Cervical cancer, which many physicians of 2019 consider to be a success in terms of establishing widely used forms of early preventative and diagnostic technologies, experienced a reduction in incidence rates in women by over fifty percent between 1975 and 2016. Cervical cancer does not often present in women with symptoms until it has entered a later stage of the disease. Because of this fact, in the early twentieth century, physicians were often only able to diagnose cervical cancer when either the woman reported complaints or there was a visual confirmation of lesions on the cervix. The symptoms women often reported included vague abdominal pain, bleeding after sex, and abnormal amounts of vaginal discharge, all of which are non-specific symptoms, making it even harder for women to be diagnosed with cervical cancer. This thesis answers the following question: How does the history of cervical cancer show that prevention helps reduce rates of cancer-related deaths among women? By studying the history of cervical cancer, people can understand how a cancer that was once one of the top killers of women in the US has declined to become one of the lowest through the establishment of and effective communication of early prevention and diagnostics, both among the general public and within the medical community itself. This thesis is organized based on key episodes which were pertinent to the history of cervical cancer, primarily within the United States and Europe. The episodes are organized in context of the shifts in thought regarding cervical cancer and include topics such as vaccine technologies like the Gardasil and Cervarix vaccines, social awareness movements that educated women on the importance of early detection, and analyses of the early preventative strategies and attempts at treating cervical cancer. After analyzing eleven key episodes, the thesis determined that, through the narrative of early attempts to treat cervical cancer, shifting the societal thought on cancer, evolving the importance of early detection, and, finally, obtaining a means of prevention, the history of cervical cancer does demonstrate that the development of preventative strategies has resulted in reducing cancer-related deaths among women. Understanding what it took for physicians to evolve from simply detecting cervical cancer to being able to prevent it entirely matters because it can change the way we think about managing other forms of cancer.

While some stress during pregnancy is normal, continuous stress during pregnancy could have negative lasting impacts on a child’s health. The type of stress that is harmful during pregnancy is “the kind that doesn’t let up” (Watson). This type of stress is chronic and is more intense than the normal stresses of everyday life. Researchers have shown that when fetuses are continuously exposed to such levels of stress, their bodies react in unhealthy ways. Given all the data showing that varying stressors experienced by pregnant women negatively affect their children’s postnatal health and development, it is important to identify the specific impacts of these stressors in order to understand how they affect the health of children.
By conducting a literature review, I have found a number of studies reporting links between a pregnant woman’s stress and the development of health issues in her child. For example, researchers of one study found that infants born to women who were depressed during pregnancy had early brain development issues and difficulty regulating emotions and stress (Hayes, et. al). In another study, researchers observed a positive association between maternal anxiety during pregnancy and asthma in offspring (Cookson, et. al). Such findings indicate the significance of the prenatal period in healthy child development. However, while we may suspect that there are some negative outcomes for children born to chronically stressed women, there was interestingly a lack of information in areas where we may expect to find effects on the child. This gap in the literature indicates that we do not fully understand the effects of stress during pregnancy, and it seems that we do not know what really seems important to know about mental health during pregnancy. Thus, the results reflect that the existing knowledge in this area is lacking, making it challenging for medical specialists to understand how they may best intervene in order to promote the healthiest pregnancies and children.

Background: Endometriosis is a condition characterized by the growth of the endometrium, or the tissue that lines the uterus, outside of the uterus, and it is diagnosed through the presence of endometriotic lesions in the pelvic region. The disease is most often associated with abnormal and painful vaginal bleeding. Currently, minimal literature exists concerning the management of endometriosis in low and middle-income countries (LMICs), which may influence the lack of a cultural competent understanding of menstruation in LMICs and, therefore, a lack of evidence-based policies concerning menstruation.

Methods: Social and cultural barriers influencing endometriosis reporting and management in LMICs were examined through a systematic literature review. Online databases yielded a list of relevant studies. Then, use of MAXQDA, a qualitative data analysis software program, helped to extract and code specific text segments from each study that pertain to the research topic. In-context analysis of coded segments revealed the most common trends, which were organized into broader themes.

Results: Findings demonstrated that social and cultural ideas regarding vaginal bleeding influenced the lack of disease reporting and management of endometriosis in LMICs. Socioeconomic challenges include a lack of hygiene and sanitation measures and education regarding menstruation and vaginal bleeding. Also, many diseases associated with the abnormal vaginal bleeding are often disregarded and not prioritized in clinical settings. It also became clear that cultural taboos regarding menstruation and vaginal bleeding often create feelings of anxiety and fear in women and girls throughout communities in LMICs. However, further research is needed to examine the ways in which women in those communities treat symptoms of irregular vaginal bleeding related to endometriosis.

Conclusions: Socioeconomic, gender, and sex-related factors may influence the ways in which endometriosis is reported and treated and may affect the way the related diseases are understood. Evidence-based policies using a culturally competent understanding of abnormal vaginal bleeding in LMICs may help positively affect the reproductive health of women and girls in such areas.

Prior to the legalization and regulation of abortion and contraception in the late twentieth century, women could not readily access safe birth control, abortion, and other reproductive health options at clinics and doctor's offices. Thus, women sought out alternative means to control their reproduction that were often illegal, unreliable, and unsafe, often because they were provided by untrained reproductive health care providers. The untrained providers who performed unregulated reproductive health services during the 1800s through the mid 1900s were often referred to as "female physicians," despite not having any formal medical background. Those providers filled a demand to serve women who were not able to tend to unwanted pregnancies and other reproductive issues on their own, but their role in the history of women's health has not been well understood. I have investigated the following questions: (1) How have women sought alternative non-medical approaches to managing reproduction, and (2) what historical patterns and situations can we see showing that non-medically trained people were active in the reproductive lives of women throughout the 19th and 20th centuries in the US? To study this, I have engaged in historical review methods to trace the evolution of reproductive health care providers and educators. Specifically, I have examined historically active people, organizations, and events that involved women seeking alternative care and how the state of women's health care effected women's medical outcome. Through my investigation, I found a large number and variety of non-medical providers and approaches to women's reproductive health solutions due to an unmet need for reproductive healthcare and restrictive laws. Women obtained concocted birth control pills, illegal abortions, home-brewed menopause relief treatments, and learned how to give self cervical examinations from non-medical providers. In response to the rigidity of the male dominated medical field, non-medical forces intervened and women's healthcare evolved beyond the traditional male physician's office into supportive healthcare groups like Planned Parenthood. My findings are relevant in the ongoing political debates surrounding issues like contraception and abortion access. By demonstrating the struggle for sound standard of care for non-medical reproductive health care providers during the nineteenth and early twentieth century, this project emphasizes what the standards of reproductive health care for abortion and contraception might be like if the organizations that made them so readily available, like Planned Parenthood, were defunded or criminalized in our modern setting.

Background: Breast cancer affects about 12% of women in the US. Arguably, it is one of the most advertised cancers. Mammography became a popular tool of breast cancer screening in the 1970s, and patient-geared guidelines came from the American Cancer Society (ACS) and the US Preventative Task Force (USPSTF). This research focuses on ACS guidelines, as they were the earliest as well as the most changed guidelines. Mammography guidelines changed over time due to multiple factors. This research has tracked possible causes of those changes. Methods: Research began with an extensive literature search of clinical trials, the New York Times and the Washington Post archives, systematic reviews, ACS and USPSTF archives. Results and Discussion: ACS was the first organization to provide easily accessible patient geared mammography guidelines. The guidelines have changed six times since 1976. The first came after a large clinical trial, which screened 60,000 women and showed that mammography use decreased breast cancer deaths by 30%. During the 1980s and 1990s, anti-cancer lobbyists and health insurance companies were in conflict, as the former pushed for more frequent mammography screening while the latter pushed for less. The USPSTF published their first guidelines in 2002, separated women into different age groups, and suggested screening intervals, but also included a rating of evidence quality (A-I) that supported the screening recommendation. They changed in 2009 and 2016. The frequent changes had different, not all purely scientific and evidence-based causes. The political influence of anti-cancer activists, as well as media coverage, increased public interest in mammography, which in turn influenced changes in mammography guidelines, sometimes against scientific evidence. Most changes moved towards more frequent screening for women older than 40, and less frequently for younger women, probably because multiple clinical trials had found that mammography was not useful for younger women with no history of breast cancer. There was also growing evidence of overdiagnosis and overtreatment risks from frequent mammography use. Conclusions: The patient-geared mammography guidelines have changed due to multiple and not always well-grounded factors, such as public interpretations of mammography usefulness, social attention to mammography, and influence of different stakeholders at the time. Some changes have resulted solely from political and social factors, disregarding building scientific and clinical evidence against frequent mammography use.

The Dynamic Landscape of Abortion Law in the United States explores the ways abortion laws have changed in the United States over the course of US history. Abortion laws in the US have historically been fluid, changing in ways both big and small. Those changes can occur after advances in science, changes in understanding, or changes in public opinion. And there have been various periods in the history of the US where tolerance abortion waxed or waned, and common law reflected those attitudes. Roe v. Wade was a pivotal moment in the history of abortion law that accomplished much in the way of broadening women's access to abortions. But Roe v. Wade was not the beginning or the end of the fight for abortion rights in the US. There were legal abortions prior to Roe v. Wade and illegal abortions after. Roe v. Wade granted that women had a constitutional right to have an abortion but the ruling left the boundaries of that right somewhat undefined and most courtroom battles over abortion laws are fought over where a woman's right to an abortion ends and a States right to regulate and protect fetal life begin. Much change has occurred in abortion laws over the past 50 years, this thesis tracks those changes principally through Supreme Court Cases, such as United States v. Milan Vuitch, Roe v. Wade, and Gonzales v. Planned Parenthood among others. The landscape of abortion law in the US continues to shift today, as recently as 2017 with Plowman v. FMCH cases were being heard in courts that wrought subtle yet important changes in abortion law.

Scientific and public interest in determining the sex of a child prior to conception has a longstanding history. Since at least the fourth century BC, people have been interested in what determines whether a child will be a boy or a girl. It was not until the mid 1800s, when scientists first discovered female eggs and male sperm, and further learned that the combination of the genetic make-up of those sex cells began the process of conception, that science began to take precedence over popular beliefs and scientists began to make discoveries about the reproductive process in humans. In the mid-twentieth century, two methods of sex selection emerged based on the idea that human male sperm cells are physically different based on which sex chromosome they carry, either X or Y. The first type of method gained popularity in the 1960s and involved timing intercourse throughout the female menstrual cycle. The two timing methods of sex selection outlined in this paper are the Shettles Method and the Whelan Method. The second type of method was based on the idea that the physical differences between the two types of sperm cells allow for sperm cell separation using technology. The method that is outlined in this paper is called the Ericsson Method of Sperm Separation, and this paper also outlines a company called Microsort that utilizes this technology. However, many studies that tested the methods based on differences in the two types of male sperm were inconclusive, meaning that the methods were supported by some and rejected by others. Despite the evidence that can neither prove nor contest those methods with absolute certainty, their popularity has been maintained in the public eye. By questioning methods of sex selection since their early development, and often discovering that they are unreliable, scientists have increased the creative and technological capacity of the field of reproductive health. The presentation of these methods to the public, via published books on timing methods and company websites for sperm sorting, increased interest in, and influence of, sex selection within the global society. The purpose of explaining the history, interest, development, and impact of various sex selection methods in the mid-twentieth century based on the information that is available on them today is to show couples which methods have failed and provide them with the knowledge necessary to make an informed decision on how they choose to go about utilizing methods of sex selection. This paper also reflects on the ethical considerations of sex selection. The ethical considerations demonstrate the influence that sex selection has on both a global and local scale and how it is being managed in different parts of the world. This allows an individual member of the public to determine what they consider to be an ethical decision based on this information, in addition to an informed decision about the methods if they wish to go through with choosing the sex of their child.

Most individuals entering college are taking responsibility for their own health for the first time. Students are used to having a parent or guardian nearby to diagnose and provide remedies for common health issues. Entering college, whether in a different city or just down the road, means they must assume those responsibilities themselves. Navigating that transition can be difficult for college students. A large majority of students turn to internet health resources, such as WebMD, for health information. However, studies show that despite overall internet savvy, college students are not very skilled at finding legitimate health information online. Therefore, a health resource designed specifically for college students would be a valuable resource for many students at ASU. Working with local Phoenix physician Doug Lakin, I and a team of other Barrett students revised Dr. Lakin's healthcare guide, Thrive 101: Health & Wellness for College Students. I was responsible for the guide's second chapter, which provides information on specific illnesses and injuries. I conducted a literature review to discover the best practices for communicating medical information. I found that using short sentences, simple words, bullet point lists, numbered lists, and subheadings improved the effectiveness of a health resource. I also found that health information seekers want resources to be tailored specifically for them. They want personalized resources. Personalization means including health information that the intended reader wants, excluding the health information the reader does not want, as well as featuring personal anecdotes from individuals like the reader dealing with health problems like the reader's. I applied what I discovered to Thrive 101. I reorganized the chapter I was assigned, incorporating subheadings and clear organization of the information. I also eliminated information I judged irrelevant to college students and brainstormed what information was missing that college students would benefit from. At this time, the revision team has not gotten to the point where we are researching and writing new information, but we do have lists of items we want to include. The information already in the guide I reformatted into bulleted and numbered lists where possible. As with the new information, we have not begun to revise the guide on a prose level, shortening the sentences and simplifying the vocabulary, but we intend to work into the summer to finish our revisions.