For several decades women have battled and continue to battle for equality — not just educational, societal, and occupational opportunities but for improved and increased access to quality healthcare. Over the past century, the battle to bring women’s healthcare to the forefront of the health industry has resulted in groundbreaking advances. Although, without a doubt there’s more work to be done, exploring how women’s healthcare has evolved over the past 100 years can help us understand just how far we’ve come and how far we still need to go.
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History of women’s healthcare in the 20th century (1901 – 2000)
So how has healthcare changed in the past 100 years? Starting with the 20th century, from the invention of mammograms to pap smears, this period was an innovative era for women’s healthcare in America. Here are some of the key milestones that marked the century.
- In 1916, Margaret Sanger, America’s most famous advocate for birth control opened the first birth control clinic in Brooklyn, New York. She also founded the American Birth Control League which has evolved into what we know today as the ‘Planned Parenthood Federation of America’.
- The pap smear, a test used to detect uterine and cervical cancer was invented by George Papanicolaou in 1923. However, it wasn’t until 1943, that his findings became recognized as a medical breakthrough. According to the Centers for Disease Control and Prevention, as a result of the test, mortality rates due to cervical cancer in the U.S decreased by 81.6% between 1950 and 2003.
- Hormone replacement therapy (HRT) first became available in 1942, with the drug Premarin. This was used in replacing lost estrogen, or both estrogen and progesterone, in order to bring relief from menopause symptoms such as hot flashes.
- The period between 1953 and 1956 saw one of the steepest declines in maternal mortality rates, going from 582 to 40 deaths in every 100,000 pregnancies. This decline is largely attributed to the legalization of induced abortion as well as certain other factors such as the use of aseptic techniques during childbirth, the introduction of antibiotics, and improvements in access to healthcare for women.
- In 1960, the Federal Drug Association (FDA) approved the safety of birth control pills. Birth control became legal for married couples to purchase in 1965 but remained illegal for unmarried couples until 1972.
- In 1966, the first mammogram machine was used by doctors for early breast cancer detection. Prior to that, doctors had been making use of x-ray machines which had been regarded as potentially harmful due to the high doses of radiation.
- In 1973, the groundbreaking decision in the case of Roe v. Wade finally gave women the right to get abortions in the first trimester of their pregnancies.
- Cryopreservation, a process in which cells, tissues, and organs are stored at very low temperatures, was first used in assisted reproductive technology in 1953 with the cryopreservation of sperm. In 1983, cryopreservation was used to freeze women’s embryos.
- Government sponsored programmes, such as Medicaid, were expanded to improve access to healthcare for women in the 1980s. Medicaid, in particular, was expanded to include pregnancy and has since broadened to include screening and treatment for breast and cervical cancer.
- Despite the fact that women make up 51% of the U.S. population, they were largely excluded from being subjects in medical research. Data was not analyzed for sex and gender differences until 1993, when the National Institute of Health Revitalization Act was passed. The federal law made it mandatory for women to be included in clinical research for new drugs, and the results had to be sorted out by sex. Further, in 1998, the FDA ruled that information from drug makers on the safety and effectiveness of new drugs had to specifically look at gender.
Where are we now?
Despite the giant strides made to advance women’s healthcare in the 20th century, a lot was left to be desired crossing over to the 21st century. However, the century is not without its milestones. In 2010, the Affordable Care Act was passed, and many might refer to as the most important advance for women’s healthcare since the 20th century. First, let’s take a look at some of the other milestones in women’s healthcare that have marked this century.
- The progestin-releasing intrauterine device (IUD) first became available in the United States in 2001, followed by approval of the single-rod progestin-releasing implant in 2006. These safe, convenient, reversible, and highly effective contraceptives allow women to plan with high confidence when and when not to get pregnant.
- 2006 marked another leap in women’s sexual health. Over the counter sales of oral contraceptives became legal to women 18 and older. And in 2009 the age requirement was lowered to 17.
- In 2014, doctors began using a DNA tests to screen for HPV (human papilloma virus), either alone or in combination with a pap test, to detect early signs of cervical cancer. An HPV DNA test for primary cervical cancer screening alone without the pap was approved for primary screening of women aged 25 and older.
The Affordable Care Act and Women’s Health
The Affordable Care Act was enacted and passed into law by President Obama on the 23rd of March 2010. The passing of the Affordable Care Act (ACA) marked the beginning of a whole new era for women’s healthcare. Here’s a quick list to highlight these advancements.
- Beginning on the 1st of August 2012, preventive services such as well-woman visits, screenings for gestational diabetes, domestic violence screenings, breastfeeding supplies, contraceptive counseling, and HIV screening were guaranteed without copays under the ACA. The ACA enjoins insurance companies to provide preventive health services without deductibles or cost-sharing. The ACA also established the Prevention and Public Health Fund which allocated $18.75 billion for prevention services in communities and states including immunizations, heart health screenings, pandemic preparedness initiatives and other interventions.
- Through the ACA, access to birth control and other family planning and maternity services has become more available. All Food and Drug Administration-approved contraceptive methods, sterilization procedures, education, counseling, and management services about contraceptive methods are covered under the ACA.
- Although eligibility for Medicaid was expanded in the 1980s to focus more on women’s healthcare, only low-income women who were pregnant, mothers of children younger than 18 years, or disabled typically qualified for Medicaid. The ACA has, however, extended coverage to all individuals below 138% of the federal poverty level.
- In 2014, insurance companies were prohibited by the ACA from charging patients more based on their health status or gender. Before then, 33 out of the 56 states in the USA charged women more than men for the same services.
- Before the passing of the ACA, women were disproportionately affected by preexisting eligibility clauses to health insurance. While there was variation among states, some individual health insurance carriers even considered pregnancy to be a pre-existing condition for which insurance didn’t cover. Starting in 2014, insurers were stopped from refusing to cover women who have had breast cancer, cesarean deliveries, or any pre-existing condition.
- One of the key provisions included in the ACA, which is of immense benefit to women’s healthcare, is the “Patient’s Bill of Rights’ which eliminates gender rating of premiums. The provision prohibits insurance companies from charging women higher rates than men for similar coverage.
The most important thing about the Affordable Care Act for women is that it makes affordable, quality health insurance available to millions of uninsured and underinsured women. Since its implementation in 2012, the ACA has reduced the number of uninsured women by 9.5 million in the United States.
So what’s next?
Although great headway has been made over the past hundred years in improving healthcare for women, especially with the inception of the Affordable Care Act, a lot of work still needs to be done. Key components of women’s healthcare such as their access to contraceptives as well as abortion services, both central components of reproductive healthcare, continue to be protested, legislated, and restricted to this day. From increased research into conditions which peculiarly affect women to the enactment of more legislation like the ACA which give women access to better healthcare, we hope the next couple of decades brings on greater breakthroughs for women’s healthcare.