Jessica Sattler, MS, WHNP
The landscape of women’s healthcare has changed significantly over the last hundred years. From the introduction of the pap smear in 1923 to the Food and Drug Administration’s approval of the birth control pill in 1960 to Roe v. Wade in 1973 which gave women the right to reproductive decision making including abortion, to the passing of the Affordable Care Act in 2010, great progress has been made over the past century in improving women’s health.
Though advancements in women’s reproductive health have accelerated, significant health disparities persist for women, particularly for women of color, women living in poverty, and women living in rural areas, who experience less access to high-quality care and poorer health outcomes.
This blog post will highlight four areas that are critical to addressing to improve women’s healthcare.
Access to care
Some things that make access to care difficult have little to do with healthcare. A 2020 paper from the American College of Physicians found that lack of transportation and the inability to take time off of work introduces barriers that significantly limit access to preventive care and treatment. Similarly, women with children at home have the added challenge of either finding childcare or bringing their kids along to their appointments, which is not always feasible. Over twenty percent of U.S. residents speak a foreign language at home. When patients don’t have access to linguistically competent care and written materials in their language, it can impact the quality of care they receive. Other structural barriers include inadequate insurance coverage, clinic locations and hours, and proximity to public transportation.
In the US, particularly since the reversal of Roe v. Wade in 2022, the legal landscape surrounding women’s reproductive health can feel both complicated and frightening. Access to reproductive healthcare services, including infertility care, birth control, and abortion, now varies widely from state to state. This impacts, and in some states, severely constrains, how healthcare systems and providers are able to deliver needed care. Medical residency programs in states with restrictive abortion laws face challenges in providing residents with the practical experiences around abortion care required to keep their program accreditation and for graduates to be able to sit for specialty board certification exams. The downstream effects of these state legal restrictions impact medical schools’ ability to recruit faculty and students into women’s health specialties such as OB/GYN, maternal-fetal medicine, and reproductive endocrinology. In states such as Louisiana and Texas, states which have some of the poorest health outcomes for women, the unintended consequences of these restrictions further deprive citizens of high-quality women’s healthcare.
When women experience discrimination from healthcare providers, they are less likely to get the preventive care they need and have poorer health outcomes. One of the most frequently named reasons for loss of trust is poor communication, specifically, that patients don’t feel listened to. Conversely, when women have healthcare providers they trust, and feel cared for without stigma or judgment, evidence shows increased engagement with the healthcare system, more involvement in medical decision-making, improved health behaviors, and reduced stress. Representation and cultural competence in healthcare teams also builds trust. For example, Black patients have improved health outcomes when treated by Black physicians. Past healthcare failures (or successes!) can have a huge impact on trust, confidence, and the decisions women make about their own care.
Health equity means that all people have a fair and just opportunity to be as healthy as possible. Improving equity in women’s health requires addressing avoidable inequalities that disadvantage or cause harm. One such area is in pharmaceutical research and clinical trials. Women are underrepresented in research and clinical trials. This leaves healthcare providers with incomplete information about how women respond to different health conditions, often presenting with different symptom profiles than men do, and may require different treatments and management. There are even lower levels of participation in clinical trials by women from racial and ethnic minorities–groups who, at the same time, often bear a disproportionate burden of disease. Structural improvements, such as the Food and Drug Administration’s draft guidance on new regulatory requirements for diversity planning and recruitment in clinical trials, are an important step forward and can help ensure that drugs or treatments being developed are safe and effective for both men and women.
When women support one another, we can make profound and amazing things happen.
Improving access to care, including reproductive care, building trust between care teams and patients, and ensuring more equitable representation in the development of medicines and treatments will by no means address all of the root causes of health disparities for women. We need both practical, point of care approaches to improve care locally while we also work to address policies and systems that introduce or perpetuate structural barriers to equitable care.
For more information about how you can help advance health equity for women, check out the following resources: