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Racial Disparities in Gynecology and Reproductive Health

Racial

Recently, a spotlight has been cast on racial disparity and inequality in aspects of medicine and healthcare. Its effect is far-reaching and challenges the perceived integrity of our current healthcare system. The field of Gynecology has not been spared, as there are several factors that contribute to inequalities in Gynecology and Women’s Health. This includes incidences of sexually transmitted infections, knowledge and correct use of contraception, access to HPV vaccinations, use of preexposure prophylaxis (PrEP), and management of chronic conditions, such as uterine fibroids.  A systematic review published in June 2022 proposed “Healthcare systems must assign greater value to patient experiences and patient empowerment with particular attention to feedback from minorities. Opportunities must be created for providers to reflect upon, explore and overcome their own race-based and class-based assumptions.”

The emphasis on a complete shift of provider-patient relationships is critical in the effort to mitigate healthcare disparities.  Limited access to accurate, evidence-based information plays a role in patients’ inability to advocate for themselves and their health. Medical professionals function as a resource for patients, responsible for providing sufficient education to patients on disease processes, potential complications, and disease prevention and treatment. However, provider assumptions about a patient’s level of education and socioeconomic status can significantly impair the medical professional’s ability to provide unbiased information.  For simplicity, this discussion will emphasize the importance of combatting disparities by improving patient education. By establishing standards for patient education, providers can discuss comparable information with patients on an equalized platform. 

Discussing prevention, progression, and potential sequelae of sexually transmitted infections are important factors for patients to make informed decisions about safe sexual practices.  Providing patient education also encourages better treatment compliance. Standard of care should include discussing the implications of sexual health on fertility and overall well-being.  Prevention of communicable diseases should be encouraged including HPV vaccinations, PrEP for HIV, proper disposing of contaminated needles, condom use, and best prevention methods for other serious sexually transmitted infections.  Counseling on contraceptive options and resources should be offered to all patients of childbearing age so that they can make informed, educated personal choices.   

Regarding Women’s Health, the following examples exemplify racial disparities in healthcare that disproportionately affect traditionally underserved or rural communities.  The current data reveals several inequities worth noting in Gynecology.  Rates of HPV-related cervical cancer and HIV are statistically higher in Black and Hispanic populations compared to White counterparts.  Asian Americans and Pacific Islanders are less likely to get pap smears and have a higher incidence of breast cancer. Native Americans embody the youngest population with less than 6% of individuals over 65 years old.  This population is the poorest and least educated and is at high risk for young pregnancies, poor birth outcomes, sexually transmitted infections, and other significant health concerns.  Hispanic populations have the lowest rate of steady health insurance.  Additionally, many of these underserved communities have higher rates of smoking and alcohol intake which can affect risks of maternal-fetal complications, sexually transmitted infections, overall gynecologic health, and cancer risks.  Infrequent medical visits, language barriers, lack of health insurance, and socioeconomic differences negatively influence patient care and patients’ ability to make informed decisions.  

Black women are three times more likely to have symptomatic uterine fibroids than White women.  Although the incidence of uterine fibroids is higher in Black populations, this community is more likely to receive delayed care for their symptoms. This may be due to numerous factors, but medical mistrust is one factor that exists in minority communities. Medical providers can play a role in changing the narrative and building more trusting relationships with their patients in these populations.  Analyzing the reasons for this breakdown, respecting cultural and ethnic differences, and patient education are a few factors that can promote positive outcomes.

These are only a few examples of how ethnic disparities and socioeconomic status can influence the medical perspective.  Each encounter is an opportunity for improvement in health for minority or underserved populations. Providers can play a central role in initiating a shift towards better patient outcomes. Transparency between the patient and provider, building mutual trust, communication, and education will be at the foundation of dissolving racial inequalities in healthcare currently burdening our minority communities. 

When considering best practices, it is important to incorporate cultural differences, ethnic disparities, and socioeconomic status among minority communities.  

 

References

1. Beroukhim G, Mahabamunuge J, Pal L. Racial disparities in access to reproductive health and fertility care in the United States. Current Opinion in Obstetrics & Gynecology. 2022;34(3):138-146. doi:10.1097/gco.0000000000000780

Author
Leighton Mendez, PA-C and Rachel Spieldoch, MD

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