One of the most disturbing aspects of the GOP’s American Health Care Act is how it punishes women in particular by defunding Planned Parenthood and making pregnancy and heavy periods “preexisting conditions.” And when you look at images of the press conference after the bill passed the House, it’s pretty clear why women’s needs might have been neglected:
President Trump is surrounded here by some of the Republicans in Congress who helped pass the bill — a bill that was also almost entirely drafted by men.
Chris Cillizza at CNN points out that when you zoom out of the narrow frame here, there are actually a few women around. But that’s a silly quibble: The reality is this portrait is actually quite representative of the administration so far. Of the 436 people hired by Trump, fewer than a third are women. In Trump’s Cabinet, the picture looks even worse: Women have just 16 percent of the posts, making it exceptionally male for a modern US Cabinet. The Republicans in Congress are also overwhelmingly male, even more so than Democrats.
On the surface, it seems obvious that this kind of imbalance might give us policies that are unfavorable for women and their health. But what do we really know about how being a man or a woman influences decision-making about health?
It turns out there’s a growing body of science that’s found gender does indeed matter hugely when it comes to lawmaking. When women are elected into power, they tend to prioritize health in their legislation and elevate women’s health issues. Researchers have even found that the health status of women improves when you have female leaders.
At a time when the health of American women has been declining on several key measures, it’s worrying that so few women hold key roles in the executive and legislative branches. If women don’t have a place at the decision-making table, we’re bound to end up with more bills that look like ... well, the AHCA.
When women are in power, they prioritize women’s health
Men still vastly outnumber women in political leadership positions. But researchers from around the world have been studying the effects of gender on policymaking when women do gain power. Most of this work looks at women elected to local governments, but it suggests there are very positive gains for women when other women govern.
In this 2011 paper, researchers from the UK and Spain wanted to find out whether women politicians in India were more likely than their male counterparts to effect positive change in women’s health.
They compared villages with close elections, where there was less than a 3 percent difference between whether a man or woman won an election. The researchers found that "a one standard deviation increase in women’s political representation results in a 1.5 percentage point reduction in neonatal mortality, an outcome that is closely tied to investments in maternal health."
In other words, there was a strong link between female political representation at the village level and improvements in child and maternal health outcomes, at least in the short term.
The researchers also discovered that the likelihood of women doing other important things for their health and the health of their families — attending antenatal clinics, breastfeeding, immunizing their children — improved more under female leaders compared with male leaders. "The estimated impacts are large," the researchers wrote, "suggesting that raising women’s political representation may be an effective — and novel — way of improving public health delivery in developing countries."
In another study on more general effects of women as policymakers in India, the researchers determined that "female village chiefs invest more in public goods than do male chiefs," and specifically, public goods that the female villagers were concerned with (in this case, safe drinking water). This study was important because it showed that leaders who happen to be women prioritized issues that their local female constituents cared about.
Closer to home, there’s a robust literature demonstrating that woman lawmakers in the US (particularly Democrats) have a track record of being more likely than men to sponsor bills related to education, health care, children’s issues, and welfare policy — all issues that can directly or indirectly impact women’s health.
Michele Swers, a Georgetown University researcher who has written two books on the effect of female representation in Congress, told me she’s seen a number of examples in her years of research of women lawmakers in the US helping to boost women’s health. "I think the women [in Congress] are basically stronger advocates for [women’s health]," she summed up.
For example, she described how in the 1980s, when researchers began to discover that an aspirin a day can prevent heart attacks (based on studies only done in men), it was the women in Congress who pushed for the creation of the Office of Research on Women’s Health at the National Institutes of Health and new requirements for quotas on female representation in clinical research.
In 1990, Congress passed the Breast and Cervical Cancer Mortality Prevention Act. Prior to that law, breast and cervical cancer screening was only available for people who had insurance. But female bipartisan lawmakers noticed the evidence that these screenings could have a positive impact on health, and pushed through the legislation so all women could get access regardless of insurance status.
We need champions of women’s health now more than ever
Women’s health in America has been going the wrong way on several important measures. Consider this blockbuster 2015 study from Princeton University documenting a dramatic rise in mortality among middle-aged white Americans. Buried in there was an even more dramatic — and surprising — trend showing that women’s health has been backsliding on many important indicators. From 1999 to 2013, while the death rate among middle-aged white women steadily ticked up, white men actually saw decreases in mortality since 2005.
Women are dying by suicide more often these days, their obesity rate is climbing while men’s is plateauing, they’re now dying of lung cancer and accidental poisonings at a faster rate than ever before, and they’re much more likely to die during childbirth than they were in the early 1990s.
The maternal mortality rates in the US are extremely high compared with those of other rich countries, and when I asked researchers who study the trends why America is such an outlier in that regard, they nearly uniformly raised the concern that law- and policymakers here don’t seem to care about women’s health.
As Boston University public health professor Eugene Declercq put it, “The argument we make internationally is that [high maternal mortality rates are] a reflection of how the society views women. In developing countries that’s a big part of the problem. ... I think that’s the same here.”
We need leaders more than ever who will champion women’s health and legislate in ways that will improve it — instead of putting forward bills like the AHCA that some have called “the worst bill for women’s health in a generation.”