I am a woman.

I am young. I am brown. I am a mother. I am rural. I am a worker. I am an immigrant. I am old. I am of the North. I am a professional. I am happy. I am poor. I have access to resources. I am disabled. I am white. I am of the South. I am urban.

I am a woman. I am an individual.

Address to the United Nations
Fourth World Conference on Women
Susan Dowse, age 24, Vancouver, Canada

I Am A Woman
Women, Poverty and Healthcare in the New Millennium

By Jenny Singer

"The Physical, Mental and Social well being of a world, a nation, a state, a community is dependant upon the physical, mental, social well being of the bearer of life -- the Woman, the Mother."

-- The Women's Health Institute

Neolithic man did not know they played a role in the act of creation. In ancient times it was women who were worshipped as the Goddess, the creator and giver of life. Women were perceived as powerful beings. Not even the greatest warrior could bleed for seven days a month and still live. Only women had the power to bring forth new life from their bodies.

As we moved from a matriarchal society towards a distinctly patriarchal one, women's power became a source of fear. Women's power became a thing to control and subjugate. The new millennium has brought new awareness but not necessarily any kind of definitive change in the statistics that reflect the socioeconomic status of women in America. According to the Bureau of Labor Statistics, impoverished working women still outnumber working men. Black women are estimated to have a poverty rate that is nearly twice that of black men and three times that of white men.

Poverty and Healthcare

Breast Cancer
There are substantial differences in breast cancer survival rates when researchers looked for an association between race, socioeconomic status and survival rates. Researchers at Harvard Medical School found that black women are often diagnosed with breast cancer at an earlier age and they were more likely to die of breast cancer than their white counterparts. The researchers concluded that the higher mortality rates had nothing to do with the genetics of black women. The findings reflect the conclusion that black women's low economic status, education, and their ability to have access to health insurance and healthcare is a stronger predictor of survival than genetics.

Women and HIV
The National Institutes of Health estimate 30 percent of the 40,000 new infections reported every year in the United States are accounted for by women. More than 75 percent of those women contracted the virus through heterosexual sex. Women are in the difficult position of potentially passing on the virus to their unborn children or through breast milk. A staggering 64 percent of those infected women are black and another 18 percent are Hispanic. Many of the women that become infected have children and families to care for meaning their treatment programs must take these factors into account. In the past there was very little participation by women in the clinical studies of new drugs. Most research studies are based on the results obtained with men. More attention needs to be placed on the biological differences between men and women. New studies are being created that take biology into account and are inclusive of women. Recent discoveries include new evidence that differences in gender affect the way HIV medications Viramune and Sustiva are metabolized in the blood. Women can be at risk for drug toxicity and additional side effects.

The American Psychological Association is awarding a grant this year in order to inspire new research into the area of developing programs that are gender, cultural and age appropriate in regards to HIV/AIDS prevention and treatment. The grants are small amounts of money but the Section on the Psychology of Black Women is making an effort to make an impact in the reduction of HIV infections among black women and teenagers. HIV PLUS Magazine reports that there is a severe shortage in general in volunteers willing to make themselves available for clinical trials. In the early days of the HIV crisis there were often long waiting lists to get on the these drug trials but the advancement of pharmaceuticals and longer survival rates has made the HIV community complacent. The lack of volunteers is a problem because programs depend on participation in order to receive funding.

Women are often at a disadvantage when dealing with the complex physical and emotional issues of HIV and AIDS because they lack insurance and access to healthcare. The most successful treatment programs have coordinated pediatric, psychological and child care.

Poverty is a pervasive issue in the treatment of HIV/AIDS. It was estimated in the year 2001 that Americans spent 1.4 trillion on healthcare. Kathy Hiers, chief executive officer of AIDS Alabama is quoted as saying, "As is the case with any health care issue, it is always the low income people who fare the worst." To make a bad situation worse, much of the grant money previously available is beginning to dry up. Some speculate that it is a result of having a Republican President in the White House. Historically it has been the Democratic Party that has generously provided resources for social programs. There have also been reports that researchers need to be more creative in their applications for grant and research money. An interesting article in American Aids Magazine describes the changes that are being made in allocating funding of grants to HIV research. According to the magazine, "Scientists who study AIDS and other sexually transmitted diseases say they have been warned by federal health officials that their research may come under scrutiny by members of Congress because the topics are controversial. Such inflammatory terms as ësex workers' and ëneedle exchange' won't be allowed and the funding of certain research projects that use them might be curtailed."

Follow the Money Trail: Women and Reproductive Health

The cost of an average hysterectomy is roughly between three to six thousand dollars. Historically this procedure has been a profitable one for doctors even in the age of managed care. Dr. Stanley West, author of The Hysterectomy Hoax says, "Hysterectomy is lucrative for the physician doing the surgery, lucrative for the pharmaceutical companies supplying hormone replacement to 600,000 lifelong customers a year." Doctors have reasoned for years that once a woman is past childbearing age the uterus becomes a useless organ and many feel that it is preferable to remove the uterus as a proactive measure in the interest of cancer and disease prevention. Some books actually list hysterectomies as an option for birth control related sterilization. A male physician typically performs hysterectomies. The average patient to undergo this radical, life changing procedure is most often an African American woman from the south who has less education than her peers.

According to the CDC there are more than 600,000 hysterectomies done on an annual basis and it is the second most commonly performed surgery on women, only slightly behind cesarean births.

The American College of Obstetricians and Gynecologists published a recent article stating that only 10 percent of the total hysterectomies done in this country are a result of uterine cancer. It is astounding that nearly 500,000 of the 600,000 hysterectomies done each year are done as elective procedures. Perimenopause, Changes In Women's Health After 35 by James E. Huston, MD and L. Darlene Lanka, MD states, "If you have small fibroids, heavy periods, menstrual cramps, sagging uterus or stress incontinence you could benefit from a vaginal hysterectomy."

Some of the lasting effects women suffer as a result of having a hysterectomy include fatigue, depression, heart palpitations, mood swings, hair loss, loss of sex drive and urinary tract infections.

There is a debate going on right now in the medical community as to whether it is a wise use of resources to screen woman who have had hysterectomies for cancer with the traditional Pap Smear. Although the Pap Smear is an effective way to screen for cancer among these patients, the American College of Obstetrics and Gynecology argue that it is not cost effective to screen women who are missing their uterus for cancer with pap smears. They are concerned with the 300 to 500 million dollars it costs the healthcare system to test women for cancer.

This is the same organization anxiously waiting for the Senate to limit liability for doctors in medical malpractice suits citing the high cost of medical insurance among the many reasons such action is necessary. Ob-gyn's are sued for malpractice an average of 2.5 times in their careers.

Clearly it is the responsibility of women everywhere to become educated about their bodies and the decisions physicians make in regards to its care. Since most of the Doctors performing this procedure are men, they will never be faced with a decision that is reported to leave women feeling as though she were castrated. We must educate the medical community about alternative approaches to all of women's health issues.

Poverty and women's health are two difficult social issues that don't appear to be easily repaired. Women are often the primary caregiver to their children and the head of single parent households. Women are primarily in charge of raising our future generation. The need for resolution is urgent on so many levels. It would appear that taking care of women would be a wise thing to do but answers are slow in coming.

Susan Dowse concluded her address to the United Nations Fourth World Conference on Women with the following words, "We have come to talk about this thing called 'women'. We have come to talk about 'her' and the issues 'she' is facing. Oh, the inequality. Oh, the oppression. Sisters of the world unite. Fight the common enemy.

But our enemies are not common. Our struggles are not equal. We do not come here as one -- the almighty female monolith. We come here as many. We come here as individual voices bound together in various coalitions by common politics, nationality, color, sexuality, age, or occupation. Our stories are not the same. Our power is not equal. We, too, withhold the capacity to oppress each other.

Let us forge ahead in this awareness of our diversity...."++


National Institute of Health

The Woman's Health Institute

United States Bureau of Labor Statistics

Harvard University, Women Studies Department

Centers for Disease Control


APA Online ñ 2003 HIV/AIDS Prevention Small Grant Application

HIV PLUS Magazine, May 2003, Volume 6, Number 3, LPI Media

HIV PLUS Magazine, July 2003, Volume 6, Number 4, LPI Media

American Aids Magazine, May 2003, Volume 12, Number 5, Art and Understanding Inc.

The Unofficial Guide to Women's Health, Carol A. Turkington with Susan J. Probst MD, IDG Books Worldwide, © 2000

Physicians Committee for Responsible Medicine

What Your Doctor May Not Tell You About Menopause
, John R. Lee MD with Virginia Hopkins, Warner Books, © 1996

Perimenopause, Changes In Women's Health After 35, James E. Houston, MD and L. Darlene Danka, MD, Second Edition, New Harbinger Publishers, © 2001

United Nations Fourth World Conference on Women

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Space graphic above from the Rosette Nebula in Hydrogen, Oxygen, and Sulfur.
Credit: T. A. Rector, B. Wolpa, M. Hanna.