May 28 is International Day of Action for Women’s Health. First observed in 1987, the Day of Action was meant to bring attention to preventing maternal mortality and morbidity. This year, with the overturning of Roe v. Wade in the Dobbs case, the day has taken on additional emphasis as a focus on reproductive rights.
Ruth Haskins, MD, operates a private practice in obstetrics and gynecology in Folsom. Throughout her career, she has been a strong advocate for women’s health and the freedom of choice for her patients. Her roots as a native of Pittsburgh, PA are readily obvious by the array of Steelers memorabilia in her office.
In commemoration of this year’s International Day of Action for Women’s Health, we thought it would be a good time to visit with Dr. Haskins and get her thoughts on the state of health care for women, how tightening restrictions on abortions across the nation are affecting patients, and what physicians can do to fight for policy changes. She was interviewed by SSV Medicine managing editor Ken Smith; questions and answers have been edited for length and clarity.
How did you end up practicing in California?
I joined the Air Force to participate in a scholarship program that paid my way through medical school in Pittsburgh. After medical school, I was stationed at Travis Air Force Base in Fairfield to complete my OB-GYN residency. That was in 1985, and by my completion in 1989, I had made the decision to continue to practice in California — the catalyst being the state of women’s health care.
Pittsburgh was a very conservative city and is highly monopolized by UPMC [University of Pittsburgh Medical Center], a characteristic of Western Pennsylvania. I'm very strong spirited and somewhat of a control freak. I enjoyed the freedom in California to practice medicine only with consideration to what’s best for the patient, not always what’s best for the corporation.
When I first came to California in 1983 as a medical student, Jerry Brown was governor and women’s health was well supported. When I returned for solo practice I enjoyed the politics of Governor Pete Wilson and then Gray Davis, both supporters of women’s rights. Working with the Legislature during their administrations was so satisfying and empowering, I became a vocal activist for women’s issues.
What is your message for International Day of Action for Women's Health?
In this state, the focus isn’t on abortion issues so much as women having ownership over all aspects of their health: being educated, informed, and having choices. As more of the Boomers become menopausal, I’m happy that celebrities are using platforms like conferences, TED talks, and blogs to speak openly about menopause and issues that come with aging. For too long, these areas of study have not been addressed in a public forum.
On the other hand, this focus lends itself to abuse as scammers try to capitalize on aging women by promising them products to make them look or feel younger. Some work, many don’t. But taking advantage of women by making them feel bad about aging is very different than making women feel more comfortable with the changes that naturally come with age.
I want my patients to be healthy and happy. I don’t want them to feel that they need to purchase products to make them smell better or appear thinner. On International Day of Action on Women’s Health, we should be empowering women to take control of their health to optimize their comfort and longevity, not extrapolating women’s insecurities to sell them products they don’t need. An international day of womanhood should not be, “Let's turn everybody into a Barbie doll.”
Historically, how has women’s health care differed from health care for men?
Women’s health studies have always lagged behind studies for men, and this is especially true for pregnant women or women of color who tend not to be represented well in studies of medical products or devices. Of course, it would be unethical to “experiment” on pregnant women, but the outcome is that we can rarely say that any drug is perfectly safe in pregnancy. It will always be, “As far as we can tell, take it if the benefits outweigh the potential risks.”
Women of color suffer from racism and bias that often is unrecognized by the providers themselves. In the background of this, the rate of morbidity and mortality of black women is downright embarrassing. In caring for my vulnerable populations in pregnancy, I try to double down on my routine care, checking everything twice, simply knowing these statistics. Rather than smooth over or blow off a worry a patient expresses, saying “Oh, that’s probably normal,” as is often done, I say, “If it concerns you, it concerns me; come on in and let’s check it out.” I never want to underestimate a complaint and have one of my patients become a dreadful statistic.
It's morally reprehensible to all of us as women and as physicians to see legislators stepping into an interpersonal decision.
What is the sense among California physicians about the restrictive rules on abortion that are in more than half the states now?
It's morally reprehensible to all of us as women and as physicians to see legislators stepping into an interpersonal decision. It's just reprehensible at its face value. From a personal perspective, it makes me happy to live in California, but it also changes our practice here in California because we have young women now in droves getting IUDs — and they've got to get their IUDs in July and August before they go off to college because these are gals going off to a state where they don't know what would happen if they got pregnant. So, it was amazing how many intrauterine devices I placed in July and August of last year. And still, people come home for a break on Memorial Day and they'll ask, “Can you get my daughter in? She's only going to be home for this day and I want to get her an IUD.”
We also see more women who are younger asking for permanent sterilization. In the old days, the paternalistic doctors would say you’ve got to be over 35 and have more than two children before we'll consider it because the risk of regret is so high. We're just not really as conservative as that. You know, when somebody looks you in the eye and says, “I never want to have children,” we believe them. We empower our patients to make personal life choices.
Do you find it ironic that some of the people who are really driving these bans are the ones who are most vocal about freedom?
It's horrible. I find it awful that the most vocal crusaders are old white men. I hate that old white men are the ones that seem to be the most vocal about saving the lives of these babies, but they're not voting to give more care to the pregnant women, they're not voting to give more care to the newborns, or to give better education, or to support child care at work, or any of the myriad things that could be helping to really demonstrate that they care about these little people. They care about these little people when they're in uterus and then they don't give a hoot, and I think that's horrific.
What effect do you think Dobbs has had on local physicians?
Well, the activists among us are engaged in the national outlets and organizations. We’re donating more to Planned Parenthood and we’re supporting the organizations that we support with a little bit more money. Personally, as a gynecologist here in this state, the only two things that I’m seeing directly impacting my practice are the rate of sterilization requests and the increased requests for long-acting reversible contraceptives.
What can a physician in our area do help?
Support the national networks financially. I mean, they need all the money they can get. Becoming not just a supporter of Planned Parenthood, but an activist for Planned Parenthood. I'm constantly telling my patients there are 13 Planned Parenthoods in Sacramento, but only three of them do abortions. So even my religious population, who tend not to be in favor of termination of pregnancy, are happier to support Planned Parenthood when they know that they're giving medical care to the underserved.
Just being kind of a spokesperson for the organizations that are helping people across the country, just keeping the word up by actively talking about it with patients is as much as we can do here in this state. Speak with our wallet, with our authority and our credibility.
Do you find that the religious groups are as strong of a bloc in anti-abortion positions as maybe they're made out to be?
No, I think politics comes in more than religion. I have had many patients who are spiritual in their faith come in for a termination of pregnancy with no outward regrets or apology. It’s always a difficult decision. But it is hers, and hers alone, to make.
I think politics comes in more than religion. I have had many patients who are spiritual in their faith come in for a termination of pregnancy with no outward regrets or apology.
Are you or your colleagues getting patients from out of state?
I haven't had any, but my practice is so small. I have a solo practice where I only offer termination services up until seven weeks and only to patients who are my current patients. So, if somebody reaches out to me having found my name online, I am unable to provide that service not having taken care of them previously.
Have you heard of any physicians who are leaving the states they've been practicing in because of the reproductive rights restrictions?
No, I think there are way too many doctors leaving because they're burned out than because of the politics of their community. I'm not aware of new doctors coming to California, but that would be awesome! We have such a shortage of providers there is widespread overuse of emergency rooms for patients who simply cannot find primary care in California. I honestly still think people are in shock and disbelief and I think it's going to turn around after an election.
But so much that is driven by states these days.
Well, that's just these days, because that's the way it got set up when Roe was returned to the states. But given a new president, with a new Congress, we may be able to revert back to a national recognition of women’s right to choose.
What concerns you most as an OB-GYN? What concerns you most for your patients?
That they can't find doctors. That's why I said it would be great if there was an exodus to California related to what's going on. Routinely, every patient who comes to me wants me to do everything in primary care that I can do because they either can't find a primary care doc or their primary care doc doesn't sit, look them in the eyes and hold their hand and talk with them. Generally, the primary care docs in our community have four patients an hour, they have to see 28 to 30 patients a day, and they're just writing prescriptions and referrals. The only docs that are really being a good old Norman Rockwell doctor are the concierge. So, we've got this two-tiered community of the really wealthy people that can have a doc they're paying for, and they have to pay through the roof to get good care, and everybody else either gets no care or just doesn't get that loving care that I wish my patients could find.
If you had an overall message to physicians right now about the state of women's health and in the context of the International Day of Action, what would you tell them?
To write or phone their legislators and make their voices heard. Tell them that I'm in a corporate world where insurance is painting the picture through [patient survey firm] PressGaney and the way I get paid, I can't practice the style of medicine I want to practice and I'm not going to make it past 60 years old in this community without burning out. So, I'm not enjoying my job, I'm not able to do what I'm trained to do, and your citizens who voted for you are getting the shaft. They're getting the short end of the stick because of the way the system is set up. That's the letter I would write.
What keeps you from getting burned out?
I did in various points of my life, so I made changes. Now that I have a solo practice, I'm surrounded by a supportive staff and have made enough changes in what I do and how I do it, I love every minute of my life. But you know, you have to sacrifice. My salary today is the same as it was in 2008, so I'm clearly not doing it for the money. I set up a salary when I set up this practice and I haven't changed it. So all of the cost of living expenses have gone to my staff, and I'm surrounded by a staff that is extraordinarily supportive — just wonderful, wonderful people. And so I've kept their wages up but I'm not being compensated in the range of my peers.
But how I make up for that is in how comfortable I am in my job, how good I feel every single night when I look back on the patients I saw and what I did. There's just no money value you can put on that. How I keep from getting burned out is that I find enjoyment in every single thing I'm touching.
Any other thoughts?
You know, with half our population being women, we sure get the short shrift when it comes to medicine. It’s sad that the focus on health is male driven as they have been the “breadwinners,” but that's not the case any more. It’s the women who are carrying much more of the societal load. There are so many more women in the workforce, contributing the the household equally. Additionally, there are expectations of contributing to the income while bearing and raising the children with disproportionate expectations for responsibilities. With a diminished monetary value in the workplace, and unmet needs in the family and societal unit, it is adding insult to injury to have basic life choices taken away by government entities. To always have to give more, pay more and prove yourself harder, at the same time as being devalued as a decision maker in your own personal health matters is nothing short of deplorable.
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