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How Our Health System Screws Over Women

It's time to tell to tell the medical establishment and our elected officials to stop playing Russian roulette with women's lives.

Should we schedule our first mammogram at age 40 or 50? Every year or every two years? And what about the cervical Pap smear? The screening that gets many women in this country to the only doctor they see on an annual basis. Should it start at 21 years old or later?  

Welcome to the latest round of Women’s Health Roulette, with ever-changing numbers declared as winners.  

It may be that more testing causes more unnecessary procedures and ultimately results in more harm to women, but everyone has a sister, aunt, mother, best friend who swears her life was saved by early detection. And although it’s hard to argue with the authoritative sound of evidence-based medicine, let’s not forget hormone replacement therapy. Scientifically “proven” in the 90s to be the completely safe and even beneficial treatment for post-menopausal symptoms, it actually caused an uptick in breast cancers, strokes and heart disease.  

So what’s a woman to do? Ideally, she’ll decide with her doctor on the timing and frequency of testing based on individual risk factors and that decision will be honored by her insurance company. But the reality may be quite different. Some of us might put off screening indefinitely. (I mean honestly, what woman can’t wait to schedule her mammogram?) Then we haven’t a clue whether insurance companies will change their policies. Currently, Medicare covers yearly mammograms, and private insurers are required to pay for them for women in their 40s, but who knows what tomorrow will bring?  

Particularly worrisome is how the debate about new screening guidelines is diverting attention from the appalling statistics on women’s wellbeing in America, conveniently being ignored in our current discussion of healthcare reform. 

In the 2009 Global Gender Gap Report issued by the World Economic Forum, evaluating the gender equity of 134 countries, the United States came in at a depressing 34th   place, slipping from 27th in ’08. The study examines several criteria including Health and Survival, where we rank 40th behind Cambodia and Yemen. This category compares men and women’s longevity, considering the number of years shortened by illness, malnutrition and violence.      

Violence against women is rampant in America, fueled by recession-induced masculine insecurity and a media and entertainment industry catering to the young male market. Television shows like Criminal MindsKiller InstinctSupernatural and The Invasion seem to be competing with the top-billing CSI and with one another in coming up with ever more grotesque ways of slaughtering women: unleashing poisonous spiders, dicing women into pieces, impaling them on the ceiling where they spontaneously combust. You name it. Electronic gaming? Same story. In the most popular games—Duke Nukem, Road Rage 3, Grand Theft Auto— players advance by killing women, often prostitutes who beg to be slain.  

Academic research has suggested a strong correlation between on screen aggression and actions. Scientists at Indiana University’s School of Medicine studied brain waves of adolescents playing a violent video for half an hour and found an irrefutable physiological connection between the games and belligerent behavior.  

In real world America, three women are killed every day by current or former intimate partners, but unless it’s a celebrity like the late swimsuit model Jasmine Fiore, murdered by her husband, the crime doesn’t capture national attention. Domestic violence is a leading cause of death among women ages 15-44, and the leading cause of death of pregnant women according to a new report in Womensenews, using figures released by the Centers for Disease Control.     

We have the highest number of teen pregnancies in the Western world, a fact overlooked by Abstinence Only mythology as well as Stupak-Pitts & Company, who in addition to the amendment also removed coverage of contraception from the list of basic benefits all insurers had to cover. You really have to wonder what these folks were thinking since access to birth control is linked to a reduced number of abortions.  

Our infant mortality rate is a shameful 37th  world-wide, second worst among industrialized nations, topped by a tie among Latvia, Hungry, Poland and Malta.

“In countries where mothers do well, children do well,” said Charles MacCormick, president and CEO of Save the Children. Difficult as it is to accept, MacCormick’s words apply to the U.S. almost as much as to developing nations. For African-Americans, the newborn death rate is nearly twice what it is for the United States as a whole. Low birth weight and prematurity, the usual suspects, are frequently the result of malnutrition. And with food insecurity (the euphemistic term for hunger) sky-rocketing in this country — 49 million Americans had trouble getting enough to eat in 2008 (numbers for 2009 will be higher)—and affecting African-American, Latinos and single-parent families the most, we’re not likely to see newborn survival rates improving in the predictable future.  

Without question, our present healthcare system sidelines women. For the first time since 1918, women’s life expectancy is actually dropping in America. Poor women are dying from a host of treatable diseases: kidney failure, stroke, heart attack, diabetes. Not one state in fifty, not one, received a satisfactory grade in a women’s health report card issued by the National Women’s law Center in 2008.  

Even with all the gains women have made over the past thirty years, most still work in low income jobs without benefits or health insurance. And when women purchase insurance policies on their own, they pay hundreds of dollars more than men of comparable age and medical background.   

In many illnesses, such as strokes, heart attacks, certain cancers, immunological disorders, HIV/AIDS, women present with symptoms different from men and respond to dissimilar medications and therapies. This is true for example of heart disease which kills more women than men every year, a fact known only to 8 % of primary care physicians across the country, according to the American Heart Association. And yet here we are in 2009 and women are still not routinely included and retained in clinical trials. “For too long, women have been treated as ‘little men,’ without appreciation of the differences in prevalence and symptoms among various conditions and what those differences mean for diagnosis and treatment,” said Phyllis Greenberger, president of the Society for Women’s Health Research.  

So— important though it is, we shouldn’t get bogged down in the dispute about screening. All the dismal statistics on women’s health add up to this: It’s time to tell to tell the medical establishment and our elected officials to stop playing Russian roulette with women’s lives. 

 

Barbara J. Berg, PhD is a women's historian and has taught at Sarah Lawrence College, Yale Medical School, Columbia University's Physicians and Surgeons, and the Horace Mann School where she started a women's history program. Her latest book is called Sexism in America: Alive, Well, and Ruining our Future.
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