When it comes to women's health care in America, contradictory indicators and continuing controversy frame public debate. While recent years have seen millions of American women obtain health insurance coverage, many remain unable to afford copays associated with common procedures. And though rates of chronic illness have fallen among female adults over the last decade, U.S. women are far more likely to fall ill than their counterparts in other wealthy nations around the world. Simultaneously, a wide body of research suggests that women struggle to be heard by their doctors, finding their concerns dismissed unjustifiably by biased health care providers.
We set out to explore the state of women's health care across the country, emphasizing issues of access that affect women of all ages. To do so, we scrutinized the latest data from the Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), a large-scale annual study of common medical concerns and health care access. Our findings reveal stunning discrepancies in care and significant areas of potential improvement. To learn what we uncovered, keep reading.
Women and men reported being in solid overall health at roughly equal rates: About 81% of women claimed to feel generally healthy, while over 82% of men said the same. This result is somewhat surprising, as men are more likely to experience many forms of chronic illness (and have shorter average life spans as a result). Perhaps this finding suggests differences in perception, with male respondents tending to take a more positive view of their well-being.
Turning to mental health, however, women were far more likely than men to report challenges. Among male adults, 69% said they'd had no poor mental health days in the last month. Just 59% of women made the same claim. Mental health difficulties were most common among women aged 18 to 24: Just 38% said they'd had no poor mental health days in the last month, and almost 23% said they'd had 14 or more difficult days during that period. This statistic could reflect earlier differences as well: Teenage girls are especially likely to struggle with mental health issues compared to their male peers.
This gender disparity is not an exclusively American phenomenon: Around the world, women are more likely to be diagnosed with common mental health disorders, such as depression and anxiety. According to experts, these trends stem predominantly from the stressors to which women are exposed, rather than any genetic vulnerability. Globally, women are more likely than men to experience sexual and domestic violence, discrimination, and financial insecurity.
Mapping Mental Health Challenges
In certain regions of the country, women seemed especially likely to experience mental health struggles. In West Virginia, for example, nearly 22% of women reported 14 or more poor mental health days in the last month.
This result could relate to the state's recent exposure to the opioid epidemic, with the nation's highest rate of drug overdose deaths in 2017. But it might also stem from the state's limited resources: West Virginia has long suffered from a shortage of qualified mental health professionals that might help women in need. This theme was evident in other states with high rates: Alabama, for instance, has alarmingly few mental health practitioners.
In other states, however, women were strikingly likely to experience mental health issues when compared to men. In Idaho, for example, female residents reported 14 or more poor mental health days in the last month at roughly twice the rate that male residents did. This disparity might reflect the obstacles that women in Idaho encounter. The state has an unfortunate reputation for gender discrimination and employment inequality, factors that could precipitate or exacerbate mental health issues in women who are affected.
Detection and Prevention
Screening tests represent another crucial dimension of women's health care: Many illnesses that primarily affect women can be identified and addressed early with the aid of simple procedures. Accordingly, medical organizations recommend that women begin regularly undergoing a few key tests once they reach certain ages.
Among female BRFSS respondents, about two-thirds had a mammogram to detect early signs of breast cancer. And because physicians typically recommend mammograms to women aged 45 and older, rates were far higher among older women (although women with a family history of breast cancer may wish to start regular screenings sooner). Still, our findings indicate that getting into the habit can be difficult: Just 84% of 45-year-old women had gotten a mammogram before.
Similarly, whereas doctors recommend Pap tests beginning at age 21 to screen for cervical cancer, the majority of 21-year-old women surveyed hadn't yet gotten one. For HPV tests, which are recommended at age 30, a quarter of 30-year-old women hadn't received one.
However, it's likely that even more women would forego these tests if not for the Affordable Care Act. The law demands that most health insurance plans cover women's health screening services at little or no cost, and research suggests this benefit has encouraged women to seek testing.
Screening Rates by State: Mammograms
Our findings suggest that women aged 55 and older are particularly likely to get mammograms every year. This is despite the relaxed recommendations at this age: In recent years, major organizations have advised women aged 55 and older to get a mammogram every other year, instead of annually.
In specific states, however, women of all age groups were particularly likely to meet screening guidelines. In Hawaii, which is universally admired for its positive health statistics, roughly 7 in 10 women received mammograms as often as suggested. In South Dakota, which has launched an aggressive "All Women Count!" campaign to help residents access screening services, rates were nearly as high.
Unfortunately, many other states had alarmingly low rates instead. These included rural places such as Idaho and Wyoming, where less than half of women received mammograms as frequently as experts recommend. Because some women are deterred by the prospect of traveling long distances to get screened, these states must rely on innovative measures. One Idaho hospital, for example, has operated a mobile mammogram program since 1994, screening over 100,000 women on renovated buses.
Screening Rates by State: Pap and HPV Tests
Pap tests are necessary less often than mammograms, and the recommended frequency declines as women age. In fact, women aged 65 and older aren't typically advised to get Pap smears at all, and women between the ages of 30 and 65 need just one every five years.
Yet, in many states, a surprisingly low percentage of women met Pap test recommendations. Once again, rural states such as Idaho lagged behind more populous areas, with fewer than three-quarters of women getting tested as often as suggested. HPV testing rates presented a similar pattern: Idaho and North Dakota had the lowest percentage of female residents meeting recommendations. For women who live in these rural places, novel technologies may offer a more convenient route to consistent testing. At-home HPV tests are now available to the public, eliminating the need to travel long distances to a medical professional.
At the other end of the spectrum, New York led all states in the percentage of women keeping up with Pap testing guidelines, with nearly 9 in 10 women meeting recommendations for their respective age groups. Similarly, the Empire State had the highest percentage of women meeting guidelines for HPV testing. This figure reflects well on the state's Cancer Services Program, which makes Pap and HPV tests available to low-income residents at no cost. Hawaii, where over 88% of women met Pap test recommendations, operates a similar program.
Expanding Access, Exploring Options
In interpreting the results of this project, we urge you to find a reason for optimism in the data we've presented. Certainly, our findings show that a substantial portion of American women are skipping or delaying essential medical tests – and thus missing key opportunities for early detection. Moreover, health care access seems especially limited in particular corners of the country, where seeing a qualified provider is unduly challenging. Yet, there is a precedent for rapid improvement and much room for hope as a result.
In recent decades, the rates of breast cancer screening have grown at an astounding pace. Likewise, new policies and medical technologies have expanded women's options for mental health care. With increased awareness and ongoing innovation, real progress is possible.
At Health Testing Centers, we're proud to play a role in that process. Our convenient and affordable medical tests empower women and men to make informed decisions about their care without confronting prohibitive costs. If you need a medical test, STD testing or an at-home HPV test, learn how we make it easier to access vital information about your own body.
Methodology and Limitations
For this project, we evaluated 2018 data from the Behavioral Risk Factor Surveillance System (BRFSS). It is published annually by the CDC and presents data about the health and health care habits of the American population. We focused on questions about women's health status and habits. The BRFSS data use an internal weight, which we applied to the data shown in this project.
BRFSS data include data for all U.S. states. We excluded U.S. territories from our analysis. No statistical testing was performed.
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