Basics

Overview

Women’s Mental Health Month and Maternal Health Month serve as poignant reminders of the multifaceted challenges shaping women’s health. Today, because of innovation, research and development, and medical breakthroughs, women have shorter diagnostic journeys and more viable treatments than ever before. Despite this progress, hurdles continue in normalizing conversation on women’s health in the workplace and achieving higher levels of health equity among minority populations. Lawmakers and experts are searching for solutions that will align incentives, enhance access, and foster an ecosystem that improves outcomes. 

This Basic provides an overview of critical domains impacting women’s well-being, including maternal health, menopause, oncology, and infertility treatments such as in vitro fertilization (IVF). Through an in-depth analysis of statistics, research methodologies, and legislative initiatives, the goal is to shed light on the complexities of women’s health and avenues for equitable access to care across diverse communities.

Maternal Health

The United States ranks as one of the most challenged industrialized countries in the world for maternal health. Despite advancements in healthcare, barriers to treatment persist, disproportionately affecting women of color, particularly in southern and rural areas. The Centers for Disease Control and Prevention (CDC) reveals a stark reality; the United States grapples with a maternal mortality rate of 32.9 deaths per 100,000 births. Of profound concern, is the finding that Black patients face a mortality rate three times higher than their white counterparts, underscoring racial inequities in this part of the healthcare system.

One of the most challenging subsets contributing to poor maternal health is postpartum depression — a condition affecting approximately 1 in 7 mothers. Defined as a health condition occurring after childbirth, postpartum depression can have enduring effects if left untreated, further exacerbating maternal health disparities. The symptoms include depression, insomnia, fatigue, anxiety, and loss of energy, among others. Risk factors for the condition include a history of depression, risky pregnancy, mother’s age, and chronic conditions. Barriers to treatment include low awareness and mental health stigmas as well as a small window of assessment, diagnosis, and treatment compared to other conditions. 

Legislation to address the maternal health crisis made its way to President Biden on April 3rd, 2024, when the President signed critical maternal health priorities into law as part of the bipartisan Consolidated Appropriations Act and Further Consolidated Appropriations Act for Fiscal Year 2024. More than $100 million in funding was secured through the Black Maternal Health Caucus’ “Momnibus” efforts. The bill includes funding for the National Institute of Health to implement maternal health initiatives, grants for minority-serving institutions to study maternal health disparities, funding for community-based organizations supporting moms in geographic areas with high rates of adverse maternal health outcomes, state grants for maternal health innovation, funding a maternal health hotline, implementation of midwife education and training, and more. 

Infertility/IVF

Infertility represents a significant health challenge affecting millions of people worldwide. Infertility is a medical condition recognized by the American Medical Association and the World Health Association. Defined as the inability to achieve a successful pregnancy based on a patient’s medical, sexual, reproductive history, age, physical findings, diagnostic testing, or any combination of those factors. According to the World Health Organization, infertility affects 1 in 6 people globally.  Assisted reproductive technologies (ART), such as in-vitro fertilization (IVF) offers hope to many, with approximately 100,000 babies born through IVF each year in the United States. IVF enables individuals who use fertility preservation services to save their eggs, sperm, or reproductive tissues to have children at a later time. However, access to infertility diagnosis and treatments, including IVF, remains limited. Only 47% of large employers offer coverage for IVF treatment.

Without preeminent federal legislation, Without federal legislation, the ability to access diagnosis and treatment is left to the states, which can vary greatly. Twenty-one states and the District of Columbia have passed fertility insurance coverage, and seventeen cover fertility preservation for iatrogenic (medically induced) infertility. Fifteen of those have included IVF coverage as well.

Oncology

Breast and cervical cancers pose formidable challenges to women’s health, with disparities in screening rates exacerbating existing obstacles. In 2024, over 310,720 women will be diagnosed with invasive breast cancer and 13,820 will be diagnosed with cervical cancer. Concerted efforts are needed to bridge the gap in awareness and access surrounding breast and cervical cancer screenings.

Lower cancer screening rates persist among uninsured and underinsured populations. To combat low levels of screening, the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was created to address these disparities by offering critical screenings, diagnostic tests, and treatment referrals to limited-income, underserved, underinsured, and uninsured communities. The program has provided more than 15 million exams to more than 6 million eligible people. To be eligible for the NBCCEDP program, patients must be at or below 250% of the federal poverty level and between the ages of 21-64 for cervical cancer screenings and 40-64 for breast cancer screenings.

Legislative efforts, such as the Screening for Communities to Receive Early and Equitable Needed Services (SCREENS) for Cancer Act, aim to bolster support for these vital programs and expand access to lifesaving care. The SCREENS Act is a bipartisan, bicameral bill led in the House of Representatives by cosponsors Rep. Joe Morelle (D-NY) and Rep. Brian Fitzpatrick (R-PA) and in the Senate by Sen. Tammy Baldwin (D-MN) and Sen. Susan Collins (R-ME). With its passage, the NBCCEDP would be reauthorized until 2028. 

Menopause

Menopause is a natural biological transition marking the cessation of menstrual cycles affecting an estimated 41.5 million women worldwide. Menopausal transition has three phases: (1) perimenopause: the time when the body experiences a natural decline in reproductive hormones resulting in the end of a woman’s menstrual cycle; (2) Menopause: the point when a woman has gone twelve months without a period. Most women experience this between 40 and 58; and (3) Postmenopause: The time of life after menopause. 

Symptoms of menopause can include but are not limited to, inconsistent menstrual cycles, hot flashes, trouble sleeping, joint pain, decreased focus, decreased mental health, and more. Some symptoms, such as hot flashes, can continue to occur for an average duration of 8.8 years. Despite its profound impact on women’s health and quality of life, societal perceptions often fail to afford menopause the same significance as pregnancy or parental leave. This oversight is reflected, in part, by the economic toll of menopause-related symptoms, with the US economy hemorrhaging an estimated $2.5 billion annually due to productivity losses and healthcare expenditures. 

Women navigating menopause encounter myriad challenges in the workplace, where support and accommodations remain inadequate. Twenty percent of the workforce are in some phase of the menopause transition, fifty percent of which have reported symptoms having a negative impact on their work life, and twenty-five percent considered not pursuing, or did not pursue, leadership positions because of symptoms. The workplace culture around discussing menopause is largely unwelcoming. 

More than half of women say they feel uncomfortable talking about menopause at work. This lack of communication is clear between employer and employee. Seventy-six percent of HR benefit managers reported talking about menopause-related issues with employees, whereas only three percent of female employees reported discussing those same topics with their HR benefit managers.

When polled, female employees feel there should be greater awareness, education, and employer benefits related to menopause. Eighty-one percent say there is a need for better education on menopause before, during, and after its onset. Another sixty percent believe menopause is generally stigmatized. Accessing menopause professionals can be challenging given the lack of provider education. The workplace benefits female employees have reported valuing are a written menopause policy, hormone replacement therapy and nonhormonal treatment options covered by health insurance, and access to menopause professionals. 

Looking Ahead

In conclusion, women’s health is shaped by an individual’s social, economic, and cultural circumstances. By acknowledging and addressing disparities, lawmakers, healthcare providers, employers, and communities can foster a future where every woman has equitable access to care and support.

Key Definitions:

• Maternal Health: Refers to the health of a woman during pregnancy, childbirth, and postnatal period. Most maternal complications and deaths are preventable.
• Menopause: A life stage, typically in a woman’s late 40s or 50s, defined once 12 months have passed after the last menstrual cycle. Medical procedures that damage or remove the ovaries can also result in the onset of menopause, regardless of age.
• Oncology: The study and treatment of tumors.
• Infertility: The inability to achieve a successful pregnancy based on a patient’s medical, sexual, reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.
• In Vitro Fertilization: A procedure in which a woman’s eggs are removed from a woman’s ovary and combined with sperm outside the body to form embryos. The embryos are grown in a laboratory for several days and then either placed in a woman’s uterus or cryopreserved (frozen) for future use.
• Barriers to Treatment: Events or characteristics of the individual or system that restrain or serve as obstacles to a person receiving healthcare. Examples can include location, language, stigma, etc.
• Postpartum Depression: A health condition occurring after childbirth, postpartum depression can have enduring effects if left untreated, further exacerbating maternal health disparities. The symptoms include depression, insomnia, fatigue, anxiety, etc. Approximately 1 in 7 mothers is affected.
• Risk Factors: A component increasing the chance of developing the disease. Some example risk factors of cancer are age, family history, smoking, infection of certain viruses/bacteria, radiation, etc.
• Perimenopause: The transitional time when the body experiences a decline in reproductive hormones, resulting in the end of a woman’s menstrual cycles.
• Hormone Therapy: A medical treatment for menopausal symptoms involving replacing hormones the body’s ovaries are no longer producing; also known as hormone replacement therapy.