Win some, lose some: about integration projects of women's health care

A t the last Teaching Women’s Health Care conference in London in 1993, I gave a plenary lecture about how Aletta, the National Centre for Women’s Health Care transfers its knowledge and insights to regular health care. I explained that Aletta does this by developing postgraduate training programs (furthering of expertise) and by transferring these to, among others, general practitioners. The strategy Aletta applies is one by which it adapts its message to the various target groups, the target group segmentation. Feminist-oriented general practitioners attending a postgraduate course at Aletta at their own request, for example, are presented with different themes that are approached from a more critical point of view. In workshops that form part of regular postgraduate training courses for general practitioners, Aletta takes much smaller steps and tends to start out more from the prevailing traditional ideas about men and women, which it very carefully criticizes. In this case, the message presented is not so much a critical attitude and knowledge (the feminist lens) but seeks the creation of an initial awareness of gender as a classification principle that impacts our society, affecting the way we perceive sickness and health, the communication between doctor and patient, and the kinds of complaints men and women have. Aletta has, furthermore, developed various educational programs that advocate a treatment for specific gynecologic complaints and that take the lives of women into consideration. Two examples follow. In the case of problems related to incontinence in women, we stress suggesting pelvic muscle exercises to the patient rather than prescribing incontinence materials. The point of departure is that these exercises increase a woman’s personal control over her bladder and, as a result, over her own body and life. In the case of problems related to the menopause, we stress the importance of carefully weighing the advantages and disadvantages of hormone replacement therapy. The point of departure is that it is necessary to counterbalance the immense promotion of hormones by the pharmaceutical industry. In all of these educational programs, attention is paid to the possibilities of referral to the various self-help groups for women, for example, with regard to ~~‘~O~“,‘,~~~~~~bS Institute