The pandemic brought a surge of barriers for people seeking access to reproductive care and abortion, especially among women who identify as Asian American and Pacific Islander (AAPI)—from increased disease severity and mortality rates, to xenophobia and acts of violence. In 2021, 74 percent of AAPI women reported personal experience with racism or discrimination.
For Asian American and Pacific Islander Heritage Month, Ms. spoke with Dr. Sophia Yen, clinical associate professor at Stanford Medical School and CEO and co-founder of Pandia Health, an online birth control delivery company that provides expert reproductive health care from doctors and educates people about effective contraception.
Ms. spoke with Yen about the disparities that different racial groups face when it comes to medical treatment in reproductive health, particularly when it comes to AAPI women. She offered insight into how racism has blocked AAPI women’s access to the medical care they need and recommended solutions for how AAPI women and their allies can advocate for themselves and their communities.
Claire Kenny: A recent study showed faculty from the American Association of Medical College’s (AAMC) Faculty Roster who identified as white were consistently overrepresented as department chairs, while Asian faculty were consistently underrepresented in leadership and ranked lowest in leadership part parity among the ethnic groups studied.
As an AAPI woman with ample experience in both the academic and business realms of medicine, could you speak a bit about your cultural background, your upbringing and the experience of navigating these spaces where AAPI women continue to be underrepresented?
Dr. Sophia Yen: My parents came from Taiwan, and we consider ourselves Taiwanese. That is a political statement, because Taiwan has claimed itself for a long time as the ‘Republic of China.’
When the Kuomintang (KMT) party fought the communists in China and lost, they fled to Taiwan, where they then took over. They forced the Taiwanese people not to speak any Taiwanese in the schools, and the official language became Mandarin. So, my parents were part of the movement in Taiwan that fought for a democratic government, and it wasn’t right that Taiwan was one of several states represented by the Republic of China.
Growing up as a Taiwanese American and Asian American—being the minority wherever you were—presented challenges, but luckily, I grew up in Northern California where we have a larger community. However, in my medical school class, probably only 10 out of 140 of us were AAPIs.
But my kind of pitch is: Don’t put all AAPIs in the same basket. Sometimes I absolutely want to reunite with all people of color to fight for our equality and equal representation, but other times, we need to realize that to raise people up, we need to further cut the pie.
Out of the five quote-on-quote “Chinese” people in my class, four were Taiwanese. So as a Taiwanese American, I absolutely benefited from people not checking what language you speak. But they would do crazy stuff like send us to Chinatown to “be with our people,” because they thought we spoke the language. But I don’t speak Cantonese. So I thought: Why don’t you send the Caucasians to learn what it’s like to be with Chinese Asian people?
When working at Harvard as a translator, I experienced similarly crazy situations. I would show up and they’d tell me, “We asked for the Spanish translator,” and I was like, “Yo hablo español.” And then in the ER, they’d ask, “Hey, do you speak an Asian language?” And I was like, “Not all Asian languages are the same.” There’s Mandarin, Cantonese, Japanese and Thai, for example. One time, they said, “We have this woman who speaks this very rare Chinese dialect.” It was Fukien, which is very similar to Taiwanese. But mine just wasn’t good, because my Taiwanese is at the level of a 3- to 5-year-old. So, trying to talk about vaginas and discharge with a grandma in 3- to 5-year-old language just didn’t cut it.
It’s absolutely disheartening to hear that Asians are underrepresented in leadership. And we’ve seen that also, in my husband’s world where he’s a programmer, Asians don’t rise. There may be stereotypes of Asians, but we know Asians come in all flavors and sizes. If you go to Japan or China, there are certainly Asians in leadership. However, part of the barrier might stem from the oppression we faced as immigrants, where we had always been told to keep our heads down, not speak up and go with the flow—and maybe that’s not seen as leadership skills.
I’ve also seen many people self-nominate. Every time I’ve won an award, I’ve had to nominate myself. Even if I talked about all my credentials when I self-nominated, people said I deserved the position but could only be nominated by a friend. It feels awkward, especially when no one thinks of you.
As a Taiwanese American, I absolutely benefited from people not checking what language you speak. But they would do crazy stuff like send us to Chinatown to ‘be with our people,’ because they thought we spoke the language.Dr. Sophia Yen
Kenny: The overall health of American women has definitely improved over the past few decades, but not all women have benefited equally. Today, there remain large disparities in healthcare access and treatment for women in different racial and socioeconomic groups. How do these disparities affect AAPI women?
Yen: I think it’s important for everyone to realize that medicine was based on the 70-kilo white male, but the average woman weighs less than 70 kilos. Only since 1993 has the law required women to be included in clinical research.
As a researcher, I get it: If you test a drug on a female animal whose hormones are going up and down, that would be far more complicated than a male with flat hormones. I also understand this from a liability standpoint, because I would be concerned about getting sued as a doctor. And if this organism can risk getting pregnant, I risk getting sued. While I understand these perspectives, we can’t just assume that a woman is a man, because she fluctuates in hormones, has babies, breasts and a uterus. So maybe we need to adjust our medicine.
Disparities exist because first, we didn’t do the research. Socioeconomic status also comes into play with the racial disparities, because someone may live surrounded by gunfire, cloistered with five people in one room making noise or has a mother working two or three jobs—the immigrant experience. So it really is about access to healthcare.
It’s important to realize that not everyone is the same. Not everybody from Taiwan is the same, for example, because Taiwan was colonized by the Portuguese for some time. So there’s Portuguese blood running through some of us, which will make some of us metabolize drugs differently than somebody who came from China with the KMT to Taiwan. So, just because you’re Taiwanese doesn’t make you all the same, in terms of how you’re going to process drugs.
At Pandia Health, we’ve come up with an algorithm that works better for Asian and Black individuals. I’m a woman of color, and I spoke with other Black doctors and Asian doctors. We discussed how what we learned at those academic institutions does not work because we’re not white females. If you’re a Caucasian female that wants to bleed every month: Yes, do what we’ve been taught at all these academic centers. But I’ve ranked all the birth control pills in terms of most likely to make you bleed and least likely to make you bleed, and with our proprietary exclusive algorithm based on your age, your body mass index and your race can be used as a proxy for genetics until we can get genetics.
Kenny: A recent article from Scientific American reports, “Nearly 40 percent of Americans belong to a racial or ethnic minority, but the patients who participate in clinical trials for new drugs skew heavily white—in some cases, 80 to 90 percent.”
What effect does this underrepresentation in clinical trials have on women of color? Especially AAPI women?
Yen: If the statistic is 80 to 90 percent white, then it’s very unlikely that they’ll have enough data about AAPI women to have an effective study. Their research studies would have to be 10 times bigger to get enough Asian representation. And even then, ‘Asian’ is a glob, and I would want to see enough representation of all the subgroups.
There’s a phrase in research called ‘power.’ If you don’t have enough numbers of a particular subgroup, then you don’t have the power to detect a difference between the placebo and the treatment group. To get enough power to detect that, they would have to include more minorities in clinical trials—which would make all the research far more expensive. I think inclusive testing should still be done, but the question remains: Do we have the money to go there?
Kenny: What are the most effective ways that AAPI women can advocate for themselves to get the reproductive health treatment they need?
Yen: A doctor that is sensitive to the differences by race is important, and that person doesn’t necessarily have to be Asian. Sometimes there just aren’t enough Black doctors, Asian doctors or doctors of color. However, I don’t want all these doctors to lose many patients because they can’t match them by race. I think the key is to consider these differences and treat people to the best of their ability, in a sensitive manner.
Sometimes, you just need to educate the doctor that there are 40 different [birth control] drugs and eight different progesterone ones. And if you failed one, there’s seven others that you can try.
The other important thing for AAPIs is that in general, we have lower bone density. We also have lactose intolerance, that also applies to Black and Latino people. So, at Stanford adolescent medicine, Stanford pediatric gynecology, Stanford pediatric and endocrinology, we recommend 30 micrograms of estrogen until you’re 30 years old for your birth control pill—because less than that is not good for your bone density.
From age 15 to 30, or 35, you’re gaining bone density. And they’ve shown that if you’re on a 20-microgram pill, then your bone density won’t be as good. If it were me, my daughter, my friend or my patient, I would want them to have the best bone density possible.
Many people in the younger generation are mistaken when they want the lowest hormone possible. With respect to estrogen, you don’t want the highest or the lowest; you want enough to keep your bone density. This applies particularly for Asians who have a risk of low bone density later in life. So do not go for the lowest hormone possible for your birth control pills.
Research studies would have to be 10 times bigger to get enough Asian representation. And even then, ‘Asian’ is a glob, and I would want to see enough representation of all the subgroups.Dr. Sophia Yen
Kenny: How can Ms. readers take action to bring more awareness to the health of minorities so that everyone in the country is getting fair and accessible treatment?
Yen: The best thing is to vote for people who believe in racial equality, people who would support the ERA and people who would support voting rights, because these same legislators hopefully would support equal research in medicine. We need the research in order to treat people to know what we’re treating. If we don’t have the data, then we can’t really know. We also need to help people have access to reproductive health services, and we need more people of color in medicine.
Kenny: What lessons do you have for other minority women who want to become trailblazers in their field of expertise?
Yen: Build your support group of peers and mentors. Don’t be afraid to ask others for help. Everybody that I’ve asked for help as a minority or as a woman, or even in general, generally will help—particularly if they’re a minority and a woman, because they know what it’s like. You also have male allies, who can be very helpful to organizations. Essentially, don’t do it alone. Ask for as much help as possible. Find accelerators and organizations that can help you.
Also, if you are choosing a birth control company, put your money where your mouth is. Find out which are women-owned, women-led and women-founded, versus ones where a man started the company. Choose companies that match your values instead of choosing the cheapest that you find online or whoever has the biggest marketing budget. Take a little time and research, and explore your options.
U.S. democracy is at a dangerous inflection point—from the demise of abortion rights, to a lack of pay equity and parental leave, to skyrocketing maternal mortality, and attacks on trans health. Left unchecked, these crises will lead to wider gaps in political participation and representation. For 50 years, Ms. has been forging feminist journalism—reporting, rebelling and truth-telling from the front-lines, championing the Equal Rights Amendment, and centering the stories of those most impacted. With all that’s at stake for equality, we are redoubling our commitment for the next 50 years. In turn, we need your help, Support Ms. today with a donation—any amount that is meaningful to you. For as little as $5 each month, you’ll receive the print magazine along with our e-newsletters, action alerts, and invitations to Ms. Studios events and podcasts. We are grateful for your loyalty and ferocity.