Women's Healthcare Disparities and Discrimination

Civil Rights Journal, Fall, 1999 by Alyson Reed

This article was written pursuant to the limitations relating to abortion found under 42 U.S.C [sections] 1975a(f) in the Civil Rights Commission Act of 1983. The author regrets the limitations that this law imposes on the content and scope of this article.

Access to health care has never been treated as a basic human right in the United States and has been viewed as a civil right only to the extent that it is denied to individuals on the basis of their race, sex, or membership in a "protected" class as defined by law. However, it is the ability to pay that continues to be the chief determinant of whether individuals can access health care. Although hospitals may not legally turn away patients who need emergency treatment, any other type of health care service is usually preconditioned on the source of payment, be it public or private.

Any discussion of women's health disparities, and discrimination against women in the context of the U.S. health care system, therefore needs to address the economic status of women and the role that economics plays in their ability to access health care and the quality of the health care services they receive. According to a 1997 guide on women's health issues published by the Institute of Medicine (IOM), the lack of preventive services for those without health insurance coverage "creates a deadly class disparity." (The IOM was chartered in 1970 by the prestigious National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public.) But economic class is not the only cause of disparities or discrimination in the health care field. A number of minority groups have traditionally suffered from discrimination based on race/ethnicity, sexual orientation, disability, age, and/or immigrant status. Finally, there is the overarching issue of gender-based discrimination, which is prevalent throughout American society and affects every aspect of women's lives, including their health, both physical and mental. Clearly, economic status, membership in a minority group, and gender are all overlapping and interacting factors in determining both access to health care services and the content of health care research.

A Historical Pattern of Disparities and Discrimination

To understand gender-based discrimination in the health care field, it is important to understand the history of the U.S. health care system and women's interaction with health care providers. According to the IOM guide, "the medical enterprise, both in scientific research and in clinical practice, has traditionally viewed female lives and bodies through a lens of masculine experience and assumptions." A common medical view has been that the "female reproductive organs occupy a special realm, distinct from the body at large, and one that just happens to define their owner's essential nature." Under this model, the male body and male behavior were viewed as normative, while the female body was viewed as "other," with particular emphasis on the reproductive tract as setting women apart from men.

Given the gender breakdown within the health care professions, this history is not surprising. Women have traditionally been care givers for their families, and this expertise is reflected by women's dominance of the nursing and midwifery professions. Meanwhile, the better paid and higher status medical profession, which has an unfortunate history of excluding and resisting women physicians, remains dominated by men to this day. For reasons based on economic competition and sexist attitudes, many male physicians denigrated the female-dominated care-giving professions and asserted their role as the "experts" on the provision of women's health care. Despite this so-called expertise, women patients were frequently ignored, mistreated, not taken seriously, or denied access to needed services. For example, early gynecologists had an unfortunate history of "treating" women for symptoms such as nymphomania, epilepsy, and nervous and psychological problems, such as hysteria, by removing the ovaries and/or amputating the clitoris. As recently as the 1970s, a popular gynecology text advised gynecologists that the greatest diagnostic aid to use when listening to women's health complaints is the ability to distinguish "fact from fancy," implying that women were not to be taken seriously.

The Modern Women's Health Movement

The approval of the contraceptive pill by the FDA in 1960 and the so-called sexual revolution which followed were profound events in the lives of women, not just for health reasons but also for their social and economic well-being. Approval of this new, highly effective contraceptive meant that women could now control their reproductive functions to an extent previously unknown. In conjunction with larger social transformations, this helped to reduce maternal mortality and morbidity rates, enabled women to pursue educational and employment opportunities not widely available earlier, and spurred a revolution in women's attitudes about their own sexuality and those of their partners. As a result of these developments, and women's frustration with their mistreatment by the male dominated health-care establishment, the modern women's health movement was born, coinciding with the larger women's liberation movement of the early 1970s. As one history of the era has written, "The women's health movement was informed by the belief that women had the right to full and accurate information concerning diagnosis, treatment, and treatment alternatives; that women should be full partners in making decisions about their health; and that they were capable of making reasonable derisions given adequate, accurate information." Women were concerned about being undertreated (for conditions traditionally associated with men, like heart disease) and about being over-treated (for conditions associated with the reproductive cycle, such as uterine cancer). The care received by pregnant women is a good case in point. On the one hand, less than a third of uninsured pregnant women get proper prenatal care, while well-insured pregnant women suffer from many unnecessary medical interventions, such as cesarean sections, episiotomies, labor inductions and continuous electronic fetal monitoring. According to Dr. Stephen Thacker of the Centers for Disease Control and Prevention (CDC), the high rate of cesarean sections in the U.S. "is a major public health problem impacting health care delivery. Reducing the rate of cesarean section by five percent would save $800 million that could be spent on prenatal care and preventive programs."