When Gender, Race, and Poverty Become Liabilities in U.S. Health Care

Recently, two viral videos dominated our feeds—one involved an African American mother in painful labor, screaming while being ignored by staff at a Texas hospital. The other showed a woman denied prenatal care for being unmarried, linked to Tennessee’s new Medical Ethics Defense Act. The country reacted in typical fashion with a mix of shock and complicit inertia.

We have largely become trapped in a news cycle: a woman in pain is denied care, the video goes viral, community leaders hold press conferences, and the public moves on. But as a healthcare provider, I am trained to differentiate between symptoms and root causes. These tear-jerking stories are not anomalies without origins or cures. They point to something deeply rooted.

These often-unreported incidents land in the bullseye of a national conversation currently dominated by abortion bans and reproductive legislation, obscuring the true diagnosis. Pregnancy itself has become a liability in our connected but unequal healthcare system, where gender, income, race, and Zip codes often outweigh medical necessity.

The structural inequities of American healthcare lurk in the bowels of TikTok but rarely trend online, yet this reality shapes critical outcomes from birth weight to life expectancy.

Recent attempts to erase written history fail to backspace through centuries of bias and unequal access.

Dark History

The United States has a well-documented history of denying and delaying care to marginalized groups. In cases like Simpkins v. Moses H. Cone Hospital (1963), Black patients in the South were not allowed medical care in “white hospitals” on an equal basis. Only nine hospitals existed for African Americans in the entire state. They were overcrowded and understaffed. Ultimately, Dr. George Simpkins and others filed a discrimination suit after learning that those “white hospitals” were built with federal funds. That case effectively desegregated hospitals nationwide, but the mindset of those impacted became a legacy of distrust.

Years after the civil rights era, acts of medical discrimination continued. In 1989, the Medical University of South Carolina implemented a program that drug-tested pregnant women in Greenville, S.C., without their knowledge or consent. A positive test after the 28th week of gestation brought charges of possession and distribution to a minor. In the ensuing case known as Ferguson v. City of Charleston (2001), the Supreme Court ruled that the hospital’s acts were an invasion of privacy and unreasonable.

Fast forward to 2020, when Lovelace Women’s Hospital in New Mexico was found guilty of ethnic profiling of Native American women. These women were flagged for additional COVID-19 testing based solely on their race or Zip code instead of actual symptoms, which is the standard of care.

Not all history is distant or forgotten, especially when it shows up in today’s headlines again and again.

When Bias and Access Collide

A major hindrance to health equity for women is implicit bias in healthcare. Implicit (aka unconscious) bias refers to the attitudes that affect our actions without our awareness. It is a well-documented driver of disparities in the quality of care for vulnerable communities. Study after study shows that:

·Women are less likely to be given adequate medication for pain

·Disparities exist in transplants for Black patients

·Older adults receive fewer referrals to specialists for certain procedures

Bias may be positive or negative. It isn’t the same as discrimination, which is unfair treatment stemming from unfavorable bias. Treatment decisions influenced by bias negatively impact patient outcomes.

Bias plus limited access to care--especially in states that have not expanded Medicaid—compounds the harm by delaying preventive services and continuity of care.

The Social Determinants We’re Neglecting

The social determinants of health—nutritious food, education, housing, income—have a major influence on whether one reaches their full health potential.

Pregnancy should not be a determinant of life expectancy in a first-world country.

Beyond the Headlines

Real change requires investment in causal pathways that have been neglected for too long.

1. Education – Up-to-date training on implicit bias and improved research literacy helps build trust and improve outcomes.

2. Access to Care – Medicaid expansion, medical-dental integration, and expanded telehealth. States that have implemented these steps see better health outcomes and lower long-term costs.

3. Advocacy and Allyship – Informed policymakers and better policies derived from disaggregated data, along with more faith-based organizations partnering with local communities.

This must end, and it will, when we build a new system where care is a guarantee, not a gamble.