#BreakTheBias on International Women's Day

A day for women to celebrate the progress that has been made, examine the painful inequalities that still exist and create a call to action for a more inclusive future.

International Women’s Day is an opportunity to commemorate the achievements of women worldwide and continue the push for greater health equity by eliminating gender biases in health and the health care experience.

In honor of this year's #BreakTheBias theme, we're taking a close look at three inequities women experience in their health and health care experience and what employers can do to change them.

Inequities and Bias in Preventive Care

Preventive care allows for early detection of life-threatening diseases. For example, screenings for breast and cervical cancers and cardiovascular disease are top preventive care priorities for women, which can optimize disease management and save lives. During the pandemic, women have been more likely than men to skip health care services, creating potential neglect of serious health issues, like cancer and heart health. Surprisingly, women earning higher incomes with private insurance were more likely to have skipped preventive services than women on the lower end of the income scale with no insurance. The reason is likely fear of exposure to COVID-19.

Cardiovascular disease (CVD) accounts for 35% of all deaths among women globally. In some regions of the world, sociocultural factors put women at greater risk for cardiovascular disease. For example, in Saudi Arabia, restrictions on women’s physical activity can lead to poor physical health, obesity and ultimately CVD.

Furthermore, the medical profession has typically viewed CVD as a “male disease,” mostly because of gender bias. Often the symptoms related to CVD in women have been largely stereotyped as anxiety or stress due to a woman’s “emotional nature.” Such misconceptions are prevalent among women and their providers, ultimately leading to late diagnosis or a misdiagnosis altogether. One British study showed that over a 10- year period from 2003-2013, more than 8,000 women died in England and Wales from heart attacks because they did not receive the same standard of care as men, highlighting the possible dangers of an inadequate health care experience for women.

Employer Recommendations

  • Provide on-site services and clinics to help increase access to preventive services and provide a safe and trusted environment for patients.
  • Offer programs that include cancer and other disease education and screenings.
  • Conduct periodic preventive screenings and targeted communications campaigns to drive appropriate and timely preventive screening utilization.
  • Ensure that populations at high risk for common comorbidities are undergoing every applicable screening test.
  • Provide adequate financial coverage for health screenings and go beyond what is recommended to ensure that standards of care are met.
  • Ensure that health plans and leave/disability programs adequately address cancer care and heart disease management.
  • Support employees by providing programs and benefits that help them achieve and maintain a healthy body weight, including nutritional counseling and physical activity programs.
  • Audit or develop an inventory of current services to identify gaps in care around the globe.

Inequities and Bias in Pregnancy and Maternity Care

The World Health Organization (WHO) estimates that each day over 800 women die from preventable pregnancy-related causes. In the U.S. alone, maternal mortality rate has increased by 14%. Globally, Nigeria, India, Democratic Republic of Congo, Ethiopia and Tanzania have the highest number of maternal deaths. For example, in Nigeria, one-third of women do not have access to medical care during pregnancy. In these countries and many others, social determinants serve as barriers to optimal health and health care. These barriers include limited transportation options and high out-of-pocket costs.

Racial inequities also play a role in poor maternal and child health outcomes. The U.S. is the only high-income country where maternal mortality is increasing, with Black women experiencing increased poor maternal health outcomes. Black, Indigenous and People of color (BIPOC) also face higher risks of infant mortality than White people do. This disparity is largely attributed to discrimination and bias Black women face in clinical settings. For example, some non-Black providers believe Black people experience less pain, which often means that their pain isn’t treated.

Globally, 10%-15% of pregnancies end in miscarriage, and many women experiencing pregnancy loss develop mental health issues due to shame, grief and stigmatization. The South Asian region has the highest pregnancy loss burden in the world. Evidence shows that women in this region experience miscarriages due to toxic air and high rates of pollution. Lack of contraception and societal pressures also result in some women becoming pregnant before they are ready. In fact, in 2019, 200 million women who did not want a pregnancy had no access to modern contraception.

Employer Recommendations

  • Provide access to and encourage use of affordable, high-equality care from preconception to postpartum, potentially partnering with community health worker programs.
  • Develop a diverse, culturally competent network of health care providers from health plans and vendors and require them to use clinical guidelines and standards of care to remove implicit bias.
  • Provide benefits that address transportation barriers.
  • Provide paid sick, parental and bereavement leaves. Expand bereavement leave policies to cover pregnancy loss.
  • Partner with employee resource groups (ERGs) to ensure that BIPOC people are aware of potential disparities in maternal health and the support available to them.
  • Drive change through partnerships and funding initiatives that improve maternal health.
  • Navigate patients to the right programs and solutions to support them during, pre- and post-pregnancy.

Inequities and Bias in Caregiving and Mental Health

Caregivers are twice as likely as those without caregiving responsibilities to develop chronic illness and 49% experience exhaustion. Across the globe, women take on a disproportionate amount of unpaid work and caregiving labor that can lead to both physical ailments and poor mental health. During the COVID-19 pandemic, women globally experienced up to three times greater levels of anxiety and depression than men, as well as more stress from caregiving burdens. For example, in Spain, a recent study showed that one year into the COVID-19 pandemic, women self-reported increased caregiving responsibilities, often without help, and a self-perceived greater decline in emotional well-being compared to men. Even before the pandemic, across cultures and countries, women have been expected to be the caregivers for sick or elderly relatives. This disproportional level of responsibility for women has been linked to psychiatric morbidity in women (i.e., depression, anxiety and lower satisfaction in life).

Employer Recommendations

  • Provide culturally tailored mental health benefits and employee assistance programs (EAPs); even better, tailor services to meet the unique needs of parents and caregivers.
  • Offer a comprehensive set of family benefits that address child, adult, and elder care needs.
  • Maximize flexible work options, including remote work, flexible work hours, job-sharing, shift swapping, condensed work weeks and/or part-time options.
  • Develop ERGs and/or support groups around shared identities between women to foster a safe space and sense of community. Also, use ERGs to facilitate listening sessions to create a feedback loop.

Gender inequities stemming from societal biases and systematic barriers can negatively impact women’s health and the health care they receive. The employer community can drive change and improve the health outcomes of women through equitable and impactful benefits and programs.

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