No one escaped COVID’s impacts, but big fall in tertiary enrolments was 80% women. Why?



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Brendan Churchill, University of Melbourne

The disruption caused by the COVID-19 pandemic has been so profound, particularly for women, that it threatens to upend the progress on gender equality in recent years. During the lockdown, women were doing more of the unpaid labour – care and housework. They were also more exposed to the risks of coronavirus either as essential workers or working in industries, such as retail, hospitality and accommodation services, that were forced to close.

There is evidence also of significant impacts on men’s labour force participation. In some cases men’s job losses early in the pandemic have not been recovered.

The impacts of COVID-19 on women and men extend beyond work and home to education, particularly tertiary education enrolments.

According to the Australian Bureau of Statistics’ latest data, 112,000 fewer students were enrolled in tertiary education in May 2020 – at the height of the first wave – compared to a year earlier. This is the largest drop in enrolments in over 15 years.

Like other aspects of COVID-19, the impact was gendered with a far greater decline among women. There were 86,000 fewer women enrolled to study in May 2020 than in May 2019, compared with just over 21,000 fewer men.

Big fall was for women over 25

What do these data tell us about COVID-19, education, work and potentially the future?

These data tell us COVID-19 has not only severely disrupted the lives of women in the workplace and the home, but also in education.




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The biggest decline in tertiary enrolments was among women over the age of 25: 60,000 fewer women over 25 were enrolled in university in May 2020 than in 2019.

This steep decline in enrolments is particularly surprising given Australia’s success in educating women and potentially puts the nation’s reputation at risk. Australia is ranked equal first in the world in terms of educational attainment for women, according the World Economic Forum’s 2020 Global Gender Gap Index. The country has been atop the list for well over a decade.

Juggling caring roles with study

These data remind us caring responsibilities not only affect careers or work-life balance, but also education. The sharp decline in female enrolments over the age of 25 suggests it was likely because of caring responsibilities.




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Many of these women with caring responsibilities, for either young children or older family members, were likely forced to make a choice between caring and studying. And for those combining work and study on top of family commitments, many elected not to continue studying.

Mother seated on floor and comforting baby while working at laptop
Many women have been forced to choose between family caring responsibilities and study.
Standsome Worklifestyle/Unsplash

For many mature-aged students (those over 21), undertaking study is challenge, especially for those combining study with work and/or care. Previous research has shown a number of gendered expectations are put upon mature-aged students and their time.

For many of these mature-age women who are combining work and study, they increasingly do it flexibly or online and schedule it around other commitments. Others give up their leisure time for learning.

COVID-19 made that near-impossible. The loss of both family and formal childcare increased the burden of unpaid work for women at home. It was extended far into the workday and into the evenings where mature-aged women might ordinarily find time to study.




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Enrolments rose for men over 25

The data also highlight the gendered complexities of COVID-19 on education. Women’s enrolments were disproportionately affected, whereas the data showed significant increases in men over the age of 25 enrolling in university in May 2020 compared with 2019. Male enrolments in this age group increased by about 26,000.

This increase suggests men were either “forced” into tertiary education because of a lack of opportunities, or it was a deliberate strategy on their part to upskill so they could be more competitive for jobs once the economy recovers. In this way, older age groups of men have shown themselves to be similar to young people who tend to go into education during times of recession. This is perhaps in contrast to previous recessionary periods where the participation rate of older men declined considerably.

All of this has implications for the future, particularly for women. These data are worrisome because, even though the returns from education for women are poor, many women obtain a number of qualifications just to get on an even keel with men in the labour market.

These latest trends might make it harder for women in the long run. However, it is worth noting these data capture enrolments at a point in time – during the first wave of the pandemic. Things might have changed significantly since then.The Conversation

Brendan Churchill, Research Fellow in Sociology, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Australia expresses ‘serious concerns’ about invasive searches of women at Doha airport



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Michelle Grattan, University of Canberra

The Australian government has registered “serious concerns” with Qatar about an incident in which female passengers, including Australians, were taken off a flight bound for Australia and subjected to an invasive search.

The incident happened at Hamad international airport in Doha earlier this month after a fetus was discovered in an airport bathroom.

The story was broken by the Seven Network, which reported that “women at the airport, including thirteen Australians, were removed from flights, detained and forced to undergo an inspection in an ambulance on the tarmac.”

According to the report, Qatari authorities forced the women to remove their underwear.

A foreign affairs spokesperson said on Sunday: “The Australian government is aware of concerning reports regarding the treatment of female passengers, including Australian citizens, at Doha (Hamad) airport in Qatar.

“We have formally registered our serious concerns regarding the incident with Qatari authorities and have been assured that detailed and transparent information on the event will be provided soon.”

The matter is being handled by Foreign Minister Marise Payne.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

COVID-19 could see thousands of women miss out on having kids, creating a demographic disaster for Australia



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Liz Allen, Australian National University

COVID-19 lockdowns have led to suggestions there could be a “coronial” baby boom.

But while a baby boom as a side effect of the devastating pandemic sounds kind of nice, it is probably too good to be true.

What is more likely is that Australians will delay or forego having children because of coronavirus. This could be personally devastating for people and a demographic disaster for the country.

What are people really up to?

The pandemic has seen the birth of terms such as “corona thirst”, based on the assumption people are having more sex than usual due to all the extra time at home with nothing much to do.

A United States poll released in June signalled a COVID-induced sexual enlightenment, with 54% of surveyed couples reporting they were being more adventurous in bed.




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The ABC has also recently reported an increase in sales at adult stores and strong demand for dating apps. Meanwhile, last month, Chemist Warehouse pointed to a 30% spike in pregnancy test sales.

But despite all the hype, all signs point to fewer babies being born as a result of COVID-19, not more. For one thing, pregnancy test purchases are more likely to reflect women trying to avoid seeing a doctor in person, rather than a prelude to a boom.

We do not have the necessary ingredients for a boom

It takes more than sex (or more sex) to have a baby boom. The necessary ingredients include more people partnering and reduced contraception use among couples and we are not seeing evidence of either of these things.

The fact that gathering places like pubs and bars are either closed or restricted is limiting opportunities to meet people and interact in real life. Decreased rates of sexually transmitted infections point to a reduction in the formation of new relationships, regardless of the increased use of dating apps.

Social distancing and lockdown has made it difficult for people to meet new partners.
James Gourley/AAP

And despite all the talk about adventurous sex, it’s also highly unlikely couples will suddenly decide to increase their intended family size.

For one thing, additional, forced time with loved ones tends to strain, not nurture, relationships. Rising domestic violence rates has also show the pandemic has been unsafe for too many others.




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All the uncertainty and socioeconomic scarcity – including the inability to have basic needs, like toilet paper, met and record unemployment – also means even established, happy couples are likely to postpone having children.

It is important to note that birth rates dropped dramatically during the Great Depression, from an average of around three births per woman to about two – a substantial decline in terms of magnitude and the time it took to fall.

This offers the most comparable historical event to COVID-19, given the expectation of long-term economic doldrums due to the pandemic.

Headed for demographic disaster

Australia’s birth rate of 1.74 births per woman is already in decline, down from 2.02 in 2008. We can expect COVID-19 to exacerbate this trend.

This is a huge worry. Because, if we fall to or below a birth rate of 1.5, this is well below replacement level and places the future tax base at risk. Simply put, we won’t have enough people to work and pay taxes and fund all the roads, hospitals and welfare initiatives we need to function as a country.




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This is a demographic disaster, leading to declining socioeconomic well-being. Future generations will have to cover the bill for far more than we have had to, meaning the Australia they inherit will be worse off.

Even more worryingly, once birth rates fall to around 1.5, they don’t tend to bounce back, because social norms around children and family become ingrained even if there are incentives to change.

While countries typically rely on increased immigration to balance demographic and workforce needs, this may not be possible in the same way, due to the pandemic.

The individual impact

For people who are hoping to have children in the near future, COVID-19 has presented new and no doubt stressful challenges.

Not only is it difficult to meet potential partners, but there have been extra constraints of accessing assisted reproductive technologies. Cancellation of elective surgery during the initial COVID-19 outbreak saw some IVF treatments postponed.

Melbourne’s worsening pandemic situation is now likely to cause further IVF delays.

Even with the resumption of IVF, prospective parents may have missed their chance to have a family or increase the size of the one they already have.

Demographic ripples

Not much is known about childlessness among men in Australia because the census doesn’t include this information and research typically focuses on women.

But we do know that at the 2016 Census, roughly 30% of women towards the end of their reproductive years aged between 30-44 years reported not having any children.




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Around half of these women would have been childfree by choice, if the distribution from a 2013 Australian qualitative study was applied.

This roughly translates to around a quarter of a million women being childless against their choice, due to not having a partner or requiring assisted reproductive technology (including same-sex attracted women).

The Household, Income and Labour Dynamics in Australia survey also tells us people don’t have as many children as they plan to at the best of times. The number of children adults intend to have typically reduces over time as people realise and experience the barriers confronted by parents trying to juggle paid work, family and life.

Families may not be able to expand as they planned, due to coronavirus.
http://www.shutterstock.com

All these factors, combined with these raw numbers, conservatively suggests thousands of women will be left stranded in their childbearing years. While some of course may still have children down the track, for others, the window for childbearing will close sooner and more definitively because of COVID-19.

For some existing parents, they will not have as many additional children as they hoped for.

This is a heartbreaking individual outcome, as well as one that will send ripples into the nation’s future demography.

Demographic recovery

Post-coronavirus recovery requires comprehensive efforts to build and invest in the demographic capital of the nation, now and into the future.

This means we need to help families achieve their intended family size. The provision of accessible childcare, adequate support for the long-term unemployed and financial supports for people accessing IVF are just starters.

It’s going to be a rough road ahead. Sadly, for many Australians, it will be marked by significant personal heartache, with the ripple effects felt at a population level.The Conversation

Liz Allen, Demographer, ANU Centre for Social Research and Methods, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Women are drinking more during the pandemic, and it’s probably got a lot to do with their mental health



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Shalini Arunogiri, Monash University; Caroline Gurvich, Monash University, and Jayashri Kulkarni, Monash University

COVID-19 has significantly affected our collective mental health.

For many people, social disconnection, financial strain, increased obligations in the home and ongoing uncertainty have created distress – and with it, a need for new ways of coping.

One way people may choose to cope with stress is through the use of alcohol.

We’re now starting to understand the degree to which alcohol use has increased in Australia during COVID-19. While the data aren’t alarming so far, they suggest women are drinking at higher levels than usual during the pandemic, more so than men.

This trend is likely linked to the levels of stress and anxiety women are feeling at the moment – which, research suggests, are disproportionate to the distress men are experiencing.




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Alcohol consumption and COVID-19

Early reports of increased alcohol purchasing raised the alarm that we might see an increase in alcohol use across the population during lockdown.

However, recent data from the Australian Bureau of Statistics suggests overall, alcohol consumption remained relatively stable during April. Only 14% of Australians reported increased use of alcohol in the previous month.

But women are over-represented in this group. Some 18% of women reported increased alcohol use in the previous month, compared with only 10.8% of men.

14% of Australians reported they were drinking more than usual during April.
Shutterstock

Similarly, preliminary results from our COVID-19 mental health survey of 1,200 Australians in April found a significantly higher proportion of women had increased their alcohol intake: 31.8%, versus 22.5% of men.

Why are we seeing this disparity between women and men? The answers may lie in what we know about why women drink, and in the disproportionate burden of stress women are facing as a result of COVID-19.

Women tend to drink for different reasons to men

In Australia in 2016, 14% of men and 7% of women drank alcohol to risky levels.

Although fewer women than men drink alcohol regularly, alcohol consumption among women has increased in the past decade, particularly in middle-aged and older women. This mirrors international trends that suggest women may be catching up to men in terms of their alcohol consumption.




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Overall, Australia has observed a reduction in risky drinking across the population, with increasing numbers of young people choosing not to drink.

In contrast, women in their 50s are the only subset of the Australian population with rising rates of alcohol use. In 2016, data showed for the first time, they were more likely to drink at risky levels than younger women.

Drinking has become more normalised among women in this middle-to-older age group, potentially contributing to the rise in alcohol use. Alcohol has become a commonly accepted coping mechanism for distress, with women feeling comfortable to say “I just had a bad day. I needed to have a drink”.

This highlights a theme that frequently underpins problematic alcohol use in women: what’s termed a “coping motive”. Many studies have found more women drink alcohol to cope – with difficult emotions or stressful circumstances – as compared to men, who more often drink alcohol in social settings or as a reward.




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Women seem to be struggling more during the pandemic

With this in mind, it’s unsurprising we’re seeing increased alcohol consumption among women during COVID-19. International data show women have been more likely to experience symptoms of stress, anxiety and depression during the pandemic.

Meanwhile, Australian data show loneliness has been more of a problem for women (28%) than men (16%) during this past month under lockdown.

Caregiver load has also been a source of stress, with women almost three times more likely than men to be looking after children full-time on their own during COVID-19.

Many women have had to work from home while looking after their children.
Shutterstock

While we don’t have enough evidence yet to tell us conclusively whether family violence incidents have increased during the pandemic, this may add to the mental health burden for some women during COVID-19.

Further, younger female workers are disproportionately affected by the economic crisis in the wake of COVID-19. The fact women make up a majority of the casual workforce makes them highly vulnerable at this time.




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Together, it seems COVID-19 is having a different mental health impact on women compared to men. And this is likely to be intertwined with their increased drinking during the coronavirus pandemic.

Whether we’ll see higher rates of problem alcohol use or dependence in women after the pandemic remains unclear. However, we know women who drink at unsafe levels experience complications more quickly, and enter treatment later, with perceived stigma a barrier to help-seeking.

It’s vital we draw our attention to these gender-specific differences in mental health and alcohol consumption as we formulate our mental health pandemic plan.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.The Conversation

Shalini Arunogiri, Addiction Psychiatrist, Senior Lecturer, Monash University; Caroline Gurvich, Senior Research Fellow and Clinical Neuropsychologist, Monash University, and Jayashri Kulkarni, Professor of Psychiatry, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why do more men die from coronavirus than women?



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Jenny Graves, La Trobe University

All over the world – in China, Italy, the United States and Australia – many more men than women are dying from COVID-19.

Why? Is it genes, hormones, the immune system – or behaviour – that makes men more susceptible to the disease?




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I see it as an interaction of all of these factors and it isn’t unique to the SARS-Cov-2 virus – the different response of men and women is typical of many diseases in many mammals.

The grim figures

In Italy and China deaths of men are more than double those of women. In New York city men constitute about 61% of patients who die. Australia is shaping up to have similar results, though here it’s mostly in the 70-79 and 80-89 age groups.

COVID-19 deaths in Australia (last updated April 19, 2020).
Australian Government, Department of Health

One major variable in severity of COVID-19 is age. But this can’t explain the sex bias seen globally because the increased male fatality rate is the same in each age group from 30 to 90+. Women also live on average six years longer than men, so there are more elderly women than men in the vulnerable population.

The other major factor is the presence of chronic diseases, particularly heart disease, diabetes and cancer. These are all more common in men than women, which might account for some of the bias.

But then we must ask why men are more vulnerable to the diseases that put them at greater risk of COVID-19.

Men and women are biologically different

Men and women differ in their sex chromosomes and the genes that lie on them. Women have two copies of a mid-sized chromosome (called the X). Men have only a single X chromosome and a small Y chromosome that contains few genes.

One of these Y genes (SRY) directs the embryo to become male by kick-starting the development of testes in an XY embryo. The testes make male hormones and the hormones make the baby develop as a boy.

In the absence of SRY an ovary forms and makes female hormones.

It’s the hormones that control most of the obvious visible differences between men and women – genitals and breasts, hair and body type – and have a large influence on behaviour.

The Y chromosome and hormones

The Y chromosome contains hardly any genes other than SRY but it is full of repetitive sequences (“junk DNA”).

Perhaps a “toxic Y” could lose its regulation during ageing. This might hasten ageing in men and render them more susceptible to the virus.

But a bigger problem for men is the male hormones unleashed by SRY action. Testosterone levels are implicated in many diseases, particularly heart disease, and may affect lifespan.

Men are also disadvantaged by their low levels of estrogen, which protects women from many diseases, including heart disease.

Male hormones also influence behaviour. Testosterone levels have been credited with major differences between men and women in risky behaviours such as smoking and drinking too much alcohol, as well as reluctance to heed health advice and to seek medical help.

The extreme differences in smoking rate between men and women in China (almost half the men smoke and only 2% of women) may help to account for their very high ratio of male deaths (more than double female). Not only is smoking a severe risk factor for any respiratory disease, but it also causes lung cancer, a further risk factor.

Smoking rates are lower and not as sex-biased in many other countries, so risky behaviour can’t by itself explain the sex difference in COVID-19 deaths. Maybe sex chromosomes have other effects.

Two X chromosomes are better than one

The X chromosome bears more than 1,000 genes with functions in all sorts of things including routine metabolism, blood clotting and brain development.

The presence of two X chromosomes in XX females provides a buffer if a gene on one X is mutated.

XY males lack this X chromosome backup. That’s why boys suffer from many sex-linked diseases such as haemophilia (poor blood clotting).

The number of X chromosomes also has big effects on many metabolic characters that are separable from sex hormone effects, as studies of mice reveal.

Females not only have a double dose of many X genes, but they may also have the benefit of two different versions of each gene.

This X effect goes far to explain why males die at a higher rate than females at every age from birth.

And another man problem is the immune system.

We’ve known for a long time that women have a stronger immune system than men. This is not all good, because it makes women more susceptible to autoimmune diseases such as lupus and multiple sclerosis.

But it gives women an advantage when it comes to susceptibility to viruses, as many studies in mice and humans show. This helps to explain why men are more susceptible to many viruses, including SARS and MERS.

There are at least 60 immune response genes on the X chromosome, and it seems that a higher dose and having two different versions of these gives women a broader spectrum of defences.

Sex differences in diseases – the big picture

Sex differences in the frequency, severity and treatment efficacy for many diseases were pointed out long ago. COVID-19 is part of a larger pattern in which males lose out – at every age.

This isn’t just humans – it is true of most mammals.

Are sex differences in disease susceptibility simply the by-catch of genetic and hormone differences? Or were they, like many other traits, selected differently in males and females because of differences in life strategy?




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It’s suggested that male mammals spread their genes by winning competitions for mates, hence hormone control of risky behaviour is a plus for men.

It’s also suggested female mammals are selected for traits that enhance their ability to care for young, hence their stronger immune system. This made sense for most mammals through the ages.

So the sex bias in COVID-19 deaths is part of a much larger picture – and a very much older picture – of sex differences in genes, chromosomes and hormones that lead to very different responses to all sorts of disease, including COVID-19.The Conversation

Jenny Graves, Distinguished Professor of Genetics, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Pregnant women should take extra care to minimise their exposure to bushfire smoke



Pregnant women should try to stay inside when the air pollution is high.
From shutterstock.com

Sarah Robertson, University of Adelaide and Louise Hull, University of Adelaide

Smoke haze from Australia’s catastrophic bushfires is continuing to affect many parts of the country.

Although there’s no safe level of air pollution, the health hazards tend to be greatest for vulnerable groups. Alongside people with pre-existing conditions, smoke exposure presents unique risks for pregnant women.

Research shows prolonged exposure to bushfire smoke increases the risk of pregnancy complications including high blood pressure, gestational diabetes, low birth weight and premature birth (before 37 weeks).

These conditions can have short-term and lifelong effects on a baby’s health, with increased risk of conditions including cerebral palsy and visual or hearing impairment. Even babies born only a few weeks early can experience learning difficulties and behavioural problems, and have an elevated risk of heart disease in later life.

So it’s especially important pregnant women protect themselves from exposure to bushfire smoke.




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Why are pregnant women at higher risk?

Pregnant women breathe at an increased rate, and their hearts need to work harder than those of non-pregnant people to transport oxygen to the fetus. This makes them particularly vulnerable to the effects of air pollution, including bushfire smoke.

We often measure poor air quality by the presence of ultra-fine particles called PM2.5 (small particles of less than 2.5 micrometres in size). These particles are concerning because they can penetrate into our lungs, and into blood and tissue to cause inflammation throughout the body.

Importantly in pregnant women, environmental pollutants can cause inflammatory damage to the placenta’s blood supply. This can interfere with the placenta’s development and function, which can in turn compromise the growth of the fetus.

What the evidence says

Many studies have linked poor air quality, particularly high PM2.5 levels, to poor pregnancy outcomes. Data from 183 countries showed in 2010, an estimated 2.7 million premature births, 18% of the total, were associated with PM2.5 pollution.

A 2019 study of more than 500,000 pregnant women from Colorado looked at the effect of bushfire smoke on pregnancy outcomes. The authors analysed data on air quality, fire incidence and pregnancy and birth records from 2007-2015, during which time Colorado was regularly affected by smoke from fires burning in California and the Pacific Northwest.

The study found PM2.5 due to bushfire smoke was linked to spikes in premature birth, especially in women exposed during the second trimester.

In women exposed to smoke during the first trimester, birth weight was lower than average. Further, exposure during any trimester increased the chance of gestational diabetes and high blood pressure.

The effects were detectable even with low exposure to smoke and small increases in PM2.5. For every 1 microgram/m³ increase in average daily exposure to PM2.5 during the second trimester of pregnancy, the risk of premature birth increased by 13%.

To put this into context, in Canberra in the first week of January, PM2.5 levels averaged more than 200 micrograms/m³, compared with the typical background concentration of 5 micrograms/m³. EPA Victoria classifies PM2.5 levels above 25 micrograms/m³ as unsafe for vulnerable people.




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In another large study, a 24% increase in premature birth was seen after 10 micrograms/m³ increase in PM2.5.

As well as PM2.5, bushfire smoke contains larger PM10 particles, nitric oxides, carbon monoxide and other gases and toxic chemicals. These all have potential to impair lung and heart function in the mother, activate inflammation, and directly affect fetal and placental development.

Smoke threatens fertility, too

Air quality is also a factor for couples attempting to conceive or dealing with infertility.

Population studies suggest air pollution compromises human fertility by reducing ovarian reserve (the number of eggs in the ovary) and affecting sperm number and movement.

Direct exposure to fire, burns and fire retardant chemicals can also negatively impact fertility.




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Precautions to take if you’re pregnant

The best strategy is to reduce smoke exposure as much as possible. Recommendations from NSW Health include staying inside on high-risk days, sealing the house to prevent smoke infiltration and using air conditioning to keep cool.

Avoid creating smoke by cigarette smoking, burning candles, or frying and grilling. Use PM2 (N95) masks and air-filtering devices if possible, and avoid exposure to ash, which contains particulate material you can inhale.

Studies have shown when women are exposed to bushfire smoke during pregnancy, the rates of premature birth increase.
From shutterstock.com

Pregnant women in a fire region should carefully follow emergency services’ direction. It’s better to evacuate early, with an emergency supply kit containing clothes, medications, water and food you don’t need to cook.

Make sure your medication and prenatal vitamins are accessible, continue to take them, and stay well hydrated. Inform authorities and shelters you are pregnant and need to maintain your antenatal care.

Be aware of the signs of premature labour including abdominal cramps or contractions, a heavy vaginal discharge, loss of fluid or vaginal bleeding, pelvic pressure and low backache. Seek help if you think you may be going into labour.

Given what we know about the consequences of poor air quality on pregnancy outcomes, it’s critical pregnant women are given top priority when it comes to bushfire relief and health care support.




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The Conversation


Sarah Robertson, Professor and Director, Robinson Research Institute, University of Adelaide and Louise Hull, Associate Professor and Fertility and Conception Theme Leader, The Robinson Research Institute, University of Adelaide

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Endometriosis costs women and society $30,000 a year for every sufferer



It can be difficult to get pain from endometriosis under control.
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Mike Armour, Western Sydney University and Kenny Lawson, Western Sydney University

The average cost for a woman with endometriosis both personally and for society is around A$30,000 a year, according to our research, published today in the journal PLOS ONE.

Most of these costs are not from medication, or doctors’ visits, although these do play a part. Rather, they’re due to lost productivity, as women are unable to work – or work to their usual level of efficiency – while experiencing high levels of pain.

Remind me, what is endometriosis?

Chronic pelvic pain is pain below the belly button that occurs on most days for at least six months. The most common identifiable cause is endometriosis. Endometriosis is the presence and growth of tissue (called lesions) similar to the lining of the uterus that’s found outside the uterus.

Women with the condition have a variety of symptoms, including non-cyclical pelvic pain (which is like period pain but occurs regularly throughout the month), severe period pain, pain during or after sexual intercourse, and severe fatigue. Gastrointestinal problems, such as severe bloating (often called “endo belly” by those who suffer from it) and pain with bowel motions, are also common.




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Currently, surgery (a laparoscopy) is the only way to make a formal diagnosis of endometriosis – this is where a small camera is inserted into the pelvic/abdominal cavity to investigate the presence of endometriosis lesions.

Both medical and surgical treatments are commonly used for women with endometriosis. Medical therapies include non-steroidal anti-inflammatories (such as ibuprofen and naproxen), oral contraceptive pills and other forms of hormonal treatments.

While these medications can be effective for some, many women experience side effects and need to stop using them.

Surgery is the current “gold standard” of treatment, but despite successful surgery many women find their pain and symptoms can return within about five years after surgery.




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How many women have it?

Around 7% of Australian women aged 25–29 and 11% of women aged 40–44 are likely to have endometriosis, which is similar to the worldwide estimate of one in ten women.

Delays in diagnosis are extremely common, and combined with needing surgery for a diagnosis, means many women suffer for years with chronic pelvic pain before being diagnosed with endometriosis later in life. This contributes to the difficulty in getting exact figures for how many women in Australia have endometriosis.

Worldwide estimates of chronic pelvic pain range from 5% to 26% of women. In New Zealand, it’s around 25% and is likely to be similar in Australia but we are lacking any up-to-date and reliable statistics on this.

What did our study find?

Endometriosis and chronic pelvic pain affect all aspects of women’s lives – social activities, romantic relationships and friendships, education, and work attendance and productivity.

We surveyed more than 400 women aged 18 to 45 who were either diagnosed with endometriosis or experiencing chronic pelvic pain. We asked about health-care costs (both out of pocket and funded), employment-related costs, and other costs related to childcare and household maintenance. We also asked about their pain levels.

Women with endometriosis sometimes have to work when they’re in extreme pain, affecting their productivity.
Flamingo Images/Shutterstock

We found the average cost for a woman with endometriosis was around A$30,000 per year.

Around one-fifth of this cost was in the health sector, for medications, doctors’ visits, hospital visits, assisted reproductive technology such as IVF, and any transport costs to get to these appointments. Of this, A$1,200 were out-of-pocket costs.

The bulk of the costs (over 80%) were due to lost productivity, either because of absenteeism (being off work) or presenteeism (not being as productive as usual because you’re sick). Women with endometriosis often use up all their sick leave and then often have to work when they are in severe pain.

Overall, if one in ten women aged 18 to 45 do have endometriosis, the total economic burden in Australia may be as high as A$9.7bn per year for endometriosis alone.

Pain scores had a very strong link with productivity costs. Women with the most severe pain had a 12-times greater loss of productivity, in terms of working hours lost, than those with minimal pain.

Overall, taking into account all costs (health sector, out-of-pocket, carers and productivity) women with severe pain have six-times greater costs (A$36,000) a year overall compared to those with minimal pain (A$5,700).

Finally, we also looked at the cost of illness not only of those women with a diagnosis of endometriosis, but also of those that had other causes of chronic pelvic pain, such as vulvodynia (pain, burning or discomfort in the vulva) and adenomyosis (growths in the muscular wall of the uterus).

We found the overall costs between the two groups – those with endometriosis and those with other types of pelvic pain – were very similar.




Read more:
Adenomyosis causes pain, heavy periods and infertility but you’ve probably never heard of it


The more pain a woman has, the bigger the impact on her productivity and out-of-pocket costs.
Iryna Inshyna/Shutterstock

So what should we be doing?

The economic burden of endometriosis is at least as high as other chronic disease burdens such as diabetes. However, many women are not receiving the support they need.




Read more:
Women aren’t responsible for endometriosis, nor should they be expected to cure themselves


We also need to prioritise funding for endometriosis research, which until recentlyhas attracted comparatively little research funding.

Plans are underway to increase awareness and education, and improve diagnosis and pain management. Unfortunately, there is no such plan for women with other forms of chronic pelvic pain.

Reducing pain, by even a modest 10-20%, could improve women’s quality of life and potentially save billions of dollars each year.The Conversation

Mike Armour, Post-doctoral research fellow, Western Sydney University and Kenny Lawson, Adjunct Principal Health Economis, Translational Health Research Institute, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Diplomacy and defence remain a boys’ club, but women are making inroads



Julie Bishop and Marise Payne have risen to the top in foreign affairs, but their successes may be masking more systemic issues preventing women from advancement.
William West/AAP

Susan Harris Rimmer, Griffith University and Elise Stephenson, Griffith University

The Lowy Institute has launched a three-year study on gender representation in Australia’s diplomatic, defence and intelligence services, and the findings are critical: gender diversity lags significantly behind Australia’s public service and corporate sector, as well as other countries’ foreign services.

In a field which has long ignored research on gender or feminist approaches to understanding international relations, this report is welcome and sets forth an important research agenda within Australia.

Gender diversity is an important issue for all who value the pursuit of Australia’s national interests overseas. Attracting and retaining the best talent is more important now than ever before.

As then-Prime Minister Malcolm Turnbull said in June 2017:

The economic, political and strategic currents that have carried us for generations are increasingly difficult to navigate.

The report’s most significant findings

The Lowy Institute found that of all the fields in international relations, women are least represented in Australia’s intelligence communities.

As the funding and resources of the intelligence sector continue to grow, this is a serious problem with little transparency. The sector appears to be struggling with a “pipeline” and “ladder” problem: women are both joining at lower rates and progressing at far slower rates than their male counterparts.

Another important finding is that the presence of female trailblazers in these fields, such as foreign ministers Julie Bishop and Marise Payne and Labor’s shadow foreign minister, Penny Wong, may be masking more systemic issues. This may be leading some agencies to becoming complacent, rather than proactive, on gender diversity.




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In the bid for more female leaders, ‘mansplaining’ probably won’t help


Women’s pathways to leadership continue to be impeded by institutional obstacles, such as unconscious bias and discrimination built into the cultures of these sectors, as well as difficulties in supporting staff on overseas postings. For instance, the report notes that in 2017 the government cut assistance packages for overseas officers, including government childcare subsidies. This has gendered ramifications given that women continue to do the bulk of domestic labour.

As such, the most important and high-prestige international postings are still largely dominated by men. DFAT’s Women in Leadership Strategy has proved successful in meeting initial targets for improving women’s representation, however the industry as a whole has not yet followed suit.

Further, it is not enough to just consider how many women there are, but what roles they occupy, given that women have often been siloed into “soft policy” or corporate areas and out of key operational roles needed for career progression.

The report also draws attention to the marginalisation of women from key policy-shaping activities.

From the study’s research on declared authorship, a woman is yet to be selected to lead on any major foreign policy, defence, intelligence, or trade white paper, inquiry or independent review.




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Women in combat: the battle is over but the war against prejudice grinds on


We would mention a few exceptions of women in other high-profile foreign policy roles – Heather Smith’s stewardship of the G20 during Australia’s presidency and Harinder Sidhu’s leadership in the crucial India High Commission. We would also note the contribution of Jane Duke to the ASEAN Summit in Sydney.

Rebecca Skinner has served as associate defence secretary since 2017 and Justine Grieg was appointed deputy secretary defence people in 2018. Major General Cheryl Pearce was also appointed commander of the UN peacekeeping force in Cyprus – the first Australian woman to command a UN peacekeeping mission.

Cheryl Pearce was commander of the Australian joint task force group in Afghanistan before taking up her current role.
Paul Miller/AAP

While the under-representation of women in international affairs remains a core concern, we would argue the report could have taken a broader look at gender representation in foreign affairs-focused academic communities, think tanks and publishing industries, as well.

Many of these organisations have similarly woeful records when it comes to gender diversity. For instance, Australian Foreign Affairs magazine has been criticised for the lack of women authors it publishes. We know that it is not for lack of credible voices, but rather seems indicative of a systematic form of marginalisation of women within the wider foreign affairs community.

Bright spots for gender diversity

However, there is some cause for optimism. For instance, our current PhD project is documenting the gender make-up of leaders and internationally deployed representatives in the departments of foreign affairs and trade, defence and home affairs, as well as the Australian Federal Police. As of this January, women represented 39.5% of those in the senior executive service in DFAT, and 41.4% of those employed as heads of Australian embassies and high commissions globally.

Further, we’ve found an increase recently in the number of women who work in diplomatic defence roles. While the Lowy report notes that women held just 11% of international roles in defence in 2016 (it is unclear exactly what international roles they are talking about), we found a slightly higher percentage of women (19%) currently employed in defence attaché roles.




Read more:
Australia’s performance on gender equality – are we fair dinkum?


The achievements made in this sphere are not just limited to gender either, with women from culturally and linguistically diverse backgrounds forming an important and growing part of representation.

In fact, a more in-depth analysis of the Lowy report’s data would have produced some very interesting, and more nuanced, findings. For instance, foreign affairs has long been the preserve of men, however it has also been the preserve of certain types of men. Diplomacy remains a bastion of prestige, social class, heteronormativity, and in Australia, Anglo-Saxon privilege. It was only last year, for example, that Australia’s first Indigenous woman, Julie-Ann Guivarra, was appointed ambassador (to Spain).

Overall, as the report outlines, gender equality is not just nice to have, nor is it a marginal issue in foreign policy. Rather, the findings are clear: addressing the continued gender gaps are imperative to Australian foreign policy, national security and stability.

We can, and must, do better. Australian foreign policy needs good ideas, and it needs a lot of them. We cannot assume they will all come from the same place.The Conversation

Susan Harris Rimmer, Australian Research Council Future Fellow, Griffith Law School, Griffith University and Elise Stephenson, PhD Candidate, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Health Check: why do women live longer than men?


Biology and behaviour can explain why men tend to die younger than women.
From shutterstock.com

Melinda Martin-Khan, The University of Queensland

In Australia, an average baby boy born in 2016 could expect to live to 80, while a baby girl born at the same time could expect to live until closer to 85. A similar gap in life expectancy between men and women is seen around the world.

As we better understand why people die, we’re learning how biological and behavioural factors may partly explain why women live longer than men.

Scientific advancements also impact the health of women and men differently.




Read more:
Australian women outlive men then struggle with disadvantage


Biology and behaviour

While women may live longer than men, they report more illnesses, more doctor visits and more hospital stays than men. This is known as the morbidity-mortality paradox (that is, women are sicker but live longer).

One explanation is that women suffer from illnesses less likely to kill them. Examples of chronic non-fatal illnesses more common in women include migraines, arthritis and asthma. These conditions may lead to poorer health, but don’t increase a woman’s risk of premature or early death.

But men are more susceptible to health conditions that can kill them. For example, men tend to have more fat surrounding their organs (called visceral fat) and women tend to have more fat under their skin (called subcutaneous fat). Visceral fat is a risk factor for coronary heart disease, the leading underlying cause of death for Australian men.

Coronary heart disease, which results from a combination of biological factors and lifestyle habits, is a major reason for the difference in mortality between men and women.

Other biological factors may contribute to men ageing faster than women, but these remain to be fully understood. For example, testosterone in men contributes to their generally larger bodies and deeper voices. In turn, this may accelerate the age-related changes in their bodies compared to women.

On the flip side, women may have a slight advantage from protective factors connected with oestrogen. Coronary heart disease has been observed as three times lower in women than in men before menopause, but not after, indicating that endogenous oestrogens could have a protective effect in women.




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Not just about sex: throughout our bodies, thousands of genes act differently in men and women


Some behaviours that can lead to an earlier death are more common in men. Accidental deaths, including those caused by assault, poisoning, transport accidents, falls and drownings, are particularly high among young males aged 15-24.

Men also have a greater tendency to smoke, eat poorly and avoid exercise. These habits lead to often fatal chronic illnesses, including stroke and type 2 diabetes, and are also risk factors for dementia.

Developments in science and public health

Many scientific discoveries have led to improved clinical practice or changes in government health policies that have benefited the lives of women.

For example, innovations in birth control have enabled greater choice and control over family size and timing. This has resulted in fewer pregnancies that may have led to dangerous births, and improved general physical and mental health for women. Improved clinical care has resulted in fewer women dying during childbirth.

As people reach an older age, the gap in life expectancy narrows.
From shutterstock.com

Public health programs such as screening for breast cancer have had impacts on life expectancy over time. Similarly, vaccines to prevent cervical cancer have now been distributed in 130 countries.

Of course, there have been similar public health policies and clinical innovations that have benefited men too, like screening for bowel caner.

So although we may have some insights, we can’t conclusively answer why women continue to live longer than men.

Mind the gap

The gap between men and women decreases the longer they live. In 2016, at birth in Australia, the gap was 4.2 years, with a male expected to die at 80 on average. But as that male gets older, the gap decreases to 2.7 years at age 65, to one year at age 85 and to just 0.3 years at age 95.

This suggests men who live to an older age have been able to avoid certain health risks, giving them a greater prospect of a longer life.




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Indigenous health leaders helped give us a plan to close the gap, and we must back it


Ultimately, none of us have control of when or how we’re going to die. But paying attention to factors that we can change (such as maintaining a healthy diet, doing exercise and avoiding smoking) can reduce the risk of dying earlier from a preventable chronic disease.

While women may always live longer than men, by a year or two, men can try to make some lifestyle changes to reduce this gap. That being said, women should work towards these goals for a long and healthy life, too.The Conversation

Melinda Martin-Khan, Senior research fellow, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.