THE SPECIALIST: Dr. Taraneh Shirazian
The director of global women’s health at Mount Sinai, Taraneh Shirazian is a minimally-invasive gynecologic surgeon who specializes in problems like fibroids, endometriosis and pelvic pain. She also runs a nonprofit, Saving Mothers, that provides education and training for local health-care providers around the world.
WHO’S AT RISK
Although on average women worldwide live four years longer than men, about 300,000 each year are still dying from preventable problems related to pregnancy and childbirth.
“The women’s global health movement seeks to address the most important and predominant needs of women around the world, which are related to health problems that women can face here in the States but are more pronounced in low-resource settings,” says Shirazian.
“For instance, one of the most pressing problems is maternal mortality and related morbidities like chronic pelvic pain, fistula, prolapse — and 99% of maternal deaths each year occur in developing countries.”
Most deaths during pregnancy or childbirth result from postpartum hemorrhaging, infections and seizure, and women living in rural and underserved areas are at the highest risk. “These are treatable and preventable diseases that often strike young, otherwise healthy women,” says Shirazian. “Unfortunately, much of the risk is tied to their disadvantaged social and political position, including a multitude of challenges — young age, lack of resources, lack of education and lack of contraception.”
While providing better access to health care for hundreds of millions of women may seem like an intractable problem, doctors are finding practical, low-cost ways. “Over time, we’ve come to realize that the key is to educate and train local birth attendants who actually live in the communities,” says Shirazian. “Another push is to provide $ 5 birth kits, which dramatically decrease birth complications by providing simple tools like Purell and plastic gloves.”
SIGNS AND SYMPTOMS
One problem that remains common in the U.S. is uterine prolapse, in which part or all of the uterus drops and protrudes into the birth canal. “Thirty to 40% of women in the U.S. suffer from some degree of uterine prolapse, which is usually connected to a high fertility rate, age and/or obesity,” says Shirazian. “The primary symptoms to look out for are pelvic pressure and pain.” Prolapse is a straightforward diagnosis for women who have regular pelvic exams.
Fibroids are treatable with minimally invasive options, but they can be fatal in some parts of the world. “The hallmark of fibroids is heavy or even massive bleeding,” says Shirazian. “I encounter American women whose periods ruin their quality of life, and I encourage any woman in this position to talk to their doctor, because there are such effective treatment options.”
For groups promoting women’s health, prevention is the key. “Globally, for women, access to family planning and trained medical providers is goal No. 1,” says Shirazian. “The focus is now on educating people who live in the communities to be trained birth attendants and general health providers. In places where there are no doctors, it’s essential to train people who actually live in the rural, underserved communities.”
These workers can be trained to recognize common problems, manage them and refer patients who need more aggressive treatment to clinics. “For instance, we have a network of 160 community health-care workers in the Dominican Republic who talk to women in the rural villages about chronic conditions like incontinence,” says Shirazian. “Before, this was a problem that women wouldn’t talk about but that could be really disabling, and now, our community health-care workers are able to refer patients who qualify to go into the city center, where we can provide surgical care.”
Making basic health care more available doesn’t have to be expensive or high-tech. For example, Shirazian notes that the $ 5 birth kit includes an instruction sheet, a mat to put under the mother, a baby blanket and hat, a bar of soap, cord clamps and a pair of scissors in addition to hand sanitizer and plastic gloves.
To doctors like Shirazian, promoting women’s health is a moral issue. “There’s a crisis in global health — many women are dying of completely preventable causes,” she says. “It’s imperative that we raise awareness about the issue and take action.”
The UN, World Health Organization (WHO) and others have made vast improvements, but much remains to be done. “The goal was to decrease the maternal mortality ratio by 75% by 2015 — we’ve gotten to about 49%,” says Shirazian. “So we’ve made great strides but haven’t made a breakthrough yet.”
QUESTIONS FOR YOUR DOCTOR
Because screening guidelines have recently changed, all women should ask two questions: “How often should I be getting a pap smear?” and “How often should I get a mammogram?” Shirazian also recommends that every woman take charge of her own health by asking, “ What preventive steps can I take to lead a healthier lifestyle?”
“Here in the States, every woman’s goal should be to identify any issues early, so you can have earlier and easier forms of treatments,” says Shirazian. “Thinking globally, our goal is to promote women so they have access to preventive measures and decreased maternal death and morbidity.”
WHAT YOU CAN DO
Get informed. For more information about protecting your own health, see www.MountSinai.org/obgyn. For info on how you can improve the situation for others, check www.who.int or SavingMothers.org.
Get a yearly checkup. “Women have a tendency to take care of everything else, and we need to take care of ourselves, too,” says Shirazian. “In this country, we have a chance to access preventive care — don’t let it fall by the wayside.”
Don’t ignore symptoms. If you notice anything unusual — pelvic pressure, pain, a change in bleeding or in urination habits — make an appointment with a doctor.
Don’t assume there’s nothing to be done. Even in the U.S., many women have disabling periods that cause them to stay home or wear a diaper. Don’t assume you have to suffer through it, though. “We have great surgical and nonsurgical treatments, including many minimally invasive options,” says Shirazian.
Be an advocate. You are the best advocate for your own health. Ask lots of questions, and consider starting a file to track your progress.