US Women Face Worst Health Access, Outcomes Among High-Income Nations

Women's health outcomes and access to care in the US continue to reveal concerning disparities, including high rates of avoidable deaths and limited access to preventive and primary care services.

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When compared with women in other high-income countries, American women have historically faced greater challenges in accessing the health care they need.¹ Although the US spends more on health care than other nations, surveys consistently show that Americans are more likely to avoid seeking care due to costs, even as the nation continues to lead in the prevalence of chronic diseases.

"Research shows that investing in women’s health results in a healthier overall population, healthier future generations, and greater social and economic benefits," the authors of The Commonwealth Fund report wrote. "While there is much variation across states on access to care, quality of care, and health outcomes, the United States remains the only wealthy country without universal health care."

Limited access to primary care and insufficient coordination of health services likely contribute to the nation's poor performance in preventing, diagnosing, and managing diseases.

The most recent federal data revealed that the US has the highest rate of maternal deaths among high-income nations, despite the decline seen following the onset of the COVID-19 pandemic, simply piling on to the exorbitant amount of evidence that's been demonstrating this trend in recent years. Racial disparities persist in another statistic that solidifies the disproportionate risk of Black women, who are nearly 3 times more likely to die from pregnancy-related complications than White women.

Unfortunately, poor outcomes and racial disparities have only been exacerbated in states with extensive abortion care restrictions.² A recent state-by-state Commonwealth Fund report showcased significant disparities in health system performance for women's care. Aside from Nevada, the lowest-ranked states in the country have complete bans on abortion access: Mississippi, Texas, Oklahoma, and Arkansas. Also, states with abortion restrictions often have fewer maternity care providers; for instance, Arkansas, Oklahoma, Alabama, and Idaho have the fewest, ranging from 52 to 56 providers per 100,000 women of reproductive age.

While these figures might not be new, the nation's maternal deaths and complications may reflect broader failures in the nation's approach to women's health and health care, according to findings from a Commonwealth Fund report published today.¹

The issue brief compares selected measures of health care access and outcomes for women in high-income countries, drawing upon data from multiple sources, including The Commonwealth Fund's International Health Policy Survey, the CDC's National Vital Statistics System, the Organization for Economic Co-operation and Development (OECD), and the Institute for Health Metrics and Evaluation Global Burden of Disease.

Notable Findings in Women's Health:

Mortality: As of 2022, women in the US had the lowest life expectancy of 80 years compared with women in other high-income countries, with the highest rate of avoidable deaths (270 per 100,000) as of 2021.

Health status: The use of multiple regular prescription medications is much more likely among American women. These women also face the highest rates of mental health and social needs compared with women in other countries.

Access to care: The US is the only nation observed in the analysis that yielded a significant percentage of women who are uninsured. These women have among the lowest rates of access to a regular doctor or place of care and among the highest rates of unnecessary emergency department visits.

Affordability of care: Additionally, women in the US are within the highest rates, and in some cases the highest rate, of skipping or delaying needed care because of the cost of care and having issues with medical bills.

In terms of health outcomes, high life expectancy can be attributed to various factors, including high living standards, a healthy lifestyle, quality education, access to comprehensive health services, and superior health outcomes. Life expectancy at birth in the US was 80 years in 2022, demonstrating a reduction of at least 2 years compared with all the other countries examined.

American Indian, Alaska Native, and Black women have lower life expectancy compared with White, Asian, and Hispanic women. The US has the highest rate of avoidable deaths among women, with 270 of every 100,000 deaths being preventable or treatable if the right care were provided at the right time, while women in Japan and Korea are the least likely to die from such causes.

Cardiovascular disease is the leading cause of death for women in the US, with women in the country more likely to die from heart disease than women in other high-income countries. More research on gender differences in risk factors, expanded insurance coverage, and access to preventive screening are necessary to improve diagnosis and treatment.

Breast cancer deaths in the US have been declining, mainly due to advancements in early detection and treatment, although the mortality rate still exceeds rates in some peer nations. The rate of cervical cancer deaths has also decreased by more than half over the past few decades, largely due to increased screening and vaccination efforts.

Health outcomes and access to care for American women continually present concerning disparities, with high rates of avoidable deaths and limited access to preventive and primary care services just breaching the surface of the country's pervasive issues. These findings underscore the need for targeted interventions and policy reforms to address the systemic challenges faced by women, particularly those from marginalized communities. Efforts to improve health outcomes for women in the US should focus on addressing disparities in access to care, promoting preventive health measures, and ensuring equitable treatment across racial and socioeconomic groups, the report stated.

Additionally, expanding insurance and Affordable Care Act coverage (ACA), enhancing coordination of health services, and increasing public health initiatives can contribute to reducing avoidable deaths and improving overall health outcomes for women in the US.

"US policymakers could expand on the ACA’s reforms to allow all women to get comprehensive and affordable health care," the report stated. "For example, by enhancing marketplace plan subsidies and covering those low-income individuals who fall into Medicaid’s coverage gap, they could allow all women to receive primary care services without cost barriers."

Raising awareness about these disparities and advocating for comprehensive reforms in the health care system are essential steps toward achieving better health equity and outcomes for all women, regardless of race or socioeconomic status. The challenges outlined in this analysis provide valuable insights for policymakers, health care professionals, and advocates working to advance women's health in the US. By addressing these disparities, the US can move closer to achieving a health care system that is truly inclusive and responsive to the diverse needs of women across the nation.

"The US health care system too often fails women. American women face increasing threats to reproductive health care access, including abortion services, that could have a lifelong impact on physical and mental health," the authors concluded. "While the nation awaits the outcomes of legal challenges to state restrictions on these services, US policymakers have a number of options to improve health and health care for women."

References

1. Gunja MZ, Masitha R, Zephyrin LC. Health care for women: how the U.S. compares internationally. The Commonwealth Fund. August 15, 2024. Accessed August 15, 2024. https://www.commonwealthfund.org/publications/issue-briefs/2024/aug/health-care-women-how-us-compares-internationally

2. Grossi G. New report shows worsening health outcomes for women in states with abortion bans. AJMC. July 18, 2024. Accessed August 14, 2024. https://www.ajmc.com/view/new-report-shows-worsening-health-outcomes-for-women-in-states-with-abortion-bans