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Listening and Learning: Systemic Racism, Racial and Sexual Disparities in Women’s Health

Part 2: Reclamation vs Rejection at the GYN By Nikki Mahendru Nikki is a Duke Economics Major with minors in Global Health & Chemistry The gynecologist’s office is one of the most intimate places for a woman. It has the power to be the place where she reclaims her body and health. However, for socioeconomic […]

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Part 2: Reclamation vs Rejection at the GYN

By Nikki Mahendru

Nikki is a Duke Economics Major with minors in Global Health & Chemistry

The gynecologist’s office is one of the most intimate places for a woman. It has the power to be the place where she reclaims her body and health. However, for socioeconomic and racial minorities with unequal access to proper education and healthcare, visiting the gynecologist can also lead to confusion, disappointment, and long-lasting pain. I only fully recognized this after I stepped away from my own perception of what women’s health looked like and let the stories of women disproportionately affected by healthcare highlight how these disparities are drawn across racial and socioeconomic lines.

I began my exploration into women’s health my sophomore year of high school working as a medical receptionist at an OB-GYN clinic in New Jersey. I fell in love with the atmosphere there. As I saw patients come and go, I felt that each patient was on her way to making her health a priority. But as I transitioned from the receptionist’s desk, to shadowing visits, and soon to becoming a medical assistant, I realized that each visit with each woman was so entirely dependent on her racial, cultural, and socioeconomic status. Why? I saw how the knowledge, perception, and fears that manifested within each patient with respect to her health was largely attributed to her demographic. This was not at all what I had envisioned when I first saw the sea of patients moving seamlessly in and out of the office. Instead, what I soon learned was that each patient had a set of beliefs of what women’s health meant to her, cemented not only by her culture, but also by her experiences based in her racial and socioeconomic identity.

The Interior of a Gynecology Office, Source: Vadimborkin/ Getty Images

I listened to the story of a woman being in such unbearable pain that it became her norm, as her pain was not taken seriously by previous providers. I listened to the stories of the woman who grew up with no formal sexual or reproductive health education, resulting in her first pap smear at the age of 50.

Pan American Health Organization conducts a study on Cervical Cancer.

I listened to the story of a woman whose life was focused entirely on caring and providing for her loved ones, so she pushed the pain she felt deeper and deeper until it was almost too late. I listened to the story of the woman who was bounced from provider to provider until she found someone able to speak her language… one whole year after the onset of her pelvic pain.

While these anecdotes are not meant to be generalizations that should speak entirely to the plight of racial minorities and low socioeconomic status women in gynecological health — the stories of women who are so often marginalized within healthcare became my purpose for joining the Center for Global Women’s Health Technologies. In further researching how race and socioeconomic status played a role in women’s health and gynecology, I was startled to see racial and socioeconomic disparities in nearly all aspects of women’s health.

Black women have a higher incidence of cervical cancer, and also have double the rate of mortality compared with non-Hispanic white women. Low socioeconomic status and minority women suffer a disproportionate amount of gynecologic cancer (ovarian, cervical, and breast) related mortality. Black and Hispanic adolescent girls are less likely to complete the HPV vaccination schedule(1). Pregnancy related mortality ratios for black (non-Hispanic), Native American, and Alaska Native women are 3.3–2.5 higher than white women(2). This distressing evidence pointed to the fact that processes of care can differ so drastically across every stage of women’s health, and there is an urgency to address the structural and implicit causes.

As I heard the stories, I saw their reflections in the statistics uncovered by my research. I decided to focus more narrowly on studying acute pain management across socioeconomic and racial lines in gynecology. My reason for choosing pain management, specifically, is tied to the historical implications of female pain: pain in women has been met with skepticism(3) and has become a leading cause of shame among women in healthcare settings.

The WISH Model seeks to pay attention to the barriers women face and re-vision a way of re-framing women’s health.

Furthermore, the pervasiveness of pain management in all realms of medical care calls for gynecologists to be equipped with proper pain management skills that will prevent vulnerable populations from increasing harms such as, ignoring pain, over prescription of referrals, opioids, and benzos(4), that disproportionately affect women along racial lines. Such practices are a direct result of insufficient communication practices between patients and providers(5) and implicit biases with respect to the experience of the patient. This ultimately results in undue emotional burdens, as well as medical and economic harms placed on patients — turning women away from seeking healthcare in the future and transforming the gynecologists’ clinic from being an avenue for the reclamation of her body into a place of continual pain.

I’ve seen how magical it is for women to get comfortable with their bodies and health, but we must be cognizant that this magical moment is buried under insufficient healthcare practices for many minority patients. We must let the voices, the stories, and the evidence guide us to a better future where all women have the opportunity to be safe, proud, and in control of her own body.

Photo from American Cancer Society Study on Cervical Cancer

References

  1. Reade CJ, Elit LM. Current Quality of Gynecologic Cancer Care in North America. Obstet Gynecol Clin North Am. 2019;46(1):1–17. doi:10.1016/j.ogc.2018.09.001
  2. Petersen EE, Davis NL, Goodman D, et al. Vital Signs: Pregnancy-Related Deaths, United States, and Strategies for Prevention, 13 States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019; 68:423–429: DOI: Http;//dx.doi.org/10.15585/mmwr.mm6818e1
  3. Werner A, Isaksen LW, Malterud K. ‘I am not the kind of woman who complains of everything’: Illness stories on self and shame in women with chronic pain. Social Science & Medicine. 2004;59(5):1035–1045. http://dx.doi.org/10.1016/j.socscimed.2003.12.001. doi: 10.1016/j.socscimed.2003.12.001.
  4. Kalinowski J, Wallace BC, Williams NJ, Spruill TM. Women’s perspectives on provider education regarding opioid use. Journal of pain research. 2020;13:39–47. https://www.ncbi.nlm.nih.gov/pubmed/32021393. doi: 10.2147/JPR.S215943.
  5. Lippke, S., Wienert, J., Keller, F.M. et al. Communication and patient safety in gynecology and obstetrics — study protocol of an intervention study. BMC Health Serv Res 19, 908 (2019). https://doi.org/10.1186/s12913-019-4579-y
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