Jan 23, 2024 Sarah duRivage-Jacobs 10 min
The devastating (though expected) reversal of Roe v. Wade makes it hard to ignore a truth many advocates and healthcare providers have been aware of for decades: Essential healthcare is restricted and inaccessible for many women and people with vaginal anatomy, particularly for those of us who are also people of color, queer, trans, lower income, or who have disabilities. This reality is not limited to abortion care, though that is one significant way it shows up.
Providing and increasing access to essential care is what Origin was founded to do. While we're focused on pelvic health, we're passionate about expanding access to all forms of essential care for women and individuals with vaginal anatomy.
Although covering every aspect of healthcare in which access is limited would take a lot more than a single article, we’re highlighting some of the biggest restrictions and access issues we’ve seen and heard about as experts, practitioners, and patients of women’s healthcare.
Access to healthcare of any kind is greatly impacted by race/ethnicity, income level, insurance status, and geographical location. Moreover, race/ethnicity often can correlate with income level, insurance status, and location. We say this because people across different populations will experience access issues differently.
As you read through this article, you’ll see a focus on policy-related inaccessibility to certain types of healthcare for women and people with vaginal anatomy. In all cases, know that people of color, LGBTQ+ people, people with disabilities, and younger people often bear the brunt of this inaccessibility.
As of publishing this article, 44 states have restricted access to abortion care, nine have banned it with few exceptions (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Texas), and three more have banned care after six weeks (before many people even know they’re pregnant). The majority of these restrictions were only made possible by the reversal of Roe v. Wade and Planned Parenthood v. Casey, the latter of which began chipping away at abortion rights in the early ‘90s.
Another law, the Hyde Amendment, also continues to cut into abortion access. Under this amendment, abortion care (with some exceptions) can’t be paid for with federal Medicaid funds — though states can use their own funds to cover care. The Hyde Amendment is disproportionately harmful for people of color and people with lower incomes. Most people accessing abortion care end up paying out of pocket.
A major obstacle for young people’s access to abortion care in particular is parental involvement and consent laws. As of August 2022, 36 states require a parent to be involved if people under 18 need abortion care: 21 states just need one parent to consent, and three require both parents to consent. 35 of the 36 states with parental involvement requirements, however, offer alternative options like judicial bypass.
Over the past few years, intrauterine devices (IUDs) have gained popularity — that is, for those who can easily access this form of contraception.
Physicians may require two visits before inserting an IUD, which can be more challenging for IUD seekers to accommodate. Even if someone has health insurance that covers IUDs or other birth control, they might not be able to miss work or find childcare for two separate appointments.
People with lower incomes or without insurance may face additional barriers getting IUDs. Getting access to IUDs in community health centers, which people with lower incomes or without insurance often rely on for care, can be more challenging due to upfront costs for the clinics as well as training and staff limitations.
For adults who need access to gender-affirming care, two significant barriers are the dearth of experienced providers and a lack of insurance coverage.
A 2020 study from the Center for American Progress found that one-third of the transgender individuals who participated had to educate their providers themselves in order to get appropriate care. That same study found that more than half of transgender participants experienced issues accessing care because of cost issues.
Compared to cisgender folks, trans folks are disproportionately more likely to be uninsured. Those who are insured may find that their health plans don’t cover gender-affirming care. As for Medicaid coverage, 12 states explicitly prohibit it.
Young transgender individuals face the biggest obstacles when it comes to gender-affirming care. Alabama, Arkansas, Arizona, and Texas have recently enacted restrictions to gender-affirming care for youth — as well as penalties for adults supporting access in some cases. Of those four states, three have been blocked, temporarily, by court orders. Since the start of 2022, 15 states have introduced bills restricting access.
Pelvic pain disorders are difficult to diagnose. In the U.S., more than a third of people with vulvodynia wait more than three years and 15 appointments after they first experience symptoms before getting a diagnosis. Less than 2% of people who experience symptoms actually get a diagnosis. For endometriosis, the average time to diagnosis is over 10 years.
A factor that’s fairly unique to this particular instance of inaccessibility is the history of treating (or not treating) pain in people assigned female at birth. Instead of having their pelvic pain validated and acknowledged, it’s often dismissed and untreated. This is especially common in the Black community, for whom disbelief in pain can be traced back to forced experimentation without consent or anesthesia on enslaved Black people who were assigned female at birth.
Part of the reason science doesn’t understand female pain is because we just don’t study it enough: 80% of pain studies are conducted on male mice or humans.
Fertility-related procedures, such as egg freezing and in vitro fertilization, can be prohibitively expensive for many people. Seventeen states require insurance companies to cover or offer fertility treatment, but some use eligibility criteria that hinges on a diagnosis of “infertility,” which excludes same-sex couples and people who want to have biological children on their own. Elective egg freezing is rarely covered by state insurance.
Employer benefits packages often have the most expansive coverage of fertility-related procedures, but just under half of insured people in the U.S. don’t have employer-sponsored insurance.
The postpartum period, or the time after a baby is delivered, is an incredibly critical time for quality care and monitoring. More than half of maternal deaths happen in postpartum, and 12% of them happen after six weeks postpartum — which is when the last insurance-covered appointment is scheduled.
This is especially true in the U.S., where the maternal mortality rate later in the postpartum period is higher than it is in other high-income countries. Mortality rates are significantly higher among Black birthing people as compared to white birthing people.
Going through menopause at some point (the average age in the U.S. is 51) is a given for anyone with menstrual cycles, so menopause care should be accessible, right? Unfortunately, menopause care is not nearly as accessible as it should be.
A review of insurance claims from Yale found that although 60% of people with significant menopause symptoms try to get medical support, almost 75% of them don’t get treatment. One reason why is that doctors often aren’t getting the training they need to provide menopause care: Only 20% of residency programs for OB-GYNs offer menopause training, and many of the courses aren’t mandated. As a result, almost 80% of residents say they feel “barely comfortable” with talking about menopause or treating patients who need menopause care.
Healthcare inaccessibility isn’t something any one individual can solve — it’s a systemic issue that would involve policy change, comprehensive training of clinicians, and the destigmatization of female reproductive systems.
What we can do, however, is advocate for the care we deserve. The easiest way to do this is by speaking up about abortion access and other limitations to essential healthcare. We can prioritize going to healthcare institutions and providers that support access. We can also reach out to our representatives and demand what we need: more healthcare for more people (including the expansion of Medicaid), paid parental leave (which we’re the only high-income country not to offer!), and access-promoting legislative action.
Need help accessing care yourself? Here are a few helpful resources: