Tag Archives: health disparities

Bearing the Burden of Injustice: Black Maternal Mortality

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Mother and babyWhen it comes to maternal mortality, American women don’t all live in the same country. While white women live in Qatar, black women live in Mongolia.

Maternal mortality is death related to complications from pregnancy or childbirth. Most of us don’t come from a time or place where the prospect of dying in childbirth is a tangible possibility — in the past century, as medicine has advanced, maternal mortality rates have plummeted.

To raise healthy families, we need access to general and reproductive health care, including preventive care, prenatal care, and maternity care.

The United States, though, hasn’t come as far as would be expected. Although its wealth should have put it on par with other developed nations like Canada, the United Kingdom, Australia, Japan, and those in Scandinavia, women in these countries fare far better than those in the United States. So do women in Libya, Bosnia and Herzogovina, Bulgaria, and Kazakhstan, indicating that national priorities — and not necessarily national wealth — are key to ensuring maternal health.

The United States’ high maternal mortality rate is heartbreaking no matter how you look at it, but is even worse for women of color. African-American women are 3.5 times more likely to die as a result of pregnancy or childbirth than white women. Between 2011 and 2013, the maternal mortality rate for white women was 12.7 deaths per 100,000 live births. Comparing that to 2015 data from the World Health Organization (WHO), that rate puts white women’s maternal mortality on par with mothers in Qatar and Bahrain, two wealthy Persian Gulf nations. African-American women, however, suffered 43.5 deaths per 100,000 live births, putting their maternal mortality on par with those of Turkmenistan, Brazil, and Mongolia. Continue reading →

STD Awareness: Transgender Men and Cervical Health

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Healthy cervical cells as seen under a microscope. Image: National Cancer Institute

Just one month ago, headlines screamed that the Centers for Disease Control and Prevention (CDC) received a list of “banned words” from the Trump administration. One of those words was transgender, raising the alarm that the current president might be eyeing policies that would further marginalize the trans population and harm their health. (Other forbidden words include fetus, evidence-based, and vulnerable.) Some have argued it wasn’t Trump policy per se, but self-censoring on the part of the CDC to protect their budgets from being slashed by legislators hostile to transgender rights, abortion rights, science, people of color, and poor people.

In any case, refusing to use words like transgender can have grave consequences for trans health. If the CDC can’t reference the trans population when requesting money for services and studies, they will be hobbled in their ability to serve that population’s needs.

Recommendations for cervical cancer screening are the same for anyone with a cervix, whether trans or cisgender.

January is Cervical Health Awareness Month. Anyone who has a cervix can develop cervical cancer — including transgender men who have not had their cervixes surgically removed. In observance of the month, and in defiance of directions to avoid the word transgender, today we’ll discuss the importance of cervical health in trans men — and why taxpayer-funded entities like the CDC and the National Institutes of Health must be able to study and serve this population.

Transgender men (or trans men for short) are individuals born with female reproductive organs, but who identify as male. Likewise, cisgender women were born with female reproductive organs and identify as female. Both trans men and cisgender women were born with cervixes, and wherever a cervix exists, the possibility of cervical cancer exists. Continue reading →

STD Awareness: What Does “Congenital Syphilis” Mean?

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Treponema pallidum, the bacteria that causes syphilis

Treponema pallidum, the bacteria that causes syphilis

Congenital syphilis, for centuries a leading cause of infant mortality, is often thought of as an antique affliction, relegated to history books — but it is on the rise again. Between 2012 and 2014, there was a spike in congenital syphilis rates, which increased by 38 percent and are now the highest they’ve been in the United States since 2001. As of 2014, the last year for which we have data, more babies were born with syphilis than with HIV.

The word “congenital” simply means that the baby was born with syphilis after being infected in the womb. When an expecting mother has syphilis, the bacteria that cause the disease can cross the placenta to infect the fetus — and will do so 70 percent of the time. As many as 40 percent of babies infected with syphilis during pregnancy will be stillborn or will die soon after birth. It can also cause rashes, bone deformities, severe anemia, jaundice, blindness, and deafness. Congenital syphilis is especially tragic because it’s almost completely preventable, especially when expecting mothers have access to adequate prenatal care and antibiotics. Penicillin is 98 percent effective in preventing congenital syphilis when it is administered at the appropriate time and at the correct dosage.

More babies are being born with syphilis — but this trend can be reversed with wider access to prenatal care.

Incidence of congenital syphilis is growing across all regions of the country, but rates are highest in the South, followed by the West. Rates have also been increasing across ethnic groups, but, compared to white mothers, congenital syphilis rates are more than 10 times higher among African-American mothers and more than 3 times higher among Latina mothers, illustrating the need to increase access to prenatal care for all expecting mothers — and to ensure that this prenatal care is adequate.

Anyone receiving prenatal care should be screened for syphilis at their first visit, and some pregnant people — including those at increased risk or in areas where congenital syphilis rates are high — should be screened a second time at the beginning of the third trimester and again at delivery. Continue reading →

Square Pegs, Round Holes: Building Trans-Inclusive Health Care

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transgenderFor the first time in history, trans persons are being recognized in the mainstream and their identities are being embraced like never before. Laverne Cox’s cover story for Time and Amazon Prime’s original series Transparent winning four Emmys are examples of this recognition.

Kinda.

Today is National Transgender HIV Testing Day.

Truth is, the trans persons in the media are not representative of the norm. The findings of the National Transgender Discrimination Survey — a survey that collected responses from more than 6,000 transgender and gender-nonconforming individuals — give a clearer picture, and it’s not pretty. The authors of this study found trans persons faced adversity in almost all aspects of life, from experiencing double the rate of unemployment to suffering through a high rate of violent attacks (26 percent and 10 percent of the respondents reported being physically and sexually assaulted, respectively) because of their gender identities. Among all these results, I found one to be particularly unsettling:

“Respondents reported over four times the national average of HIV infection, with rates higher among transgender people of color.”

To me, a person born after the AIDS epidemic of the ’80s and privileged with a world that now has readily accessible condoms and HIV prevention medication (i.e., Truvada), HIV seemed like a relic of the past. Examining the amount of new HIV infections in the cisgender population (0.4 percent for females and 1.2 percent for males), this is an easy assumption to make. I was wrong. Other studies echoed the large disparities of HIV incidence and prevalence in trans persons. One systematic review uncovered four studies that found that 24.8 to 30.6 percent of male-to-female (MTF) transgender persons tested positive for HIV. Another study — conducted in Ontario, Canada — sampled 433 trans persons and found 7 percent of female-to-male (FTM) transgender persons and 19 percent of MTF persons had a high-risk sexual experience in the last year. Yet another found that 35 percent of MTF persons (and 2 percent of FTM persons) had HIV, and again, persons of color — in this case, African-American identified individuals — were at a greater risk. Indeed, in this study, African-American trans persons (FTM and MTF) were approximately three to 12 times more likely to have HIV. Given these data, the cynic in me questions, “Is anyone even trying to prevent HIV in trans persons?” Continue reading →

Toward Improved Care for LGBTQ Patients: New Guidelines Shine Spotlight on Addressing Health Disparities

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doctorsOn January 5, Florida became the 36th state in the nation to legalize same-sex marriage, joining a movement that is sweeping across the United States. With federal judges striking down same-sex marriage bans left and right, it seems inevitable that we will soon live in a country that recognizes the freedom to marry. Yet, although more Americans than ever support marriage equality, the fight for the full inclusion of lesbian, gay, bisexual, and transgender individuals in our society is not over, as they continue to face significant barriers to quality medical services.

Full equality includes access to high-quality medical care, regardless of sexual orientation or gender identity.

The obstacles that have historically prevented LGBTQ patients from obtaining medical care continue to plague our modern health care system. Sure, the American Psychiatric Association no longer considers homosexuality a mental illness. But a concerning number of health care providers still refuse to serve LGBTQ individuals, and until the passage of the Affordable Care Act, insurance companies were not required to extend domestic partner benefits to same-sex couples. Moreover, the stigma that surrounds homosexuality prevents many patients from disclosing their sexual orientation to doctors. Because the LGBTQ community faces higher rates of certain conditions, including depression and substance abuse, failing to discuss sexual activity can lead to inadequate treatment.

One of the U.S. health care system’s most serious shortcomings is its failure to prepare doctors to work with LGBTQ patients. Young doctors are emerging from medical school ill-equipped to deal with the specific needs of the LGBTQ community. A 2006 study published in Family Medicine surveyed 248 medical students, finding that the vast majority of students held positive attitudes toward LGBTQ patients and hoped to provide them top-tier care. Unfortunately, the same group of students failed spectacularly when tested on LGBTQ-specific health concerns. Another study revealed that most medical schools throughout the United States and Canada devote minimal (if any) instructional time to LGBTQ issues, and that the quality of such instruction varies drastically across institutions. And significantly, many doctors report that they feel uncomfortable discussing sexual behavior with LGBTQ patients. Continue reading →

STD Awareness: Gardasil and Males

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menIt’s Men’s Health Month, and yesterday was the last day of Men’s Health Week, which means we’re going to look at a men’s health issue that is usually ignored: the impact of human papillomavirus (HPV) on the male population.

You’ve probably heard of HPV in discussions about cervical cancer and Pap testing. But HPV doesn’t care about gender, and is perfectly content to invade cells in anyone’s genital tract, mouth, throat, or anus. In males, HPV can cause genital warts as well as anal, oropharyngeal (mouth and throat), and penile cancers.

HPV will cause more oral cancer than cervical cancer by 2020.

The good news is that most HPV infections can be prevented by a vaccine called Gardasil, and you don’t need to be female to get it. However, few males are actually getting the HPV vaccine: In 2012, 20.8 percent of U.S. males 13 to 17 years of age had received at least one dose of the HPV vaccine, but only 6.8 percent completed the three-dose series.

Gardasil Is for Everybody: Good News from Australia

This huge disparity in promoting Gardasil to female patients rather than male patients has real-world consequences. In Australia, girls have been vaccinated with Gardasil since 2007, covered by their national health system. Four years into the program, genital wart rates fell by 93 percent in females less than 21 years of age. Even though males weren’t being routinely immunized, genital wart rates fell by 82 percent among heterosexual males in the same age group. That’s because their female partners had received the vaccine, which had the effect of protecting much of the male population. That might sound pretty nifty, but the female-only vaccination policy left out gay and bisexual males, whose genital wart rates saw no corresponding decline. Continue reading →

Women’s Health Week: Making Time for You and Your Health!

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yogaThe following guest post comes to us via Stasee McKeny, Planned Parenthood Arizona’s community engagement intern.

Mother’s Day kicks off National Women’s Health Week (May 11 to 17), a week dedicated to empowering women to make health a priority in their lives.

After celebrating Mother’s Day, make health a priority throughout Women’s Health Week!

Making health a priority isn’t always easy for women. Women are more likely than men to avoid getting necessary health care because of the cost — 30 percent of insured women didn’t fill a prescription, 21 percent didn’t see a specialist, 24 percent skipped medical test treatment or follow-up, and 27 percent had a medical problem but didn’t see a health care provider. Affording health care is significantly more difficult for women who not only make less money than their male counterparts, but also use more health care services, like 12 months of birth control. Luckily, with health care reform, these disparities are slowly changing. Close to 27 million women with private health insurance gained expanded access to preventive health care services with no cost-sharing.

More women than ever now have access to affordable health care services and there is no better time to take advantage of this. During National Women’s Health Week, women are encouraged to do a number of things — whether it is making an appointment with a health care provider for a well-woman exam or deciding to eat healthy and exercise. Continue reading →