Touching the lives of women through research

Imagine a research project that spans more than a quarter of a century and has touched the lives of more than 57,000 women; a juggernaut that has captured hundreds of millions of data points.

Their complex intersections – analysed in more than 1000 publications by over 1500 researchers from around the world – have contributed to global knowledge in more than 20 health-related areas and influenced a slew of clinical guidelines and public policies.

This is what the Australian Longitudinal Study on Women’s Health (ALSWH) has become – one of the longest running research projects at The University of Queensland.

Since 1996, the study – led by its director, UQ Faculty of Medicine’s Professor Gita Mishra – has examined the health fortunes of four generations of Australian women.

“The women studied are broadly representative of the many varied backgrounds and circumstances which exist within the Australian population,” Professor Mishra told Research News.

“The Study takes a life course approach so the of age of each cohort was particularly important; each group is representative of an important period of change over the course of women’s lives.”

The oldest cohort recruited for the ALSWH were born in the years 1921–26, shortly after the First World War and the Spanish flu decimated the global population. They grew up during the deprivations of The Great Depression and Second World War. In 1996, these women were 70–75 years old and already defying social expectations of old age.

Twenty participants from the original 1921–26 cohort turned 100 years old in 2021, a milestone celebrated by ALSWH staff, given the invaluable insights these women have provided through their lived experience.

Data from the 1921–26 cohort reveals the factors that contribute to ageing well – not just reaching old age, but actively enjoying the journey. Their data has shown that using home care services can slow older women’s rate of admission to residential aged care. Women who used more services had a significantly lower rate of admission to aged care than women who only used a few basic services.

The 1946–51 cohort were aged 40–45 when joined the study in 1996. They have contributed to our understanding of how the timing of reproductive events impacts our health in later life. For instance, women who get their first period before the age of 11 are 50 per cent more likely to experience frequent hot flushes and night sweats during the menopause transition.

Those who experienced premature menopause (before age 40) are twice as likely to experience a non–fatal cardiac event before the age of 60 as those who went through menopause at age 50. Women who had an early menopause (before age 45) were 40 per cent more likely to suffer a non-fatal cardiac event. These are valuable insights for women approaching the menopause transition, and their clinicians.

In 1996, at age 18–23, the cohort born between 1973–78 were starting their journey through adulthood – higher education, first jobs, relationships, and families.

The emerging field of preconception health investigates how women’s health and lifestyle in the years before conception can have a long-term impact on their health during pregnancy and their children’s outcomes.

Professor Mishra led the Australian contribution to an overview of international research on preconception health, published in the Lancet.

She has called for action at a national level to improve the health of Australian women, to reduce risks in planned and unplanned pregnancies and improve the future health of women and their children.

“The evidence overwhelmingly shows healthier pregnancies and better outcomes for mothers and their children when they are able to make positive lifestyle changes before conception, such as eating well, being more active or quitting smoking and drug use, or seeking help for mental health issues” Professor Mishra said.

“For instance, research with the 1973–78 cohort has shown that gradual weight gain during women’s 20s increases their risk of gestational diabetes.

“Use of cannabis in the years before pregnancy increases a woman’s risk of post-natal depression. And a healthy diet before pregnancy can reduce the chance of children having behavioural problems.”

Change is a constant factor at the ALSWH. The women of the ‘young’ cohort are now 44–49, and entering peri-menopause. To ensure the study stayed relevant to the experiences and needs of young Australian women, a fourth cohort of 18–23 year olds was recruited in 2013 – this time born between 1989 and 1995.

“We’re able to directly compare the health of these two cohorts of women at the same ages and there are some concerning differences,” Professor Mishra said.

These young women are eating more fruit and vegetables than their older peers did at the same age and they’re getting just as much exercise. But their general health is worse, their rates of obesity are far higher, and their mental health is much worse than their older peers at the same age.

“As we follow participants across their life course, we can identify the timing and long-term effects of a range of social, physical, mental, and environmental factors that contribute to women’s wellbeing and future risk of chronic disease,” Professor Mishra said.

Influencing factors on health can often be intersecting and compounding, placing certain people at far greater risk of morbidity or sustained challenges to quality-of-life.

“We know that victim-survivors of domestic violence have worse physical and mental health in the long term. We also know that taking on a care-giving role can have negative impacts on women’s health,” Professor Mishra said.

“Around one in 20 middle aged women have both these life experiences and they have twice the normal odds of experiencing depressive symptoms and stress – and they also had worse physical health than other women.”

Outcomes from ALSWH’s research allows governments and organisations to not only prepare medical responses, but make systematic adjustments to the way public health is structured.

“Our research isn’t about pressuring women at an individual level or making them feel guilty,” Professor Mishra said.

“It’s going to take a huge social shift to tackle the big health issues facing Australians – the obesity crisis, the mental health crisis, ageing, chronic disease, and domestic violence – and to do that we need population-level health initiatives supported by all levels of government.”

An involvement at the coalface of women’s health placed Professor Mishra in a prime position to lead an evidence review for the Australian Government Department of Health’s National Women’s Health Strategy covering the years 2020–2030.

Heavily supporting and drawing from the work of the ALSWH, the strategy identified the following priorities for the current decade:

·       Maternal, sexual and reproductive health

·       Healthy ageing

·       Chronic conditions and preventative health

·       Mental health

·       The health impacts of violence against women and girls

The Strategy specifically called for continued investment in the ALSWH to strengthen women’s health research and data collection.

The juggernaut that is ALSWH shows no signs of slowing down. ALSWH continues to grow and reflect the changes in Australian society.

In October 2020, the Australian Federal Government pledged $8.5 million in funding over a three-year period for The University of Queensland the University of Newcastle to continue their joint management of the study.

“That funding has enabled us to recruit more women with South-East Asian backgrounds into the study and address contemporary issues,” Professor Mishra said.

“We are ensuring participants reflect the current Australian population, providing us more complete and accurate information about women’s current and future health needs.

“The importance of the study and its many applications has been evidenced by the current pandemic.

“The ALSWH has conducted a series of surveys and reports documenting women’s experiences of the COVID-19 pandemic, as varied as understanding people’s living arrangements, their employment status, home schooling, experiences of abuse, and general wellbeing.

“Understanding the stressors faced by women during the pandemic and how these have affected their health will allow the community to address issues now, and proactively, prepare for future events.”