Social change and women's reproductive health care

Abstract

Ihe issue of women's reproductive health care lies at the busy intersection of social and medical tradition and social and medical change. No other area of medical practice so closely impinges on emotion-laden attitudes, beliefs, and behaviors or has engendered such rage and conflict, both private and public. The modern practitioner is bombarded with medical change, governmental change, and psychosocial change. 1 Comfortable assumptions crumble; contradictions and complaints abound. Providers and consumers of obstetric and gynecologic (ob/gyn) care are having a hard time understanding and collaborating with each other. Women are bombarded daily by a barrage of advice, unsynthesized data, and highly emotional opinions about reproductive health care from sources other than personal care providers: friends, self-designated health experts, and the media. 2 They are subject to historical, psychological, and environmental influences on the conduct of their reproductive lives. There is no way for the obstetrician/gynecologist to stay on top of developments in the specialty, conduct a practice, maintain a personal life, and follow both lay and expert influences on reproductive issues. The medical practice model on which our health care training is based is one that has disappeared from many health care systems. 3 Perhaps for that reason, some observers of medical care issues tend to romanticize it. The old-fashioned doctor role had both advantages and disadvantages. Its purported limitations are what modern medicine has triumphed over, and its idealized interpersonal skills are what some critics of modern medicine mourn.