A Health System That Gaslights, Gatekeeps, But Doesn't Girlboss

The female body. 

Did I scare you? Sometimes it seems like even mentioning women’s sexual wellness or the physiology of menstrual cycles or the harrowing details of labor is met with nothing short of a gasp, the words “vagina” and “vulva” treated as taboo that elicits a horror-movie-esque jumpscare. That’s because for the many Millenia that human women have existed there has been precious little investigation into the complexities of the female body and its functions. 

We’re only now breaking through the mist of myth, fear-mongering, and superstition that once obscured the true biological wonders that take place within our bodies. The new technology, research, education, and access to health services we see today stem from a newfound interest in how to actually care for women, and it’s helped us live better and longer. The more we learn, the more autonomy we have over our bodies and their care. 

But nowadays, that autonomy seems delicate. Not the female body itself; biologically, our bodies show extremely impressive resilience to the multitude of problems that can appear within it and the even greater multitude that can attack it from the outside. Instead, they are made delicate because female health has so often been ignored or overly-simplified. Delicate because the decisions of kings and lawmakers and doctors have historically ruled over the quality of care women receive when they face problems with fertility, pregnancy, or sexually transmitted diseases. Our bodies are resilient, but not invincible. The delicate part isn’t us–it’s the healthcare system that’s supposed to help us when our female strength encounters something too vast to face alone. 

As a woman from Louisiana, nowhere does the promise of care seem more delicate than in my own state. I hear too many stories of too many women who find themselves slipping through the cracks of the healthcare system, when what they need is support from it. 

Our state already experiences staggeringly high rates of infant mortality, pre-term births, sexually transmitted diseases, and cervical and ovarian cancer. The maternal mortality rate in 2022 was the highest of all 50 states. The state of women’s healthcare in Louisiana is, as Joseph Betancourt, president of the Commonwealth Fund says, “fragile”. In my view, it’s not just fragile. It’s dire. 

To start, rural women face unique blocks to healthcare access. Forty out of 64 parishes in our state are considered rural. That means approximately 600,000 women live in rural Louisiana today. These rural parishes are home to 49 hospitals, but only 15 of those 49 offer labor and delivery services. Pregnant women living in rural areas are likely to have to travel more than 30 minutes, and often far more than that, just to access labor and delivery services, a time delay that increases the risk of maternal morbidity and mortality. The sparsity of hospitals also makes receiving postnatal and prenatal care inconvenient, inaccessible, or completely unavailable for rural women, making it more likely they will experience pregnancy complications.

Meanwhile, rural hospitals face unique blocks to funding, especially when it comes to maternal care. The cost of delivering a baby is pretty consistent whether urban or rural; staffing physicians, nurses, and midwives 24/7 to support a labor and delivery ward is expensive no matter where you are. It’s an expense that many urban hospitals don’t have a problem offsetting because of the sheer amount of people they serve every day. But rural hospitals don’t have constant, booming business to rake in comfortable income. Often, they lose money purely because they have delivery services. Insurance plan payments, which may be adequate to cover costs in urban hospitals, fail to offset the expense of more scarce but equally expensive rural births. 

That’s all to say, it’s getting difficult for rural hospitals to offer labor and delivery services and remain financially viable. For many rural hospitals who struggle to break even on operating expenses, eliminating labor and delivery seems like the best way to cut costs, even if it leaves many women living in rural areas underserved. 

So, women already living with scattered prenatal, obstetric, and postnatal care are now experiencing more obstacles as their nearest hospitals close down their labor services entirely. In Louisiana, a whopping 36% of our parishes are maternity care deserts, meaning they are barren of obstetric services, with another 22% having low to moderate levels of care. And further ignoring both the compounding obstacles to healthcare rural women face and the financial struggles rural hospitals must grapple with will undoubtedly create even more of a maternity care crisis in the state. 

Women’s health deserves wider attention than purely obstetric care, though. Louisiana has the highest rate of Sexually Transmitted Disease (STD) cases in the country, with about 1,000 STD diagnoses per 100,000 people in 2023. Access to proper STD prevention, diagnosis, and treatment is an essential and often overlooked aspect of our health. Our breast and cervical cancer rates are also far higher than the national average. Screenings like mammograms, breast checks, ultrasounds, and pap tests from the age of 21 are essential to catch these types of cancer in their earliest stages and explore the best treatment plans. 

But some hospitals, especially ones in rural areas, fail to offer these services; others are too far away for women to make it to appointments, especially if they’re working full-time or don’t have access to reliable transportation. This means that smaller healthcare clinics like Planned Parenthood are the only places offering services like STD testing and treatment, cancer screenings, and contraceptive services in some areas. Despite attempts from anti-abortionists to stigmatize Planned Parenthood’s services, abortion makes up only 4% of the services Planned Parenthood provides nationally and 0% of the services they provided in Louisiana before they shut down in the state last month. The vast majority of federal funding they receive goes to reimbursing these essential screenings, testings, and preventative care. 

All of this is to say: rural women in Louisiana aren’t given much choice in terms of the accessibility and quality of their care. But don’t let that fool you– all of Louisiana’s women face blocks to care, and those blocks will only be exacerbated by the policy attacks on healthcare we’ve experienced at both a state and national level.

The One Big Beautiful Bill Act, which was signed into law on Independence Day this year, slashes Medicaid funding and requirements, a detrimental blow to general healthcare and the resources available to already disadvantaged women in our state. 

Two in five childbearing-aged women rely on Medicaid in urban Louisiana. That number skyrockets to one in three women of the same age in rural parishes. Women rely on this coverage for everything from family planning services to prenatal and postnatal care to cancer and STD screenings. In fact, 64% of births in Louisiana were covered by Medicaid in 2023. 

Combining the alterations to Medicaid eligibility and the millions of dollars cut from Medicaid funding, an estimated 200,000 Louisianians could lose their coverage over the next decade, according to the Kaiser Family Foundation. With our high rates of preterm birth, infant mortality, and maternal vulnerability, an expansion of access and attention to maternal healthcare is imperative, not elimination. 

Expanded Medicaid benefits covering outreach about maternal health, doula care, home visits, and maternal mental health services could help relieve the struggles Louisianian mothers face. But with the state estimated to lose up to 35 billion dollars in Medicaid funding, these necessary expansions now seem not only improbable but impossible. Furthermore, Medicaid cuts mean less Medicaid revenue for rural hospitals, making it even more likely that they will be forced to close their obstetric services, leaving thousands more Louisiana women to fend for themselves in healthcare deserts. 

Now, Congress has set aside $50 billion for state grants intended as a rural health fund, but Louisiana will have to apply and be approved to see any of this funding. The amount we’d receive doesn’t seem to be directly based on rural population or need, either. Even still, the fraction of that $50 billion we may receive wouldn’t be nearly enough to cover the colossal blows to our healthcare system we’ll experience in the next decade due to cuts to Medicaid. Of course, the closure of rural health services impacts all women in affected areas, not just those covered by Medicaid. In a disheartening show of sisterhood, if some women suffer, all women suffer. 

Well, that leaves us with independent clinics and places like Planned Parenthood to reach out to for OBGYN care and family planning resources. Except, Planned Parenthood faces federal Medicaid reimbursement cuts and relentless campaigning against their services. The future of gutted funding combined with the political barrage against Planned Parenthood has melded into a crisis for Louisiana’s clinics. In fact, the last two Planned Parenthood clinics announced their closure just this month. 

The death of these essential healthcare resources strips away accessible and affordable care for thousands of women. The majority of those covered by Medicaid received contraceptive services, STI testing and treatment, Pap smears, and pregnancy testing. Many will lose access or the ability to afford these essential services. The closures put even more capacity and fundraising pressure on other healthcare providers, leaving the state’s health resources underfunded and stretched incredibly thin. 

Disguised as a noble crusade against the facilitation of abortion, the attacks on Planned Parenthood are assaults to an already weak healthcare system, especially for Louisiana women. If we want women to get diagnosed and survive cervical cancer, if we want STD rates to decrease, if we want women to feel safe delivering and keeping their children in this state, we need an investment in obstetric and gynecological health services, not an ethics campaign against them. 

Of course, an overview of women’s health wouldn’t be complete without a dive into the state’s most burning controversial topic on reproductive health: abortion. Ever since the 2021 Dobb’s decision, which overturned Roe v Wade and ruled that there existed no Constitutional right to abortion, Louisiana’s suffocating grip on women’s reproductive rights has only tightened, resulting in some of the strictest abortion laws in the country. 

Our state law only allows abortion in cases where the mother’s life is directly endangered by the pregnancy or if the fetus would be unable to sustain life after birth. Violation of these statutes puts medical professionals at risk of up to 10 years in prison accompanied by a $10,000 to $100,000 fine. New legislation passed during this year’s session expanded the ability to sue abortion providers, now including both in- and out-of-state parties responsible for an illegal abortion. Louisiana’s brutal campaign against abortion may portray itself as a battle against a moral evil, but while supporters of strict abortion bans champion the sacred preservation of life, their actions actively endanger the lives of Louisiana women. 

Abortion law in Louisiana puts healthcare providers in a precarious situation–should they deem a woman’s life in danger and facilitate an abortion, they run the risk of heavy fines and prison. It’s a risk some doctors simply aren’t willing to take. I don’t particularly believe we can blame them; their reputation, their record, and their livelihoods could be seriously jeopardized simply for trying to uphold their oath. 

But by protecting their practice, they can easily put a woman’s reproductive health or even her life in danger. Miscarriages can be life-threatening if they aren’t handled properly. Should any pregnancy tissue remain in a woman’s uterus, it can trigger a septic miscarriage, which is a uterine infection that, if not treated, can lead to death. During a complicated incomplete miscarriage, emergency intervention may be needed to prevent hemorrhage or permanent damage to a woman’s reproductive organs. 

Abortion bans not only scare doctors out of providing emergency care to a woman experiencing pregnancy complications, they also cut away funding and resources that provide doctors with training and women with services to treat these complications. That’s even less investment in the infrastructure of women’s healthcare from Louisiana, on top of the threats to hospitals, Medicaid coverage, and Planned Parenthood. Whether you morally agree with abortion or not, it is plain fact that restricting abortion access affects the entire web of obstetric care.

The result? Young women are  afraid of having babies in the state. Medical providers are afraid of practicing in the state. We lose families and, in a phenomenon further contributing to the grim state of women’s health, we lose OBGYNs and women’s healthcare providers. Even more resources seeping out of our state. Even more women are left underserved and unprotected. 

And all of this has only touched the surface of the healthcare disparities facing women. Black women are especially vulnerable in our state’s healthcare system; they are four times more likely to experience pregnancy related death, and their babies are two times more likely to die than white infants.  

Along with blocks to affordability and access, racism still persists in diagnosis and patient care in the healthcare system. Often, Black women’s symptoms are dismissed and belittled, and even the experience of living with racial prejudice and inequality can increase stress and worsen health. A deep dive into the racism and sexism Black women face in the Louisiana healthcare system deserves an entirely separate essay; for now, it will suffice to say that they deserve better. 

It shouldn’t be hard or controversial to give women’s unique health needs the attention they deserve. Because investing in the well-being of Louisiana’s women is investing in our present and our future. It’s investing in the health of your mother and grandmother and sister. It’s investing in the health of your children. That isn’t optional. It’s vital. 

We women aren’t just smaller men with a few different parts. Our bodies are complex in ways the world is just starting to comprehend, and capable of feats the male body could never dream of. Our bodies don’t make us a fragile or vulnerable sex. If anything makes us weak, it's those in power who consistently ignore our needs and strip away our autonomy. 

And we know what happens when we’re made vulnerable. Misinformation persists. Cancer goes undiagnosed. STDs spread. Fertility is endangered. Bodies are permanently damaged beyond repair. And, ultimately, women and babies die. The stakes are high. It’s time those in power treat them as such.