Willa Johnson tells her story about being an educated young woman, but still not having the information, encouragement, and support to take charge of her reproductive healthcare. The matter of knowing when to get a check-up is not often on our day to day radar. How can we better support people in learning about the functions of their reproductive systems, and how to take good care of the overall reproductive health before there is illness or unintended consequences?
Access to health can mean lots of different to things to different people. In general, it refers to the ability of a person or community to receive necessary health services and information in a timely and culturally appropriate manner.
Access differs by gender, race and ethnicity, income level, as well as rural versus urban location, among others. Although both men and women face access problems, women’s access to health care differs from men’s access in a variety of ways. Women’s health needs also change through their lifetime. Women are more likely to have a chronic health condition and to rely on prescription drugs[i]. In general, women have greater health needs and report greater barriers to accessing health care than men.[ii] Men, however, are more likely to be uninsured and have a shorter life expectancy.
Often times, people talk about health insurance—both private insurance and public insurance such as Medicaid—when they are talking about access to health. Although having insurance does not guarantee health access, people with health insurance tend to face delays in care and other access barriers less frequently.
Women living in poverty, who are low-income, single mothers, have low education levels, and Latina women are more likely to be uninsured[iii]. According to a study on rural women’s economic and health status, rural women in Kentucky lacked health insurance at a significantly higher rate than state levels[iv].
In addition to lack of insurance, women face many other barriers to access to care. For example, transportation, child care, ability to take time off work, proximity of health care provider, poverty, and being in an abusive relationship can all create barriers to access, especially for women. A study also found that the percentage of rural women in Kentucky living in poverty was also significantly higher than the state levels of poverty[v].
In rural areas, where transportation is a concern and women have fewer options of providers, women may also perceive lack of privacy when seeking care from a provider that knows them and their family.
Women also play a particularly important role in families, as they are generally the ones making health decisions for the family members and are the primary care providers for children and elderly relatives.
Policies at the federal, state, and local level affect access to care. For example, state laws lay out what services insurance companies have to cover. These laws vary from state to state, with great variation around women’s health services such as maternity care and fertility care. Policies around women’s reproductive health are also particularly politically charged, making women’s health particularly vulnerable to changing political tides. This means that women also have political and social barriers to health access.
With the recent passage of the Affordable Care Act (ACA, also known as the health reform law), women’s preventive health services will become more available to women in all states and more women will become eligible for public insurance coverage. The ACA eliminates cost-sharing for a number of preventive care services, including annual well-woman visits; screening for gestational diabetes; testing for HPV; counseling for sexually transmitted infections; counseling and screening for HIV; contraceptive methods and counseling; breastfeeding support, supplies, and counseling; screening and counseling for interpersonal and domestic violence[vi].
- 21% of Kentucky’s population 64 years of age and under is covered by Medicaid or other public insurance[vii]
- 22% of Kentucky nonelderly adults are uninsured[viii]
- In Kentucky, private insurance plans are not mandated to cover mental health services, fertility services, or maternity care [ix]
- In 2010, almost 1 in 5 people in Kentucky reported not being able to see a doctor because of cost[x]
- Have you or someone you know ever put off seeing a health provider because of cost? What about because of distance or transportation? Other reasons?
- What are some unique barriers to access faced by women in your community?
- What role do fear and stigma play in access to care in your community?
- Do you feel you have adequate access to health services and information? In relation to sexual and reproductive health?
- What can be done in your community to improve access to care?
Resources and Links:
- The Henry J. Kaiser Family Foundation, (information on access, insurance, health policy, statistics, etc.)
- Centers for Disease Control and Prevention, Social Determinants of Health
- Healthy People 2020, Access to Health Services
- Agency for Healthcare Research and Quality. National healthcare disparities report 2008 [Internet]. Washington: Agency for Healthcare Research and Quality; 2008. Chapter 3, Access to healthcare
- National Rural Health Association
- Center for Excellence in Rural Health
- AHRQ, Navigating the Health System
 HPV stands for human papillomavirus. This is a very common sexually transmitted disease that can cause cervical cancer.
 Mental health coverage applies to private and small group private insurance; maternity and fertility care apply to private insurance plans in general
[i] Kaiser Family Foundation, 2004 Kaiser Women’s Health Survey.
[ii] Kaiser Family Foundation, 2004 Kaiser Women’s Health Survey.
[iii] Kaiser Family Foundation, 2004 Kaiser Women’s Health Survey.
[iv] Simmons et al, The State of Rural Women’s Economic and Health Status: Kentucky, Maryland, and New Hampshire, Eastern Family Economics and Resource Management Association, Abstract, 2006 Conference, available online at mrupured.myweb.uga.edu/conf/6.pdf
[v] Simmons et al, The State of Rural Women’s Economic and Health Status: Kentucky, Maryland, and New Hampshire, Eastern Family Economics and Resource Management Association, Abstract, 2006 Conference, available online at mrupured.myweb.uga.edu/conf/6.pdf
[vi] U.S. Department of Health and Human Services, HRSA, Women’s Preventive Services: Required Health Plan Coverage Guidelines.
[vii] Kaiser Family Foundation, Statehealthfacts.org, Kentucky: Health Coverage and Uninsured, available at http://www.statehealthfacts.org/profileind.jsp?cat=3&rgn=19
[viii] Kaiser Family Foundation, Statehealthfacts.org, Kentucky: Health Coverage and Uninsured, available at http://www.statehealthfacts.org/profileind.jsp?cat=3&rgn=19
[ix] Kaiser Family Foundation, Statehealthfacts.org, Kentucky: Health Insurance and Managed Care, available at http://www.statehealthfacts.org/profileind.jsp?cat=7&rgn=19
[x] Kaiser Family Foundation, Statehealthfacts.org, Kentucky: Health Costs and Budget, available at http://www.statehealthfacts.org/profileind.jsp?cat=5&rgn=19