Interview

Ignorance is NOT Always Bliss: An Experience with Healthcare During Pregnancy

sbubrooklogueLeave a comment

by Ayesha Azeem, December 19, 2022

Mary’s Interview

One of the most significant events in a woman’s life is when she goes through her first pregnancy, an experience that changes her life forever. This experience can be further complicated by one’s culture and its respective social norms that may affect women negatively. I interviewed Mary [pseudonym given to protect her identity] in both English and Urdu about her experiences with pregnancy and the healthcare she received during all three of her pregnancies, one of which was experienced in her home country, Pakistan. Mary was only 22 years old when she got married and found out she was pregnant soon after. When asked about how she felt when she found out about her pregnancy, Mary described how little she knew about morning sickness, and because at-home pregnancy tests are not easily accessible in Pakistan, Mary had to make a doctor’s appointment to confirm her pregnancy. Mary describes the first emotions she felt after hearing the news as being excited and nervous: she was excited to have her first child and finally start the family she always dreamed of, and nervous because she truly did not know what to expect. However, Mary’s experiences with pregnancy arose in less-than-ideal circumstances that proved to make the duration of pregnancy very difficult for her: while Mary was living in Pakistan with her in-laws, her husband was in the United States, working two jobs to support his new family, his brothers, and his mother. Thus, Mary was understandably terrified when she heard that she was pregnant: she did not expect to have to live through this without her husband by her side. While Mary recounts her mother-in-law taking very good care of her – accompanying her to doctor’s visits, supervising her diet to ensure that Mary received the nutrients necessary for a pregnant woman, and preventing her from completing any household chores – she did not feel adequately prepared or supported without her husband. 

Lack of Knowledge About Pregnancy

Mary describes her experiences with prenatal care in Pakistan as disastrous. There was very little communication from the doctor; Mary would have monthly ultrasounds, would be told that her baby is breathing, and receive an injection at the end of every visit to “help with weakness.” Mary explains that the injection was very painful and was something she didn’t truly understand, as all of her questions would go unanswered during the visit. Unfortunately, Mary had very little knowledge of reproductive health and pregnancy; when she first experienced morning sickness, she thought she had food poisoning, and did not realize she was pregnant until she went to the doctor. Mary also did not know how to take care of herself during her pregnancy, as no one had told her that intense exercise was ill-advised. Mary recounts playing cricket with her cousins one day when she started bleeding from her vagina. Rather than panicking and rushing to the hospital, Mary simply assumed that her period had begun; it was not until she had asked her mother-in-law for a pad that Mary realized the severity of the situation. Thankfully, her mother-in-law’s quick judgement saved Mary’s fetus from further harm. 

Unfortunately, the education system and healthcare system had failed Mary so horribly that she had never learned about the birthing process until the actual day of her delivery – she spent this day in a panic, trying to figure out how she would survive. After Mary had given birth, the obstetrician had unknowingly left a dangerous blood clot unaccounted for in Mary’s cervix, leaving Mary with excessive bleeding. The obstetrician removed the clot after a week via an emergency operation, but while the physical symptoms were removed, this event effectively scarred Mary psychologically. 

Following the birth of her first child, Mary fell into a deep depression. This was not postpartum depression, but instead due to the almost instantaneous change in her mother-in-law’s behavior once her grandson was born. Previously very caring, Mary’s mother-in-law’s attitude toward her was now unwaveringly cold. She became very cruel, constantly hurling verbal abuse and treating her like a common housemaid rather than the wife to her oldest son. 

Arrival to the United States

When Mary arrived in the United States, she expected that things would change drastically in her life and reproductive experiences. Mary hoped that she would now receive the supportive care she dreamed of from her husband. However, her expectations were never met. Mary’s husband was far from living the American dream, working long evening shifts as a taxi driver in an attempt to make ends meet for his family in America as well as abroad in Pakistan. Mary found herself more alone than ever before. Whereas she had her mother-in-law to take care of the house throughout the duration of Mary’s pregnancy, Mary now had to do everything herself during her second and third pregnancies. Not only did she have to cook food and maintain the house, but Mary also had to attend doctor’s appointments by herself as her husband was often catching up on his sleep. Whereas Mary always had her brothers and father to accompany her when she left the house, Mary now had to learn how to be independent after a life of depending on others. Without the right support from her mother-in-law, mother, or husband to help her throughout her experiences, Mary often felt lonely, and it was not long before she relapsed back into depression. 

Differences in Healthcare Between the United States and Pakistan

While her personal life was exceedingly difficult, Mary found a light at the end of the tunnel: the vast difference in healthcare quality in the United States compared to Pakistan. Here, Mary found that her obstetrician was willing to listen to her complaints and work on finding solutions together, actually allowing Mary to be heard. Mary described the healthcare she received in America to be very progressive and professional; her doctors informed her of their concerns every step of the way and educated her on several things she knew nothing about, reflective of the poor health education she received in Pakistan – Mary took classes on breastfeeding, the child birthing process, and taking care of her child after birth, learning more in a few months than she had ever learned in Pakistan. 

A Desire to Learn

Unfortunately, Mary’s experiences in both Pakistan and the United States are common for many women in both countries. As Mary explained in the interview, she did not have an adequate amount of knowledge regarding reproductive health and pregnancy, and thus often made mistakes in taking care of herself. 

In the article titled “‘I Thought I was Dying:’ (Un)Supportive Communication Surrounding Early Menstruation Experiences,” the researchers conclude that women who menstruate hold a desire for knowledge about the health and practical information regarding menstruation, and that there is inadequate communication within close relationships regarding menstruation and reproductive health for young women (Rubinsky, Gunning, & Cooke-Jackson, 2018). The same can unfortunately be said for pregnancy; many women express a desire to know more about the pregnancy process and how they can take care of themselves. 

Unfortunately, in Pakistan, there is restricted access to programs that focus on advancing knowledge on female sexuality and reproductive education. In many schools across the country, health classes cover every topic other than reproduction, because it is seen as “vulgar” to speak about such topics in a co-ed classroom. This leads young women to develop negative attitudes towards their bodies and reproductive health as they learn through social cues that their sexuality is meant to be secretive and cannot even be shared with their parents (Rubinsky, Gunning, & Cooke-Jackson, 2018). Further, women like Mary are often unprepared when they become pregnant, not knowing what to expect or how to take care of themselves. Their mothers do not provide the right knowledge to them because their own mothers never did, leading to a chain of dangerous ignorance that partially explains the high maternal mortality rate seen today in both countries. 

The Treatment of Women in Pakistan

This negligence of women’s reproductive health stems from a systemic disregard for women, who are often deemed to be “inferior” in Pakistan’s society, even today. Women in Pakistan are held to different standards than men, as they are expected to compromise more in relationships, leaving their personal lives for a permanent devotion to their husband and his family. In the event of a divorce, regardless of the cause, the ex-wife is often put under intense scrutiny and is blamed for not being a “good enough wife.” 

Women’s experiences with mental health, menstruation, and other aspects of reproductive health are often disregarded, and women who speak up about their trauma are carelessly labeled as overdramatic attention-seekers. These women are cast aside and deemed to be ungrateful of the many blessings they have, such as having a husband and children with no long-term medical conditions – effectively staining their reputations in response to speaking up about the trauma they have faced. 

In Pakistan, women are expected to act similar to how Professor Lobel characterizes an “ideal woman” in her lecture on autoimmune disorders – suffering in silence, not asking questions, and always being compliant. Women who are vocal about the issues they face – whether it is personally or in a healthcare setting – are treated poorly for standing up for themselves. 

Gender Roles and Mental Health

Further, women’s emotional experiences with pregnancy and other health concerns are often affected by the lack of support they receive from their families, especially their husbands or significant others. Like Mary, many women are expected to carry out familial duties and are part of a family system in which others depend on them. These women often prioritize the health of other family members above their own, proving to be very harmful for women who are pregnant and need to take care of themselves. 

As stated in the article titled “Emotions and Mental Health During Pregnancy and Postpartum,” the strains associated with balancing work and family life with reproduction and child care are major stressors that affect women’s emotional states during pregnancy and after childbirth (Lobel & Ibrahim, 2018). In Pakistan, most women are expected to work as housewives, regardless of the amount of education they’ve had, with a lifelong commitment to caring for their children and their husbands who come home from work each day. Because of these sociocultural norms that also exist in the United States, male partners are often excused from the responsibilities that revolve around child care and household chores, even when their female partners are pregnant or otherwise unable to complete these duties. These expectations substantially prevent pregnant women from getting the rest and prenatal care they need to ensure their good health as well as their fetus’s. 

The Patient-Provider Relationship

Women often receive inadequate care when they visit healthcare providers, specifically obstetricians. As Professor Marci Lobel and Lisa Rosenthal state in the article titled “Explaining Racial Disparities in Adverse Birth Outcomes: Unique Sources of Stress for Black American Women,” power plays an important role in the patient-provider relationship, and women often report feeling dissatisfied and powerless when interacting with gynecologists and obstetricians, as the medical field of reproduction is often characterized by control over women’s bodies (Rosenthal & Lobel, 2011). This is especially true for the healthcare system in Pakistan, in which physicians often dominate the patient-provider relationship and make health decisions without informing the patient and obtaining consent. As Mary stated in her interview, she would be given an injection to combat “weakness” every month with little say in the matter. The patient-provider relationship in Pakistan makes it difficult for patients, especially female patients, to vocalize their concerns about their health and receive answers to the questions they want to ask. 

In addition, it is quite difficult to access quality healthcare in Pakistan, as there is no national health insurance. While there are government-funded hospitals, the care given at these facilities are often not the best and patients still have to pay fees. Private hospitals are often considered to provide the best care one can receive in Pakistan, but even at these facilities, the quality of care could be much improved. Mary described her experiences with visiting a doctor in a private practice, and recounted that even though her obstetrician had won multiple awards and was considered the best in her hometown, the care Mary received was subpar at best. This was because the doctor neglected to treat Mary as an actual human being and decided to instead take control over the decisions Mary was meant to make. 

Furthermore, there are very few pharmacies in Pakistan like CVS or Walgreens in the United States that have standardized rates for medications, allowing physicians to charge patients as much as they like without much retaliation. Thus, patients often delay seeking medical care, especially obstetric care, for fear of not being able to afford all the fees associated with the visits. This delay in seeking patient care due to cost, coupled with the lack of advanced technology in Pakistan, contribute to Pakistan having one of the highest maternal mortality rates in the world. 

Looking to the Future

As Mary’s experiences indicate, much work is needed to improve the healthcare experiences of women who go through pregnancy and other reproductive events in their lives, both in the United States and in Pakistan. Rather than completely medicalizing patient care, we as a society need to work to mitigate the causes that lead to the many complications women face during pregnancy and childbirth, including lack of knowledge, lack of support, and unbalanced power relationships in healthcare. Many of the sociocultural norms in both Pakistan and the United States affect the way in which women see themselves and prioritize their health, which can later affect the lives of their children. Equal treatment of women, both personally and professionally, is essential to improvements in mental and reproductive health outcomes, and can only be done when sociological efforts are made to change the way women are perceived by their loved ones as well as in public. 

References

Rubinsky, V., Gunning, J. N., & Cooke-Jackson, A. (2020). “I thought I was dying:” (Un)supportive communication surrounding early menstruation experiences. Health communication, 35(2), 242–252. https://doi.org/10.1080/10410236.2018.1548337

Lobel, M. & Ibrahim, S.M. (2018) Emotions and mental health during pregnancy and postpartum. Women’s Reproductive Health, 5(1), 13-19. 10.1080/23293691.2018.1429378

Rosenthal, L., & Lobel, M. (2011). Explaining racial disparities in adverse birth outcomes: Unique sources of stress for Black American women. Social science & medicine (1982), 72(6), 977–983. https://doi.org/10.1016/j.socscimed.2011.01.013

Interview With a Female Fibroids Patient: How One Woman’s Story Speaks Volumes About the US Healthcare System

sbubrooklogueLeave a comment

by Vineeta Abraham, May 6, 2022

Disclaimer: This paper was written for Dr. Marci Lobel’s Psychology of Women’s Health class in Spring 2022. This paper is intended to analyze the real experiences of a woman suffering from health issues. It should be noted that the use of the word “female” in this paper refers to the sex assigned at birth rather than the gender of “women” in general. Name of the interviewee has been changed for confidentiality.

In discussions of menstrual health, we often neglect to pay enough attention to the less apparent changes occurring in our reproductive organs. While one may focus their knowledge of reproductive processes in the female body on the phenomena of menstruation, reproduction, and menopause, there are other symptoms and diagnoses that can impact a female’s menstrual health. 

I was fortunate to have been able to interview Sarah [pseudonym], a 53-year-old registered nurse living on Long Island, about her recent experiences with uterine fibroids, which she identified as noncancerous growths in the uterus. Sarah has been married for 25 years and has three children ages 21, 18, and 16. She is originally from India and moved to the United States in 2003 after receiving her bachelor’s degree in nursing. She follows a Protestant-Christian religious practice and works overnight shifts at Queens Hospital Center. 

Sarah reported finding out about her uterine fibroids at the age of 51, about two years before this interview was conducted. She was lucky enough to have received the diagnosis before experiencing any serious side effects or symptoms. She claimed, “I went in for a regular check-up at my doctor’s office. We had been discussing my anemia for a few visits, so she recommended that I consult with my gynecologist to rule out fibroids.” Unfortunately, the opportunity for a “rule-out” never came. I asked Sarah whether she looked into treatment options upon hearing of her diagnosis of fibroids. She responded grimly, “Yes. The only treatment option is surgery to remove [the fibroids]. That or ablation, which is to block blood supply to the fibroids to shrink them.” Unsurprisingly, Sarah was not eager to undertake such invasive treatment, so after a few weeks of contemplation, she carefully declined. “Temporarily,” she clarified in our discussion. “I won’t be getting any further treatment unless serious complications arise.” She described how having uterine fibroids was not impacting her day-to-day activities any more than other related health concerns that previously existed before this diagnosis. For example, Sarah described how, although 53, she has not yet reached menopause, which is a great cause of concern for her. She also suffers from menorrhagia, which she described as having “severe anemia.” In an afterthought, she added that the fibroids may be adding to this.    

I then asked Sarah about any support or lack thereof she had received from friends and family regarding her diagnosis. She explained that the least support seems to come from her husband: “I asked him to ask around or look into other solutions, if he knows any other doctors, to ask if there are options other than surgery.” He did not follow through with the task, but Sarah did not comment any further on this. On the other hand, she claims better support came from other women, friends or co-workers who had either experienced similar problems or knew of others who had. Sarah described often talking with these women about gynecologist recommendations or side effects in her hunt for more information. When asked if she had felt any financial boundaries inhibiting her from receiving treatment, she said she did not think so, and does not think it would be an issue if she decides to get treatment in the future. 

I also made sure to ask Sarah about how living with this physiological health concern has impacted her mental or psychological health. Fortunately, Sarah replied that she did not experience any psychological differences as a result of her diagnosis. She explained that she is not particularly stressed about having fibroids, as it “doesn’t run in the family, doesn’t give [her] any side effects, and there are no hormonal changes.” She claimed that her lack of distress is one of the reasons she is okay with waiting before jumping into treatment. 

Much of what Sarah discussed with me in our conversation relates to topics discussed in Dr. Marci Lobel’s Psychology of Women’s Health course. For example, Sarah was clear in her explanation of limited options presented to her in terms of treatment for her uterine fibroids. The option of invasive surgery – and not much alternative – seems drastic and frightening for patients like Sarah. This reminded me of a concept discussed in the “Introduction and Overview” reading excerpted from the Physical Health, Illness, and Healing textbook, in which the authors explained how doctors show “more interest in restricting [women’s] reproductive potential than in treating their illnesses.” Although Sarah has decided she will not be having any more children, she described that she is not comfortable with getting rid of all her reproductive organs, an option presented to her through the discussion of surgery. She mentioned that although she may not want to have kids, she needs those organs to produce hormones for the rest of her life (she also demonstrated a distaste for taking external hormone supplements). The thought of invasive surgery comes with many risks and potential side effects, and is therefore understandably less appealing to women who are caretakers or full-time employees – or, like Sarah, both. 

Perhaps this is one of the many reasons Sarah has decided to wait on the decision to treat her fibroids. As she mentioned multiple times in our conversation, Sarah’s fibroids are not an obvious hindrance to her day-to-day routine. In the midst of her hectic work schedule and household responsibilities such as childcare, home maintenance, or cooking, her fibroids are therefore being metaphorically “pushed to the backburner.” This information came as no surprise to me after hearing Dr. Lobel’s lecture on women’s cardiovascular health on February 1, 2022 during which she described how there is often a delay in women seeking healthcare services. Dr. Lobel attributed this delay to factors such as having various other responsibilities or a general lack of knowledge. Sarah’s own testimony relates closely with this concept, as she claimed that her hesitancy to receive treatment came from her desire to learn more information instead of jumping hastily into a decision. This idea of not receiving adequate information was also discussed in the “Introduction and Overview” article, in which the authors described how female patients sometimes receive less information than male patients or report feeling dissatisfied with the communication they had with their healthcare providers. This could come from providers being biased and assuming that male patients are better able to understand their diagnoses or treatment options compared to their female counterparts. However, this lack of strong communication can cause women to feel disrespected or underserved, further discouraging them from seeking healthcare services in the future. True to this idea, when I asked Sarah when the last time was that she went to her provider to check on the status of her fibroids, she responded, “about a year [ago].” Sarah admitted to understanding that the fibroids could grow exponentially in that time frame, and claimed that she will go in for a checkup soon, although she did not clarify when that would be. 

In Sarah’s defense, she has made attempts to remedy her lack of knowledge regarding her diagnosis and treatment options. Sarah described going to her husband primarily to help with the situation. “I asked him to ask doctors that he associates with about other options or if they knew of good places to go for the surgery or ablation.” Sarah’s husband also works in a hospital, and she wished to take advantage of his access to multiple healthcare providers and professional opinions. However, she was disappointed to find that he soon forgot about her situation and never followed through with an inquiry. The lack of support Sarah received from her husband was a theme discussed in Dr. Lobel’s lecture on autoimmune disorders, where she discussed how social support from family and friends can play a large role in the recovery process for female patients. In Sarah’s situation, lack of support from the husband has been a contributor for the delay in her treatment, which may lead to more serious consequences if her fibroids grow.

On the bright side, Sarah claims that she has received better support from her friends and co-workers. Dr. Lobel’s lecture mentioned the benefits of having a support group for patients to connect with individuals who have similar diagnoses or experiences. While Sarah did not attend a formal support group for her diagnosis, she was able to discuss her diagnosis with female friends and co-workers who have experienced reproductive complications. These discussions resulted in sympathy and advice in the form of treatment alternatives or gynecologist recommendations that helped Sarah to feel less alone in her journey. While Sarah, unlike many of the women we learned about in lecture, did not report having serious psychological effects as a result of her diagnosis, she was grateful for the support she received from her friends. This type of support, as we’ve learned, can help women feel less alone in their journey of recovery. 

As seen in our lectures and readings, many of the factors impacting Sarah’s experiences are not unique to her. Female patients are often put in difficult circumstances in which their reproductive organs and menstrual health are endangered, often being placed in situations that male patients and physicians cannot personally relate to. Because of this, it is easy for women to feel isolated or unsure about their treatment options. Women are also disproportionately placed in social frameworks that label them as caretakers or being tasked with other social responsibilities, which adds to the delay in proper treatment. This delay can put them in riskier situations as their conditions may either worsen or become more complicated without proper resources. As in Sarah’s case, there may also be circumstances in which treatment options are available but not ideal, which can also lead to delays and uncertainty in patients. Healthcare services should therefore strive to improve their communication and flexibility in treatment options for females with menstrual and other health related complications. Female patients should feel well supported by both their providers and their social structures throughout their healthcare journeys.