What Our Health Care System Fails To Recognize About Women’s Pain
t was the spring of 2024, and on paper, I was a twenty-nine-year-old with a glittering resume. I was a law student in Arkansas, with clerkships, internships, and a previous career in public service. No one who knew me back then would have described me as sick or struggling with my health. In reality, I was desperately ill, and had been for a long time.
That spring, I had finally convinced a gynecological surgeon to perform a routine laparoscopy to investigate the pelvic pain, bloating, urinary urgency, and other symptoms I had been living with for more than a decade. For years, doctors had waved it off with non-urgent explanations: stress, cysts, hormones, diet. Nothing that required more than ibuprofen and endurance. My surgeon expected to find mild endometriosis, if anything.
But when the surgical team opened me up, they saw something they weren’t expecting: a pelvis glued together by severe endometriosis, and a tumor growing quietly on my ovary. I was quickly diagnosed with an adult granulosa cell tumor, a rare form of ovarian cancer nobody expected to find in a twenty-nine-year-old. There was no way to tell how long it had been there, or where else it could have spread inside my pelvic cavity.
That moment split my life into two parts: before cancer, and after it. Before, I was a normal woman trying to keep up with what everyone needed me to be. Afterwards, I was a young woman suddenly living with cancer in a state where women’s health outcomes rank among the worst in the nation. In Arkansas and across the country, women are made to rely more on luck for diagnosis and relief than they do on medicine. If I hadn’t gotten lucky, I might be dead by now.
My cancer was not the first time a woman in my family had been told to wait, to cope, to accept suffering as normal. My mother spent her twenties cycling through birth control pills and dismissive doctors who told her heavy bleeding and late miscarriages were “just part of being a woman.” My grandmother, too, was handed aspirin and silence instead of answers. Three generations of us, carrying pain as if it were an inheritance.
My grandmother never knew the reason behind her suffering. She received a hysterectomy at the same time she gave birth to my mother in 1969. My mother pleaded with her doctor to do something, anything, for years. Finally, after a failed endometrial ablation procedure to stop her heavy menstrual bleeding, they discovered she had a severe uterine septum. It was a birth defect that was present her whole life, which separated her uterus into two parts. This condition causes heavy bleeding, pain, and miscarriages. If she had been diagnosed earlier, she would have had access to better treatments and better care. When she had a hysterectomy, she was also diagnosed with endometriosis.
For women in Arkansas, medical neglect isn’t an anomaly. It’s the standard of care. Arkansas also ranks among the worst states in the country for maternal mortality, according to recent research published by the Commonwealth Fund and the Centers for Disease Control and Prevention. When it comes to ovarian cancer, more than 70 percent of women in Arkansas are diagnosed at a late stage, after treatment options become limited and survival rates plummet. By the time most women in my state know they have gynecological cancer, it’s already too late for early intervention.
Unfortunately, the infrastructure needed to change these outcomes barely exists. Half of Arkansas is considered to be a maternity care desert—areas without any birthing facilities or obstetric clinicians. While 35 percent of all U.S. counties are considered maternity care deserts, nearly 51 percent of the counties in Arkansas do not have access to obstetrical care. To make matters worse, 66 percent of rural hospitals in Arkansas are at risk of closure due to pressing financial constraints. These financial struggles are largely attributed to inadequate reimbursement from patients’ private health care plans, an issue that will be exacerbated by the passage of the new One Big Beautiful Bill Act. While these rural hospitals are currently held afloat by government reimbursements for Medicaid patients, the legislation will cap these payments and force state Medicaid programs to reduce reimbursement, further devastating rural hospitals’ finances. With the closure of even more hospitals, more women in small towns will be forced to drive hours for even basic screenings or prenatal visits. Government-supported research projects have tracked these disparities for years, but funding has not kept up with need.
The pain that my doctors wrote off as stress or “just cysts” was actually endometriosis, a disease in which uterine lining tissue begins growing outside of the uterus. Endometriosis can spread to multiple organs, causing severe pelvic pain and fertility complications. By the time my endometriosis was finally recognized, it had wrapped itself around my bladder, colon, and ovaries, twisting and tethering them in ways that made daily life unpredictable.
Endometriosis affects an estimated one in ten women of reproductive age, yet diagnosis in the United States still takes an average of seven years from the onset of symptoms. In that time, organs can become permanently damaged. I lived that reality. I was collecting degrees while collecting diagnoses, trying to prove I was both brilliant and believable.
Experts in obstetrics and gynecology have been trying to raise awareness and funding for these issues for years. A 2004 report in The Lancet concluded, “There will probably be a new repertoire of approaches for treatment and perhaps cure of this enigmatic disorder in the near future.” In reality, there has been very little change in how endometriosis is treated in the twenty years since that article was published. The National Institutes of Health has documented systemic disparities in women’s pain care since.
The inequity is especially stark when comparing endometriosis to conditions that primarily impact men. Studies show men are more likely to receive pain medication in the emergency room, while women are more likely to be told their symptoms are psychological. Appendicitis and related symptoms in men are treated as an emergency in ER departments. With that condition, patients are often given scheduled pain medication, antiemetics, and booked for surgery. Crohn’s disease is monitored aggressively with scans, scopes, and surgery by specialists and primary care providers. But when women describe the same intensity of pain tied to gynecological concerns, they are told to endure it with little to no medical management. In emergency rooms, studies show that women wait longer for treatment, and their pain is more likely to be attributed to anxiety. Nationally, women are underrepresented in clinical trials, meaning the drugs and devices prescribed to us are scarcely tested on bodies like ours.
In Arkansas, a near-total abortion ban leaves virtually no exceptions for women’s health emergencies. This is even true in cases where a pregnancy threatens a woman’s health, but is not clearly life-threatening. This legal and cultural climate shapes the care women receive, narrowing their options for reproductive care long before a crisis arises.
The very first gynecological oncologist I saw spoke like I wasn’t in the room, recommended that I try for babies as soon as possible, and prescribed birth control of all things. The next surgeon told me that my pelvis was a wreck, and emphasized that there was no point in trying to have a child based on my health status and the risk a pregnancy would pose to me. He recommended a total hysterectomy. In Arkansas, my diagnosis wasn’t about me as a person. It was about my ability to have children. That was an odd thing for me to grapple with, considering that fertility-preserving treatments are often out of reach for women who don’t fit the traditional mold, and I was one of them.
When I expressed interest in receiving onco-fertility care, I found that insurance in Arkansas does not require coverage of fertility services for single adults, even if they have cancer. If I had been married with a proven track record of wanting children but unable to have them, insurance would have been forced to pay. Because I was single, my fertility status didn’t matter. This happens to many cancer survivors. This led me to push the state legislature to pass legislation similar to a bill Texas recently passed.
These kinds of insurance gaps make matters worse for all women, not just the ones needing fertility care. Arkansas has one of the highest rates of Medicaid-covered births, with more than 40 percent of births covered by Medicaid in 2023. Despite this, Arkansas is the only state in the nation without twelve-month postpartum Medicaid coverage. Many women fall through the cracks between what is covered and what is actually needed.
None of these patterns of women’s medical neglect is new, and none of them is isolated to the backwaters of Arkansas. These trends are systemic and national, costing lives that could be saved.
When my father was diagnosed with laryngeal cancer, his care was immediate and coordinated. Surgeons, oncologists, and speech specialists lined up to help him. No one doubted his pain. No one questioned whether his body deserved intervention.
My experience of care was the opposite. By the time I heard the word “cancer,” it felt less like a diagnosis and more like confirmation of what I already knew: The system was never built to save me. Women like me aren’t statistical outliers. We’re the evidence.
The state of women’s health care in Arkansas is simply an extreme version of what women across the country endure on a daily basis. Still, we see headlines questioning the decline in U.S. birth rates. Women can’t have babies if we’re dead, and the current public policy in Arkansas seems to be maximizing that likelihood.
Survival should not depend on luck. But for women in Arkansas, and for women all over the country, it still does.
Kayley Corley is a native Arkansan. She is deeply committed to advancing reproductive justice and reducing preventable maternal and infant deaths. Check out her Substack: ‘She Didn’t Die.’
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