The Environmental Cost of Healthcare: A Closer Look at OBGYN Waste and Sustainability Challenges

Could our hospitals be sickening the planet? As we grapple with the urgency of climate change, examining the environmental impact of various industries becomes paramount. One sector that often escapes scrutiny is healthcare, despite its significant contribution to waste and pollution. In this article, we delve into a specific realm of healthcare – obstetrics and gynecology (OBGYN) – and shed light on its profound environmental costs. From single-use plastics to energy-intensive procedures, the sustainability challenges within the OBGYN field in the USA warrant closer examination. Understanding the extent of its ecological footprint is critical to pave the way for more environmentally conscious practices and mitigate the adverse effects on our planet's health.

Often, sustainability is related to high costs when, in fact, it can be the opposite. Sustainable practices can help clinics and hospitals reduce costs and prevent waste when focusing on their supply chain management and operations. 

We invited Jane van Dis to talk about waste and climate change to give us more insights into how OB-GYN practices impact our environment and human health. She is an Assistant Professor in Obstetrics & Gynecology from the University of Rochester. Jane is passionate about the climate and plastics crisis and its effects on Women's and Maternal/Fetal health. She is a Co-Founder of OBGYNs for A Sustainable Future, a specialty interest group of Healthcare Without Harm, and has done extensive research on the impact of climate change on women's health. 

“Given that 80% of all CO2 emissions in healthcare are from the supply chain, we need to make changes in our purchasing and our use in the operating room, on labor and delivery, so that we can be part of the solution instead of part of the problem.”

The conversation highlighted challenges in the healthcare industry regarding waste, and it served as a wake-up call, emphasizing the urgent need for healthcare facilities to align their values with environmental and community health.

How does the healthcare industry, especially OB-GYN practices, harm the environment? 

So we know that hospitals are the largest or second largest users of energy and the number one users of water among commercial buildings nationwide, and they account for billions of dollars of spending per year. They're also usually the number one waste producers in their community, with the average hospital contributing 14,000 tons of waste per day, and a third of that waste comes from operating rooms. And, of course, as obstetrician gynecologists, we are in the operating room performing gynecologic surgeries, but then we're also in labor and delivery performing C-sections, which is one of the number one surgical procedures performed in the United States. It's also responsible for 30% of facility waste and 66% of red bag waste, which is a very expensive and highly CO2 intensive waste, because that red bag waste has to usually be incinerated. 

In addition, there are anesthetic agents used in hospitals and labor and delivery units which contribute to greenhouse gas emissions. For instance, one of the worst players is desflurane. This is an anesthetic agent used by anesthesiologists in the administration of general anesthesia, and desflurane as a molecule is 2,540 times more powerful as a greenhouse gas than is CO2 or carbon dioxide. It also persists in the atmosphere for over 100 years. On labor and delivery we also use nitrous oxide, so while this does not have quite the same greenhouse gas effect, it does stay up in the atmosphere for somewhere between 100 and 120 years. 

There are better options than others and I think as obstetrician gynecologists it behooves us to understand the types of agents that we're using, the amount of red bag waste that we're creating. I see in my own operating room sometimes non-red bag waste is going into red bag waste and in fact they've done studies showing that sometimes the amount of appropriate red bag waste in a red trash bag is only 15%. So 85% of what's going into the red bag is  unnecessarily incinerated. 

Another way that OBGYNs are impacting the environment is in the use of plastic speculums. There was a study where they did what is called a “Life Cycle Analysis”, measuring the carbon footprint of a plastic speculum versus a stainless steel speculum and what they found was that the stainless steel speculums contributed an average of 2,800 pounds of CO2 per year, where the plastic speculums contributed almost 12,000 pounds of CO2 per year. 

In the operating room, we, as doctors, have the choice between using single-use plastic instruments versus reusable instruments, and what some studies have found is that, interestingly enough, single-use instruments cost 19 times as much as a reusable instrument. But doctors have been, in my opinion, swindled in part by the plastics industry, which continues to try to tell us that single-use is better. They might say that it's better for infection, when in fact there's no data to show that single use instruments are better for infection control. So we absolutely have to approach this as a systemic problem that infiltrates every single area, every single unit, every single floor and every single aspect of healthcare delivery in the US. 

As you probably know, the US is the largest generator of plastic waste in the world and healthcare in America is the largest contributor to that plastic waste. The estimated lifespan of plastic is 450 years, so all of these things that we're using and disposing of are going to be around for generations. 

Sadly, we're starting to see more and more about the human effects of plastic and plastic waste on human health.  A study came out a couple of weeks ago, showing that of 62 placentas that were looked at under the microscope, every single placenta was full of microplastics. Now the problem is that we don't yet have all the data that we need to say why or how this is harming human health, but I can guarantee you that having our babies being born full of plastics is not going to go well for their health or for the health of humanity. 

We know that plastics have over 10,000 chemicals in them. We have studied chemicals like phthalates and bisphosphonate, and what we've found is that these chemicals are contributing to increased rates of cancer and, in my area, preterm birth, stillbirth, miscarriage and infertility. 

The time is absolutely now to stop all of this plastic waste and to look at our scope. Given that 80% of all CO2 emissions in healthcare are from the supply chain, we need to make changes in our purchasing and in our use in the operating room, on labor and delivery, so that we can be part of the solution instead of part of the problem.

Why is it so complicated to measure the waste that hospitals or clinics are having?

Yeah, I think that's such a great question, and when I first saw that question, I thought, well, is it political or social will? Obviously, we measure a lot of things in healthcare. For me, as an OBGYN, things that we measure are, for instance, our C-section rate. We measure the number of postpartum hemorrhages we have, we measure how many episiotomies we make, and we measure how many patients have high blood pressure. So the fact of the matter is that, in fact, healthcare, and especially academic healthcare, is incredibly well suited to measure all sorts of metrics by which they're going to determine reimbursement. We measure the length of stay, and we measure complications for surgery. Measuring is something that healthcare does very, very well every single day across thousands and thousands of metrics. 

The idea that we wouldn't be able to measure waste is a fallacy. We absolutely can. So why aren't we? It's due to a lack of interest and will. Some might say a lack of resources, but we're fine using complex computers and personnel to measure other streams and analytical data in healthcare. It's absolutely a fallacy that we wouldn't be able to measure waste, so the absolute answer is that it usually requires someone to care. 

There needs to be more interest and political will to do what's right for the community. It's alarming that an organization that purports to care for the community and its health does not connect the dots on how the waste they create is affecting the patients they serve.

As I mentioned, the studies showing that 85% of what goes into a red bag is not, in fact, red bag waste should be an incentive for the hospital to know that they're paying a lot more than they should for red bag waste incineration. I would not know what the cost differential is. Still, I would think that if you cared enough, you would require that your staff who work in the operating rooms and on labor and delivery pass a competency right where they have to demonstrate that they have this knowledge of what goes in the red bag and what goes in the regular trash. That still needs to be done, and yet we are passing competencies for all sorts of things daily at the hospital. Everyone who works at the hospital has to understand and go through anti-sexual harassment training and compliance training, so why not require training about how to make sure that we manage our waste effectively? 

What are some effective ways OB-GYN practices can reduce their environmental impact?

The OBGYN area is similar to all the other areas of the hospital. I saw an article about an organization called Eye Sustain, a group of concerned ophthalmologists, and they have put together many ideas on their website as to how ophthalmologists can limit their emissions in the operating room. And I have co-founded a similar type of organization OBGYNs for Sustainable Future, and what we've tried to do is post videos regarding webinars that we've had about how to decarbonize our specialty. I do think that sometimes it helps to have someone who's in your own specialty, talking about the exact names and types of instruments that could be replaced with reusable items. 

Having said that, the principle is the same: to start out and conduct an audit. If you are a surgeon, look at everything automatically opened for you before starting and determine whether all items automatically opened for you will be used. A lot of the waste in healthcare comes from opened but unused items. That's obviously inefficient and costly. So, conduct an audit on yourself, determining if everything that you are given in a surgery is necessary; then look at the items you are using in a surgery and decide whether or not those items could be replaced with reusable items. 

The problem is that no one has asked OBGYNs to consider their sustainability as part of their practice. And while my colleague Dr Malnick and I work very hard to educate our colleagues about their practices and how to make them more sustainable, the fact is, another place that change could happen is from patient demand. I feel like it's a very tricky conversation sometimes to have, but we signed up to be doctors to improve human health, and we would be remiss if we didn't ask about how our very practices of medicine in the United States are harming human health, either by contributing to more significant greenhouse gas emissions or contributing to increased plastic waste in the landfill.

What are some things that patients can pay attention to when going to the OBGYN and be aware of? 

I think it's awesome to ask your doctor to find out if this is something that they're thinking about. People can go to our website and look at some of the webinars and papers we post to help physicians and patients educate themselves. I think that the more people who are aware, the faster it will change. 

For example, I have begun conversations with my patients about these environmental effects and how they affect pregnancies. I always mention on the webinars and podcasts that pregnant women are especially vulnerable to heat due to the changes in pregnancy in the heart, the lungs, and the immune system. High temperatures increase women's risk for a preterm birth, for a low birth weight, and for stillbirth; it is also a risk factor for fetal growth. In addition, we're seeing increased salt water going into groundwater, affecting the salt concentration in the water that women are drinking. This mostly happens in coastal areas, but putting increased salt in the water that we consume increases pregnant women's risk for high blood pressure and preeclampsia. 

These things are related, and our healthcare administrators should implement strategies and policies in supply chain, procurement, and waste management that help to limit not only emissions but also the plastics we're putting into the environment.

This interview is an important reminder that the health of our planet and the care clinics and hospitals provide are intrinsically linked, urging a united front for sustainable change in the medical community.

Mika Health is committed to continuing to research and build innovative solutions to support clinics and hospitals that desire to implement cost-effective and sustainable practices and add value to care delivery. For more information about our solutions visit our website.