President’s Update: Observing Health Literacy Month: Health Literacy IS Health Equity

October 13, 2023 | Wendy Nickel

Imagine being pregnant and going into labor. You rush to the hospital where you are excitedly awaiting the birth of the child. You speak very little English, but know that the doctors and support staff will take good care of you. You are getting deeper into the final stages of labor, are in pain, and exhausted. You are given a form to sign, but since it’s in English, don’t exactly understand what you are signing. You sign anyway because you are under duress and think it’s in your best interest to sign. The nurse also tells you you have to sign the paper. You give birth to a beautiful baby. Sometime after giving birth, you are told that you had a tubal ligation during the birth. No more brothers and sisters for your beautiful baby. You are ashamed because you allowed this to happen by signing a form that you didn’t understand.  This impacts your relationship with your family, and especially your husband, who wanted more children.

Sound like an imaginary story or maybe something that would happen in a different country? Unfortunately, it’s a true story told in the documentary, No Mas Bebes and happened in the 1960s and early 1970s right here in the United States, in Los Angeles. The main theme of the movie is the story of a community of Mexican immigrants who were coercively sterilized upon going into labor, many not finding out until years later. Although there was a lawsuit against major institutions, including the LA County University of Southern California Hospital and the state of California, the trial ruled in favor of the hospital. However, the lawsuit brought to light the plight of Mexican immigrant women who were fearful, marginalized and disempowered.

Additionally, this story affirms the very real reason health literacy IS health equity. If health equity is defined as a society in which everyone has an equal opportunity to live the healthiest life possible (Robert Wood Johnson Foundation), did the women in No Mas Bebes have equal opportunity? Without a doubt, they did not – they did not speak the language (or speak it well) in which the consent forms were written, were under duress, and were coerced into signing the forms.  Accountability for ensuring the women’s understanding was not incumbent upon the women – it was tasked to those who they trusted for their care.

In order to achieve health equity, we must assess an individual’s health literacy and ensure health literacy is prioritized through our health care systems. It is incumbent upon us in health care to ensure that our patients understand the care they are receiving from the moment they enter our doors to the time they exit. In fact, it is a moral obligation. Health literacy is a powerful factor in an individual’s health– it has a greater impact on health than age, income, race, and even education. Low health literacy results in more emergency visits, more hospital stays, and higher mortality. And the opposite is true also – those with higher health literacy have decreased readmissions within 30 days, are more engaged in their care, shorter hospital stays, and decreased utilization.

As we celebrate Health Literacy Month, let’s all pledge to ensure No Mas Bebes never happens again. We can each have an impact on health literacy by evaluating our patients’ understanding of care, developing materials in multiple languages, and ensuring appropriate reading levels for written materials. For additional health literacy resources, please reach out to HCIF for support or visit:

Wendy Nickel
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