Do global medical and health entities align with current public perceptions of women's health? We examined Twitter to find out.
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How does the public define women’s health?

Do global medical and health entities align with current public perceptions of women's health? We examined Twitter to find out.

The conversation on women’s health naturally directs attention to topics including pregnancy, childbirth, breast cancer, and human papillomavirus (HPV). Healthy People 2030, objectives set by the U.S. Department of Health and Human Services, include key women’s and girls’ health objectives centered primarily around these topics and addressing gender-based violence. Meeting these objectives is often viewed through a healthcare lens, such as improving referrals, diagnoses, screenings, counseling, and access to care, including Medicaid. Notably, the Healthy People 2030 goals also discuss social and upstream factors impacting women’s health, such as health equity and race, which is a shift from previous goals. This holds significance, given that health inequalities persist among women in the U.S. based on race.

The World Health Organisation has also established women’s health goals, which seek to define women’s health more broadly by considering power and social norms. However, these goals also retain a focus on women’s reproductive roles. Looking into these two definitions helps us grasp how women’s health is perceived worldwide, one from a U.S. standpoint and the other from a global context. As we assess these and other definitions, it becomes evident that women’s health lacks a consistent and clear description. Additionally, critical components appear missing from the women’s health agenda (e.g., a life course perspective).

This leads to the question: Is it possible to work toward a more inclusive and expansive definition of women’s health? Specifically, a definition that does not limit women’s health to their role as reproductive bodies but includes other life complexities such as mental health, social norms, healthcare access, race, and power in a more consistent manner?

Turning to social media for answers

As the definitions of women’s health were explored, a noticeable absence emerged: public voices and opinions were largely absent from the conversation. Incorporating their insights and viewpoints is crucial because the intricate influences on women’s health manifest in various ways, given cultural and contextual differences. This work aimed to understand their perspectives on how they talk about women’s health so that key actions could better align with their viewpoints.

In this 2020 study, the research team at the University of Pittsburgh School of Public Health looked to Twitter posts to uncover the natural discussions about women’s health on the platform. This was a unique moment in history to explore the topic, as the COVID-19 pandemic was unfolding, lockdowns were in progress, and though the legal right to abortion in the U.S. was upheld at the time of data collection, the Dobbs v Jackson case overturned that right in 2022, when this work was published. As a result, conversations about women’s health have become even more significant and timely within the evolving landscape of women’s healthcare access across the U.S.

Women’s health is political

This study analysed over 1,700 tweets, which crossed 15 key themes associated with women’s health, ranging from Abortion to Chronic Disease to Telehealth, signalling diverse conversations on women’s health. The data set from March to April 2020 focused significantly on politics, the most widely discussed topic associated with the hashtag “women’s health.” This demonstrates the intense politicisation of women’s health, especially during the early days of the COVID-19 pandemic. These politicised conversations on women’s health discussed funding and healthcare coverage for women. For example, users tweeted politicians to make changes, and users with diverging beliefs discussed abortion rights. The findings align with other research highlighting the global politicisation of women’s health as a significant obstacle to achieving women’s health objectives.

Do global medical and health entities align with current public perceptions of women's health? We examined Twitter to find out.
Figure 1. Network diagram of identified tweets from March to April 2020 by thematic codes and geographic location. Small nodes represent each tweet colour-coded by continent of origin, and the ties show connections to each coded area, where tweets could be coded in multiple categories. Large nodes represent the code categories, and the size of these nodes reflects the number of times this code was utilised.
Credit. Healthcare for Women International

Maternal, reproductive and sexual health are still critical

The topics that received the most attention were maternal, reproductive, and sexual health. The public expressed concern about the insufficient evidence compared to men’s health, emphasising the need for accurate and timely information concerning women’s health matters. Notably, discussions on maternal health covered various issues, including pregnancy nutrition and physical activity, prenatal care, identifying warning signs during pregnancy, childbirth options, caesarean sections, adjusting to motherhood, and addressing maternal health disparities, particularly among Black women. Additionally, conversations frequently revolved around family planning, contraception, women’s health during menopause, HIV/AIDS, hormones, cognitive well-being, and sexually transmitted infections (STIs), among other reproductive health subjects.

Moving toward a more expansive definition of women’s health

Within everyday conversations that unfolded on social media, the study found that discussions of women’s health were widespread, and the themes of these conversations provide an opportunity to identify the areas of women’s health that are currently missing from globally recognised definitions. While discussions concerning maternal and reproductive health are vital components of women’s well-being, there are certain aspects of women’s reproductive health that Twitter users feel receive inadequate attention, such as menopause.

Similarly, health objectives linked to women’s diets mainly focus on pregnant women, underscoring the prevalent emphasis on women’s reproductive roles rather than addressing issues like obesity or cardiovascular effects, despite known distinctions in risk factors compared to men. Similarly, discussions surrounding smoking and substance use predominantly pertain to their impact during pregnancy or among college students (e.g., alcohol). Interestingly, mental health is conspicuously absent from women’s health definitions despite the higher occurrence of depression and distinct experiences of stress and anxiety among women.

On a positive note, structural and equity-related factors that affect women’s health were focal points of discussion on Twitter, reflecting Healthy People 2030 considerations. The WHO definition of women’s health has expanded to encompass critical elements of women’s well-being, including gender equity and power dynamics. These aspects, also evident in social media conversations, highlight issues such as gender-based violence.

The study implications

The findings of this research indicate that Twitter hosts a wide array of discussions related to women’s health, offering a valuable window into public dialogue and priorities. Drawing from this analysis, which is firmly rooted in the insights of the Twitter community, this research proposes that health professionals, researchers, care providers, policymakers, and organisations strive for a consistent and inclusive definition of women’s health.

This expanded definition should encompass a broader spectrum of domains to depict women’s well-being comprehensively. This approach aims to establish a unified and comprehensive comprehension of all facets of women’s health, extending beyond political agendas and reproductive rights. By adopting this strategy, health professionals can advance cutting-edge, all-encompassing research and formulate programmatic objectives to enhance women’s health globally.

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Journal reference

Baumann, S. E., & Thompson, J. R. (2023). Toward a more expansive and inclusive definition of women’s health: A content analysis of Twitter conversations. Health Care for Women International, 1-20. https://doi.org/10.1080/14488388.2023.2199600

Sara Baumann, PhD, MPH, is an Assistant Professor in the Department of Behavioural and Community Health Sciences at the University of Pittsburgh School of Public Health. Her research agenda embraces community-engaged approaches for exploring and designing evidence-based interventions to improve women's reproductive health and mental health. She is a global health, mixed methods researcher and is dedicated to incorporating participatory, arts-based, and visual research methods into her scholarship centred on social and cultural determinants of health. Dr. Baumann has a background in sociology, social justice, public health, and documentary filmmaking, as well as over 14 years of experience conducting research and programming in health and development in numerous global contexts.

Jessica Thompson, PhD, MEd, is a Senior Research Associate with the Community Impact Office of the University of Kentucky Markey Cancer Centre. Her research focuses on community-based approaches, chronic disease prevention, women's health, rural health, and systems science. She utilises community-engaged mixed-method approaches to uncover factors related to chronic disease risk among women, predominantly in rural and Appalachian communities. In addition to 15 years of experience in community-engaged research, Dr. Thompson has a background in public health, behavioural science, and innovative participatory methodology to reveal complex multilevel factors affecting chronic disease conditions such as cardiovascular disease and cancer.