I remember when “Our Bodies, Ourselves” came out in 1971. It was eye-opening and truly groundbreaking. It provided useful, practical information about how a woman’s body worked and what might go wrong. It focused on issues of autonomy, puberty, sexual enjoyment, pregnancy, and staying healthy during child-bearing age. It gave me a map of my body and reassurance that I could inhabit it and take care of it.
An updated edition came out in 1994 – “The New Ourselves, Growing Older: Women Aging with Knowledge and Power” – it was marketed as a book for women over forty and looked at the “potential of the second half of life”. I was in graduate school, working on fulfilling my potential in that second half of life.
Waiting for an Update
It is now 2023, and there is an even greater need for women (and men) to learn about our bodies and to take charge of what happens to them, not just in this “second half” of life, but in the final stages of life. Among too many of us there is an uncomfortable lack of understanding of the biology, physiology, psychology, and metabolism of our aging bodies.
When I flip through the pages of my well-worn copies of the two original publications, I am amazed at the chutzpah it took to write these guides. Ironically, while much change has occurred in the intervening years, in terms of the political discourse around feminism and who has a say in what happens to a woman’s body we appear to have come full circle and are now having to start over.
Ashes, Ashes, We All Fall Down
What many of us believed to be a fundamental change for the better that could not and would not be undermined has, with frightening rapidity, evaporated in the last few years. Not just with the overturning of Roe, but also with the withdrawal of Federal money for Medicaid expansion, and the ending of emergency funding for Covid-related programs. Don’t even get me started on the threats to defund Medicare and Social Security. Women are put at risk and actually harmed in greater numbers by these changes.
While this has huge impact on those in their childbearing years, we also need to pay attention to how it affects post-menopausal women. Sadly, in order to get our needs met, we must continue to advocate for ourselves. This includes addressing the abysmal lack of research into how illness, injury, and chronic disease impact women in their later years.
And Then There Was COVID
All of this is bad enough, but COVID definitely upset the apple cart. Too many of us who are over 60 struggled with understanding information about what might happen if we were exposed to the virus. Too many of us found ourselves not trusting what we were told. Too many of us got sick, and even though we recovered, we still are dealing with the lingering effects. Too many elders who were in long-term care died.
The systems that were in place proved as vulnerable as we did to the virus. Public health, long underfunded and understaffed, was suddenly tasked with managing not just a microbe, but also the virus of falsehoods and conspiracy theories spreading on social media and other so-called sources of information. Turns out, this was almost as bad as SARS to the overall health of our systems.
Even Without the Fall Out from Covid, We Are Facing Huge Challenges
It continues to amaze me just how little most of us know about our bodies. And, how many of us no longer respect the people who are educated, trained, and dedicated to treating our bodies. Most folks I know consult with “Dr. Google” before they consult with their healthcare provider!
Many will take the advice of a friend or relative about taking a pill or “nutritional supplement” over what is prescribed by a licensed healthcare provider. Most will go into elaborate indictments of Big Pharma, but never question the quality of a miracle cure they saw pitched on Shark Tank or QVC.
What Does This Mean?
We have lost trust in the people and institutions who are tasked with our care. There is a paucity of providers who understand and treat aging bodies, and coverage for care is declining or being limited. The things that are making our lives challenging as we age do not seem to be a priority for elected officials. This means we are left holding the bag.
Fewer and fewer medical students are going into family practice or geriatric specialties, even as we see more women entering medicine as a whole. This makes for limited choices in finding providers with the skills, experience, and knowledge needed to treat aging women, in spite of the fact that we make up a large portion of those needing treatment.
What Would It Look Like to Truly Be Aging with Knowledge and Power?
I am throwing down the gauntlet here. What do you know about your aging body? Where did you get your information? Much of the information gathered by the Boston Women’s Health Book Collective remains solid and it is a useful handbook for both educating yourself and sharing with others.
We need to understand the difference between “fixing”, “curing”, and “living with” as they pertain to our physical body. We need to understand the options available to address body parts that break down (e.g., osteoporosis and arthritis), chronic but manageable diseases (e.g., diabetes, heart disease, cancer) and surgery (e.g., hip and knee replacement). We have to accept the consequences of choices made when we were younger, and learn to adapt how we live rather than expect others to save us from ourselves.
At a minimum, as women, we need to understand what habits are good for us and which are not. We need to define what it means to be vital; sexually, socially, spiritually, and culturally. We need to find safe, sustainable places to live and people to live with us. We need to find care for ourselves. We need better transportation, access to and distribution of healthy food. And, we need to remove all barriers to care, including ageism, sexism, racism, and all the other “isms”.
Those Making the Regulations Don’t Seem to Understand
The cumulative impact on Boomer’s health and the challenge of aging in today’s health care world can no longer be ignored. Yet, once again, there are those in Congress who are suggesting that Medicare and Social Security are cash cows that need slaughter.
While more and more aging adults are facing health challenges such as heart disease, cancer, COVID-19, stroke, chronic lower respiratory diseases, Alzheimer’s disease, and diabetes, there are fewer and fewer providers who are trained in geriatric medicine, palliative care, and end-of-life care.
Preventative screening specifically for women’s health issues, which could save millions of dollars, not to mention lives, is now under threat with the efforts to repeal the Affordable Care Act. Breast cancer, colon cancer, and ovarian cancer all impact aging women disproportionately. If preventative screening is not covered, it is clear that many more women will die needlessly.
What’s in the Way? A Broken Healthcare System and Ageism!
The system is broken. No one is arguing that. The symptoms you share (or choose not to share) with your healthcare provider may routinely be discounted as “just in your mind” or explained away as “just part of growing old”. Staff will too often categorize female patients as being “worried well” — women who just come in to complain rather than actually having a medical problem.
There is a good possibility that when you do see your healthcare provider, he or she is younger. Without question, that provider is smart and well-educated, but they may have little experience with anyone over 30 (other than their parents), except as case studies or stereotypes.
Ageism is present, but rarely called out. The medicine prescribed for your heart condition was approved by the FDA, but the majority of studies that went into creating that medicine were done with participants between the ages of 18 and 45, and the majority of those were probably men.
Keeping Track of Things
Paperwork has taken over patient care. Insurance coverage is a mare’s nest of prohibitions, restrictions, coverage limitations, and requirements for prior authorizations on the part of the patient. On the part of the provider, it is a maze of forms, applications and approvals, differing payment tiers, coding challenges and delays in getting paid, assuming the service is approved. More time is spent documenting your visit that actual time spent with your provider.
Privacy used to be assumed, but since implementation of the Health Insurance Portability and Accountability Act (HIPAA), there have been more data breaches than ever. More money has been spent in creating systems to protect your privacy than in providing care. The primary beneficiary of all of this is not you the patient. It is the companies who created the systems now required to run a practice.
The Country Cousin: Behavioral Health Care
Demand for behavioral health care services is high. Providers trained in behavioral health can actually successfully address the issues you are needing support around. Therapy takes time, however, and for many aging women who act as the primary caregiver in their family, an hour a week for several months is out of the question.
Instead, women are routinely prescribed antidepressants and antianxiety medications by their primary care providers. This turns out not to be all that effective, but does make a lot of money for the insurance companies who act as Pharmacy Benefit Manager, determining what meds they will cover while contracting with pharmaceutical companies to produce them.
Even when a referral is made to a licensed behavioral health practitioner, finding a provider who takes your insurance is challenging, and out of pocket costs may be prohibitive.
A Call to Action
Back in the 1970’s, women were dying from back alley abortions, poor pre-natal care, and the on-going, seemingly ever-present reality of being responsible for raising children without adequate financial or social support. Women’s health improved dramatically once a woman’s right to choose became the law of the land.
Advances made in prevention and treatment during the intervening decades marked a huge step forward from literally centuries of subjugation by patriarchal decision-makers who saw little benefit in spending money on women’s health.
Making these kinds of changes has historically started with a group of like-minded folks who see a problem and come together to solve it. That effort becomes known and replicated, and gathers momentum. This turns into a movement, and movements result in change.
While it can feel like we’ve already done this once, I invite all women, regardless of age, to reclaim the core messages of “Our Bodies; Ourselves”: The message that we are worth the effort needed to insure our health, and our autonomy. That we must be responsible for knowing and understanding our bodies, our minds, and our value in the world.
And especially as aging women, that we are deserving of dignity and receiving quality healthcare across the lifespan.
4 responses to “My Body, My Self – Getting Older”
Wow. Great blog. I have to tead it again
bravo mary-so many highpoints hit! my only dispute is your statement they do not understand-they understand and have charted the current course way better than us targets of oppression and misogyny. generations of hatred, fear and racism created our current situation, and their wish for indentured servitude and/or outright slavery is in the not too far distance. money and power of unfettered capitalism do us no favors.
I’m on the younger side of the age curve, but old enough to remember updated copies of ‘Our Bodies’ being read, re-read and referenced – don’t remember a single college-aged woman who didn’t have a copy! We were only beginning to see the full Information Age, and its equipment was far too expensive (compared to a print book) at the time to be able to have affordable online research access. We were remarking the other day that most expectant parents attend MONTHS of classes in preparation to bring a life INTO this world. But as anyone who has served as a primary caregiver for and aging or critically ill parent or relative will tell you, there is NO similar preparation for those family members tasked with helping someone LEAVE this world! We have entire school systems we pay for to educate younger members of our community – yet nothing similar to educate those same members when they face equally important new challenges and and are in need of pertinent facts and support on the older end of the curve! So if you decide to put together something similar to the Women’s Health Cooperative to research and publish (in print AND online) a similar guidebook to aid in information access for ‘Our (Older) Bodies, Ourselves’, I’m sure there are others out there who would be willing to help. I would be – we shouldn’t all be forced to ‘reinvent the wheel’ when there are others who have already faced the difficult decisions and changes – and may have answers which would be of benefit… except that they are not available in one easy-to-find (and use) source!
So right on! Hard enough to deal with the health issues without having to deal with all the medical issues. And I know that my doctor friends aren’t happy about some of them either.