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c h a p t e r t w e l v e 1992: The Year of the Menopause Nineteen ninety-two, according to the pundits, was the year of the woman in politics. Eleven women won primary contests as candidates for the United States Senate, four of whom prevailed in November’s general election (Carol Moseley Braun of Illinois, Barbara Boxer of California, Diane Feinstein of California, and Patty Murray of Washington), bringing the total number of female senators to six (the two incumbents were Nancy Kassebaum of Kansas, elected in 1978, and Barbara Mikulski of Maryland, elected in 1986). While the tripling of their numbers was welcomed, the exceptionality of their success was shrugged o√ by Senator Mikulski, who told the media, ‘‘Calling 1992 the Year of the Woman makes it sound like the Year of the Caribou or the Year of the Asparagus. We’re not a fad, a fancy, or a year.’’∞ Mikulski had a point. Although their numbers were small at all levels of government, women’s influence in the public sector was growing. Nowhere was this more evident than on the subject of women’s health. In the decade from 1979 to 1988, an average of only five or six bills on topics pertaining to women’s health were introduced each year in the House of Representatives and the Senate combined . In the 101st Congress, which met 1989–1990, that number leapt to thirtyeight new bills annually, and in the decade from 1991 to 2000, it increased tenfold from the previous decade, to an average of fifty-eight bills proposed every year.≤ In September 1990 the e√orts of Senator Mikulski and her colleagues in the Congressional Caucus for Women’s Issues to increase the visibility of women and women’s health concerns in the research agenda of the National Institutes of Health (NIH) paid o√, with the formation of the O≈ce of Research on Women’s Health. Located within the O≈ce of the Director of the NIH, this division of the nation’s primary agency for medical research was charged with promoting, coordinating , and monitoring research on women’s health, as well as ensuring the inclusion of women subjects in clinical trials. Although the proposed appropriations for this o≈ce were but a tiny fraction of the overall annual budget for the NIH 1992: The Year of the Menopause 223 ($20 million out of $7.5 billion, or less than three-tenths of 1 percent), the mere fact of its establishment held symbolic significance, namely, that women’s health deserved special attention.≥ Six months later another symbolic milestone was reached in the realm of government science, when Bernadine Healy received confirmation as the director of the NIH, the first woman ever to hold that position. This heightened awareness of and attention to women’s health signaled the advent of a new women’s health movement, one that di√ered in personnel, strategies , and priorities from the grassroots movement that took shape in the 1970s.∂ The earlier movement demanded that women be allowed to participate in medicine , as both consumers and providers, and some of its successes, such as the opening of medical schools to female students, helped to pave the way for the new movement. In the late 1980s and 1990s, women in positions of power—physicians , medical researchers, elected and appointed o≈cials—worked to incorporate women’s health into the established institutions of medicine and medical research. Whereas the earlier generation of feminists had challenged the hegemony of organized medicine (for example, by setting up self-help clinics with lay providers), women who became doctors in the 1970s and 1980s joined the ranks of medical professionals. Female physicians (and government o≈cials) acted within the system to e√ect change, while feminist activists strived to change the system itself. Both groups shared the ultimate goal of improved health care for women, and they agreed on the immediate need for randomized controlled trials as the scientific basis for the evaluation of drugs, devices, and procedures used in the practice of medicine. But with the letters M.D. after their names or o≈ces on Capitol Hill, the leaders of the 1990s advocacy e√orts had greater authority and more clout to enact their agenda for women’s health. What is interesting about this agenda—indeed, about much of the discourse about women’s health in the early 1990s—was the emphasis on middle-aged women. If...

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