Efforts Underway to Improve Access to Comprehensive Healthcare for Women

Many freestanding women’s health clinics offer prenatal care, contraception and cancer screening exams. Recent studies point to concerning trends in women’s health, including deaths from complications of pregnancy, rising sexually transmitted infection rates, trend-reversing increases in mortality from cervical cancer, and limited access to effective emergency contraceptives, which may be related — at least in part — to the clinic closures.

“As health professionals, any one of these issues should give us pause,” states Beri Ridgeway, MD, Chair of Cleveland Clinic’s Ob/Gyn & Women’s Health Institute. “Taken as a whole, however, we see reason to be concerned about the state of women’s health in the United States.”

Cervical cancer mortality rates reversing the gains made in the last several decades

A study presented at the 61st Annual Meeting of the American Society for Radiation Oncology found that states that experienced closures women’s health clinics saw a 2% decline in cervical cancer screenings compared to states without closures. According to the study, which was not published by Cleveland Clinic researchers, nearly 100 comprehensive women’s clinics closed between 2010 and 2013. The most significant screening declines were for women with no insurance, Hispanic women, women aged 21-34 years and unmarried women. Women who are socioeconomically disadvantaged or are non-Caucasian typically have the highest rates of morbidity and mortality from cervical cancer, making decreased access more concerning. This study found an increase in the risk of dying from cervical cancer among women in these communities.

“Cervical cancer is a disease of access,” according to Miriam Cremer, MD, MPH, Director of Global Health Research for Cleveland Clinic’s Ob/Gyn & Women’s Health Institute, and a member of the World Health Organization’s Expert Group on Cervical Cancer Elimination. “In the United States, we haven’t had a lot of cervical cancer because most people have access to screening and treatment. But when women don’t have easy and affordable access to care, they may present with higher grade lesions.”

“Cervical cancer is definitely preventable,” according to Dr. Cremer. “For this reason,” she states, “we should absolutely be concerned about the loss of important health services — like breast and cervical cancer screenings — for women who need them.”

According to a study published by the United Health Foundation, Ohio met only 14% of the need for publicly funded women’s health services, ranking 48 of the 51 states. “It is unacceptable that women are losing access to basic healthcare. Making sure these clinics stay open — and expand— will go a long way in keeping Ohio women healthy,” Dr. Cremer says.

Reproductive health clinics offer many important preventive services, including the detection and treatment of sexually transmitted disease, cytology screening, and HPV testing and vaccination. The clinics also provide invaluable education and effective treatment for sexually transmitted diseases, which — if untreated — can have devastating effects on the health of populations.

The political context of women’s health

Women’s clinics provide access to effective birth control methods, including emergency contraceptives. Political context also appears to play a role in access, according to a study coauthored by Pelin Batur, MD, a women’s health special specialist working in the Department of Subspecialty Women’s Health within the Ob/Gyn & Women’s Health Institute, and a member of multiple national committees involved in writing U.S. guideline recommendations for contraceptive access and follow-up on abnormal cervical cancer screening testing.

Dr. Batur was part of a multi-institutional study of providers’ knowledge of and attitudes toward emergency contraception. The group found that women in conservative-leaning counties may face difficulties obtaining emergency contraception from healthcare providers.

“Women in more politically conservative areas were much less likely to get emergency contraception services, which are part of the full spectrum of contraceptive services and can actually be the last chance to prevent pregnancy in a woman who is at high risk for complications, or who may be taking medications that can harm the fetus,” Dr. Batur explains.

Ob/Gyns as educators and advocates

As evidenced by the advocacy work of Drs. Batur and Cremer, Cleveland Clinic’s Ob/Gyn & Women’s Health Institute is committed to moving the needle on preventable mortality among women and children. Within our own institution, Ob/Gyns play important roles, encouraging preventive services and adapting our practice to current public health trends.

“For example,” states Oluwatosin Goje, MD, an Ob/Gyn and a fellowship-trained Reproductive Infectious Diseases Specialist, “we are expanding our prenatal STI screenings, and hope to provide education and guidance on how to treat STIs and prevent re-infection with expedited partner therapy.”

In addition, Cleveland Clinic has several efforts underway to decrease preventable maternal morbidity and mortality, including developing and implementing protocols to optimize care in obstetric emergencies, encouraging participation in CenteringPregnancy® groups, and working with community organizations like First Year Cleveland to address structural racism.