The Cost of Being a Woman

It’s not just about Roe, American healthcare is pricing women out of existence

This is the mid-week version of Men Yell At Me. A newsletter about the intersection of patriarchy and politics in America. You can read more about me here. If you like it and you want more, well, there is more where it came from. And you should subscribe.

---

Dr. Kaaren Olesen is angry when she talks about it. A bottle of Addyi, the female Viagra, costs around $200 and is not covered by health insurance. Actual Viagra? That is covered.

“Women also have to sign a contract stating they won’t drink while using Addyi,” Olesen explains. “Despite the fact that Viagra has similar complications when used with alcohol, the FDA does not require men to sign a pledge that they won’t drink either.”

As the Supreme Court weighs challenges against Roe v. Wade, abortion has become, again, the focus of discussion around women’s healthcare. And undermining Roe, undermines the health and well-being of all women. But to merely focus on Roe overlooks some of the stunning discrimination against women that is currently allowed by the law.

The Addyi example is just one of the many ways it costs too much to be a woman in America.

Dr. Olesen points out that Medicare and Medicaid also have poor coverage for drugs commonly used for menopausal women that help with vaginitis, endometriosis, and fibroids. 

Currently, in America, hospitals are closing maternity wards, noting that it costs too much to operate them. There is no official count of how many maternity wards are closing in America. In rural America, the number was up before the pandemic. A news search reveals many more have happened as a result of the pandemic. 

What this means is that many women have to travel long distances for prenatal appointments and post-birth checkups. In 2019, MPR’s Catharine Richart wrote a comprehensive look at the cost and struggle of accessing qualified birthing care for a family in rural Minnesota.

But it’s not just women who live in rural states. In 2020, the Center for Health Journalism highlighted the closure of 13 maternity wards in Philadelphia and how that impacts some of the city’s poorest mothers.

In Iowa, a Catholic hospital group has banned any kind of contraception, except natural family planning. This same group has also shut down labor and delivery units.

Women, forced to give birth but with nowhere to go? “It’s the Mary method…find a barn,” notes State Senator Janet Petersen, who has long been a vocal advocate for reproductive rights in the state of Iowa.

According to the Guttmacher Institute, a pro-choice think tank, there are currently 12 states that allow some healthcare providers to refuse to provide contraception-related services and 18 states allow healthcare providers to refuse to provide sterilization services.

In 2017, 1 in 4 women noted that they skipped or delayed medical appointments because of the costs. This has only gotten worse in the pandemic.

Kaiser Health reports, “A larger share of women have gone without health care services during the COVID-19 pandemic, particularly women in fair or poor health.” And women are more likely to be impacted financially. It’s women losing their jobs and leaving the workforce. It’s women on the front lines.

…to be a woman in America involves paying a steep fine for simply trying to live. For trying to be free. For trying to be on your own. For trying to be a human.

Now I want to tell you about my teeth. When I got divorce, I was immediately taken off my former partner’s health insurance. He initiated that the day I moved out, and I was off his insurance within a month. 

For two years, I did not have health insurance, and I did not go to the doctor or the dentist. I did go to the eye doctor (the stress made my eyes worse, and I needed new contacts) and paid on credit cards with money I didn’t have. Not long after I finally got health insurance, America went into lockdown. 

I could have gone to the dentist. But my last dentist had accused me of being “concerned with my vanity” when I asked for a crown on a tooth he’d done a root canal on almost 10 years prior. We had an argument. I told him it was ugly and making me self-conscious. He called me vain. Eventually he relented. (It’s worth noting he also didn’t believe me when I came in with tooth pain. The tooth pain that would eventually lead to the root canal.)

And also it was a pandemic. I was scared of exposing my kids. Scared of taking risks. Risks that I know other people in my life weren’t afraid of taking. So that made me more cautious. More worried.

When I finally went back to the dentist (it took them three months to fit me in), my gums would spontaneously bleed in the middle of the day. The diagnosis was $4,000 out of pocket in dental work; my insurance covered the other $3,000. All of it a direct result of the neglect that had happened for so long.

I know this is far afield of where I began, with sexual healthcare, but it relates. It relates because to be a woman in America involves paying a steep fine for simply trying to live. For trying to be free. For trying to be on your own. For trying to be a human. Women who divorce, on average, are less well off then men. Divorced women see a 20 percent decline in income, while men become richer.

It links because every decision I’ve made to be a person in the world, who lives and makes her own choices and her own way has cost me and not just financially.

It links because being a woman in America means that even if Roe remains the law of the land, good luck getting an abortion in Mississippi, good luck getting one in Texas, good luck finding one in Iowa. Good luck finding affordable birth control. Good luck paying to have that baby. Good fucking luck with post-partum care. Good luck raising it as a mother with no paid leave, forced to go back to work while you are still bleeding from the episiotomy.  The fine levied on the bodies of women in this country becomes greater as you age. Your fine is greater if you are a woman of color or single, or anything else than a white middle-class married person. 

When I asked Olesen, Who did this? Who made these sexist requirements for the drug Addyi? She tells me simply, they didn’t come about through the GOP or politics. They came through the FDA.

In sum, the bias against women’s health is so much a part of our culture it’s baked into the FDA.

Note: This newsletter has been updated to clarify the quote in the end.

---

If you read this newsletter, and you like it, consider going to the paid version. Paying for the newsletter allows me to keep writing this like it’s my job. And has allowed me to travel and report and research the things that I write about here. I also have an editor and (if you can believe it), I sometimes hire writers and pay them above-market rates so we can expand the conversations we have. If it’s not in your budget (no worries!), I am working to keep the bulk of what I write free. But if you can, that helps me keep doing this. Subscribers receive a special Monday newsletter where we talk about anything, everything. And are also able to comment. Once someone paid money to comment that they hated me. Maybe that’s you! Subscribe today.