As physicians, it is all too obvious to us that women’s health in the United States is in a state of crisis. Compared to other high-income countries, women of reproductive age in the United States have the highest rates of pregnancy-related death, preventable death, chronic health conditions, and mental health care needs. They are more likely to die during childbirth than their mothers, and the Supreme Court’s anticipated reversal of Roe v Wade will likely further increase pregnancy-related deaths.
Even more staggering are the inequities: Black women are three times more likely to die during pregnancy, regardless of education or income. The costs of health care are also burdensome, with women delaying care due to cost and suffering financial hardship due to medical bills, even if they have private health insurance.
These poor outcomes negatively affect society and the workplace. When faced with the challenges of navigating work and family without adequate support to do so, many women simply opt to leave the workforce. This attrition results in decreased diversity, lost talent, and less productivity. The Covid-19 pandemic only exacerbated these trends. Between 2020 and 2022, 1.1 million women left the workforce, accounting for 63% of jobs lost during the pandemic. While many are gradually rejoining the labor force, many — especially mothers — are choosing not to return.
Employers can take action today to combat these challenges. Investment in women’s health results in a healthier population overall. Companies that offer comprehensive support for women’s health have higher productivity, better retention of female employees, and most importantly, they help improve health outcomes for women.
Women’s Health Is a National Priority
At a national level, recognition of these poor outcomes in the United States has led to new efforts to improve them. In December 2021, the White House made a call to action to reduce maternal mortality and morbidity. This effort included a $3 billion investment in maternal health, encouraged states to increase Medicaid postpartum coverage from 60 days to 12 months, and established a “Birthing Friendly” designation for hospitals that take steps to improve maternity care. The Centers for Disease Control and Prevention (CDC) currently funds perinatal quality collaboratives that convene a variety of stakeholders to improve the safety and patient-centeredness of maternity care. The National Institutes of Health — whose 27 individual institutes strikingly does not include one dedicated to women’s health — recently announced new funding for research into improved maternal health diagnostics.
The private sector has not kept pace with these advances. Women account for more than half of the national workforce, and most obtain health insurance through their employer. These plans, however, often impose serious financial barriers for essential health care services.
While the Affordable Care Act requires private plans to cover many preventive services, such as prenatal visits and mammograms, other essential services are not covered, such as genetic screening and prescription medications during pregnancy, hospitalization for childbirth, and diagnostic testing after an abnormal mammogram or pap smear. This is in stark contrast to Medicaid plans, where the amount that patients have to spend out of pocket for these services is exceedingly low. Unfortunately, these gaps in coverage are often most detrimental to employees living on lower incomes and those in marginalized racial-ethnic groups.
Employers are powerfully positioned to advance women’s health in the United States. There are several ways in which they can support women and in doing so, ultimately create a healthier society.
1. Provide better health insurance.
Currently, even among women with private health insurance, 98% of new moms in the United States are left with thousands of dollars of out-of-pocket costs after childbirth as the result of “low cost,” high-deductible insurance plans. In fact, more than half of women with private insurance change their plan around the time of childbirth to seek savings. When employers try to maximize the aggregate value of insurance plans, critical gaps still exist at the individual level.
Therefore, it is essential for employers to seek comprehensive insurance plans that include coverage for pregnancy, childbirth, and postpartum care without high deductibles, co-pays, or out-of-pocket costs. These plans should also cover crucial mental health services, including treatment for substance-use disorders, and evidence-based management of chronic conditions across women’s lifespans. Women must have a seat at any table where insurance plan benefit design tradeoffs are being decided.
Since health care payers are sensitive to market pressures, demands by purchasers for high-quality women’s health insurance coverage will drive market change within the health care delivery system. This should not be seen as a short-term expense, but rather, as a long-term investment.
Employers’ comprehensive insurance plans should include access to safe abortion, which unequivocally saves lives, helps people achieve their life goals, and is an essential part of comprehensive health care. However, if the Supreme Court overturns Roe v Wade, as a leaked draft opinion suggests it may do, abortion will become illegal in at least 13 states with trigger laws, and other states are also likely to restrict abortion access.
Multiple companies have therefore pledged to reimburse travel and lodging expenses for employees seeking abortion services, since many may soon have to travel out of state. Should access to safe abortion become restricted, such corporate provisions, alongside insurance coverage for abortion care itself, will become increasingly important to foster access to the full scope of health care and avoid deleterious effects on employee retention and recruitment. Employers unable to cover costs of travel or treatment can protect safe abortion access by providing paid medical leave as some have done.
2. Provide paid parental leave.
The United States is the only high-income country without national paid parental leave. Lack of paid leave means that pregnant and postpartum people take less time off work, which is associated with increased birth complications and worse maternal and infant health.
Paid leave doesn’t just benefit maternal and infant health; it benefits everyone. A recent study compared companies in states that have enacted paid parental leave with those that haven’t. It found that in the states with paid leave, performance rose by 1%, productivity rose by 5%, and employee turnover decreased. What’s more, longer paid parental leave keeps more women in the workforce. Companies that have begun to invest in paid parental leave are already reaping rewards.
3. Redesign the workplace to support women.
Women face many barriers and stigmas around basic health and wellness in the workplace. A 2020 survey study found that only 10% of new mothers had designated breaks to support breastfeeding, and only 17% had support from supervisors or coworkers. Support for preventative health appointments, childcare, and mental health is often lacking as well.
With input from women employees, employers need to design a workplace that supports positive health behaviors and recognizes that women often shoulder an unequal burden of caregiving at home. Many have begun to reimagine the workplace as one that includes on-site subsidized childcare, spaces for pumping breaks and breastfeeding, and flexible work-hour arrangements to accommodate appointments and caregiving responsibilities.
Resources and guides are available to make these changes. By intentionally integrating support into the workplace itself, companies are more likely to retain talent and improve the employees’ health, wellness, engagement, and productivity.
In a social and political environment that sees growing threats to women’s health and autonomy, the steps outlined above represent ways for corporate leaders to make women’s health a priority. The moral case is obvious, but the business case is just as strong. By investing in comprehensive support for women’s health, companies can improve productivity, realize their employees’ full potential, and reverse the troubling health outcome trends that continue to unfold in the United States.