E&M’s Francesca Monticelli on how the healthcare system is not exempt from the reach of the patriarchy.
The current mode of healthcare is patriarchal. Often a one-size-fits-all approach is adopted, but as one-size is based on men automatically women are at a disadvantage. Despite there being evidence to support this case there is a lack of focus on re-transforming the system. From a public health perspective we know that good health is preserved by the social determinants of health like socioeconomic status and education. These are determined by the society that we live in. As we live in a patriarchal society, gender bias is institutionalised by the healthcare system.
I find it paradoxical to demonise biomedical research and the healthcare system but it’s hard for me to ignore the fact that women are losing out. Medical treatment unfortunately doesn’t exist in a vacuum to the rest of society so it isn’t impermeable to gender bias and racism, even when drugs are made to save lives. The gender bias issue in the healthcare system disproportionately affects BAME and trans-women, but in the scope of this article this won’t be evaluated. We live in a society where female pain is often misdiagnosed. A society where the conversation about women’s health is often dominated by a woman’s capability to reproduce, while other health aspects are often dismissed. This happens most frequently in medical diagnoses of gynaecological conditions. We distrust our pain receptors and blame our hormones on what we’re feeling because of the history of belittling female pain and blaming it on hysteria and other psychological disorders associated with women.
When it comes to conditions like endometriosis, pain and other symptoms are overlooked or understudied because the primary focus is fertility. There is an attitude in society that as long as you, as a woman, can reproduce, then you’re fine. We are pressured to suffer in silence, because the pain we feel has been sold to us as merely a ‘little’ discomfort. I think if men got UTIs as often as women did, by now, there would be a cure. Or at least more effective treatment than Cystopurin.
Whilst the gender-bias is more prominent in the treatment of gynecological conditions it is perpetuated in other areas of health research as well as in medical interventions and treatment. Research shows that adherence to treatment differs between men and women and women are more likely to have an adverse reaction to a drug than men. The one-size-fits-all approach, to a certain extent, can be attributed to budget limitations, however gender-based treatment has overarching benefits, including economic ones in the long run. Yet drugs aren’t being tested adequately on women as women tend not to participate in clinical trials. This is even greater cause for concern because groundbreaking treatment is being tailored to men. Also common drugs, like aspirin, work differently in men and women. Women participation in clinical trials, however, is only part of the problem. Biomedical research happens in academic institutions predominantly governed by men so there is a distinct shortcoming when it comes to observing gender as a determinant of good health. If men are setting the health research agenda, women will never be prioritised.
I think if men got UTIs as often as women did, by now, there would be a cure. Or at least more effective treatment than Cystopurin.
There is also a huge disparity between how the healthcare system treats women and their child at the time of birth. Whilst women fit the role of ‘baby-making machines’, during pregnancy, the healthcare system is fully equipped to provide extensive support, offering regular check ups. Statistically, it has never been safer to give birth in a wealthy country (with the odd exception of America). But once the baby pops out the support women are offered from the healthcare system dramatically decreases. There is no evidence that postpartum depression rates are dropping, yet support hasn’t ramped up.
Over 90% of women experience tears to their pelvic floor muscles after giving birth, sometimes this is severe to the point where faecal incontinence is a possibility. How can this be labelled as an inconvenience? This is a stark reminder that women, even when the symptoms are visible, need to justify their pain. As a society we’re not doing enough to dismantle the pretty, but fake, picture that women are miraculously on top-form again after having a baby. There is a rhetoric that women have had children forever therefore it’s about survival over well-being.
2018 saw the start of a shift in conversation in women’s health. Celebrities like Serena Williams discussing frankly about their hardships as mothers is a good start. But it shouldn’t be up to them to promote the conversation. We should be giving the women around us more of a platform to discuss their pain. Just the other day research was published showing that if a woman is having multiple miscarriages then the sperm should also be tested. It is ludicrous that women tend to be solely blamed for miscarriages, when it clearly takes two to tango. The best we can do is to try and make 2019 the year women’s health is adequately prioritised.