By Dr. Doug Laube

Ten years ago, the Centers for Disease Control listed the top 10 achievements of public health in the 20th century -- among them, family planning, control of infectious disease, and vaccinations. These achievements vastly improved our quality of life, resulting in an increase in life expectancy, worldwide reduction in infant and child mortality, and the elimination or reduction of many communicable diseases.

Following President Obama’s historic address to the nation, America is poised for the first dramatic public health achievement of the 21st century.

What makes this moment truly life-changing in every sense of the word is that, for the first time, more women and their families will have coverage than ever before in our nation’s history.

However, if a new national health plan is to fulfill the goal of correcting our fragmented health system and improving America’s health, then it must address the specific health needs of women. That’s why earlier this year, I and a group of medical and public health colleagues contributed to a scientific, data-driven report stating that reproductive health should be an essential part of any national health plan. Our statement was endorsed by 39 deans of schools of public health.

According to the report, issued under the aegis of Columbia University’s Mailman School of Public Health, “a well-woman standard of care -- one that includes access to comprehensive care and services essential to reproductive health -- will ensure that women can attain good health, maintain it through their reproductive years and age well.”

Put simply: without making women’s reproductive health a central component of health care reform, we will not have real reform in the 21st century.

The scientific data point to the compelling need to improve the reproductive health of all Americans. Rates of maternal and infant mortality, low birth weight, unintended pregnancy and sexually transmitted infections are much too high for a nation that is rich in resources and technical competence. Moreover, health problems are concentrated among disadvantaged groups, and these disparate rates have stagnated or worsened over the past three decades.

The good news is that the proposals currently being considered in the House and Senate contain many of the critical elements that will help us address these problems. For the first time, women will be able to participate in a health care system in which:
  • Maternity and reproductive health will be part of a basic care package.
  • Women won’t be charged more because of their gender.
  • An affordability provision will subsidize those who can’t afford insurance.
  • Out-of-pocket costs will be capped so that families don’t go bankrupt.
  • No American can be denied health coverage because of a pre-existing medical condition, including breast cancer, pregnancy or evidence of “uninsurability” such as being a victim of domestic violence.
  • Key preventative tests, like mammograms and pap smears, will be included in basic care.
The reforms currently on the horizon are significant not just for women but also for their families, because women act as gatekeepers for the health care that their children, spouses or parents receive. According to the Department of Labor, women make approximately 80 percent of all family health care decisions. But until now, these gatekeepers have all too often been denied the keys to the health care kingdom.

Nearly one-quarter of all women depend on coverage through their husbands’ employment, leaving them vulnerable to the loss of coverage if divorced or widowed, or if their husbands lose their jobs. Recent years have seen an overall decline in health insurance coverage for women. In 2006, 10 percent of American women received coverage through Medicaid, while 18 percent of women were completely uninsured.

For all of these women, including the 21 million American women and girls currently without health insurance, change cannot come soon enough.

As the president said in his speech, health care reform is not about politics -- it is about shaping the future. But in order to bring about that future, we must show what is at stake and why it is in everyone’s interest to demand coverage that recognizes women’s basic needs and is truly health care, not just sick care.

Without these critical changes, our current system may well top the list of the biggest health care disasters of the 21st century.
Dr. Laube is Professor of Obstetrics and Gynecology at the University of Wisconsin and Past President of the American College of Obstetricians and Gynecologists.
Copyright (C) 2009 by the Wisconsin Forum. 10/09