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Health Care Justice - What It Looks Like to Women

Rev. Marjorie Signer, United Methodist Church

The Christian teaching that all men and women are created in God’s image and of equal worth in God’s eyes takes on a special meaning on Health Care Justice Sabbath. Jesus revealed the meaning of justice in when he included all persons in the healing and saving power of God. It seems clear that God’s holy purpose for us includes the fundamental human right to adequate health care, regardless of gender, race, religion, age, economic or social condition, or nationality. Yet we persist in treating health care as a privilege and luxury, a scarce commodity that is bought and sold on the open market.

This is the most medically advanced and wealthiest nation on earth. Yet we have tremendous disparities in health care and fail to provide essential services for the most vulnerable, including women of color and poor women. A few facts tell the story. In a nation that holds motherhood in high esteem, one in five pregnant women, or three-quarters of a million, still do not receive timely prenatal care or receive no prenatal care at all. Our infant mortality rate is the worst among industrialized nations. We have one of the highest rates of unintended teen pregnancy, with young women routinely left to shoulder the burden of pregnancy and the demands of parenthood.  Over the past 15 years, maternal mortality rates have not dropped, and the risk is four times as high for African American women as for white women. For virtually all illnesses, women of color suffer more. Black women die from cervical cancer at three times the rate of white women.

You probably have heard that one in three American women is sexually assaulted during her lifetime. Perhaps you know a woman who has suffered an assault and has bravely gone forward to report the crime. But did you know that as many as half-a-million untested rape kits remain on the shelves, because police departments are unwilling to spend the money to test them? The rapists go free, perhaps to rape again.

As Christians, we say that not one of God’s children should be denied access to health and wholeness. How are we to understand the cutbacks in Medicaid and the growing numbers of uninsured women? How are we to understand the denial of constitutional abortion services to poor women under Medicaid? Or the recent questions over when women should have mammograms and how often, given the high rate of breast cancer deaths?

Women—particularly women of color—are the fastest-growing HIV positive group in the United States. Worldwide, about a third of the 10 million people infected with HIV are women. Nearly all have been infected through heterosexual sex. In the world, then, and increasingly in the United States, AIDS is a disease of women and children, of people of color and the poor. Yet women’s symptoms have frequently been dismissed or misdiagnosed or undiagnosed and left untreated.  Our inequalities here in the United States are even larger on the world stage.  The failure to stem the transmission of HIV from mother to child with an inexpensive, readily available medication is nothing short of sinful, as Anglican Archbishop Ndungane of South Africa has said.

What does health care look like to the half of humanity that is female, who constitute the majority of consumers and workers, paid and unpaid, in our health care system? Do they feel they are treated with dignity? What of the biblical injunction that the poor, the suffering, and the oppressed participate in the promises of God’s reign? For the five to ten million adolescent girls and women (compared with one million boys and men) with an eating disorder or borderline disorder, healthcare may not exist. They are not considered to be ill—only dieting or vain. Part of their illness is the fantasy that they must be super-thin to be loved and valued. Since there are few resources to prevent eating disorders, healthcare means trying to save an emaciated, psychologically fragile person long after the damage is done. After almost a generation of the women’s movement, women and girls diet in record numbers, starving to please others.

For almost 20 percent of America’s 140 million women, health care is meager and portioned out begrudgingly. They are poor or women of color or immigrant women. Poverty is the most basic cause of ill health and early death in our society. The poor, who are mostly women and children and disproportionately people of color, have many of the same problems as middle-class women but suffer more illnesses and die in greater numbers and earlier.  

To women in their childbearing years, health care is largely about reproduction—contraception or perhaps seeking an abortion or seeking to overcome infertility. Most American women spend their reproductive years, ages15 to 40, either trying to avoid pregnancy or planning a pregnancy. The most basic health care for most women, for a large part of their life, is to ability to control reproductive capacity. Yet many health plans still refuse to cover prescription contraceptives along with all other prescription drugs and the government delays passing legislation that would mandate coverage. As a result, women pay up to 65 percent more for prescription medications than men. Emergency contraception, a back-up method of birth control that must be taken within 72 hours after unprotected sex, is available only by prescription or in a very few pharmacies. Not so long ago, women regularly died in childbirth or from illegal abortions. Today, access to abortion is highly restricted by politics, harassment at clinics, and hundreds of legal barriers. In 86 percent of the counties in the United States, there is no abortion provider.

The stereotype of women as “hysterical” and hypochondriacs persists. Women are often not heard or misheard or inappropriately diagnosed. A midlife woman might find herself making frequent trips to an obstetrician-gynecologist, ending with a hysterectomy, one of the most frequently performed procedures in America. Several careful studies have shown that at least 30 and perhaps as many as 50 percent of these operations are clearly unnecessary. At least 40 percent of all women who have hysterectomies have surgical complications, including blood clots. Or she might be directed to a psychiatrist and put on medication, when another therapy—probably more expensive and time-consuming—would be better. The continuing lack of adequate insurance for mental health care makes a mockery of the Christian teaching to care for the whole person—physical, mental, emotional, spiritual.

Until the last 20 years, most health research has been directed at so-called men’s diseases. Women still are not considered potential candidates for heart disease.
Although men do suffer more heart attacks than women, heart disease is the most frequent cause of death in women over the age of 50. In addition, a greater percentage of women who have heart attacks die from them. In this, women are victims of a research bias and of ignorance about their health risks.  To older women, health care is Medicare. The nation's health insurance program for older women and men is not typically thought of as a "women's program" but it should be. Almost six in ten individuals receiving Medicare are women and more than seven in ten over the age of 85 are women. Today in America, the average woman age 65 and over is widowed and living alone. She struggles to make ends meet on an annual income of $15,615 (compared with over $29,171 for men). During her lifetime she probably spent 17 years caring for children and 18 years caring for elderly parents. Her retirement income is also smaller because she probably did not receive a pension and was paid less than the average man. Yet she spends 20 percent of her income each year on out-of-pocket health care costs.

The answer to the question of what health care looks like to women is—it looks like a society in which men are the standard and women are still the afterthought. In a just society, health care would not be withheld or sold as a commodity. Like the biblical understanding of salvation, health care should be available to all of God’s people. A just health care system would offer healing and wholeness of mind, body and spirit. It would provide adequate preventive care, including prenatal and mental health care; comprehensive treatment and coverage for long-term care and catastrophic illnesses; coverage for medications and prosthetics; and a complete range of voluntary and confidential services, including family planning and reproductive services. It would be sensitive to the rich diversity in our culture, promote wellness rather than focusing on illness, and inspire innovative research. It may be that the health care gender gap will only close when women are more involved in setting policy and passing legislation.  
This is our vision of justice—caring for human lives, not bottom lines, recognizing that God has given us a world of abundance and we have the resources to provide care for all.


Note: Most data and statistics are from The New Our Bodies, Ourselves (1998), published by the Boston Women’s Health Book Collective (Touchstone, a division of Simon and Shuster) and available at all bookstores and online. Data on older women is from OWL, the Older Women's League.)  Additional data is from government reports that are available online.  

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