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Health
  Discriminatory Treatment
  Maternal Mortality
  Access to Health Care
  Conclusion and Suggested Questions

The Initial Report of the U.S. government elaborates on racial disparities but does not examine the situation for women of color, other than mentioning maternal mortality. However, women of color in the United States chronically suffer poorer health than other social groups due to a variety of factors. For example, women of color have higher rates of AIDS, hypertension, stroke, heart disease, uterine cancer, breast cancer, respiratory disease, alcohol related diseases and conditions, lupus and pregnancy-related mortality than other ethnic groups.28 Women of color also experience higher rates of maternal mortality than European American women. High rates of poverty, lower educational levels, the dangers of immigration, and often increased stress from dangerous, low-paying or unstable jobs and the double or triple workday frequently expose women of color to greater health risks and encourage them to ignore their health concerns.29 This is exacerbated by the fact that women of color often receive discriminatory treatment and diagnosis and that research efforts have historically ignored women’s particular health concerns and have ignored altogether the specific concerns of women of color.30 Women of color also face numerous barriers to accessing health care including restricted access to insurance and lack of access to affordable healthcare clinics; women of color often lack transportation, the ability to pay for services, health insurance information and geographical accessibility to health care services.31 Moreover, they often face language barriers and a dearth of translation services:32

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Discriminatory Treatment

According to the National Institutes of Health, women of color develop cancer at higher rates than European American women and are less likely to survive.33 For example, Asian Americans are more likely than people of other races to develop stomach and liver cancer; cervical cancer is more prevalent among Latino and Vietnamese American women; and African American women are less likely than European American women to survive breast cancer.34

Even more disturbing than those statistics is evidence that women of color are receiving discriminatory care from their healthcare providers.

• Although African American women’s heart-disease death rates are 34 percent higher than European American women’s, their complaints are less likely to be examined in a timely manner. Julia Carson is a fifty-eight year old African American woman who, in 1996 recognized that her heart was failing her. Once an active woman, Carson found that she had no energy and that her chest was frequently tight and painful. Upon visiting her doctor and asking him to check her heart, Carson was dismissed, told to eat a more healthy diet and told that her heart was fine. One day she found that she was too weak to walk. When she went to the hospital, one of the main arteries to her heart was completely blocked and another was 90 percent blocked. Luckily, Carson underwent surgery and survived. Meredith Wadman, A Heart Attack Of Her Own, 140 Fortune Magazine 10 (1999).
• Latina participants felt that they were mistreated by health care providers on the basis of their ethnicity. In discussing interactions with medical providers, many participants noted the importance of nonverbal communication (e.g., tone of voice, lack of eye contact) that they interpreted as discomfort, judgment, or lack of interest on the part of the provider. Regardless of the intentions of the providers, these experiences may negatively affect abused women’s willingness to seek help from medical providers. Heidi M. Bauer, et al, Barriers to Health Care for Abused Latin and Asian Immigrant Women, Journal of Health Care for the Poor and Undeserved, 11 (February 2000).
• Susan Shinagawa was alerted to her high risk history for breast cancer by a friend, so she started to check herself. When she discovered a lump, she took a mammogram and then a sonogram, which showed that the lump was a solid mass. She sought help from a surgical oncologist (a specialist in breast cancer surgery). He told her “you have no family history of cancer, you are too young to have cancer, and Asian women don’t get breast cancer.” When she asked him to do a biopsy he responded, “Susan I see thousands of women like you every year and you just have to trust me, you don’t have breast cancer and I will not biopsy it.” Because of the pain it was causing her she finally found a surgeon at the University of Alabama. He took a biopsy, showing that she did in fact have breast cancer. Personal interview, WILD for Human Rights, September 1999

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Maternal Mortality

A recent study conducted by the Centers for Disease Control and Prevention in Atlanta found that African American women in the United States are nearly four times as likely to die during delivery, or shortly thereafter, than European American women.35 The study found that African American women are at a higher risk than European American women for dying from every pregnancy-related cause of death reported.36 Although factors such as lack of access to prenatal care, quality of prenatal care, delivery, and postpartum care, contribute to this disparity, it crossed socio-economic lines and the above factors did not fully account for the disparity. Although this difference has persisted for over forty years, the federal government has failed to institute a single research program to identify the cause and seek improved care for pregnant women of color.

• In late 1998 in Washington, D.C., a thirty-year-old African American woman died from an amniotic fluid embolism, in which fluid from her womb escaped into the bloodstream and lodged in her lung. Despite the fact that doctors suspect that this form of embolism may be a chronic condition, no studies have been funded to determine this and to save women’s lives.

Only twenty-five states conduct examinations of a woman’s death in childbirth and where they are conducted, they are grossly underfunded. This leaves the disparity in maternal mortality rates unresearched and the unequal numbers of deaths among women of color unexplained.37 Although there are no large-scale studies of other ethnicities, the disparity is not limited to African American women. The maternal mortality rate for Latinas is 23 percent higher than the rate for non-Hispanic women.38 In addition, despite the fact that prenatal care has been shown to reduce the incidence of low birth weight and infant mortality, as well as reduce pregnancy complications, only 68 percent of Latinas in California begin prenatal care in the first trimester, compared to 85 percent of European American women.39 Epidemiological, sociologic, health-care delivery, and program research are needed to identify key factors and remedies for the disparity between women of color and European American women in maternal health whether at the individual, clinic, community, or health systems level.40

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Access to Health Care

Women of color also face significant difficulty getting access to adequate healthcare. This is at least partly due to lower incomes, immigration status, and linguistic issues. Poor urban communities with high proportions of African Americans and Latinos averaged only 24 physicians per 100,000 (in 1996 there were about 280 physicians per 100,000 population). Poor communities with low proportions of African Americans and Latinos averaged 69 doctors.41 Additionally, studies have shown that Latina women are seven times more likely than other social groups to be without a health insurance plan.42 Latinas in California are less likely to have health insurance than any other group.43 Low-income women of color may lack the resources to cover childcare, transportation and/or out-of-pocket medical expenses associated with obtaining medical care.

The federal welfare reform program limited access to Medicaid. In many states, welfare recipients are now required to apply for Medicaid separately.44 Moreover, although people leaving welfare are automatically entitled to health insurance under Medicaid for six months to a year, many states have not carried out this requirement.45 As a result, as of June 2000 nearly a million low-income parents had lost Medicaid coverage.46 A study conducted by Families USA in 1999 showed that half of all women who lost Medicaid were unable to obtain new insurance.47

Women of color not only face more difficulty in getting access to adequate health care; they are criminally prosecuted when their discriminatory treatment leads to the death of a child. For example,

• Tabitha Walrond, a 19-year-old African American woman from New York was prosecuted for manslaughter, and found criminally guilty of negligent homicide for the death due to undernourishment of her seven-week-old son. She was denied access to health care, and then prosecuted for the death that resulted from such denial. Walrond was not told that her previous breast reduction surgery could lead to decreased production of breast milk. In her attempts to seek health care for her son, she was refused because Medicaid, due to some bureaucratic red tape, failed to provide her and her son with a Medicaid Card. Katherine Stapp, Rights-U.S.: Infant Death Conviction Sparks Outrage, Global Information Network (1999).

Issues of linguistic and cultural competency are critical when examining access to health for women of color. Language differences affect provider-patient interaction, especially the patient’s ability to understand the medical information provided. In addition, women of color are more likely to visit the doctor if she feels comfortable there. Spanish-speaking patients have been found to be less likely to than their English-speaking counterparts to receive sufficient preventative information or referrals from their healthcare providers.48 Moreover, language confusion can lead to misdiagnosed illnesses or inadequate consent from patients. The U.S. government has started to address this situation through Executive order 13166 “Improving access to services for persons with limited English proficiency,” issued by former President Clinton. However, there is no guarantee that the current administration will continue this effort and there are reports that doctors are refusing to treat patients with limited English ability because of the cost of translation.49 Moreover, part of the problem with cultural and linguistic competency is the low numbers of women of color health providers and anti-affirmative action measures are leading to decreasing numbers of women of color in medical school.

Finally, women of color, due to their geographic marginalization and lower income status, along with the fact that they are more likely to be uninsured and need for more medical care, especially reproductive services, disproportionately suffer from the merging of hospitals and closings of local health care clinics, which has accelerated in recent years. Courts have repeatedly allowed hospitals to close or consolidate, despite the impact on people of color, especially women. For example, in a case in San Antonio, Texas, all the maternity and newborn nursery services were moved from a downtown hospital to a suburban hospital 11 miles away.50 The court decided that the disproportionate impact was not extreme enough compared to the benefits of consolidation and allowed the change. In one recent case in Northern California, the court did suggest that disparate racial impact could prevent a merger, but allowed the consolidation after the county increased hours at nearby clinics and improved transportation options. However, the plaintiffs still objected to the consolidation.51 Consequently, fewer of these mergers are being challenged at all.

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Conclusion and Suggested Questions

Despite these glaring disparities in the health of women of color, only 1 percent of the National Cancer Institute’s budget is spent on research questions that specifically address the needs of the poor and people of color.52 Former President Clinton committed the United States to eliminate disparities in heath experienced by people of color by 2010. Toward that end, the Centers of Disease Control recently awarded $9.4 million to thirty-two community coalitions in eighteen states to reduce the level of disparities in one or more of the priority areas of: infant mortality, diabetes, child and adult immunizations levels, and HIV/AIDS. This is a small beginning. There simply are no statutory entitlements, no recognized guarantees under the United States Constitution, and no body of case law that assures access to comprehensive, basic health care to all women and children, regardless of their race. Thus, the facts that women of color receive less health care, often of lower quality, and remain neglected as a subject of medical research, remain unexamined and unaddressed.

• What steps has the federal government taken to increase funding for research into the high level of illness among women of color, particularly reproductive cancers, maternal mortality, and high blood pressure, and including an examination of the impact of discrimination on the provision of health care and the mortality rate?
• What steps has the Department of Health and Human Services taken to ensure that women of color have access to health care providers who are culturally and linguistically competent and within their geographic area?
• What research or studies has the federal government conducted into access to insurance for women of color, especially the impact of welfare reform on the availability of such insurance?

Next: Gender Asylum

Footnotes
28 See id. at 764.
29 Susan Waysdorf, Fighting for Their Lives: Women Poverty, and Historical Role of United States Law in Shaping Access to Women’s Health Care, 84 KY.L.J. 745, 759 (1996).
30 See id.
31 See id. at 748.
32 Lisa Fernandez, Volunteer Asian Women’s Health Project in San Jose, CA, San Jose Mercury News (September 7, 1999).
33 Julianne Malveaux, Racing for the Cure Versus Curing the Races (1999).
34 See id.
35 Sheryl G. Stolberg, Black Mothers’ Mortality Rate Under Scrutiny, N.Y. TIMES, Aug. 8, 1999 at A1.
36 See id.
37 See id.
38 Initial Report of the United States of America to the Committee on the Elimination of Racial Discrimination,Committee on the Elimination of Racial Discrimination, CERD/C/351/Add.1, at 376 (2000).
39 Latina Health Policy Project of the Latino Coalition for a Healthy California, Ensuring Health Access for Latinas, (January 1999) at 33.
40 U.S. Department of Health and Human Services, Morbidity and Mortality Weekly Report: State-Specific Maternal Mortality Among Black and White Women (June 1999).
41 Initial Report of the United States of America to the Committee on the Elimination of Racial Discrimination,Committee on the Elimination of Racial Discrimination, CERD/C/351/Add.1, at 377 (2000).
42 Gloria Smith, W.K. Kellogg Foundation, Grantmakers in Health Bulletin, September, 1998.
43 Ensuring Health Access for Latinas, at 23.
44 JOEL F. HANDLER & YEHESKEL HASENFELD, WE THE POOR PEOPLE 207 (1997).
45 See id.
46 Robert Pear, “A Million Parents Lost Medicaid, Study Says,” New York Times, June 2000 at A14.
47 Families, USA, Losing Health Insurance: The Unintended Consequences of Welfare Reform (1999).
48 Ensuring Health Access for Latinas at 46.
49 Interpreters: Requirement Could Mean Less Access to Care, AM. HEALTH LINE (The National Journal Group, Inc.), June 13, 2001.
50 United States v. Bexar County, 484 F.Supp. 855 (1980).
51 Latimore v. County of Contra Costa, No. 95-15886, 1996 U.S. App. Lexis 3524 (9th Cir. Feb. 15, 1996).
52 See Malveaux, supra.

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