Why the Social Determinants of Health (SDOH) is a Women’s Health Issue

By Sydney Etheredge, MPH

The World Health Organization (WHO) defines the social determinants of health (SDOH) as “the conditions in which people are born, grow, live, work, and age, as well as the wider set of forces and systems shaping the conditions of daily life.” While it may seem obvious, there is now greater understanding that chronic exposure to social and environmental stressors — such as food insecurity, unstable housing, lack of access to transportation, and many others — can have a significant adverse impact on an individual’s health, sometimes accounting for up to 90 percent of a person’s health status.

SDOH are also intertwined with racism, discrimination, and structural bias. As WHO states, “these circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities — the unfair and avoidable differences in health status seen within and between countries.”

As awareness of SDOH as the primary contributor to a person’s health becomes more mainstream, more attention must be given to how these factors uniquely impact women of reproductive age, particularly women with low incomes and women of color in the United States. In fact, in 2018, the Centers for Disease Control and Prevention (CDC) found that most avoidable deaths among women of reproductive age were attributable to “broader failures of social support.”

What are some of the ways that SDOH impact women of reproductive age?

Economic Security: According to the National Women’s Law Center, “because of employment discrimination, caregiving responsibilities, and other factors, women are over-represented in low-wage jobs and are at greater risk of poverty than men throughout their lives — which means that families depending on women’s earnings are at risk, too.” In fact, women face a wage gap and typically make less money than men across nearly all occupations, leading to decreased access to health care and a higher likelihood of experiencing mental health challenges, including anxiety and depression.

Homelessness: According to the American College of Obstetricians and Gynecologists, women and families are the fastest growing group among the homeless population. Homeless women are at higher risk of injury and illness, and are less likely to obtain needed health care than women who are not homeless. Seventy-three percent of homeless individuals report having at least one unmet health need.

Intimate Partner Violence: Women are more likely to experience intimate partner violence (IPV) than men. About 1 in 4 women, as compared to nearly 1 in 10 men, experience IPV. Studies show that the impact of IPV extends far beyond the incident itself — victims of IPV are more likely to have physical, mental, and sexual and reproductive health effects such as increased risk of hypertension, substance abuse, and miscarriage.

Maternal Health: While 60 percent of maternal deaths are preventable, the United States stands alone as a country where maternal mortality has increased. Black women are three to four times more likely to die during or shortly after birth compared to white women. The inequities can be explained by a number of factors, including social factors like transportation and health care access issues, and differences in hospital and health care quality.

In short, the SDOH are a women’s health issue and more must be done to integrate them into women’s health care.

To better address these unique needs of women, Planned Parenthood recently conducted research on this issue. We surveyed women of reproductive age (18–44) under 300 percent of the Federal Poverty Level (FPL), with a sample approximately split evenly among Black, Latina, Asian Pacific Islander, and white respondents.

Among the key findings are:

• Women of reproductive age face difficulties in paying for basic necessities. Over half (67 percent) of respondents say it is very or somewhat hard to pay for the very basics, such as food, medical care, housing, and heating.
• Women of reproductive age report needing support related to SDOH. While the types of these needs vary, the most commonly reported areas of need for assistance were: having enough food for themselves or their family (23 percent); utilities (17 percent); transportation (17 percent); employment or help finding a job (15 percent); childcare (12 percent); and housing/having a steady place to live (8 percent).
• Women of reproductive age report being comfortable discussing SDOH with a Planned Parenthood provider. Overall, about half of the respondents said they were very or somewhat comfortable discussing SDOH needs with a Planned Parenthood provider, which is a similar percentage reported for comfort in discussing SDOH needs with a primary care provider (PCP). Women of color respondents reported being more comfortable discussing SDOH needs with Planned Parenthood providers.
• By nearly every measure, if a respondent reported having been to a Planned Parenthood before, they reported being more comfortable discussing SDOH needs with a Planned Parenthood provider.

This research makes it clear that women of reproductive age with incomes below 300 percent FPL are in need of SDOH-related assistance. The next question is, how can we best address that need?

One of the first steps is the simple recognition, from all health care stakeholders (policymakers, federal/state/private payers, and providers), that SDOH uniquely impact women of reproductive age, and are fundamentally a women’s health issue. In turn, stakeholders must all have a hand in making SDOH a more recognized and integrated part of the care that women of reproductive age say they need most. This means meeting women where they are because sexual and reproductive health care services are often the first point of entry into the health care system for many women.

The entire system must recognize that SDOH is a women’s health issue and engage frontline providers such as Planned Parenthood as full partners. Until then, we will not reach those most in need and will not entirely address SDOH.