Special Groups of Women and the Barriers They Face When Seeking Reproductive Health Care

Vandana Mathur

 

Having worked in a health center that dealt with women’s reproductive health issues, I noticed certain concerns that I thought were not fair to particular patients.  These patients were not the average females that made appointments at my health center.  They were women that stemmed from ethnically diverse populations.  They were woman that were first generation here in the United States of America and were not clued in about their health care rights.  These women were considered to have less money, little health education, and were dealt with in an even smaller regard.  I do understand that it was not the health center’s fault, completely, to treat these women as if they were a waste of time, but the sad truth is that this, regardless, occurred.  I want to discuss my observations and thoughts on this matter.

When a patient is sick, it is often overlooked how seeking care for the illness can make the patient feel.  This is because many items are assumed.  The patient should feel empowered with more knowledge of the illness and how to remedy it.  The patient is supposed to feel comfortable with the environment and the health care professionals that are available.  The element of shame should not be felt by the patient when seeking care.  All this is very logical, infact, it seems a bit obvious.  The growing problem in our current health care system is that women that belong to a minority or a different culture do not have the luxuries mentioned above.

Women’s health can contain many areas.  The area that I believe the most barriers exist in is the reproductive health arena.  A woman, during her lifetime, will need annual pap smears and mammograms.  She may seek attention at a family planning service for birth control, sexually transmitted disease screening, abortions, and emergency contraception.  Mother-child care is another chapter of women’s health she may come to need at a point in her life.  Though the list is expansive and has the feel of importance, many women are do not seek help in this realm due to many reasons. 

These reasons may include the idea that stigmas are attached to women in this society if they want care in reproductive health.  For example, a woman wanting birth control may feel isolated because her insurance will not cover this medication.  Hence, the importance of the decision that she made is belittled.  Or, a woman seeking an abortion due to a rape incidence is called names and screamed at by members of her own society as she enters an abortion health center.  The idea that her own peers are not sensitive or understanding can create a feeling of guilt to this patient. Sometime, just the frightening concept of a pap smear is enough for a woman to not have one every year, and this can cause her cervical cancer being overlooked.  These example, though few, are strong enough that is can be seen that women, in general, feel as if they need to hide their bodies and risk health care so that they do not feel ashamed and guilty.

The possible reasons that exist for minority or special culture women not seeking health care are ones that are far more involved, yet far less studied.  Ethnically diverse women were rarely included in research data in the USA.  This act of ignoring these populations led to lack of knowledge about them and their needs.  Today, this problem has been noted and attempts are being made to research the broader population.  But, until this is common practice, these barriers need to be made aware of so that ethnically diverse women can over come them.  This simple human right has been overlooked in the USA; largely due to USA having a large cultural population.  I believe overcoming these barriers will allow special group women to talk about sexuality more freely.  The simple act of learning about this issue can create more empowerment and less confusion among these groups.  Once a group can be taught there is no need to feel ashamed and that their reproductive health care is actually a right they have in this country, perhaps rates of the spread of sexually transmitted diseases (STDs), unwanted pregnancies, and certain female related cancers will go down.  The first step is to acknowledge the barriers this special group of women face.

The list of barriers includes lack of education.  There may be little or no education towards this field by the female patient.  This can be for reasons involving shame and simple innocence.  A young female in her twenties may not know that now is good time to have a pap smear done, regardless of being sexually active.  This lack of knowledge can be harmful in the future.  Little education in women’s reproductive health can be associated to the female’s culture. Depending on family structure and culture, sex may be considered taboo, whether it is premarital or not.  Therefore, seeking health care related to sex can be uneasy to the patient.  When sex is not discussed in these situations, often there is an unsaid rule about doing just so, not talking about sex.  This can lead to many problems.  The female may not know when certain medical attention is needed.  This can cause her from taking advantage of many preventative measures.  For example, if a sexually transmitted disease is gone untreated, infertility or death could result, along with harming all her partners.  This is a serious consequence to pay for feeling uncomfortable in seeking care.

Also, confidentiality can be a main reason why women may not obtain reproductive health.  Confidentiality can also be tied to culture.  These cultures may include communities that are tight-knit, and this may lead to the patient being worried about gossip.  This is something that affects all aged women.  Depending on the culture, privacy does not exist.  A woman’s right to health care includes her right to have it remain confidential.  If her family or partner do not understand this or condemn her for keeping this between herself and her health care provider, it is yet another reason she may not want to walk into a women’s health center. 

The main barrier that these special groups of women are facing that results in them not seeking appropriate reproductive health care is language.  It is extremely difficult for a non-English speaking patient to explain to a health care provider why she needs to be seen.  It takes time for both parties to communicate with one another when trying to figure out the problem.  This can be not only time consuming, but also, a bit frustrating for everyone.  The reprocautions of a patient not knowing the language can lead to:

1)     Lack of proper treatment

2)     Possibility of being over charged due to wrong treatment

3)     Lack of proper administrative help

4)     Possibility of being under served if no one can understand the patient

5)     Being shunned away from ever knowing the real problem, due to humility

 

Though there many reasons the public health community should pay more attention to the barriers that women face when it comes to their reproductive health, there are also many possible solutions to help the female patient feel more comfortable.  Women should not have to feel ashamed or guilty for caring for themselves.  Women’s health centers’ workers should have more patience.  Their training should allow room for them to learn that tolerance and being open-minded is a priority if different cultures are involved.  Health care providers, busy with their tight schedules and ringing phones, are sometimes forgetful when it comes to taking time out for the patient.  Spending a little more time per patient can go a long way.  Sometimes, it just takes another 2 minutes to answer a question, one that may truly have caused a serious problem, if not answered at all. 

It is understandable that the schedule at the health center is full, and therefore, there is no time for walk-in patients, let alone walk-in patients with little English skills.  Remaining calm and collective and not giving off negative vibes to the confused patient is what the main goal should be.  The ideas of ignorance, intolerance, and stereotyping should not be part of this high stress situation, yet, everyday, women’s ego and efficacy are hurt when a potential health care provider has fallen ill to one of these negative ideas.

Health care providers should try to remember that the population they are serving might not know the English language very well.  It is a large barrier to over come.  This is why, finally, there are some efforts being made to assist the non-English speaking communities.  There are ‘Spanish-Only Days’ at Health Centers, which leads to the fact that it is very important to speak more than English if applying for a job at these centers.  The difficult thing to accept is that not every health center can speak every language that the near by community may require.  This does not mean that efforts should halt, but it does mean that more programs need to be funded to support centers with certain communities, cultures, and languages.

Also, advertising the idea that there are health centers willing to help these ethnically diverse groups may be necessary.  The idea alone of wanting to help will not be enough.  It must be communicated that the patients will feel comfortable, safe and be reassured that there are no hidden agendas on behalf of the health center.  For example, this health center should not attempt to try to convert these patients to a different religion or have these patients practice something that their culture is not accepting of. 

Marketing techniques will need to be used to gain the attention of these groups.  The health center should learn when the major holidays occur for these different cultures.  This way, the female patients may feel more comfortable in the environment.  Flyers in different languages should be distributed in neighborhoods.  The key here is to pass out flyers and to advertise with women already respected in this particular community.  This will produce the issue of trust and reduce the language barrier.

In some cultures, it is the male counterpart that knows more English and has the single income in the family.  Though this may be taken in many ways, good and bad, it may be a good way to bring in the male partner. Involve him in not only the learning of reproductive health, but also in dissolving the barriers mentioned, perhaps more can be accomplished.  This method can encourage communication between couples, families can be shown the main issues concerning health, and more females may feel comfortable if their male partners are with them during this process.  It is understood that some females will feel anything but comfortable with their partners involved.  This proves another point; certain methods and schemes are only productive in certain cultures.  Much more research will need to be started in the near future and more organizations will need to be present in this public health issue.

References

  1. www.iwhc.org
  2. Davis, Cortney.  I Knew A Woman, New York City, New York. August 2001.
  3. Betancourt JR, Jacobs EA.  Language Barriers to Informed Consent and Confidentiality: The Impact on Women’s Health, Medical College of Cornell University, New York City, USA.
  4. Gerrish K.  The Nature and Effect of Communication Difficulties Arising From Interactions Between District Nurses and South Asian Patients and Their Careers, University of Sheffield, Sheffield, UK.
  5. Jackson S., Camacho D., Freund KM., Walcott-McQuigg J., Hughes E., Nunez A., Dillard w., Weiner C., Weitz T., Zerr A.  Women’s Health Centers and Minority Women: Addressing Barriers to Care.  The National Centers of Excellence in Women’s Health, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA.
  6. Naish J., Brown J., Denton B.  Intercultural Consultations: Investigation of Factors That Deter Non-English Speaking Women From Attending Their General Practitioners For Cervical Screening, Medical College of St. Bartholomew’s, London, UK.
  7. Kreps GL.  Communicating to Promote Justice in the Modern Health Care System, University of Nevada, Las Vegas, Nevada, USA.
  8. Stokes T., Mears J.  Sexual Health And the Practice Nurse: A Survey of Reported Practices and Attitudes, University of Leicester, Leicester General Hospital, UK.
  9. Killien M., Bigby JA., Champion V., Fernandez-Repollet E., Jackson RD., Kagawa-Singer M., Kidd K., Naughton MJ., Prout M.  Involving Minority and Underrepresented Women in Clinical Trials: The National Canters of Excellence in Woman’s Health, University of Washington, Seattle, Washington, USA.