1. Key messages
- For some aspects of women’s health, data can be lacking, difficult to access, analyse, and use, and this results in gaps in well-being, health prevention and care.
- An intersectional approach should be applied to address issues in women’s health.
- Women in Belgium experience, overall, good health but gaps persist.
- Women’s health should be placed high on the public health agenda.
2. Why a report on women’s health?
Gender and sex have a significant impact on health, as a result of both biological and socially shaped differences and inequalities. Historically, the health of women and girls has often been overlooked due to discrimination. As a result, women and girls are prevented from attaining their full potential of health. Today, there is still a clear underrepresentation of women in clinical studies and inadequate attention to sex and gender differences in research. Women are also more likely to be under-treated and misdiagnosed in clinical settings compared to men, even though women have more contact with healthcare professionals.
This report aims to make an overview of the available epidemiological evidence on women’s health and provides a baseline understanding of some of the key issues in the health status of women in Belgium today. Women’s health is a broad topic and this report is not meant to be exhaustive but rather seeks to stimulate discussion and further exploration by focusing on a few highlighted issues. Health topics were selected based on the impact they have on women, their public health importance, and the availability of data. In writing this report, a number of areas stood out for the lack of information or the underuse of collected data on issues unique to women in Belgium.
3. The health of adolescent girls
Inequalities between boys and girls begin to widen in adolescence, particularly in mental health
Evidence from school-based surveys shows that adolescent girls have poorer mental health than boys. More girls report psychosomatic and depressive symptoms as well as suicidal thoughts, and half as many girls as boys say they are often or always self-confident. Some of these symptoms may be influenced by changes in hormones common to adolescence, but others are related to gender expectations and stereotypes in society. While girls do better with measures of prevention and self-care behaviours, they are overall less physically active than boys. Furthermore, the adolescents in the survey were overall insufficiently informed about sexual education, which is not a compulsory subject in schools throughout the country.
Source: Belgian average based on HBSC French Community [1] and HBSC Dutch Community [2]
4. The health of adult women
More support for sexual and reproductive health would improve the well-being of women
In 2018, 84% of sexually active women aged 15 to 49 years old were using contraceptives. The most popular methods in Belgium are contraceptive pills and intrauterine devices (coil, IUDs). Over time, the use of pills has been decreasing while the use of IUDs has been increasing. An increase in the use of contraceptives was found following the introduction of reimbursement in some groups which suggests an opportunity for improving access. We also observed that voluntary termination of pregnancy is decreasing among young women and increasing among older women. Sexually transmitted infections are increasingly diagnosed, and some of these increases may reflect a higher incidence.
The prevalence of infertility is unknown in Belgium
We do not know exactly how many people are struggling with infertility in Belgium, but the World Health Organization estimates that globally approximately one in six people experience infertility in their lives. There is an increasing number of pregnancies resulting from in-vitro fecundation (IVF) treatments in the Flemish Region and the Brussels-Capital Region. Nevertheless, other information such as access to fertility care and the mental and physical health burden associated with fertility treatments is lacking.
Source: Adapted from the regional reports of perinatal health 2022 (Santé périnatale en Wallonie [3], Santé périnatale en Région bruxelloise [4], Perinatale gezondheid in Vlaanderen [5])
Not enough is known about the impact of endometriosis and PCOS in Belgium
Women suffering from endometriosis and polycystic ovary syndrome (PCOS) can experience debilitating symptoms that are often misdiagnosed or unrecognised, leading to an impact on their quality of life and delaying possible treatments. No data are currently available on the epidemiology of endometriosis or PCOS in Belgium and both are risk factors for infertility and other conditions.
Overall, maternal and perinatal health in Belgium is good, but inequalities exist
Women in Belgium have access to one of the best qualities of care for maternal health which is reflected in a low neonatal mortality rate of 3.2 per 1000 live births in 2020. Nevertheless, Moroccan, sub-Saharan African and Turkish nationality women living in Belgium have, on average, poorer maternal and perinatal health outcomes, including a perinatal mortality rate 80% higher than women with Belgian nationality. In addition, information on the prevalence and consequences of post-partum depression (PPD) are lacking in Belgium.
Poor mental health is also found in women into adulthood
Women are frequently found to have worse results in mental health indicators than men. The higher prevalence of anxiety and depressive disorders in women can be explained by various biological, societal and healthcare-related factors. Overall, women are more likely than men to use health services for mental health problems. Women report higher needs for psychological support but also higher unmet mental health needs. Suicide mortality rate is lower for women than for men in Belgium but among the highest in Europe.
Women have better occupational health than men but need targeted approaches to prevention
Gender differences remain in the types of jobs women and men in Belgium do and if and how they are remunerated for that work. These differences can have an impact on health. A European survey showed that in Belgium women experience poorer mental health, more musculoskeletal problems, and more violence in the workplace than men. Progress has been made in setting up health monitoring projects for workers in Belgium, but information by gender is often fragmented or incomplete. For instance, women are underrepresented in the Belgian Occupational Diseases Fund giving low visibility to occupational diseases or injuries in women in administrative data.
5. The health of women in later adulthood
Symptoms of perimenopause are undertreated in Belgium and can have a negative impact on quality of life and risks for disease
No exact estimates of the burden due to perimenopause exist, however, several conditions and symptoms are associated with this transition such as insomnia, feeling worn-out, depressed mood, and lower self-rated health. Improving the quality of life of women who are experiencing perimenopause is possible via hormone replacement therapy and management of symptoms. However, lack of awareness and hesitancy may limit women in seeking care. An overarching collaboration of different sectors and the wider society can help lift taboos around menopause and ensure access to care and treatment.
Cardiovascular diseases have a high burden on women and there is room for improvement in understanding and acting on risk factors for cardiovascular diseases in women
Except during the COVID-19 pandemic period, cardiovascular diseases have been the main cause of death in women in Belgium for many years. In Belgium, one in three registered heart attacks occurs in women. Women have a high risk for cardiovascular disease (in part due to hormonal shifts during menopause) which may go unrecognised by the women themselves and healthcare providers. Women with cardiovascular disease also often experience fewer and different symptoms than men.
Cancer screening rates differ across the regions of Belgium
Breast cancer and cervical cancer both have a high incidence in women in Belgium and early detection can improve a woman’s chance for survival. The coverages for breast cancer, cervical cancer, and colorectal cancer screenings are higher in the Flemish Region compared to the Walloon Region and the Brussels-Capital Region. A large proportion of cervical cancers are caused by the sexual transmission of human papillomavirus (HPV) and vaccination has proven an effective prevention strategy. Vaccination against HPV is available to adolescent boys and girls free until 18 years old. However, vaccination rates remain too low and more work is needed to extend coverage.
6. The health of women in the third age
Women live longer than men but will spend more of those additional years in poor health
Women in the third age face unique and multiple health challenges. Since women live, on average, longer than men, they are more exposed to age-related health problems. Older women are especially affected by frailty, multimorbidity, and dementia. Additionally, certain conditions have a higher prevalence in women aged 65 and above, such as musculoskeletal diseases and urinary incontinence.
Older women are particularly at risk for falls and osteoporosis leading to fractures impairing their quality of life
Falls and osteoporosis are the main causes of fractures in older women. Osteoporosis, particularly important in post-menopausal women, leads to bone loss, increasing thus the risk of fractures. The prevalence of osteoporosis was almost ten times higher in women aged 55 and over (13%) than in men (1.8%) and is linked to changes in bone density from menopause. Part of the difference between women and men may be accounted for by an underdiagnosis of osteoporosis in men. Additionally, falls are a major cause of mortality and morbidity in the third age. In Belgium, more falls are recorded among women than among men. Measures exist to prevent falls and work best using a holistic and coordinated approach.
Source: Belgian Health Interview Survey [6]
Women are more likely to develop Alzheimer’s disease than men and no adequate treatment exists
Of the estimated 23,370 cases of Alzheimer’s and dementia in Belgium in 2020, 60% were in women. This is in part due to their longer life expectancy but research suggests that differences in the immune system and the menopause transition could also play a role. In 2020, Alzheimer’s disease and other types of dementia were the first cause of death in women after COVID-19 while it was the 5th in men. More research into the prevention and treatment of Alzheimer’s disease and dementia is urgently needed as well as an increase in awareness of the influence of risk factors such as alcohol use, physical inactivity, poor diet, and tobacco use.
7. Read more
References
- HBSC Fédération Wallonie-Bruxelles, ULB, 2018. https://sipes.esp.ulb.be/
- HBSC Vlaanderen, UGent, 2018. https://www.jongeren-en-gezondheid.ugent.be/
- Santé périnatale en Wallonie, CEPIP, 2022. https://www.cepip.be/rapport-bw.php?LG=fr
- Santé périnatale en Région bruxelloise, CEPIP, 2022. https://www.cepip.be/rapport.php?LG=fr
- Perinatale gezondheid in Vlaanderen, UGent, 2022. https://biblio.ugent.be/publication/01HFXKVPK9MHYJSMCV7GYX3VGE
- Health Interview Survey, Sciensano, 2013-2018. https://www.sciensano.be/en/projects/health-interview-survey
Please cite this page as: Sciensano. Women's health, Health Status Report, 29 Apr 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/womens-health