The post-Covid recovery also passes through women’s health and gender equality, so much so that one of the ‘transversal priorities’ of the National Recovery and Resilience Plan (PNRR) developed by the Italian government concerns precisely these aspects together with those of sustainability and chronicity. According to research conducted by the WorldHealth Organization, adequate management of women’s health could contribute $ 12 trillion to global GDP in 2040. Every dollar spent on reproductive, maternal, neonatal and child health interventions can generate $ 20 in economic benefits. In addition, women are estimated to guide family health decisions in 80% of cases. Promoting women’s health and well-being, therefore, also means having an impact on the whole family.
Women’s health and economic growth
The Covid-19 emergency has had heavy effects on everyone, but has aggravated the condition of women even more and not only on the labor front (according to Istat data, in Italy out of 101,000 fewer employed, 99,000 are women), but also on their health since there has been an inevitable reduction in women’s health protection and care services: 54% fewer gynecological examinations, -34% of new treatments, about 130,000 fewer contraceptive cycles and an average increase 45 days of waiting for a gynecological examination. “We have seen a diagnostic delay for some diseases as fewer checks, fewer check-ups, fewer screenings were performed. Many surgeries have been canceled or postponed,” he said. Giovanni Swaps, scientific director of the Gemelli Foundation and president of the European Society for Gynaecological Endoscopy, speaking in a scientific and institutional meeting organized in Rome by Organon. “It is likely that in the short term we will see an increase in cases in a more advanced phase and in any case the Health System will go into stress to recover the criticalities resulting from the pandemic”.
The promotion of women’s health passes through a profound cultural change that is not yet seen in Italy and which should concern the various stages of a woman’s life, starting from adolescence, when one begins to become familiar with one’s sexuality. According to data from the European Atlas of Contraception, Italy ranks 26th in Europe for access and information to contraception and access to various possible tools for the prevention of pregnancy or a sexually transmitted disease is limited to just the 16% of women of childbearing age. “Women in Italy know and little use hormonal contraception,” she explained Weather in Franca Fruzzetti, president of the Italian Contraception Society (Sic). “In recent months, the spotlight has been turned on the thromboembolic effects associated with the use of contraceptives following the anti-Covid-19 vaccination. But there is no evidence on the role of estrogen-progestogen and all hormonal therapies in the onset of a thromboembolic event. “Nor is it good on the opposite front, that of the birth rate since the Covid emergency has worsened the scenario: the latest data Istat show, for 2021, a 3.8% drop in births compared to 2020, a new all-time low of births since the unification of Italy.
The complete lockdown of the Medically Assisted Reproduction (PMA) Centers for over 5 months during the Covid-19 emergency was also causing a decrease, with an impact of -1500 new born with these techniques. In Italy today, fertility problems affect about 20% of couples (1 in 5), compared to 10% about 20 years ago, but couples are taking longer and longer to seek help. In fact, in recent years, one third of PMA treatments have been performed in couples in which the woman is over 40, with negative repercussions on the birth rate. “In 1965, on average, Italian women had their first birth at 23, in 2015 the average age was 32.3 years. In 2017, over 70% of women who underwent assisted fertilization treatment were over 35 “he pointed out Filippo Maria Ubaldi, president of the Italian Society of Fertility and Sterility-Reproductive Medicine (Sifes). “The possibility of obtaining developmental embryos, even in vitro, is significantly reduced especially after the age of 40 and the chances that the embryos obtained are chromosomally normal are reduced already after the age of 35”.
Thirty years of life in menopause
The other phase in a woman’s life to focus on for prevention is that of menopause, especially since life expectancy today is 84-85 years. This means that a woman spends about 30 years in menopause, but only 7% of Italians resort to hormone replacement therapy to treat the symptoms of menopause, in particular those of the autonomic type (such as hot flashes, sleep disturbances, night sweats) and prevent long-term cardiovascular complications, as well as benefiting from a better quality of life. “The transition between fertile life and menopause lasts an average of 4-5 years but in many women the symptoms that accompany this phase can last even longer,” she explained. Angelo Cagnacci, president of the Italian Menopause Society (Sim). “There are various types of tools to help women cope with this long period in the best possible way, but the ideal therapy is a low dose of hormone replacement therapy for a reasonable number of years, at least 5 gradually reducing the dosage and evaluating the woman”.
Unfortunately, the incidence of cancer in women is on the rise. According to the latest Aiom data, in 2020 there were about 6,000 new cases more than the previous year. In total, there are over 1 million and 922 thousand patients who today live with a neoplasm. And among female cancers, breast and ovarian cancers seem to have a greater impact on the emotional sphere. “The social burden of female cancers – he declared Saverio Cinieri, elected president of the Italian Association of Medical Oncology (Aiom) – is very high: tens of thousands of women get sick every year from breast, uterus and ovarian cancer and when a daughter, a mother, a wife of cancer is as if the whole family gets sick. So the numbers, in terms of social weight, triple “. Gender plays a role in this area as well, as you pointed out. Stefania Gori, president of the Aiom Foundation and of the Italian Patients Oncology Network (Ropi): “The influence of sex and gender on the pathogenesis of neoplastic diseases is increasingly considered: from the differences in lifestyles to those in the incidence and mortality of various oncological diseases and in the response to therapies and adverse drug reactions, up to the problems relational, psychological, social differences between men and women affected by cancer “.
80% of the National Health Fund for chronic diseases
The lengthening of the age brings with it another problem that affects everyone and not only women: that of chronic conditions. In Italy there are 24 million patients with chronic non-communicable diseases, including tumors, cardiovascular and osteoarticular pathologies, which absorb about 80% of the National Health Fund. Chronic non-communicable diseases are responsible for 93.3% of deaths and 90.2% of DALYs (Disability-adjusted life year: value that expresses the number of years lost due to the disease). The Covid-19 emergency also had a negative impact on therapeutic continuity in the territorial management of chronic diseases.
