Aiming to achieve equity in women’s health care

At MultiCare, we are committed to working toward health equity — ensuring all people have access to quality health care regardless of age, race, ethnicity, gender identity, religion, sexual orientation, ability, socioeconomic status or location.

But we also recognize the reality that longstanding biases and barriers embedded in the health care system, and our society, can prevent people from accessing the care they need.

In this series — inspired in part by society’s growing awareness that not everyone has the same chance to be healthy — we take a deeper look at the disparities that impact our patients and how we as health care providers and community members can reduce those disparities and improve the health and well-being of all.

How is MultiCare supporting equity in women’s health care?

Either through MultiCare’s own programs and services, or in conjunction with community partners, MultiCare works to provide support and resources to women. The following covers how MultiCare is addressing challenges women may face in receiving care including access to important health screenings and treatments, and innovative approaches to primary, specialty and prenatal care geared specifically toward women.

Access to maternity care

The United States has the highest rate of maternal death among developed nations, with significant differences among racial and ethnic groups. The most alarming difference is that Black women are three to four times more likely to die in childbirth than non-Hispanic white women.

Receiving health care before and during pregnancy plays a huge role in decreasing the risk of pregnancy complications and maternal death. Ensuring every pregnant person gets access to that care is vital.

The OB Access Clinic (OBAC) at MultiCare Tacoma Family Medicine is a prenatal health clinic that aims to provide that access. The clinic opened in 1989 after the Washington State Department of Health approached the Tacoma Family Residency program due to a dire need for prenatal care in the community.

“Our mission has always been to care for patients who are struggling to access care,” explains Rebecca L. Benko, MD, associate program director and director of rural fellowship with obstetrics at Tacoma Family Medicine. “The heart and soul of this clinic believes all patients deserve high-quality, evidence-based care delivered in a compassionate way regardless of background.”

Finding prenatal care for women who might be high-risk and under-resourced can be difficult, and Monica Abbi, MD, associate program director and medical director for the OBAC, recognizes the day-to-day struggles women face.

“They are working hard; some are working two jobs,” says Dr. Abbi. “They might have trouble finding child care or requesting time off work. These are real-world challenges, but offering virtual care has really helped with those challenges.”

In addition to medical care, the clinic offers on-site maternity support services through a grant-funded organization called Answers. Services include help with transportation to appointments, postpartum home visits, and assistance with lactation and nutrition.

“It doesn’t matter if a patient has insurance or not,” Dr. Abbi says. “We have ways to help those patients get the insurance or financial aid they need. No one is getting turned away because they are un- or underinsured.”

Access to women’s primary and specialty care

Responding to needs in the community, MultiCare Capital Medical Center will open a center for women’s health in summer 2023.

1. Abigail Tan, MD, family medicine physician and medical director of the center, says it is a place for all women — from the childbearing years to post-menopause — where stigmatized topics like menstrual health, pelvic health, sexual health and menopause can be addressed.

“It can be challenging being a woman and navigating the health care system,” says Dr. Tan. “Due to unconscious bias, there can be a tendency for providers to dismiss or ignore the concerns of women. Men are known to be more stoic and not come in until they absolutely need care. We want to truly serve women and want them to feel they can share health care concerns without being dismissed.”

“Due to unconscious bias, there can be a tendency for providers to dismiss or ignore the concerns of women.”

Although women use the health care system more than men, their needs can be harder to address. Manifestations of disease and responses to medication can be different than men’s, yet women are under-researched.

In fact, until 1993, the U.S. Food & Drug Administration didn’t require women to be part of clinical trials. And still today, only 4 percent of all research and development spending in the biopharmaceutical sector is dedicated to health issues that affect women.

Women are also less likely to bring up certain stigmatized topics, like pelvic issues.

“I hear the same story over and over from female patients all the time: ‘I leak when I go for a run, but I didn’t think to bring it up because it’s just what happens to your body when you get older,’” says Dr. Tan. “But it’s not normal to leak urine when you run, and women shouldn’t be taught to accept it or be expected to live with it.”

The center will open with Dr. Tan, two family medicine nurse practitioners, and rotating physicians from urogynecology and bariatric, breast and colorectal surgery. A patient navigator on the team will help connect patients to specialists, support and resources.

Future plans include adding an internal medicine physician, social worker, mental health specialist, nutritionist and other specialty physicians so patients can receive all their care in one place. The center will also offer quarterly classes on women’s health topics.

Access to substance treatment during pregnancy

To help women with substance use challenges during pregnancy, MultiCare established the Substance Treatment and Recovery Training (START) unit at MultiCare Good Samaritan Hospital. It’s a voluntary inpatient program for any woman at any stage of pregnancy.

START provides access to prenatal and medical care, medical detoxification and stabilization, chemical dependency treatment, social support and counseling. It opened July 2022.

“The fentanyl epidemic is profoundly affecting the women we see in our program. The overwhelming majority of those seeking care are doing so because of fentanyl,” says Abi Plawman, MD, physician with MultiCare East Pierce Family Medicine and medical director of the START program. “The second most common reason is meth, then cannabis and alcohol.”

The only other pregnancy-specific programs in the state are in Seattle and Aberdeen, and START is the only program in Washington that treats women at the end of their third trimester.

“Those who have substance use disorders and are pregnant tend to fall through the cracks,” explains Dr. Plawman. “OBs are typically not familiar with treating these disorders.”

Once medically stable, patients participate in group sessions that follow a targeted curriculum covering different aspects of a woman’s journey through recovery. The topics include parenting, work, relationships, how to manage physical symptoms, support in navigating the child custody process, and connection to WIC and parent-child assistance programs.

“The fentanyl epidemic is profoundly affecting the women we see in our program.”

Patients are connected to multiple recovery resources in the community, such as AA, NA and Smart Recovery, so they can decide which one fits them best.

“Our patients are very well supported during the program and beyond,” Dr. Plawman adds. “We connect them with an outpatient medical provider and treatment resources near where they will be living, so they have a seamless transition to postpartum and newborn care.”

Access to breast health education & screening mammograms

Despite advances in diagnosing and treating breast cancer, it remains the second-leading cause of cancer in women. One of the most staggering statistics is that Black women are 40 percent more likely to die of breast cancer than white women.

To address this disparity head on, the Carol Milgard Breast Center — MultiCare’s mammography partner in Tacoma — developed the FaithHealth in Action program. The program collaborates with African American, Pacific Islander and Hispanic churches in an effort to enhance breast cancer awareness, provide comprehensive health education, and reach uninsured or underinsured women of color.

In addition, the Carol Milgard Breast Center hosts four screening mammogram events each year to provide “no out-of-pocket expense” mammograms to women who are uninsured or medically underserved.

Access to heart care

When it comes to heart disease, men and women are not created equal. Not only are women underrepresented in heart disease research, but they also exhibit different symptoms and often require different treatments.

Women have higher rates of obesity, high blood pressure and high cholesterol than men and are more prone to risk factors that cause heart disease, according to the American Heart Association. However, identifying and addressing these risk factors can go a long way in preventing the disease.

That’s why, in 2020, MultiCare’s Pulse Heart Institute developed a program geared toward improving women’s heart health.*

At the initial visit, patients’ blood pressure, BMI and waist circumference are measured, and they meet with a nurse navigator to discuss risk factors that affect the likelihood of developing heart disease. After six months, patients meet with the nurse again to recheck measurements and see if they’re on a trajectory to better heart health.

So far, those who have participated have shown great improvement in their health — exercising more consistently, lessening waist circumference and lowering blood pressure.

Pulse Heart Institute also tries to meet women where they are in the language they speak. Recent outreach efforts have included working with the Tacoma Housing Authority to give blood pressure screenings and educational lectures on heart health at the Salishan community, where the lecture was interpreted in three languages.

Steps toward equity

While there is still progress to be made — on a global, national and local scale — MultiCare will continue to support that progress, working toward health care that is more equitable and accessible to all women.

Learn more about MultiCare’s commitment to diversity and equity.

*The Pulse Cardiovascular Health Program is now open to men and women.