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women's health

Money, time, and access: the cost of reproductive healthcare

The cost of reproductive health care are as unequal as the access to healthcare in Washington, and poor women of color are mainly affected, according to healthcare providers in the city.

Pregnant women, along with children and adults up to age 64 are eligible for healthcare regardless of economic status since the District of Columbia expanded Medicaid in 2011. However, there are levels to the type of coverage everyone gets.

Those levels get even more complex for low-income women in Wards 7 and 8 – areas where most of the residents are black and brown.

According to healthcare professionals, low-income black women are facing a new challenge when it comes to getting the best prenatal care since the closure of two major care centers in Southeast, D.C. two years ago, Providence Hospital and the maternity ward at United Medical Center.

The closures came without sensible explanation, according to community activists.

“Because of this, we see a lot of patients that tend to present later for care, mostly because they’re like ‘well, I didn’t want to travel all the way to Northwest when I started having bleeding during my pregnancy’,” said Dr. Tashima Lambert, an obstetrician and gynecologist at the Anacostia Health Center. “It takes a lot of my patients 45 minutes, or more, to get there.”

The majority of patients in Southeast neighborhoods have some form of government-assisted insurance. Lambert commends the city’s expansion of Medicaid but said the inequalities of the insurance continue to be a larger issue.

“When it comes to obstetrics it’s a big deal,” said Lambert. “For our patients, when they have a certain insurance it really restricts where they can go for care.”

Providence Hospital and the maternity ward at United Medical Center accepted all forms of insurance when they were open, making it easier for poor residents to go there instead of other facilities around the city. Other hospitals won’t accept the insurance the majority of low-income residents can afford, according to Lambert.

“For women in their third trimester, we recommend that they are seen by a diagnostic center two or three times a week,” said Lambert. “My patients in Southeast are not going to do that. They make it very clear that if it’s not absolutely mandatory, they’re not going to do the things that are recommended because they can’t afford to go to Northwest three times a week.”

Currently, the D.C. Metro fare costs about $2.25 at minimum and $6 at maximum during peak hours, according to the transit website. Paying this fare three times a week to and from a hospital appointment is not possible for many low-income residents, according to Lambert.

“If patients drive, there is also an issue of paying to park,” said Lambert.

Christine Harrison had her daughter at Howard University Hospital.

“That was one of the few choices I had,” said Harrison, 29, a clerk at a local Aldi. “Getting there was hard, especially when I was really pregnant, I didn’t want to really do much.”

Working long hours to care for her family and commuting primarily by Metro, Harrison said she’s always thinking about getting more money.

“Doctors are too expensive, even with insurance.” said Harrison. “Some things I have to pay for out of pocket, or like, pay for copays and they can be high. I just think it’s not fair. I avoid going to the doctor unless I really need to.”

Poverty in the city has existed for generations and the issue remains complex, systematic, and racial. Wards 7 and 8, with the largest populations of African Americans in the city continue to see the highest levels of poverty, violence, housing and educational disparities.

Lambert believes one way to alleviate some issues is through advocacy and education, and the retention of healthcare providers who work in poor neighborhoods.

“How are we going to retain providers in these communities? What can we do to ensure that people coming here caring for patients, actually stay?” said Lambert.

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