For the one year anniversary of my scary, messy, gynecological emergency, I want to call attention to a problem that 10 million rural women and birthing people in America are facing: we need more OB-GYNs. I also want to acknowledge that this story is extremely US-centric and doesn’t draw a picture of OB-GYN access worldwide.
To keep a long story shorter, a year ago, I spent New Year’s Eve in my tiny county’s emergency room. A week prior, I had started using an anti-bacterial medication prescribed by my primary care practitioner (PCP) for bacterial vaginosis (BV). The morning after applying the medicine, I woke up with a fever and couldn’t keep food or water down. My doctor told me I had a “stomach bug,” but I knew there was something bigger wrong with my reproductive system.
Cut to a week later, New Year’s Eve, when my fever became much worse. A darling friend drove me to the ER, where I underwent the second pelvic exam of the week. Any woman who’s had one can tell you how invasive and uncomfortable these exams are.
Many hours, and invasive procedures later
The next morning, after 2 more pelvic exams, a CAT scan, blood work, a visit with a general surgeon, and an intense round of intravenous antibiotics, I started to feel better. Then I started bleeding heavily. We still didn’t know what was wrong with me, so the surgeon ordered a pelvic ultrasound. It was yet another invasive, uncomfortable procedure. However, the ultrasound determined what the pelvic exams missed: my IUD was dislodged and sitting in my cervix, causing a bad infection, which had inflamed my appendix for good measure.
I am lucky the doctors gave me an accurate diagnosis. I’m lucky I could get the IUD removed (though not for another few days…) and get a new one quickly. I’m lucky I have health insurance. But when I went to see my PCP a few days later for a follow-up, she said she still thought I’d had appendicitis.
Primary Care Practitioners are great, but not always enough…
Look, my PCP is generally a fantastic doctor. I find her easy to talk to, which is an important trait. But when it comes to my sexual and reproductive health, she has let me down. I would be far better off seeing an OB-GYN when it comes to any matter related to my reproductive health, and my story is only one example of why.
The AAMC estimates that half of the counties in the United States don’t have an OB-GYN. Rural women are more likely to need to drive upwards of 30 minutes to receive obstetric and gynecological care. In an emergency like, say, complicated childbirth, this distance could be fatal.
It’s getting worse: US hospitals only added 200 new OB-GYN residency positions for doctors-in-training between 1996 and 2016. There’s an estimated shortage of 8,000 OB-GYNs nationwide. We are in desperate need of more rural gynecologists. Pediatricians and PCPs are essential, and they do an immense amount of life-saving and preventative healthcare work. But as it is, women’s reproductive health is already a massively understudied field. In particular, incarcerated women, women of color, and queer women’s health are the most ill-understood. It’s not just a research gap, though. This lack of understanding means that these women face more health risks, and there are fewer resources to help them.
There are extensive activism and scholarships on the need for better reproductive healthcare for estrogenic and birthing people.
There is a world of brilliant Black women scholars and activists who are studying, publishing, and advocating for Black women’s reproductive health. Among others, Dorothy Roberts, author of Killing the Black Body, Loretta Ross, who coined Reproductive Justice, Harriet Washington, who wrote Medical Apartheid, and ShiShi Rose, a Black birth worker who does expansive work to uplift Black lives through her social media work. You can support her work at her website so that she can continue to provide necessary doula services. These women’s work speaks to the vast injustices of our maternal healthcare system in the united states, particularly when it comes to race.
At the intersection of these medical injustices and rural healthcare deserts, there are rural Black women. Women who already face the worst maternal and reproductive healthcare, whom the medical system has failed most universally. These women are also most likely to be starved of any OB-GYN care at all. During the pandemic, many rural Black women have chosen to give birth at home for fear of contracting Covid-19 at the hospital, in addition to the racism they are already accustomed to facing from medical professionals.
Everything that I dealt with would be hundreds of times worse if I were not white. Doctors would be less likely to listen to me about my pain, they would be even less likely to trust my own knowledge of my body, and more likely to make decisions about my “care” that went against my wishes.
But OB-GYNs are not enough.
And yet, racist OB-GYNs do more harm than good. Transphobic OB-GYNs have no place in our healthcare system. OB-GYNs in cities are inaccessible to rural women. It’s not enough to say, “we need more doctors.” We need a network of solutions: more actively anti-racist medical professionals, more rural OB-GYNs, and midwives, more scholarships for Black women to become doulas and gynecologists, more research on birthing people in general. There is so much we don’t know about the female reproductive system.
Gynecological health is about more than reproduction. Estrogenic people should be able to ask about their tissue health, about yeast infections and whether or not they’re normal, about birth control, etc. OB-GYNs should be able to talk about consent, not just condoms. They should be able to discuss healthy relationships and boundaries. They should be able to assure young people that their bodies are normal before they grow to think otherwise.
After my IUD’s dramatic exit from my life, I returned to the city where I go to college. My body was still recovering from the intense antibiotics and heavy bleeding. I was tired all the time and had to leave class a couple of times due to severe cramps. My friend drove me to visit the OB-GYN at the local hospital.
I was prepared to undergo another round of invasive pelvic exams, to just hold my breath and grit my teeth until I got a diagnosis. Instead, the doctor I saw transformed my expectations of gynecological care.
Experiencing a different kind of OB-GYN care.
Before even touching me, she asked me if I had any physical or emotional boundaries she should take into account. It’s a simple question, but it opens the doors of that doctor’s office to the oceans of trauma women and birthing people across identities might have experienced around their sexual health. The simple acknowledgment that our health is complicated, messy, and personal made me feel endlessly safer in her care. Plus, she used the smallest speculum possible because “why would I choose to make this more uncomfortable for you!”
There is a world where all OB-GYNs are this thoughtful, where our traumas and boundaries are as legitimately important in the doctor’s office as our blood pressure, so rural women don’t have to stay home out of fear to give birth during a pandemic if they don’t want to. A world where our healthcare system becomes about care and not enforcing white supremacy and heteropatriarchy.