2009-08-07 / Columnists

It's My Turn

Health Care Reformers: Don't Forget Women
By Ralph Riviello, MD, MS

Ralph Riviello, MD, MS, is a board member of Physicians for Reproductive Choice and Health and an attending physician at Hahnemann University Hospital.

Recently I saw a pregnant woman I will call Lillian, a 22-year-old who brought her two children with her to the ER. Lillian has a fulltime job whose health insurance doesn't cover pregnancy. She can't afford to cover herself and her family on the individual market, and she makes too much money to qualify for Medicaid. Lillian came to the ER because she wants to make sure her baby is okay. A friend with better insurance advised her that she should have an ultrasound.

But, because Lillian told the registration clerk about abdominal pain, we had to put her through other work-ups like a complete pelvic exam, cultures, and blood tests, on top of the only test she wanted. The hospital spent at least $1,000 on Lillian, which drives up the price of care for everyone.

I discharged Lillian with worry. I know that she will have a difficult time finding standard prenatal care. Without that help, she and her baby are at much higher risk for complications, like low birth weight, that can turn into tragedy. Or Lillian's health might suffer. I am embarrassed by how many women die in childbirth in the U.S. — at 15.1 maternal deaths per 100,000 live births, our rate is higher than most developed nations.

And this pregnancy is just one facet of Lillian's health. Like most women in America, she will spend roughly 35 years of her life preventing pregnancy, trying to become pregnant, having children, or recovering from pregnancy. She might also face a sexually transmitted disease — or a common condition of the reproductive system, like fibroids or polyps. Her health insurance will not help her with any of these basic needs, yet we still call it health insurance. As a physician, I have been watching our president and the members of Congress wrangle over the costs of health care reform, hoping to hear something constructive about women. Although women comprise more than half of the U.S. population, many insurers treat their medical care as an exception to the rule, charging them more to stay healthy than men and refusing to cover basic reproductive services. This dangerous double standard must end.

When women do not receive gynecological care, they get sick when they could have easily and inexpensively been kept well. Just as she needs to be in good cardiovascular health, a woman must be in good reproductive health — whether or not she is trying to get pregnant. An undetected problem in the reproductive system can have devastating consequences. Two of my colleagues have had patients who went without ob/gyn checkups because they could not afford health insurance. By the time they saw a doctor, their cervical cancer had already spread too far to save their lives. One of these women was in her 50s. The other was 28.

A woman's reproductive health affects her throughout her life; it is inextricable from her overall wellbeing. Any plan for health care reform must reflect that reality. Reproductive health care is a necessity that too many women have gone without for too long. And when women get sick and die, their children feel the impact, as do their spouses, employers, and everyone else who depends on them.

I was disappointed but not surprised by the following survey finding: 52 percent of women in our country did not visit a doctor when they had a medical problem or went without a needed prescription or follow-up care because they could not afford these services. I have worked in Philadelphia's emergency rooms since 2002, where I have treated women of all ages who have nowhere else to go for fundamental care.

For instance, every day our department treats at least 10 women who come to the ER not for broken legs and third-degree burns but for pregnancy tests and ultrasounds. These women have to pretend that they have emergency stomach pain or bleeding so that they can get a little bit of obstetric attention.

In the rush to develop legislation for health care reform, our senators and representatives must not forget the health of half their constituents. Every private and public insurance plan must guarantee the same set of reproductive services to every woman. We can't keep Lillian and the rest of the women in this country healthy and alive without taking care of their reproductive health.

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