The Role of Primary Care in Improving Women’s Health in America

Women in the United States are more likely to die from pregnancy-related causes than those who live in other developed countries, as the U.S. is the only developed country where the rate of maternal mortality is rising, with 26.4 maternal deaths per 100,000 births, a staggering 15.2 more deaths than the next country on the list (U.K.). A recent study finds that banning abortion in the U.S. would lead to a 21% increase in pregnancy-related deaths overall, with that percentage being even higher (33%) for Black individuals. Though reproductive healthcare has been historically categorized as a women’s issue, it is important to acknowledge this is not an issue solely impacting women. Although the majority of abortions occur for cisgender women, disparities in access to safe reproductive healthcare disproportionately impact members of the LGBTQIA+ community (such as transgender and non binary individuals) who are already disadvantaged in terms of overall access and quality of care. The U.S. Supreme Court’s decision to overturn Roe v. Wade is not only a violation of reproductive healthcare and women’s rights in America, but is acknowledged as a major step backwards for the U.S. healthcare system by the World Health Organization. This public health crisis will have a profound impact on not only women’s healthcare, negatively impacting vulnerable populations the most, but the treasured doctor-patient relationship as well.

From 1990 until 2013, the maternal mortality rate in the U.S grew by 136%, proving that harsh restrictions on women’s health care, which includes but is not limited to access to safe abortions, can have devastating effects on women’s health. The Center for Reproductive Rights (CRR) conducted a study that created a scoring system with four categories – abortion restrictions; policies that support women and children’s well-being; women and children’s health outcomes; and social determinants of health. Researchers found an inverse relationship between abortion restrictions and women and children’s health outcomes. For example, there are 14 abortion resitrictions found in the state of South Carolina, and it has among the worst outcomes for women’s health in the country. In 2015, maternal mortality for the state rose almost 300%, and that same year, a reported one third of women in South Carolina had no dedicated healthcare provider

Primary Care as a Lever for Decreasing Maternal Mortality

Primary care providers play an integral role in providing a continuum of care for patients in vulnerable populations, many of whom are also at higher risk for maternal morbidity and mortality. In 2020, the maternal mortality rate for non-Hispanic Black women was 2.9 times higher than the rate for non-Hispanic White women, a statistically significant increase from 2019. Now, more than ever, access to reproductive healthcare is essential, but what is primary care’s role?

A recent longitudinal study in China found that the increase of one primary care physician per 10,000 population was associated with a 5.26 reduction in maternal mortality per 100,000 live births. Moreover, the study found that increased primary care access in the rural, less developed regions of China had even more significant reductions in maternal mortality, suggesting PCP supply reduces geographical health inequities.

A recent study of reproductive healthcare (RH) in the primary care setting demonstrates that patients are receptive to the benefits of streamlined RH in primary care, so long as “clinicians approach these services in a manner that respects patient autonomy and reproductive desires”. In another study from the Commonwealth Fund, primary care in the U.S. was determined to be well positioned to play a vital role in addressing women’s health concerns, but should be optimized to deliver comprehensive “sex-specific, sex-aware, and gender-sensitive care”. The article identifies the following three critical domains of women’s healthcare that can be optimized in primary health care systems:

  • Sex-specific care: Care related to health needs that are unique to women, such as pregnancy and menopause.
  • Sex-aware care: Care for conditions that are diagnosed or treated differently in women as compared to men, such as heart disease and neurodegenerative diseases.
  • Gender-sensitive care: Care provided in ways that are inclusive of gender-specific preferences, including lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) health needs.

Gaps in training, barriers to primary care utilization, underrepresentation of women in health system leadership, and politicization of women’s health are all factors that hinder womens’ ability to have accessible, quality primary care. However, with proper preparation and allocation of resources in primary care that specifically addresses womens’ health needs, the U.S. can begin to leverage primary care as a key tool for womens’ health reform. The Commonwealth Fund created a second report with concrete steps to achieve this:

  • Prepare primary health care providers to deliver comprehensive care that directly addresses women’s unique needs.
  • Build integrated primary health care teams equipped with the expertise to respond to women’s health needs.
  • Embrace primary health care visits as opportunities to build trusted relationships between women and providers and to effectively facilitate linkages to specialty and social services.
  • Adopt care models and digital health innovations to expand access to integrated care for women across race/ethnicity, age, and socioeconomic status.
  • Prioritize racial/ethnic and gender diversity in leadership across the healthcare industry.

As the leading country in healthcare spending, the United States is shockingly lagging behind others in health outcomes. Considering the majority of the U.S. citizenry are female (51.5%), prioritizing women’s healthcare – and reproductive healthcare for everyone with female reproductive anatomy – would improve the overall health of the nation. Primary care is uniquely positioned to reduce health inequity in the United States, including disparities in women’s healthcare and even greater disparities in reproductive healthcare for LGBTQIA+ individuals. Although large-scale legislative and societal changes are needed to truly close the gap in women’s health equity in the United States, investing in properly resourced primary care can have meaningful impact, at a time when it is desperately needed.

Nina Cloven

about

Nina Cloven, MHA is Elation's Manager of Primary Care Advancement. She received her MHA from John Hopkins Bloomberg School of Public Health and BA in Public Health from Texas A&M University.