (). The impact of being caregivers is further amplified over time. Women are living longer, yet have less access to financial resources such as pensions, lower average social security payments, retirement income, and lower overall earnings due to wage disparities. This complexity continues as women have greater need for long-term care facilities as they age, presenting with more chronic conditions than men ().
      For decades, women have fought for and to retain reproductive rights. Globally, women fight for access to education, clean water, and sanitation. They fight to eradicate gender-based violence such as sex trafficking and female mutilation. And we cannot turn our attention away from the glaring statistics, that have become increasingly public in the most recent years, about the dire maternal mortality rate among Black women (
      • Amankwaa L.
      • Records K.
      • Kenner C.
      • Roux G.
      • Stone S.
      • Walker D.
      African-American mothers' persistent excessive maternal death rates.
      ).
      Knowing the vital importance of investigating and advancing policy changes for women's health, it is not surprising that the inaugural Expert Panels at the American Academy of Nursing (Academy) were so deeply interconnected in this area. The first Academy Expert Panel (EP) was formed in 1993 to generate new knowledge on violence, its causes and health consequences. Four years later, the Academy formed the Child, Adolescent and Family; Global Nursing and Health; and Psychiatric, Mental Health & Substance Use Expert Panels. One year later, the Academy's Women's Health Expert Panel was formed along with the Aging EP. The stated goal of the Women's Health EP is “to educate and disseminate new research associated with women's health. The panel explores health issues related to women ranging from topics on health disparities for women of various racial and income groups to reproductive issues and preventable diseases” (

      American Academy of Nursing (n.d.(a)). Expert Panel on Women's Health. https://www.aannet.org/expert-panels/ep-womens-health

      ).
      In this historic year for women, the Academy's commitment to combating health disparities among women remains as solid, and as passionate, as the first discussions that occurred to formalize our work in this area. One key focus for the Academy will continue to be our work to dismantle the institutional racism and lack of resources, at all levels, that lead to increased rates of Black maternal mortality. In 2019, I had the privilege to represent the Academy at the Black Maternal Health Caucus Stakeholder Summit. At that time, the Academy pledged our commitment to the co-chairs of the Black Maternal Health Caucus, Representative Lauren Underwood, MPH, RN (now an Academy Fellow) (D-IL) and Representative Alma Adams (D-NC), that we would be partners in their efforts to address the causes, consequences, and solutions to combat two prominent issues related to maternal and infant health: increased rates of maternal mortality and morbidity as well as preterm births within the United States and especially among African-American mothers.
      Earlier this year, the Academy strongly came out in support of the Black Maternal Health Momnibus Act of 2021 or “Momnibus.” The legislation includes 12 key provisions such as “improve data collection processes and quality measures to better understand the causes of the maternal health crisis in the United States and inform solutions to address it; promote maternal vaccinations to protect the health and safety of moms and babies; and newly added for the version introduced in the 117th Congress, “invest in community-based initiatives to reduce levels of and exposure to climate change-related risks for moms and babies” (

      Black Maternal Health Caucus (2021) About the Black Maternal Health Momnibus Act of 2020. https://blackmaternalhealthcaucus-underwood.house.gov/Momnibus

      ).
      While it is often the case that we gloss over the “sense of congress” preliminary section of written legislation, going straight to the meat of the proposed provisions, I was struck by the Momnibus's clarity, which states:It is the sense of Congress that the respect and proper care that birthing people deserve is inclusive, and regardless of race, ethnicity, gender identity, sexual orientation, religion, marital status, familial status, socioeconomic status, immigration status, incarceration status, or disability, all deserve dignity (

      Black Maternal Health Caucus (2021) About the Black Maternal Health Momnibus Act of 2020. https://blackmaternalhealthcaucus-underwood.house.gov/Momnibus

      ).
      The Academy vows to uphold and honor these powerful words, “all deserve dignity,” continuing to align with our vision of healthy lives for all people. During my Presidency, through the support of the Expert Panels and staff, I have been proud of the record we hold advancing women's health issues. They are wide ranging and policy focused. In 2020 alone, the Academy advanced 12 direct policy actions (representing 23 percent of the Academy's total direct policy actions taken last year) to support women, with more in the early months of 2021. Some of these include, weighing in on the Health and Human Services Nondiscrimination in Health and Health Education Programs or Activities, requesting Congress add maternal and infant health components to the Cures 2.0 Act, supporting the Access to Contraception for Servicemembers and Dependents Act of 2019, and sharing with the Centers for Medicare and Medicaid Services opportunities to improve health care access, quality, and outcomes for women and infants in rural communities before, during, and after pregnancy (

      American Academy of Nursing (n.d.(b)). Policy and Advocacy News. https://www.aannet.org/news/policy-news

      ).
      I close with a quote by our first female Vice President:“What I want young women and girls to know is: You are powerful and your voice matters. You're going to walk into many rooms in your life and career where you may be the only one who looks like you or who has had the experiences you've had. But you remember that when you are in those rooms, you are not alone. We are all in that room with you applauding you on. Cheering your voice. And just so proud of you. So you use that voice and be strong.”
      As Fellows of the Academy, we have been in rooms where no one has had our credentials, where we were the only nurse, or the only person of color. We used our voice, we changed the conversation. We did so with holding firm to dignity, respect, and integrity. The Academy continues to advance the robust and diverse agenda of women's health issues and it bears repeating in a momentous year of “firsts” for women.

      References

        • Amankwaa L.
        • Records K.
        • Kenner C.
        • Roux G.
        • Stone S.
        • Walker D.
        African-American mothers' persistent excessive maternal death rates.
        Nursing Outlook. 2018; https://doi.org/10.1016/j.outlook.2018.03.006
      1. American Academy of Nursing (n.d.(a)). Expert Panel on Women's Health. https://www.aannet.org/expert-panels/ep-womens-health

      2. American Academy of Nursing (n.d.(b)). Policy and Advocacy News. https://www.aannet.org/news/policy-news

      3. Black Maternal Health Caucus (2021) About the Black Maternal Health Momnibus Act of 2020. https://blackmaternalhealthcaucus-underwood.house.gov/Momnibus

      4. Bureau of Labor Statistics (2021, January 8). The Employment Situation — February 2021. https://www.bls.gov/news.release/pdf/empsit.pdf

      5. Department of Justice (2015). Violence Against Women Act (VAWA) Reauthorization 2013. https://www.justice.gov/tribal/violence-against-women-act-vawa-reauthorization-2013-0

      6. Kaiser Family Foundation. (2013, May). Medicare's Role for Older Women. https://www.kff.org/womens-health-policy/fact-sheet/medicares-role-for-older-women/

      7. McGrath, M. (2021, January 12). American Women Lost More Than 5 Million Jobs In 2020. Forbes. https://www.forbes.com/sites/maggiemcgrath/2021/01/12/american-women-lost-more-than-5-million-jobs-in-2020/?sh=59e339b32857

      8. National Coalition Against Domestic Violence. (2016). Domestic violence against American Indian and Alaska Native women. www.ncadv.org (https://assets.speakcdn.com/assets/2497/american_indian_and_alaskan_native_women__dv.pdf)

      9. National Institutes of Health (2007, December). Heart Attack Symptoms in Women — Are they Different? https://www.nih.gov/news-events/news-releases/heart-attack-symptoms-women-are-they-different

      10. Office of Disease Prevention and Health Promotion (n.d.). Social Determinants of Health. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

      11. World Health Organization (2020). COVID-19 and violence against women. https://www.who.int/reproductivehealth/publications/emergencies/COVID-19-VAW-full-text.pdf