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Made Laanpere: We survey issues hid from society and the law

Made Laanpere.
Made Laanpere. Source: Alana Proosa

Much about being a woman remains concealed and associated with taboos. The film "Smoke Sauna Sisterhood," which has taken the world by storm, has sparked a revolution by presenting to the masses themes that have hitherto been taboo in public, such as sexual violence, menstruation, and abortion, writes Made Laanpere.

As gynecologists, we see that although women need to talk about their experiences, they often don't dare. On the other hand, the concerns associated with womanhood have also not been sufficiently studied. Caroline Criado Perez's ground-breaking book "Invisible Women" calls the exclusion of women, including from research, a gender data gap.

That's why the 2024 Estonian Women's Health Survey will focus on issues that often go unnoticed in society but have a significant impact on women's health and quality of life. For the first time, more than 12,000 Estonian women will be able to anonymously add their voices, wishes, needs, and experiences to a body of knowledge that will help shape better health care and policy.

We need this knowledge because silence simply means that there are no problems. When problems are silenced, any woman could feel that the "fault" is hers alone, and the shame that comes with that silence is exacerbated. For example, normal and natural menstruation causes monthly suffering for many women, but apart from the worry, women often do not know that a pain-free life is possible.

Silence also contributes to the spread of myths and misinformation. There are many unfounded myths about women's medications, but there are also misconceptions about other issues affecting women's health.

Silencing of many hidden issues is even encouraged in society and that does not help to solve problems. I speak from experience, because a decade ago a study on women's health in Estonia revealed the devastating and long-term effects of violence on women's health as one of such hidden problems.

Notably, in the 2014 survey, we used, for the first time, a violence survey instrument that has been used in many countries. We looked at different types of violence and experiences of violence at different stages of life. In the same year, a similar survey was conducted among Estonian men, and for the first time, an overview of the prevalence of violence in Estonian society and its impact on people's health and coping was made.

The findings were shocking: nearly one in 10 Estonian women have been subjected to all forms of violence (psychic, sexual, and physical) in their lifetime. Women are, in fact, three times more likely to experience all forms of violence than men.

We have seen that direct injuries do not always cause the most harm in cases of violence, despite the fact that they are used as indicators of violence in both public opinion and law. Living in fear has far-reaching consequences, affecting health throughout one's life and resulting in inferior economic well-being, fewer social ties, and a sense of insecurity. Children are also impacted, as a loss of a mother's sense of security prevents them from growing up in a secure environment, which harms society as a whole.

In the 2024 survey, we will also look at topics that haven't been thoroughly examined before, such as violence in healthcare. We are aware of the situation, but no data on how many people have been abused in the healthcare system has been collected.

Health concerns can be very private, and the patient is usually the most vulnerable party, which increases the danger of both mental and physical harm. These dangers have been factored into the design of the Estonian medical system for decades, but we still need to understand them better.

Understanding these hidden problems allows gynaecologists to be more aware and recognize indications that they would not otherwise be able to detect. We now know that if a woman often visits the doctor with stomach discomfort for no apparent medical reason, it is worth evaluating whether the pain is psychogenic and induced by violence. When it comes to pregnancy counseling, we've seen what it's like when a man goes with a woman to every session and answers all of the questions that the doctor asks her.

We will also be able to inquire about any bruising or injuries seen during an examination, and we already know what to look for in maternity wards and family rooms. In the absence of studies, each doctor should rely solely on his or her own experience and the facts that the woman is willing to share with the doctor. To avoid biased attitudes and tunnel vision, we want evidence-based information. We can then pass this information on to medical students.

The 2024 study will also look at the impact of the pandemic on women's sexual health and access to services, which is a new problem. Based on information gathered from around the world, we can conclude that this period was a significant setback for women's sexual health and safety.

Clinic closures, doctors falling unwell, and disrupted medicine supply chains resulted in seven million unplanned pregnancies, 2.7 million unsafe abortions, and an estimated 11,000 pregnancy-related fatalities globally. The lesser limitations in Estonia provide hope that the pandemic will not have as severe an impact here; however, this is only speculation until we investigate the situation.

Aside from revealing problems, surveys have another essential purpose. The decennial stocktaking survey allows us to better understand how society has changed and which decisions and policies have proven successful.

Some things we take for granted in Estonia are not the same everywhere. Estonia, for example, boasts some of the world's greatest obstetric care and sexual health indicators for young people, as well as universal health insurance for pregnant women. We have also seen a consistent improvement in women's access to healthcare and contraception, as well as, perhaps most crucially, a growth in women's self-esteem and equality.

I encourage all invited women to take part in the 2024 Estonian Women's Health Survey. Only by collaborating and incorporating as many women's views and experiences as possible can we make society and the medical system safer for women. Taboos and myths can only be broken by breaking the silence. Nothing else is conceivable; good decisions are founded on knowledge.

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Editor: Kaupo Meiel, Kristina Kersa

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