U.S Women's Healthcare Statistics-Part 1

• According to an article by The Commonwealth Fund, women in the United States have high maternal mortality compared to women in other developed countries. Among women aged 15-49 years, the U.S has a maternity mortality ratio of 14 per 100,000 successful births compared to a maternity mortality ratio of six in Germany and Australia, and four in Sweden.
• Women in the United States has a high chronic disease burden compared to women in other developed countries. 20% of women in the U.S between 18–64 years are diagnosed with two or more chronic conditions compared to 7% in Germany, 10% in Australia and the Netherlands, 12% in Sweden and U.K, 11% in Switzerland, 13% in France and New Zealand, and 14% in Norway.
• Women in the U.S are known to have the highest emotional distress rate. 34% of women aged between 18–64 years has emotional distress compared to 7% in Germany, 11% in France, 20% in the United Kingdom, and 21% in the Netherlands.
• United States women also has a high rate (320) of caesarean sections to inpatient procedures per 1,000 live births compared to women in Norway, the Netherlands, France, the United Kingdom, and Germany, with a caesarean sections to inpatient procedures rate of 161, 162, 208, 263, and 299 respectively, per 1,000 live births.
• Women in Switzerland (89%) & the U.S have the lowest (88%) rates of regular doctor or place of care visit compared to women in Germany (99%), Australia (94%), the Netherlands (100%), Sweden (94%), the U.K (94%), France (99%), and New Zealand (97%).
•  Breast cancer screening rates among United States women ages 50–69 is higher (80%) compared to 47%, 51%, 52%, 54%, and 55% in Switzerland, France, Germany, Canada, and Australia, respectively.
• Also, breast cancer (malignant neoplasm) related deaths per 100,000 females, is higher (23 deaths) in the United States when compared to other developed countries such as Norway and Sweden with 19 & 22 death per 100,000 females.
•  26% of women in the U.S have reported a high out-of-pocket cost compared to women in other developed countries such as Sweden, the Netherlands, and the U.K with only 2% of their women reporting about high out-of-pocket costs.

U.S Women's Healthcare Statistics-Part 2

• A study by the Centre for Disease Control (CDC) shows that black women are 3.3 times more prone to pregnancy-related death than white women; Alaska Native women & Native American were 2.5 times more likely to die than white women. About 13 white women and 11.4 Hispanic women die for every 100,000 live births while 42.8 African-American women and 32.5 Native American/Alaska Native women die per 100,000 live births.
• In the United States, the statistics of the female population in 2018 without health insurance coverage by age are 5.3% aged 0-17, 13.6% aged 18-24, 13.7% aged 25-34, 12.7% aged 35-44, 9.4% aged 45-64, and 0.5% aged 65 years and above.
• In the U.S, the risk/rate of pregnancy-related death increases with an increase in age. Women aged 40 and above have a high maternity mortality rate of 76.5 per 100,000 live births compared to a maternity mortality ratio of 14 per 100,000 live births for mothers aged 15-49 years.
• In terms of ethnicity, 17.4% of Hispanic or Latina American females, 10.6% of white, single race, females, and 17.8% of black or African American females, 18 years and above, live with a fair or poor health status while 82.6% of Hispanic or Latina American females, 89.4% of white, single race, females, and 82.2% of black or African American females, 18 years and above, live in excellent, very good, and good health status.
• In 2018, 1.4% of females under 18 years of age, 7% of females between 16-64 years, and 3.5% of females, 65 years and above, failed to obtain the required medical care due to cost.
• The prevalence of obesity by ethnicity and race for women in the U.S was 44.9% for non-Hispanic black women, 29.1% for non-Hispanic white women, and 36.1% for Hispanic women. In terms of age group, 29.4% of females aged 20-39, 35.9% of females aged 40-59, and 30.1% of females aged 60 and above, are diagnosed with obesity.
• A new report by the CDC reveals that the 14% of females aged 13-24, 27% of females aged 25-34, 23% of females aged35-44, 20% of females aged 45-54, and 16% of females aged 55 and above, are diagnosed with HIV. In terms of ethnicity, 59% of black African American women, 20% of white women, 16% for Hispanic/Latina women, and 4% of women of other ethnic group and races, are diagnosed with HIV.
• According to the American Lung Association, the adult smoking rates by ethnicity among U.S females are 13.5% of African-Americans women, 24% of American Indians/Alaska natives, 2.6% of Asian-Americans, 7.1% of Hispanics, and 16% of non-Hispanic whites.
• The percentage of adult females aged 18 and above who experienced severe psychological distress is categorized by age group as 2.8% of females aged 18-44, 5.5% of females aged 45-64, and 3.9% of females aged 65 and above.

Pap Smear Test Developed and Approved

• Although the pap smear test was first developed to detect uterine and cervical cancer in women in 1923, it wasn't approved for use as a diagnostic tool until 1943.
• The impact of this test has been an 81.6% reduction in mortality rates due to cervical cancer.

Oral Contraceptives

• In 1957, the FDA approved the birth control pill for menstrual disorders, and in 1960, it was approved to prevent pregnancy.
• The introduction of the pill allowed women to take control of their healthcare decisions and pregnancy timeline, allowing them to establish a career before starting a family.
• Access to oral contraceptives before the age of 21 has been determined to be the "most influential factor in enabling women already in college to stay in college," allowing women to pursue education and have children.
• According to Bloomberg Businessweek, "fully one-third of the wage gains women have made since the 1960s are the result of access to oral contraceptives." Additionally, access to birth control has helped narrow the wage gap between men and women.
• Among 25-49-year-olds, without birth control, the decrease in the gap between men's and women's incomes would have been 10% less in the 1980s and 30% less in the 1990s.
• In terms of health, oral contraceptives have also been linked to a "reduced risk of ovarian and endometrial cancers." In fact, the risk of endometrial cancer in women who have taken oral contraceptives is half what it is for women who have not.

Surgeon General's Report on Smoking

• In 1964, the Surgeon General issued a report that highlighted the harmful effects of smoking during pregnancy and was the first federal publication to "identify lung cancer as a probable result of smoking in women."
• The highest smoking rate among women in the U.S. was in 1963, just prior to the release of the Surgeon General's report. In that year, 34% of women were smokers. This rate decreased to 28% in 1985 and to 16% in 2012.
• Additional reports from the Surgeon General in 1980 and 2001 focused on risks of smoking on women and their unborn babies.
• The impact of this event is that fewer women suffer from health conditions related to smoking, including heart disease, stroke, lung cancer, depression, infertility, and premature menopause.
• In addition, due to advances in treatments and smoking cessation programs, the rates of lung cancer in women decreased every year between 2004 and 2010.

Mammography Screening

• The first mammogram machine for early breast cancer detection was used in 1966.
• In 1987, just 27% of women over the age of 50 reported having a mammogram over the past 24 months.
• Thirty years later, 72% of women over the age of 50 report having a mammogram within the last two years.
• In 2002, the Health Resources and Services Administration (HRSA) sponsored specific efforts to increase breast cancer screening rates and by 2005, the breast cancer rates had dropped by 10% due to mammography screening.
• The Affordable Care Act of 2010 requires health insurance companies to cover breast cancer screening at 100% for all women over 40.
• The impact of this event was that more women are detecting breast cancer up to three years before they or their doctor can feel a lump. Since 90% of these early-stage cancers can be cured, fewer women are dying from breast cancer.
• In 1985, the breast cancer death rate was 32.98 per 100,000 women. Today, that rate is at 21.92 per 100,000 women and still falling.

Roe vs. Wade

• In 1973, the U.S. Supreme Court declared that a woman's right to an abortion is protected by the U.S. Constitution, making abortion legal in all 50 states.
• As with oral contraceptives, a woman's ability to control when or if she has children is linked to higher educational attainment, economical success, and overall health and well-being.
• Moreover, legal abortion made the procedure safer for women, who would often turn to non-clinical solutions when abortion was illegal.

First HHS Task Force on Women's Health

• In 1983, the first Health and Human Services (HHS) task force on women's health was established, which challenged a 1977 FDA guideline that banned women of "childbearing potential from participating in clinical research studies."
• This guideline resulted in many drugs causing birth defects because they weren't tested on women who could have children. The HHS task force recognized that some drugs could work differently or not as well in women as they do in men.
• The 1985 Report of the Public Health Service Task Force on Women's Health Issues encouraged the FDA to re-examine its policy and women began to be included in more studies.
• The FDA formally rescinded its 1977 policy in 1993, which led to the inclusion of more women in National Institute of Health (NIH) studies.
• In 1994, the Office of Women's Health was established and part of its mission was to "advocate for the participation of women in clinical trials."

The National Breast and Cervical Cancer Early Detection Program

• In 1991, the Center for Disease Control (CDC) established the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).
• Since then, over 28,000 women have been diagnosed with cervical cancer and precancerous lesions using this system.
• This was also the year when the FDA approved the first diagnostic test for human papillomavirus (HPV), which causes most cervical cancers.
• Congress passed the Breast and Cervical Cancer Prevention and Treatment Act in 2000, which required Medicaid to cover treatment for uninsured women diagnosed with cervical cancer.
•  In 2001, the Native American Breast and Cervical Cancer Treatment Technical Amendment Act was passed, which made Native American and Alaska Native women eligible to for cancer treatment through Medicaid as well.
• The impact of this event is that by 2013, the rates of high-risk HPV in U.S. girls between the ages of 14 and 19 had decreased by 56%.
• Part of the decrease may also be the result of the Affordable Care Act of 2010, which requires insurance companies to cover the HPV vaccine, Pap testing, and HPV testing at 100%.

Violence Against Women Act

• U.S. President Bill Clinton signed the Violence Against Women Act (VAWA) in 1994, which provided funding for programs that assist victims of domestic violence, rape, sexual assault, and stalking.
• Since the CDC calls sexual assault a "serious public health problem" that can lead to "numerous health problems from depression to substance abuse to reproductive problems to chronic diseases," the programs funded by the VAWA helped reduce the rate of these health issues in women.
• In part due to the VAWA, the rate of serious intimate partner violence victimization fell by 70% for women between 1993 and 2017. There has also been a general decline in forcible rapes and sexual assaults since 1993.

Emergency Contraception

• In 1998, the FDA approved prescription emergency contraception and eight years later, the first over-the-counter (OTC) emergency contraception for women over the age of 18 was approved.
• In 2013, OTC emergency contraception was approved for women of all ages.
• The availability of emergency contraception has had a similar impact on women's healthcare as oral contraceptives in that women can take control of their reproductive decisions.
• About 23% of Hispanic and Black American women have taken emergency contraception compared to 21% of white American women. Approximately 32% of all women between the ages of 15 and 24 have reported taking emergency contraception. Just 10% of women between the ages of 35 and 44 have taken emergency contraception.

The Affordable Care Act

• In 2010, U.S. President Barack Obama signed the Affordable Care Act (ACA) into law. The ACA "marked the beginning of a whole new era for women’s healthcare."
• The ACA mandated the coverage of preventive services such as "well-woman visits, screenings for gestational diabetes, domestic violence screenings, breastfeeding supplies, contraceptive counseling, and HIV screening."
• Access to birth control and family planning services also increased under the ACA, giving women more control over when or if to have children.
• More women are also able to receive maternity care during pregnancy, which has positively impacted the health of both women and their babies.
• Health insurance companies can no longer refuse to cover women with preexisting conditions such as breast cancer or cesarean deliveries, meaning more women have access to healthcare.
• Finally, the ACA's Patient's Bill of Rights eliminated gender rating for premiums, which meant insurance companies could no longer charge women more than men for similar coverage.
• The impact of the ACA on women's health is that more women have access to health insurance and preventive benefits to detect and treat medical conditions earlier.

Health Insurance Barriers

• Women in the United States are more likely to have health insurance as a dependent than men. This means that they run the risk of losing the coverage if they become widowed or divorced.
• Also, women of color, low-income women, and immigrant women run a risk of being uninsured.
• Uninsured women lack access to important preventive services such as Pap tests and mammograms, have inadequate/low access to care, and have poorer health outcomes.
• It is an issue because a recent report from the U.S. Census Bureau indicates that 1 in 10 women lack access to health insurance.
• According to the article, the lack of health insurance access is due to "continued sabotage of the Affordable Care Act (ACA), including Congressional attempts to repeal the ACA and the Administration's stark reduction in federal outreach efforts."
• In 2017, 19.9% of Latina women, 13.7% of black women, 8.9% of Asian women, and 8% of white women were uninsured.
• Generally, about 11% of women in the United States are uninsured.

Cost Barriers

• In the United States, women tend to incur high healthcare cost, especially during reproduction.
• According to a survey by the Kaiser Family Foundation (KFF), "Low-income women and those in poorer health who generally have greater health needs experience some cost-related barriers at twice the rate of their counterparts with higher incomes and better health status."
•  One in three United States women agrees to have unsettled medical bills.
• This is a problem as a higher percentage of women forgo healthcare services due to cost-related issues when compared to men. About 26% of women delayed or went without healthcare due to high cost in contrast to 19% of men.
• For the uninsured women, 49% delayed or gave up on an appointment with healthcare providers, 47% postponed preventive health services, 42% skipped recommended treatments and medical tests, while 33% skipped or cut their pill doses due to the high cost of healthcare.

Logistical Barriers

• Women in the U.S face logistical barriers towards obtaining healthcare due to their roles as mothers or employees.
• Lack of adequate time and work flexibility poses a challenge in getting care for many women.
• This is a problem because one out of four women affirmed that they failed to obtain the care they needed due to time constraints (24%) and because they could not take time off work (23%).
•  One-third of low-income women (34%) reported that they missed or delayed care because they could not take time off work, compared to one in five higher-income women (19%).
•  24% of white women, 23% of black women, and 21% of Latina women could not find time to visit the doctor while 21% of white women, 25% of black and Latina women were unable to take time off work. Also, 6% of white women, 15% of black women, and 12% of Latina women had transportation issues.

Research Strategy