Women now comprise half of all American workers, and women are either the primary or co-breadwinners for two thirds of all American families. Maria Shiver, in conjunction with the Center for American Progress, published a fascinating new report last month that outlines the ways that having a large female workforce is changing the landscape of American business, family, and health status.  The entire 400 page report can be downloaded by chapter, or read online here.

Image: americanprogress.com

Of primary interest to the readers of this blog is the chapter about the health of the working woman entitled, “Sick and Tired: Working Women and their Health” by Jessica Arons and Dorothy Roberts. A few really interesting points that I’d like to pull out:

• A quarter of women still receive insurance through their husband’s employers. This means if something happens to her husband, or a couple decides to divorce, a woman could very quickly lose her coverage.
• There currently seems to be a two-tier system in the business place with regards to breastfeeding: professional mothers are accommodated, while working-class mothers are not.
• Women are often exposed to chemicals that can impair fertility while in the workplace. Alternatively they are excluded from certain male-dominated fields because of concerns over these chemical impacts, rather than just making these workplaces safer.
• The act of being a caregiver, which is usually done by women, can have health impacts: caregivers are more likely to report having heart disease, cancer, diabetes, and arthritis. The chronic stress felt causes women to also be more likely to suffer from stress-induced headaches, sleeplessness, irritability, and depression.
• Women are more likely than men to work in jobs that are low-wage, part-time, or for small businesses; all are positions that infrequently offer employer-based insurance.
• The practice of “gender rating,” or charging women more than men for insurance premiums, is common among private insurers. They are also more likely to deny coverage or increase premiums for women based on preexisting conditions that only or disproportionately affect women.
• Because they have to pay more for insurance, and make less than men, women spend a higher percentage of their income on healthcare. They are more likely to be forced into medical bankruptcy when things go wrong.

The article has a lot of good personal stories to illustrate some of the hardships encountered with healthcare for working women, and really touches on the ways that race and economic status can put certain women at even more of a disadvantage. The chapter is such a great look at the ways that we, as working women, are impacted differently by the types of jobs we have, the influences of these jobs (and our non-paying jobs as caregivers) on our health, and the ways we are able to afford our healthcare. I highly recommend checking it out; it can be directly downloaded here.

Guest blog by Dr. Jennifer Hirshfeld-Cytron, Reproductive Endocrinology and Infertility Fellow, Department of Obstetrics and Gynecology, Northwestern Memorial Hospital

The Obstetrics and Gynecology Grand Rounds this morning was given by past FIGO (International Federation of Gynecology and Obstetrics) and previous chairman of the department, Dr. John Sciarra.  He provided an incredibly informative and moving description of the global issues affecting women, particularly in the developing world.  He highlighted the issues of maternal mortality, maternal morbidity, STDs, cervical cancer, and education inequality.

For instance, in Afghanistan, 1 in 6 women will DIE from pregnancy related complications compared to 1 in 4100 in the developed world.  Pregnancy related complications include: abortion related deaths, hemorrhage, thrombotic events and eclampsia (see below). 20.5 million unsafe abortions occur each year worldwide and account for 60,-80,000 deaths.

Image: http://www.who.int/making_pregnancy_safer/topics/maternal_mortality/en/index.html)

Furthermore, HIV/AIDS accounts for 11% of worldwide deaths with approximately 47 percent of the 34.3 million adults living with HIV/AIDS being women. Cervical cancer, a preventable cancer with appropriate screening, sex education and potentially the vaccine, affects 200,000 women worldwide and is second only to breast cancer in incidence.  Cervical cancer screening in the developed world centers on cytology, which is not available in the developing world. He further highlighted the inequities of women.   Worldwide women work 66% more than men but receive only 15% of the income.  Illiteracy in parts of the developing worth is greater than 65% for women. This just begins to highlight the complicated issue of providing appropriate family planning education to the developing world.

These staggering and incredibly disturbing statistics leave us with only one question; how can we raise the status of women worldwide? Efforts are being done to partner developed with developing world medical schools to increase technical skills for the care of women, such as safe abortions.  A website (www.glowm.com) has been started by Dr. Sciarra and others providing education in the form of book chapters and how-to videos to begin to enhance knowledge to the developing world.  Access is huge problem for women and foundations such as the Bill and Melinda Gates Foundation are working towards these and other efforts.  In short, get involved.

As Mahmoud Fathalla, past president of the International Federation of Gynecology and Obstetrics, said: “Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving.”

Image: bodyandmore.auburnpub.com

Medscape Today recently wrote an article detailing the physician’s dilemma regarding delivering test results, and how this may differ based whether the results are normal or identify a potentially dangerous problem. Much of the discussion uses PAP smear results as way to discuss the issue: it something women are supposed to do fairly regularly, and the results can be life-changing. In the article, doctors discuss whether a phone call is the best way to deliver results. If so, who should do the calling: the doctor or a nurse? The general conclusion seemed to be that a form letter or nurse’s call is sufficient for normal test results, but that the doctor should do the notification for abnormal results. Interestly, the mode of doctor notification was disagreed upon: some doctors made phone-calls, others required appointments. I found some of the quotes on the topic annoying:

“”Patients with multiple questions are offered an appointment,” says an internist. “I am not going to provide unreimbursed care that includes lengthy phone calls.” An ob/gyn agrees. “If I am going to spend more than 2 minutes talking to a patient, the reality of reimbursement is that it must be a billable visit. The patient needs to come in.”"

I will say that other doctors disagreed and found this practice as gouging as I did. Either way, it’s obvious that the issue is still up for debate. What do you all think? How would you prefer to receive test results? What do you think are your particular healthcare provider’s motivations for delivering news as he or she does?