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Where women’s health care is lacking, women are dying

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A woman is more likely to die of cervical cancer in Alabama than in any other state in the country. An African-American woman in the state is twice as likely to die of cervical cancer than a white woman. 

While these statistics are harrowing, they are not surprising. Alabama’s disproportionately high cervical cancer mortality rate is reflective of a more significant trend: States that limit access to women’s health services tend to have the worst health outcomes for women. Those affected most are low-income women and women of color — people who already face the most significant barriers to care.

In the case of cervical cancer, regular screening and vaccination against the HPV virus have more than halved the cervical cancer death rate over the past four decades.

Nationally, the percentage of young adults under age 26 who have received the HPV vaccine nearly doubled between 2013 and 2018. In Alabama, rates of cervical cancer remain high, and prevention has fallen short, with youth HPV vaccination completion rates ranging from 40 percent to less than 10 percent in some of the state’s counties. 

The inadequacy of early preventive care is further exacerbated by a lack of access to women’s health services. Alabama is one of 14 states that chose to forgo Medicaid expansion under the Affordable Care Act, which increased insurance coverage for low-income women and families.

Women of childbearing age who live in states that did not expand Medicaid are more likely to be uninsured than their counterparts in Medicaid expansion states. Among the 14 states that chose to forego Medicaid expansion, 11 of them rank in the bottom 20 countries for women’s health. 

Maternal mortality is a growing crisis in America. A pregnant woman today is 50 percent more likely to die than her mother. Nearly half of all pregnant women depend on Medicaid for health insurance, and Medicaid expansion fills a critical gap for pregnant women to obtain needed prenatal care and post-partum care.

Studies show that women living in states without expanded Medicaid face higher rates of maternal mortality than those living in states that chose to expand Medicaid eligibility. 

Many of the states that have the worst maternal health outcomes are also the ones that restrict the full spectrum of reproductive health care. Georgia has the second to the worst maternal mortality rate in the country, and recently passed one of the most restrictive laws that outlaw abortions before many women know that they are pregnant.

A recent study found that states implementing such abortion restrictions increased maternal mortality by 38 percent. 

Reducing women’s access to family planning and reproductive health services not only harms women during pregnancy but also results in other adverse health outcomes. Georgia and Missouri, two other states that have passed recent restrictive reproductive health laws, have the second and sixth-highest maternal mortality rates in the country, respectively.

Georgia faces the highest standard of new HIV infections, and Missouri is in the midst of an STI epidemic that includes a 200 percent increase in syphilis across three years and a 1000 percent increase in five counties.

At a time when women’s health care should be expanded at the state level, the federal government has moved to restrict preventive care further. The Trump administration’s Title X gag rule, which bars federal funding for health centers that provide abortion care, has resulted in the closure of thousands of health centers that provide preventive care to women.

These health centers are often the only source of essential STI and HIV screening and treatment, vaccinations, cancer screenings, and contraceptive services.

In Utah, a state in which only 57 percent of reproductive-aged women receive routine preventive care and fewer than half completed the HPV vaccine series, there are no remaining Title X funded family planning clinics as a result of the new rule. 

Women’s health is essential to the health of children, families, and communities. Just as health care, in general, must be viewed in its totality rather than as an individual component, women’s health care must be understood as a whole.

Women’s health care is not limited to reproductive care, but neither can reproductive health care be separated from the rest of women’s health care. Restrictions on family planning access and insurance coverage result in detrimental effects on women’s health and community health overall.

At a time when women’s health is on the decline, our country must implement policies that improve rather than exacerbate the inequities faced by communities in need. What we need is more health care, not less. We must invest in all aspects of women’s health with the urgency it deserves. 

Nakisa Sadeghi is a visiting scholar at George Washington University Milken Institute School of Public Health. Dr. Leana Wen is a visiting professor at the George Washington University Milken Institute School of Public Health. She is also a distinguished fellow at the Mullan Institute for Health Workforce Equity. She previously served as the President/CEO of Planned Parenthood and as Baltimore’s Health Commissioner. Follow her on Twitter: @DrLeanaWen.


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