National Survey of Women's Health

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Many women do not receive needed health care due to lack of adequate health insurance and vulnerable economic status.

  • 13% of women and 9% of men do not get needed medical care in a given year.
  • 36% of uninsured women do not get needed care in a given year, compared with 10% of women covered by employer-paid insurance and 6% of women covered by Medicare.
  • Women are more likely than men to be poor and to receive Medicaid. 27% of women have family incomes <$15,000, compared to 19% of men; 5% of women receive Medicaid versus 2% of men.
  • Women are less likely than men to work full-time and less likely to have health insurance through their own work or union (40% of women versus 59% of men).
  • Because women are more likely to receive public assistance from Medicaid, fewer women (13%) are uninsured than men (18%).
  • Poor, less educated, and women of color are especially likely to be uninsured.
  • Almost four million women (5%) use the emergency room for regular care; 16% of women with family incomes of $7,500 and less rely on the emergency room as their usual source of care.
  • More than one-third of women are at risk for undetected treatable conditions.
    • 44% of women age 50 and over have not received a mammogram in the past year.
    • More than one-third of women have not had a Pap smear (35%), a clinical breast exam (33%), a pelvic exam (36%), or a complete physical exam (39%) in the past year.
    • Poor women are twice as likely not to get annual Pap smears as women with higher family incomes.
    • The use of annual mammograms increases with education. Among women age 50 and over, 43% with less than a high school education have had a mammogram within the past year, compared with 58% of high school graduates, 65% of those with some college, and 62% of college graduates.
    • Hispanic women have particularly low rates for preventive services. African American women age 50 and over are less likely than white women to get mammograms.
    • Women who are members of HMOs are slightly more likely to receive preventive services than those who are not.
    • The cost of tests was the reason most often given for not having received preventive services (29%). In addition, nearly one-quarter of women (23%) said their physician never suggested it or discussed it with them.
    • One fifth of insured women report that their insurance does not cover preventive services.
  • Women are at serious risk of heart disease, lung cancer, and osteoporosis, and lack sufficient knowledge about how to protect themselves.
    • Nearly seven in ten women (67%) are overweight. Being overweight predisposes women to heart disease, the leading cause of mortality for women.
    • Although regular vigorous exercise* such as walking or running is a preventive deterrent to heart disease and osteoporosis, only 31% of women (compared to 47% of men) exercise vigorously three or more times a week; 31% of women (compared to 17% of men) never exercise. (* pulse rate accelerated for at least 20 minutes).
    • One in four women (25%) smokes cigarettes, one of the reasons that lung cancer now surpasses breast cancer as a killer of women.
    • Four percent or 3.8 million women report drinking heavily.
    • Seven in 10 women (70%) are not very familiar with osteoporosis, a leading cause of nursing home admissions and bone fractures in later life.
    • Although knowledge of osteoporosis increases slightly with age, income and education, more than six in 10 women age 45 and over (61%) or with family incomes greater than $50,000 (62%), are not very familiar with the disease.
    • Just over half of college graduates (58%) are not very familiar with the disease.
    • Although calcium supplements for all women are generally considered an important preventive measure for osteoporosis, 70% of women do not take them. Of women ages 18-44, 79% do not take them; of women ages 45-64, 62% do not take them, and of women ages 65 and over, 58% do not take them.
    • 75% of women age 50 and over do not receive hormone replacement therapy, which reduces the risk of both heart disease and osteoporosis for post-menopausal women.
    • College educated women (31%) are twice as likely to receive hormone replacement therapy as women with less than a high school education (14%).
  • Women are much more likely than men to change physicians because they are dissatisfied.
    • Two in five women (41%), compared to one in four men (27%), have changed physicians at some time because they were dissatisfied.
    • The leading reason women change their doctors is communication problems (32%).
    • 25% of women (compared to 12% of men) report they are "talked down to," or treated like a child by a physician.
    • 17% of women (compared to 7% of men) have been told that a medical condition they felt they had was "all in their head."
    • One in 10 women thinks there are times when her physician would have treated her differently as a person or as a patient if she had been a man.
    • One in 10 women has had a problem or need that she did not discuss with her physician because she was too uncomfortable or felt that her physician was too uncomfortable to discuss it.
    • Women who are members of HMOs are less likely to rate their primary physician as excellent (42%), compared to women who are not HMO members (52%).
    • Though women of color are less satisfied with their physicians than white women, they are less likely to change physicians.
    • 38% of women and 40% of men were not very satisfied about the kindness and sensitivity of a physician who broke bad news to them.
    • Five percent or 4.7 million women have had a physician who made offensive sexual remarks or inappropriate advances.
  • Depression and low self-esteem are pervasive problems for American women.
    • 40% of women, and 26% of men, experience severe depression* in a given week (* rating derived from scale ranking responses to six statements regarding: depression, sleeplessness, life enjoyment, crying spells, sadness, feeling disliked).
    • Women of color, women on welfare, and poor, less educated, and unemployed women are more likely to experience depression.
    • Younger women are more depressed than older women: 43% of women ages 18-44 report severe depression in a given week, compared to 38% of women ages 45-64 and 32% of women age 65 and over.
    • One in five women has low self-esteem (using the Rosenberg Self-Esteem Scale from Measures of Psychological Attitudes, 1991).
    • Women who are poor and/or receive public assistance are more likely to have low self-esteem: 33% of women with family incomes of $7,500 or less and 33% of women on public assistance have low self-esteem.
    • 6% of men and 6% of women—a total of 10.9 million men and women—have seriously considered suicide in the past year.
    • The percentage of men and women who have seriously considered suicide in the past year varies little according to ethnicity, income, or education. However those on public assistance are more likely to have considered suicide.
  • Domestic violence, rape, and other physical crimes touch the lives of millions of women.
    • Within the last year, 7% of women (3.9 million) who are married or living with someone as a couple were physically abused, and 37% (20.7 million) were verbally or emotionally abused by their spouse or partner.
    • 92% of women who were physically abused by their partners did not discuss these incidents with their physicians; 57% did not discuss the incidents with anyone.
    • Within the last five years, 2% of women (1.9 million) were raped.
    • Within the last five years, 8% of women (7.6 million) were victims of mugging, robbery, or assault.
    • Nearly one-quarter of women (24%) seeking care from a doctor or emergency room staff after a crime did not feel the doctor/staff helped them feel comfortable discussing what happened.
    • Almost 3 in 5 women (59%) who were injured crime victims reported that the physician or emergency room staff who treated them did not refer them to a support service.
  • Three in ten women—nearly 30 million—report having suffered some type of abuse as a child; the effects seem to be lasting.
    • 10% of women (9.5 million) and 2% of men (1.7 million) report being sexually abused as children.
    • 13% of women (12.3 million) and 9% of men (7.8 million) report being physically abused as children.
    • More than one in four women (27%) and one in five men (21%) report they were verbally or emotionally abused as children.
    • For both women and men, their sexual abuser was most frequently a close relative, an immediate family member, or a family friend. Men, however, are twice as likely as women (26% versus 11%) to say their abuser was a stranger.
    • Abuse during childhood appears to have lasting effects, reflected in higher rates of depression, suicidal thoughts, and low self-esteem.
  • 11.4 million American women have had abortions.
    • Almost one in five women ages 18-44 (18%) has had an abortion.
    • Women of all income levels have had abortions. Among women ages 18-45, 18% with family incomes of $7,500 and less have had an abortion, 28% with family incomes between $7,501-15,000 have, 15% with family incomes between $15,001-25,000 have, 16% with family incomes between $25,001-50,000 have, and 20% of those with family incomes of $50,000 and more have.
  • Women of color are more likely to be poor, uninsured and to lack needed medical care than are white women.
    • Hispanic women make up a disproportionately high share of the uninsured: 22% of Hispanic women, 16% of African American women, and 13% of white women are uninsured.
    • Women of color are less likely to receive needed medical care than white women. In the past year, 17% of Hispanic women, compared to 14% of African American women and 13% of white women, did not get needed medical care.
    • African American (14%) and Hispanic (11%) women are more likely to receive care in an emergency room than white women (4%). Twenty-seven percent of Hispanic women do not have a regular source of care, compared with 22% of African American women and 21% of white women.
    • Hispanic women have particularly low rates for many preventive health services in a given year, compared to white and African American women:
      table
    • Among women age 50 and over, African American women have particularly low rates of mammography. 57% of African American women did not have a mammogram within the last year, compared to 44% of Hispanic women and 43% of white women.
    • Hispanic women express a stronger preference for a female physician: 15% of Hispanic women strongly prefer a female physician, compared to 9% of African American women and 6% of white women.
    • Women of color have greater reluctance to discuss problems related to their reproductive systems with a physician. Among women who reported being uncomfortable discussing problems with their doctors, 38% of African American women said this was because their problem was related to their reproductive tract, compared to 34% of Hispanic women and 28% of white women.
  • Chronic, disabling conditions limit the quality of life for millions of women, particularly elderly women.
    • In the past five years, 26% percent of women have been told by a doctor that they have arthritis compared to 18% of men; 8% of women have been told they have cancer compared to 3% of men (does not include skin cancer).
    • 16% of women have a disability, handicap or chronic disease that keeps them from participating fully in school, work, housework or other activities. These women are more likely to be poor—26% of women with annual family incomes of $7,500 and less report these functional limitations.
    • Life satisfaction is much lower for women with serious health problems. 18% of women with fair or poor health report low life satisfaction, compared to 6% of all women. 42% of women who are disabled report low life satisfaction.
    • 9% or 8.5 million women need help with routine activities such as shopping or household chores; 2% or 1.9 million women need help with personal tasks such as bathing and dressing.
    • Urinary incontinence is a serious health and social problem for older women. 8% of women (compared to 2% of men) experience urinary incontinence during a given week; it afflicts 15 percent of women age 65 and over.
    • Osteoporosis and heart disease are major life-threatening conditions for older women, yet few are familiar with the steps they can take to reduce the risk. 62% of women age 65 and over are not very familiar with osteoporosis; 50% of women age 65 and over never exercise vigorously; 58% of women age 65 and over do not take calcium supplements; 81% of women age 65 and over do not receive hormone replacement therapy.
    • In the last year: 54% of women age 65 and over have not had a Pap smear; 49% have not had a mammogram; 41% have not received a clinical breast exam; and 35% have not had a complete physical exam.

    Publication Details

    Publication Date: July 1, 1993
    Citation:

    National Survey of Women's Health, The Commonwealth Fund, July 1993

    Related Topics
    Vulnerable Populations

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