As the decade changes and we consider the state of women's health in America, who better to turn to than the authors of five taboo-busting books from 2019 that took on issues that generations of women haven't been talking about, but need to. We asked these outspoken doctors and health advocates to give us their Top 7 messages to women for 2020. Here's what they said.
1. Better birth control is possible — and necessary
"Because birth control has been an incredible force in the lives of women — allowing them to achieve (and even set) long-term educational goals and career goals, and achieve gains toward economic parity with men — there's a taboo around talking about it critically, for fear that it will be taken away, and our gains with it," says Sarah Hill, author of This Is Your Brain On Birth Control: The Surprising Science of Women, Hormones, and the Law of Unintended Consequences.
Hill wants to see more investment into research and development of better birth control. Hormonal birth control influences the brain in ways that make people uncomfortable to acknowledge, she says, including whom a woman finds attractive as a mate and, to some degree, how she responds to stress.
It used to seem like the best defense against sexist rhetoric was to pretend as if these effects didn't exist at all, Hill says. "But sticking your head in the sand is no way to advocate for a better future for women."
It can be uncomfortable acknowledging the flaws of hormonal contraception while simultaneously fighting to make it accessible, Hill says, but adds, "it's a trade-off. We have to find a way to live in this discomfort while we push for improvements. Women deserve better."
2. Most "vaginal health" products are bogus
One of the most pernicious myths is that vaginas are in a constant state of near-catastrophe and need cleaning and repair, says Dr. Jen Gunter, New York Times columnist and author of The Vagina Bible: The Vulva And The Vagina — Separating The Myth From The Medicine. Forget all those myths, she says."Your vagina has got things covered."
The messaging that a woman's genitalia needs constant upkeep — with things like special "feminine" washes, douches, hair removers, wipes and tighteners — is mostly promoted by companies that want to make women feel insecure so they'll buy something, she explains. "If our genitalia required special care, we never would have evolved this way." In general, Gunter says, it's a bad idea to rely on information from a source that's also trying to sell you something.
3. Transgender women are women
Gunter writes about gender transition and what she has heard from parents of trans kids is that it provided them with medical information that they weren't getting anywhere else — even from their primary health care provider.
What it comes down to is simple: "Having a vagina isn't what makes you a woman. It's how you feel inside," says Gunter. "We shouldn't reduce anyone to their body parts, but it happens more with women, and especially with trans women."
Ultimately, she says, "parts are parts, and people are people."
4. Women's pain is real
For years, Abby Norman experienced extreme menstrual symptoms and extraordinary abdominal pain during sex. But doctors wrote her off. "They implied they thought my pain was psychological," she says.
It was only when she started to bring her boyfriend with her to appointments that she felt taken seriously. "All of a sudden, things changed. All I could think was, 'Why wasn't it enough when I was saying it?' Why is it that being a disappointment to the man in your life is the sign that things needed to change?"
Norman wrote about her experience — which culminated in a diagnosis of endometriosis — in her memoir Ask Me About My Uterus: A Quest to Make Doctors Believe in Women's Pain. She says the big takeaway (besides the need for more awareness and understanding of endometriosis) is that "doctors need to acknowledge that women are capable of knowing themselves." This phenomenon can be compounded when the patients are women of color.
5. It's time to rethink menopause
According to historian Susan Mattern, when women in premodern, agrarian societies would exit their reproductive age, "it was viewed as an upgrade — an entrance into a really important life phase." Mattern is the author of The Slow Moon Climbs: The Science, History, and Meaning of Menopause.
Too much emphasis in mass market books about menopause, she says, is placed on menopause "treatments" (or lack thereof).
"The modern way of thinking about menopause isn't the only way," she says. "And other ways might serve us better."
Mattern says humans have been a long-lived species for quite some time, and were "engineered" by evolution to live into our 70s — and thrive in our post-reproductive years. She says that what's new is the stigma attached to old age. "We tend to think that aging is bad, and that only young people are useful. But if we're not appreciating what's going on during the rest of our lifespan, we're not understanding who we are."
6. Vagina. Labia. Clitoris. It's OK to talk about them
These clinical terms are still often treated like dirty words, and that's a problem, Gunter says. "When you can't say a word, the implication is that it's shameful and that it shouldn't be talked about. And that stifles your ability to find out what's typical, versus what might be a medical condition."
Regularly, she says, women come to her office, "and even behind closed doors, they can hardly say the words to describe what's wrong with their reproductive tract. They'll even say to me, 'I don't know why I'm having trouble saying this.' And that's not to disparage the women — that's just how effective the culture of shame is, even today."
The danger of being unable to speak freely about bodies, Gunter says, is twofold. If women can't discuss health concerns with their doctor, not only will they miss out on treatment, but they also may get bad advice from less reputable, clandestine sources.
7. Women's rights are human rights
Jennifer Weiss-Wolf is fighting to end what she calls the "tampon tax," which still exists in 32 states. She outlines the case against the taxation of menstrual products in her book Periods Gone Public: Taking A Stand For Menstrual Equity.
It's time to connect those issues to the ways society marginalizes certain other groups, she says, and push for greater dignity and justice for people experiencing homelessness or incarceration, too.
Emily Vaughn is an intern on NPR's Science Desk.
A previous version of this story incorrectly gave the title of the book Periods Gone Public: Taking A Stand For Menstrual Equity as Periods Gone Public: Taking A Stand For Menstrual Equality.