Suchitra Dalvie’s article, “Harmony, Balance and Rights: Who Pays the Price?” states that encouraging public-private partnerships to address health and well-being, as well as gender empowerment, will continue to harm women’s access to care. After 25 years in global women’s health and as the current senior director of global women’s health & special issues in women’s health for the American College of Obstetricians and Gynecologists, I find the opposite to be true.
It is clear that women in this country have little or no access to public care. There are currently 19 states in the US that have not expanded health coverage to low-income families through the Medicaid program. Without the private sector and NGOs, some women would have no access to contraception or abortion care, along with preventive care like immunization and cancer screenings.
Unfortunately, due to cost, abortion care can sometimes be hard to obtain in a private setting. Nonetheless, private health care can have an important and beneficial impact on public care in many instances, particularly in the areas of quality and patient privacy. Public health care settings do not prioritize confidentiality or even comprehensive counseling when delivering services, including abortion care. However, the introduction of private and low-cost alternatives to the marketplace often drives improvements in these practices in the public sector. This is in part because doctors often practice in both public and private settings. A provider can receive training in the private clinic and can apply that learning to service provision in the public setting.
Private clinics may need to offer sliding scale fees to compete with the public clinics, making them more accessible and giving women more options. Women’s access to care is also often improved because private clinics are more likely to offer more convenient times to gain appropriate clinic volume, like evenings, days and on Saturdays and Sundays.
In short, if we sit and hope that governments will prioritize women’s health and, specifically, women’s access to respectful and convenient abortion care, we will be waiting a long time for change. The effort to improve government’s accountability and offer safe abortion care for all women must not just be about advocacy, but also about modeling care that, while private, sets standards for quality, accessibility and affordability that can come from responsible private-sector actors.
Global Women’s Health & Special Issues in Women’s Health
American College of Obstetricians and Gynecologists