At the first-ever TIME100 Health Leadership Forum in New York City on Tuesday night, TIME correspondent Eliana Dockterman began a panel conversation about women's health by mentioning that one of the speakers -- Dr. Natalia Kanem, executive director of the United Nations Population Fund -- gave her a bracelet backstage.
"This bracelet has 28 beads, and five of them are red, representing the days that a girl might miss school. Why? Because of period poverty," Kanem said. "So we wear it to remind each other that there's things that we could do to help her out, make sure she finishes her education."
"I thought that that was a very apt symbol for what we are going to talk about today," Dockterman said.
Kanem was joined on stage by Dr. Tlaleng Mofokeng, the U.N. special rapporteur on the right to health, and Dr. Asif Dhar, vice chair and U.S. Life Sciences and Health Care Industry Leader for Deloitte Global Consulting Services. (Deloitte is a sponsor of the TIME100 Health Leadership Forum). Mofokeng spoke about how she worked to make young women feel welcome in healthcare spaces, after noticing that some were not coming into clinics in South Africa. She said she tried to make consultation settings more relaxed, even using pop culture references to make her patients feel comfortable. She emphasized the need to approach sexual health and gender identity with patients in a "non-stigmatizing way."
"We take for granted that the actual physical architecture of a clinic is conducive, and often that's what turns young people away," Mofokeng said. "It got me thinking very intentionally about the spaces we are creating within the health system for people to access care -- that even that in its design has to change to be conducive for establishing therapeutic conversations about services."
The panelists focused on how many women have shared that they distrust the healthcare system. Dockterman pointed to a recent Deloitte report, which cited a 2019 survey that found that one in five women said they felt that a medical provider had either ignored or dismissed their healthcare concerns. Dhar added that heart attacks are misdiagnosed in women more often than they are in men.
"Trust is built on experience, and if a person has a negative experience, it takes quite a while to rebuild that type of trust," Dhar said. He referenced how actress and healthcare advocate Halle Berry described at a TIME100 event in May that her doctor initially thought she had herpes, when in reality, she was experiencing perimenopause and vaginal atrophy. "You could imagine the profound erosion of trust," Dhar said.
The solution, he said, is to teach people in the healthcare space "to be able to have great capacity to listen." He said technology can also be used to help address this problem, but that it must be "engineered with health equity in mind."
"It's just as important that those teams are infused with health equity officers, with the voice of the patient and the voice of women," Dhar said.
Dockterman raised another example of the medical industry dismissing women's pain that was described on the podcast "The Retrievals," which shared the true story of how women complained of pain during their egg-retrieval surgeries but were ignored by the clinic. Later, it was revealed that a nurse had been stealing fentanyl and that the women had been enduring the procedure without painkillers.
Kanem said that many systems are male-dominated but that we're now in a moment in time "where it is within our power to make certain changes" to combat this issue. She stressed the importance of listening to patients and taking their concerns seriously.
"Part of human rights is understanding your own value and your own worth, and it starts with a girl. So I think the expectation that we should listen to girl children, make sure that they're educated and they're not hiding when they have their periods and on and on, up until we build a better health system where, of course it's automatic that we listen to everyone," Kanem said.
Dockterman also asked Mofokeng about a brief she had filed in a U.S. court in the lead-up to the U.S. Supreme Court hearing arguments in Dobbs v. Jackson Women's Health Organization. In the brief, Mofokeng argued that restricting abortion rights would violate international human rights treaties that the U.S. had ratified.
"The right to have autonomy and make decisions on your health care is a right, especially in the context of abortion, that should be discussed between physician or caregiver and the woman -- there should be no other interference," Mofokeng said.
She went on to say that the federal government doesn't interfere in other medical procedures, like a knee or heart transplant. "Doctors are trusted and patients are trusted to make the right decisions, and so the use of criminal legal frameworks in this instance of abortion further stigmatizes, discriminates, and pushes people further to the margins," Mofokeng said.
Mofokeng added that when people start taking away one right, it often makes it easier to take away others -- for instance, access to contraception.
According to a 2017 study by the World Health Organization and the Guttmacher Institute, about 25 million unsafe abortions occurred globally each year between 2010 and 2014.
"When we see maternal mortality, we know that women's health is global health," Kanem said. "All of this can be avoided if we have a caring healthcare system."