Disability Is A Feminist Issue: Gendering Health Access

When I tell people I write for a feminist site focusing on a disability issues, one of the most common responses I get is confusion. ‘What does disability,’ people ask me, ‘have to do with feminism?’ I’ve written before, very topically, about why disability is a feminist issue, and I’d hope that a lot of the content on this site backs that assertion up, considering that we’ve talked about a number of issues considered important in the feminist movement, like reproductive rights and rape, just to name two examples.

But I’d like to spend a little time drilling down into some specific aspects of disability and living with disability that tie in with feminism, very strongly, because I continue to encounter pushback when it comes to integrating disability into conversations about feminism.

Today: Gendering when it comes to access to health care and disability services. Gender inequality is a core issue in feminism and it can be seen especially clearly when it comes to disability issues, which is one reason I’m always surprised to see that people don’t consider disability a feminist issue. I’m not talking here about the gendering of disability itself, which also occurs and is a separate issue that really needs its own post to do it justice. I’m discussing gendering when it comes to who can access health care and what kind of health care people can access, and how that plays out for people with disabilities.

Let’s start with the fact that, in the United States, to access health care, you need money. You need money to pay out of pocket, or you need money to buy insurance, or you need the kind of job that includes insurance as a benefit (we’ll talk about who can access government assistance, including health care, in a moment). Guess who is likely to have less money? Women. Women of colour and nonwhite women in particular are on the bottom of a pretty incredible income disparity as a result of intersecting oppressions. When women get sick, when they are injured, when they acquire disabilities, they are less likely to be able to access treatment because they cannot afford it, they are less likely to be able to adhere to treatment because over the long term it is expensive, and they are more likely to experience complications because of issues like caring for children, trying to deal with poor access to food, and other things while also trying to get better.

Outside the United States, money can still be a profound determiner when it comes to accessing health care, because money is tied in with so many things. People with money are more likely to have pursued advanced education, to be informed about health issues, including the early warning signs of conditions in need of treatment. People with money can access care the government doesn’t cover, can afford private hospitalization, can pursue treatments that cost a lot of money, and can persist through a health crisis when it comes to demanding and getting treatment. People with money can afford that supplemental private insurance that may make the difference between being turfed off in a corner somewhere and given actual treatment. Money talks, worldwide, and women are less likely to have it, less likely to hold it, less able to earn it.

But, but, poor women can go on government assistance! Then they don’t need money to pay for health care, so everything is ok. Yeah, except, the income standards for government assistance are hopelessly skewed and hopelessly wrong. Women have to be not just poor, but really poor to quality for government assistance, and they have to stay poor. Disabled women who apply for government benefits must be willing and able to jump through a number of hoops on command; they need to pull together reams of supporting documentation, to prove they are disabled enough, and guess what the government really doesn’t like paying out benefits on? Conditions like Chronic Fatigue Syndrome and fibromyalgia, which disproportionately impact women and are often dismissed as ‘not real disabilities,’ so even after doing everything right, these women might still be denied benefits.

For women who can get on disability, it’s a lifetime of poverty. The government has very strict limits about income and assets for people receiving benefits, which means that disabled women can only work very limited hours, can’t save money, and certainly can’t own any meaningful assets. ‘But they don’t need to, they’re on benefits.’ Well, poverty tends to intersect rather dramatically with a lot of feminist issues; how do you escape an abusive partner or caregiver when you have no money in savings and you can’t afford a hotel, a deposit on a new place, bus fare out of town? How can you plan for your future when you can’t save any  money? How can you pay for treatment the government doesn’t cover when you have no funds? How do you buy the meds everyone says you have to take to be a ‘contributing member of society’ when they cost hundreds of dollars every month and the government delays your benefits for mysterious reasons all its own?

Accessing health care also requires time. You need the time to sit on the phone to make appointments. You need time to go to the doctor’s office for evaluation, time to go to the pharmacy to pick up prescriptions, time to perform prescribed exercises at home, time to argue with insurance companies about benefits. Time is something women tend to lack access to because they’re often juggling a myriad of tasks. Or they’re working in the kinds of jobs where asking for time off to get medical care is frowned upon. Or they’re working multiple jobs to afford to stay alive and can’t figure out where to fit a doctor visit into their schedule. Or they have young children whom they can’t leave alone, but can’t take to the doctor, either.

And let’s talk about the fact that a number of health conditions are underdiagnosed or diagnosed too late in women as a result of gendered ideas about who gets what. Heart attacks, for example. Are often not diagnosed in women both because they are believed to be a ‘male’ health complaint, and because heart attacks in women present differently than they do in men. This means that women are more likely to experience complications from heart attacks, if they survive, because they weren’t identified early enough.

Drilling down, we can see that certain classes of people wait longer for treatment and are often provided with inadequate care when they do receive it. Often, women are among these groups; for instance, women of colour/nonwhite women and poor women tend to experience delays in accessing breast cancer treatment.  It’s notable that breast cancer is a very popular social cause, yet there are still significant disparities in terms of who can access diagnosis, treatment, and support for  breast cancer.

This is a feminist issue. Women are dying, right now, all over the world, because they can’t get the care they need, and when they access care, they are treated unequally. For women with disabilities, the gendering of health care access creates a lifetime of barriers that don’t need to be there, from being told you ‘aren’t really’ disabled to being denied care on the grounds that the problem you’re having ‘doesn’t happen to women so it must not be happening.’ Gender disparities in health care access and treatment have very real and meaningful consequences for women who are sick, as well as disabled women. They can literally be the difference between life and death.

Tell me that’s not a feminist issue. Go on.

8 thoughts on “Disability Is A Feminist Issue: Gendering Health Access

  1. I’m so glad I ran across this article and your blog! Thank you for bringing attention to this issue.

    I have endometriosis, another mostly female disease. To my mind, endo reveals the gender disparity of our world quite poetically. Let’s face it: if it were men who had pain during sex, we would have found a cure for endo long ago.

  2. This is so, so true. I suffer from severe anxiety and depression, and neither of these are “real” disabilities in most peoples’ eyes, including my family’s. When I finally managed to psych myself up long enough to go to DSHS to apply for Medicaid, I was literally told by the social worker than I’d be lucky if I managed to get onto it, and that I’d have significantly higher chances if I got pregnant. She said it in such a way that it was almost, “Have you considered getting pregnant for this purpose?”

    I was told that I had to come back in two weeks for a psych eval to determine whether I was eligible. I stayed up all night psyching myself up to go, and after a humiliating interview I was told I’d find out my results within a month. I did manage to get onto Medicaid, thankfully, but it turns out that there are two different types of Medicaid… one which covers mental health, and one which does not. Can you guess which one I was put onto?

    I couldn’t bring myself to go back a third time to argue it, so I found a doctor who accepted Medicaid… literally the only one in my city who was taking new Medicaid patients. The practice is hugely overworked; they service pretty much all of the poor and Spanish-speaking women in my area. The earliest appointment I could get was three weeks out. My doctor put me on some anti-depressants which made me physically ill, but I couldn’t get another appointment to get a new prescription for another month. I could go on, but I think you all get the picture.

    It’s been nearly a year and I’m still suffering from the same ailments, and it’s not due to lack of effort on my part. I finally convinced myself to go to the Community Service Office on Monday to ask what I had to do to get switched to the proper version of Medicaid, and I was actively discouraged by the social worker I spoke to, and I simply do not have the mental capacity to fight this alone.

  3. Great post, especially the bit about conditions that mostly affect women not being seen as real. I have ME/Chronic Fatigue Syndrome and there’s certaintly a lot of sexism demonstrated in public attitudes and in research.

    I have one nitpic, when you say “conditions like chronic fatigue and fibromyalgia”, it’d be better to use Chronic Fatigue Syndrome, as chronic fatigue is a symptom of many conditions rather than a condition in itself. Using simply chronic fatigue reinforces the problems that already exist with the CFS name; basically that the only symptom is fatigue, whereas for a diagnosis in most countries you need additional symptoms.

  4. Thanks for the note, coldneedles; that was actually a typo on my part I didn’t catch when I was editing, since I do understand the differentiation between chronic fatigue (a symptom associated with a lot of things) and Chronic Fatigue Syndrome. I’ve updated the post.

  5. See, this is what happens when I respond to comments before I eat. You, not being me, had no way of knowing whether that was a typo or ignorance or who knows what! And I think it’s a very important distinction, which is why I’m glad you brought it to my attention. Sorry for being snippy at you.

  6. Being a woman with a psychiatric disability, I agree with everything you’ve said… Except for the fundamental thought that gender is the primary cause of the inequities. It is MUCH more an issue of low income/poverty, than it is gender. I have had my disability all of my adult life and have been in the “poor but not poor enough” category all of that time. I am truely one of those who has to choose between eating or paying for drug co-pays and Dr. bills. I am lucky enough that I am able to advocate for myself somewhat, and yes, trying to convince some Dr’s that “the little woman” knows what she is talking about has been a struggle, but the wall I have to climb over gender issues is hugely over-ridden by the wall poverty presents. There is a societal discrimination against disabilities (as though any of us asked for it or can control it!). In my opinion, gender is not the primary factor, and that income & education are the largest contributory factors.

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