Diagnosing Gender Disparities in Health Care

 by Andrea Irwin

Until I became a women’s health advocate immersed in the nuances of Medicaid, health insurance, and other complicated policy issues, I never truly appreciated the numerous disparities that exist between the ways men and women access the health care system. Most of my female friends are now in their mid-to-late twenties and I am constantly amazed at the myriad medical concerns that are unique to the female anatomy. For starters, research shows that women’s reproductive systems are just so much more complex than men’s and women are more likely than men to need health care throughout their lifetimes. Our ovaries, uteruses, breasts, cervixes, and fallopian tubes are all subject to various cancers, infections and other complications making routine monitoring a necessity, in addition to women’s overarching need for safe, effective and affordable birth control. Among my circle of friends we have experienced breast biopsies, vaginal ultrasounds, and colposcopies galore.

At a minimum, a young woman is advised to visit her gynecologist once a year to have a pelvic exam and Pap test, but she may require further and additional visits to receive contraception and STI/HIV testing, or to follow-up on any abnormalities discovered through these preventive screenings. For women with comprehensive health insurance, most of these preventive services are covered benefits – but, unfortunately, not all. Moreover, some of these services are not covered in a way that makes sense. For instance, I just learned that many insurance plans will not cover STI/HIV tests at a woman’s annual physical visit, which forces a woman to make an additional appointment for these tests and adds an extra layer of stress and burden to an already anxiety-producing procedure. Luckily, my provider pointed this out to me, but most women are not likely to be aware of such hidden costs. Instead of creating disincentives for women to be smart, efficient consumers of health care, insurers should end this policy that may increase a woman’s health expenses or lead her to avoid care altogether.

Even worse, some insurance plans do not cover contraceptives despite the fact that the plans usually cover other prescription drugs. And, even when plans do cover contraceptives, they may not cover Emergency Contraception (EC) now that it’s sold over-the-counter. EC costs around $45, which impedes access for many young women. Some insurance plans (notably the federal government employees’ plan) also refuse to pay for abortion services, despite the fact that abortion is a safe and legal procedure, and that plans cover all prenatal care and pregnancy-related services.¹ The typical first trimester abortion costs, on average, around $468, which is extremely expensive for many women, particularly young and low-income women.¹

Beyond the reproductive health disparities between men and women in terms of needed services and covered benefits, young women are more likely than men to suffer from chronic conditions like rheumatoid arthritis, lupus, or asthma.² Over one-third (38%) of women suffer from chronic conditions that require ongoing treatment, compared with 30% of men.² I’ve seen my peers struggle with all of these illnesses first-hand, as well as with the on-going treatment and medications they necessitate.

Young women are also more prone to be diagnosed with anxiety, depression, eating disorders, and other mental health conditions that may require extensive therapy and/or medications, and which may also result in increased physical health problems if left untreated.² Twice as many women as men are diagnosed with certain mental health problems such as anxiety and depression.² Even for women who have health insurance, the costs of these services can add up and co-pays and deductibles can become very expensive.

Moreover, because most health insurance plans are not required to cover mental health services, many insurers refuse to cover treatment for some or all mental health conditions, or may set very low limits on the number of mental health visits an individual can receive. These practices leave many young women with no ability to seek needed treatment. The high prevalence of violence against women -- and the media’s negative influences on women’s body image that have largely shaped our generation’s tormented relationships with our bodies (and driven us to seek out carcinogenic cigarettes to stay thin, and cancer-causing tanning beds to improve our appearance) -- also exacerbate women’s need for comprehensive health care.³ We need to advocate for policies that reduce the powerful, negative, influence of these harmful external forces on our health and promote universal health care for all.

While these insurance practices are bad for women, more than one-third of all young women between the ages of 19 and 24 aren’t insured at all.⁴ For these women, the situation is far more dire because, without health insurance, women are more likely to avoid needed health care. Women in this age group are also more likely than men to have high medical debts or to experience bankruptcy because of medical expenses.² This is due to both women’s lower incomes on average (thanks to the gender gap in pay) and their greater health care needs.⁴ Proposals that expand health care coverage to more people -- including individuals who work part-time, run their own businesses, or stay at home to raise families -- are essential to ensuring women’s autonomy and full equality with men.

One major lesson I’ve learned is that young women tend to underestimate the value of health care to our lives and well-being. We constantly sacrifice our mental and physical health so that we can nurture our careers, and build financial nest eggs for our futures. Like the importance of setting up a 401(k) at work or pursuing higher education to ensure access to better employment opportunities, accessing quality health care when we are young is an investment women must learn to make in order to ensure our health throughout our lives. Young women need to share our stories and encourage our peers to empower and educate themselves about the importance of preventive care. Most importantly, we must demand that lawmakers develop and implement health care reform proposals that meet young women’s unique health care needs.

I am fortunate to have comprehensive health insurance through my employer. I was also raised by a strong feminist mother with more than 30 years of nursing experience who helps me to navigate the increasingly convoluted health care system. My hope is that my generation will continue to advocate for improved health care services and access for all so that everyone can enjoy a brighter, healthier future and better quality of life than our grandmothers experienced.

Andrea L. Irwin recently completed a year-long fellowship focusing on Health and Reproductive Rights at the National Women’s Law Center and has returned to her home state of Maine for a judicial clerkship with the state’s Supreme Court. She received her law degree from the American University Washington College of Law and her BA in history from Bates College. Her dream is to establish a full-service clinic where low-income women can access comprehensive medical, financial, and legal services under one roof.

REFERENCES

1. National Network of Abortion Funds. Policy Report: Abortion Funding: A Matter of Justice. Amherst, MA: NNAF. 2005, 2, 6.

2. The Commonwealth Fund and The National Women’s Law Center. Issue Brief: Women and Health Coverage: The Affordability Gap. Washington, DC: CF. April, 2007, p. 4.

3. Charlie Guild Melanoma Foundation Website. “10 Facts About Melanoma.” Richmond, CA: CGMF. No date. Retrieved June 6, 2007 from http://www.charlie.org/melanoma_facts.html.

4. The National Women’s Law Center. Issue Brief: Women and Health Coverage: A Framework for Moving Forward. Washington, DC: NWLC. April, 2007, p. 2.