Stages and future of women’s health: A call for a life-course approach

Abstract

Over the years, discourse on women’s health has skewed towards reproductive health, particularly on matters relating to maternal and child health, contraception, and pregnancy-related care. In spite of the relevance of these aspects, such a narrow perspective overlooks the broader spectrum of health concerns that affect women across different life stages, hence the need to refocus women’s health through the lens of the life-course perspective. The life-course perspective is a framework for understanding human development that centers on time and space. From adolescence to old age, women encounter a wide array of health challenges and experiences, including non-communicable diseases (NCDs), mental health disorders, musculoskeletal conditions, and the long-term consequences of early-life exposures. Addressing these issues requires a paradigm shift toward a more comprehensive and inclusive approach that recognizes the lifelong nature of women’s health needs. Rather than treating health issues in isolation, the life-course perspective considers how early-life exposures, social determinants, and lifestyle factors influence health trajectories over the life spectrum. For women, this means recognizing that adolescent health behaviors affect midlife disease risk, menopause has implications for cardiovascular and bone health, and older age brings unique challenges such as frailty and cognitive decline. This model underscores the importance of preventive care, early interventions, and tailored health services at every stage of life. Consequently, this editorial takes a life-course approach to highlight the dominant health and health-related realities of women, segmented into three cardinal phases: emerging adulthood, adulthood, and late adulthood. It concludes by drawing governments and the global community’s attention to the need to focus healthcare systems on universal, gender-sensitive healthcare policies that guarantee accessible, affordable, and high-quality services tailored to women’s needs at every stage of life. Policies and programs that support women at every stage of life must take center stage in the quest to create a future where all women, regardless of age or background, can achieve optimal health and well-being.

Introduction

Women’s health has historically been limited to studies of reproductive health, with a predominant focus on maternal and child health, contraception, and pregnancy-related care. While these aspects are crucial, such a narrow perspective overlooks the broader spectrum of health concerns that affect women across different life stages. From adolescence to old age, women experience a range of health challenges, including non-communicable diseases (NCDs), mental health disorders, musculoskeletal conditions, and the long-term consequences of early-life exposures.^1,2 Addressing these issues requires a paradigm shift toward a more comprehensive and inclusive approach that recognizes the lifelong nature of women’s health needs. ³

The life-course perspective is a framework for understanding human development that centers on time and space. ⁴ Elder argued that four key components impact human development, namely historical time, and place: timing in lives, linked lives, and human agency. This means health is shaped by (1) when and where the individual grows (which impacts access to care, medical advances, and social norms around health behaviors); (2) the timing that pivotal health-related events occur (like childbirth and substance use); (3) the other people we engage with (social support, role models, healthcare providers); and (4) our own free will and health-related autonomy. A life-course approach to health emphasizes the cumulative impact of biological, behavioral, and environmental factors across different life stages. Rather than treating health issues in isolation, this perspective considers how early-life exposures, social determinants, and lifestyle factors influence health trajectories over time. For women, this means recognizing that adolescent health behaviors affect midlife disease risk, menopause has implications for cardiovascular and bone health, and older age brings unique challenges such as frailty and cognitive decline. ⁵ This model underscores the importance of preventive care, early interventions, and tailored health services at every stage of life.

This editorial advocates for the adoption of a life-course approach to women’s health, urging policymakers, healthcare professionals, and researchers to expand their focus beyond reproductive health. By integrating this perspective into public health policies, clinical guidelines, and research priorities, we can foster a more holistic and equitable approach to healthcare. Acknowledging the diverse and evolving health needs of women throughout their lives is not only essential for improving individual well-being but also for achieving broader public health and economic gains.^6,7 It is time to reframe women’s health as a lifelong priority, ensuring that all women receive the care and support they need at every stage of life.

Emerging adulthood (18–25 Years)

Emerging adulthood, ages 18–25, is a time when individuals transition from children to adults. During this time, people experience a great shift from being monitored and nurtured by their adult caregivers to fully responsible for their own lives and well-being. ⁸ This developmental stage and related transitions have a gamut of implications on women’s health including engaging in health risk behaviors, experiences of fluctuating mental health, and a heightened focus on contraception and conception.^{9 –11}

To begin, young adults are constantly exposed to images of “ideal” body types and lifestyles, as the greatest consumers of social media, at 84%, which has been shown to negatively impact their mental health. ¹² Emerging adults have elevated rates of stress and anxiety which have been attributed to media consumption, independence, and responsibility, as well as financial crises. ¹³ Not only does this manifest as anxiety and depression, but it also presents as disordered eating among young women. It is important to note that cultural differences and social norms impact manifestations of disordered eating with White women more likely to take on restrictive diets and Black and Brown women more likely to binge eat. ¹⁴ As we look to the future, it will be vital to engage young women in mental health education and intervention using the very media they spend so much time-consuming. Scholars are to examine the efficacy of hashtag movements, calls for self-care, and other tools available at the intersections of technology, media, and health.

Next, another outcome associated with expanded freedom is engagement in health-risk behaviors. For women in particular, alcohol use is highly problematic with (1) an overall decline in drinking among men and (2) the gender gap in drinking decreasing from 2:1 (men to women) to 1:1 in the United States for the first time ever. ¹⁵ Factors that promote this increase in alcohol consumption include increased rates of higher education and acquiring high-stress careers. In terms of food consumption, emerging adults are psychologically limited when it comes to linking today’s behavior to tomorrow’s health outcomes. ⁸ This means they eat fast food regularly and eat junk foods late at night with little concern for their future health. As a way forward, education about the lifelong impact of poor eating is needed early on. Youth need to enter young adulthood fully aware of the costs of their high-risk decisions. High-risk sexual behaviors peak in emerging adulthood as well. During this stage, young women have (1) more sexual partners than other stages as well as (2) inconsistent condom use. ¹⁰ Because many adults are delaying conception and monogamy, but not sex, young adults engage in more casual sex which is often unprotected. This is reflected in STI rates, with half of new cases coming from 15 to 24-year-olds. ¹⁶ As women continue to infiltrate spaces that are associated with alcohol use, more research is needed on ways to prevent use and mitigate overuse. Education around work–life balance and scholarship on its impact will help create a way forward for professional young women.

Finally, emerging adulthood is often conceptualized as the optimal time for childrearing based on infant and maternal mortality rates. ¹⁷ This means women and other birthing people are often grappling with whether to conceive and which form of contraception to commit to. It should also be noted that experiences with sexual and reproductive health are not universal and vary drastically when we consider factors like race, ethnicity, immigration, sexuality, socioeconomic status, and religion. Social issues like discrimination, patient–provider interactions, access to quality care, and norms around contraception use have differential impacts on young women across the globe.^18,19 Continued targeted outreach is vital as we work to promote equity in the sexual and reproductive health space. Since outcomes are so impacted by social factors, inclusive and tailored research and practice are the waves of the future.

Adulthood (26–64 Years)

Chronic disease is a significant concern during adulthood, with an increased risk of NCDs such as cardiovascular disease, diabetes, and cancer. ²⁰ The dual burden of caregiving responsibilities—whether for children, aging parents, or both—alongside professional obligations can impact overall well-being, leading to heightened stress and reduced opportunities for self-care. Additionally, post-fertility reproductive health matters such as polycystic ovary syndrome (PCOS), endometriosis, menopause, and hormonal fluctuations require greater recognition and management within healthcare systems. Despite their prevalence, these conditions are often underdiagnosed or inadequately addressed, leaving many women without sufficient support or treatment.

Beyond physical health, mental well-being remains a pressing issue, with stress, anxiety, and depression commonly arising from work–life balance struggles, family responsibilities, and societal expectations. Gender disparities in workplace policies, including unequal maternity leave, persistent pay gaps, and limited access to leadership roles, further exacerbate these challenges, affecting both career progression and overall health outcomes. ²¹ Furthermore, gender inequalities in research and opportunities continue to hinder progress in women’s health, with women being underrepresented in clinical trials and sex-specific health research. These gaps contribute to disparities in medical knowledge and treatment efficacy, underscoring the need for more inclusive and gender-responsive research frameworks. ²²

To address these challenges, enhancing workplace health policies is crucial. Implementing flexible working arrangements, paid parental leave, and accessible mental health support can help create a more supportive environment for women navigating career and family responsibilities. Strengthening research and healthcare strategies to prioritize gender-specific conditions, alongside increasing female representation in clinical studies, is essential for improving medical understanding and treatment outcomes. Community-based interventions should also be expanded to provide resources for caregiving women, offering support for stress management and self-care. Additionally, public health initiatives must prioritize menopause education, hormonal health awareness, and chronic disease prevention to ensure that women receive appropriate guidance and care as they age. Lastly, advocating for gender-equitable policies in healthcare access, employment, and financial security can contribute to a more inclusive and fair healthcare system that supports women throughout their adult lives. By adopting a life-course approach, we can ensure that women receive comprehensive, inclusive, and equitable healthcare at every stage of their lives.

Older adulthood (65+ Years)

Amidst the global silver wave of aging, women 65 and older are at the crossroads of vulnerability and resilience. ²³ Though wise and sometimes strong, they deal with a silent storm of health issues, such as systemic ageism, social isolation, and aging-related ailments. These problems lower their quality of life in addition to putting a heavy toll on healthcare systems. With research indicating that one in three women over 65 will suffer osteoporotic fractures, biological factors, such as hormonal changes following menopause, contribute to a higher prevalence of osteoporosis in. ²⁴

Besides, cardiovascular diseases continue to be a primary cause of death for older women, and their atypical symptom presentation frequently results in delayed diagnosis and treatment. ²⁵ With women accounting for nearly two-thirds of diagnosed cases, cognitive decline, and dementia, especially Alzheimer’s disease, present serious challenges as well. These illnesses not only impair mental and physical well-being but also make people more reliant on healthcare systems and caregivers.

For older women, social isolation is a common problem that is exacerbated by life circumstances such as widowhood, retirement, and peer outliving. Social isolation has been associated with a 29% increased risk of coronary artery disease and a 50% increased risk of dementia. ²⁶ According to the National Institute on Aging, ²⁷ the psychological toll of loneliness increases the propensity of mental health issues like anxiety and depression, which are frequently underdiagnosed in this population. Isolation restricts access to unofficial support systems, leaving many aged women to deal with health issues on their own. Mitigating these effects requires interventions that promote community involvement and technological innovations to sustain social ties.

Even with their increased healthcare needs, older women frequently face structural obstacles to receiving high-quality care. Ageism, or age-based stereotyping and discrimination, is widespread in healthcare systems and can result in symptoms being undertreated or written off as “normal aging.” For example, older women’s pain is often not adequately managed, and medical professionals tend to blame complaints on aging instead of looking into the root causes. ²⁸ Financial limitations further restrict access to necessary services, especially for older women who have outlived their spouses. ²⁹ Additionally, older women living in rural areas are disproportionately affected by geographic disparities in healthcare availability, such as longer travel times and fewer specialized services. ³⁰

To address the health and well-being challenges faced by women aged 65 and older, a multimodal strategy involving medical, social, and policy interventions is needed. Critical initiatives could include improved screening and treatment procedures for age-related disorders, community-based initiatives to address social isolation, and structural changes to end ageism and enhance access to healthcare. By placing a high priority on the health and welfare of older women, societies can guarantee the holistic well-being of this group as they continue to age.

Cross-cutting factors

Empowering women through education, leadership opportunities, and community engagement is fundamental to improving health outcomes. ³¹ Advocacy efforts should focus on increasing awareness of gender-specific health needs, eliminating stigma around conditions like menopause and mental health disorders, and ensuring women’s voices are represented in policy decisions.^32,33 Strengthening legal frameworks to protect women from gender-based violence and discrimination is also essential for fostering a healthier and more equitable society.

Women’s health is profoundly shaped by social determinants, including economic status, education, access to healthcare, and social support systems. Addressing health inequities requires a multi-sectoral approach that includes policies for economic empowerment, improved healthcare infrastructure, and targeted social interventions. ³⁴ Reducing disparities in access to nutritious food, safe housing, and quality education can significantly enhance women’s long-term health and well-being.

Women’s health is influenced by intersecting factors such as race, ethnicity, socioeconomic status, disability, and sexual orientation. Marginalized groups often face additional health challenges due to discrimination, limited access to quality healthcare, and cultural stigmas. Recognizing these intersectional dynamics is critical for designing inclusive policies and healthcare programs that address diverse needs.

Climate change disproportionately affects women’s health through increased exposure to extreme weather events, food and water insecurity, and pollution-related diseases. Women in low-resource settings are particularly vulnerable due to their reliance on natural resources for livelihoods and caregiving responsibilities. ³⁵ Integrating climate resilience into women’s health policies and promoting sustainable health interventions can mitigate these risks and improve long-term well-being.

The rise of digital health technologies presents new opportunities to bridge healthcare gaps for women. Telemedicine, mobile health apps, and AI-driven diagnostics can enhance healthcare access, particularly for those in remote or underserved communities. However, disparities in digital literacy and access to technology must be addressed to ensure that all women can benefit from these innovations. ³⁶

Conclusion

To ensure the holistic well-being of women, a life-course approach is indispensable, hence the need to be prioritized irrespective of race, geographical location, or socioeconomic status. A life-course approach to women’s health acknowledges that health challenges evolve over time and require sustained, gender-sensitive interventions. Expanding the focus beyond reproduction to include chronic disease prevention, mental health support, workplace equity, and social determinants of health is essential for achieving comprehensive and inclusive care. By implementing policies and programs that support women at every stage of life, we can create a future where all women, regardless of age or background, can achieve optimal health and well-being. Governments also need to focus healthcare systems on universal, gender-sensitive healthcare policies that guarantee accessible, affordable, and high-quality services tailored to women’s needs at every stage of life.