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Today marks International Women's Day, a global day which celebrates the achievements of women from all walks of life. One of the key missions of today is to empower women to take charge of their health and make informed decisions regarding their well-being.
As a woman, I often find myself in situations where I have to speak louder to be heard or mould myself to be more palatable to garner the same respect as my male counterparts. Although many of us have learnt how to navigate through a male-dominated world, gender bias remains a pervasive issue, with statistics revealing an alarming 90% of global gender bias against women, perpetuating discrimination across various contexts.
Concerningly, the healthcare sector is one such place.
While women have equal access to GP surgeries, doctors, and hospitals, this does not automatically ensure an equivalent standard of care compared to men. Throughout generations, women have faced healthcare challenges due to deep-seated historical gender inequalities in medical research and practice, which have excluded women in the production of medical knowledge. Despite progress, a lingering patriarchal influence frames healthcare as being “made by men for men”, influencing the training doctors receive and centring on the male body as the standard ‘human body’, relegating female bodies to reproductive parts.
My own experiences with the healthcare system, combined with being a psychology student, have sparked my interest in delving deeper into the mental health repercussions of the gender health gap for women.
Invisibility of Women in research
Discrepancies within healthcare start with clinical research.
Women are often excluded from preclinical and clinical trials due to the layer of complexity that hormonal fluctuations experienced during menstruation, pregnancy and menopause add, making research more time-consuming and costly. Such exclusion brings into question the generalisability of research findings to women, leading to an inequitable and unequal healthcare landscape due to the neglect of female physiology, preventing optimal treatment and posing risk.
The underrepresentation of women in clinical research has produced mounting evidence demonstrating the profound effects of hormonal fluctuations on drug treatments. Due to hormonal differences and body composition, the way males and females metabolize drugs differs significantly, leading to potential toxicity when women are prescribed the same dosages as men. A study analysing United States Food and Drug Administration (FDA)-approved medications found a disparity in dosing for 86 medications, one of which was a sleep medicine called Ambien which showed higher blood concentration levels and prolonged elimination times in women, contributing to increased road traffic accidents the morning after consumption. Higher doses of drugs can induce more side effects, affecting the psychological well-being and overall behaviour of women.
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The research gap in understanding disorders
Moreover, research has predominantly focused on a male-centric perspective, creating a significant gap in understanding symptom manifestations in females. This bias in studying disorders has resulted in a shortage of literature documenting female experiences, contributing to healthcare professionals frequently attributing symptoms to anxiety or stress. This, in turn, leads to delayed diagnoses, or misdiagnoses across a spectrum of over 700 disorders.
This issue is particularly prevalent in autism spectrum disorder (ASD). Traditional stereotypes of autism are rooted in male presentation, resulting in a biased perspective that associates specific behaviours with the condition, often diverging from societal expectations of femininity. As a consequence, diagnostic criteria are primarily based on observations and research of male presentations, contributing to an alarming 80% misdiagnosis rate in females at age 18. This high misdiagnosis rate is exacerbated by a lack of clinician awareness regarding the unique presentation of autism in females. Autistic traits in women often manifest as internalizing behaviours, such as withdrawal, diverting doctors’ attention to treating perceived social anxiety rather than recognising the underlying autism.
In the absence of research guiding clinical practice, women find themselves compelled to engage in discussions about their symptoms with doctors rather than receiving the support they need.
My personal encounters with healthcare professionals have heightened my awareness of systemic issues within the healthcare system. Numerous visits to the GP clinic left me feeling unheard and dismissed. Instances like being told knee pain was merely growing pains when, in reality, physiotherapy and knee surgery were viable options, or having typhoid brushed off as the flu, leading to hospitalization in a foreign country, and enduring excruciating period cramps- all underscored the overarching issue of my voice not being taken seriously. This struggle is not unique to me; it’s a shared experience faced by 4 out of 5 women in the UK and many others worldwide.
One disorder where women are particularly overlooked in healthcare is called endometriosis, a condition that affects 1 in 10 woman globally. This disorder induces severe pain, as tissue resembling the uterus lining, grows in areas such as the abdomen, ovaries, bladder and bowel.
Endometriosis develops during early adolescence and progresses into adulthood, and is often dismissively labelled as mere 'women's troubles,' perpetuated by the normalization of menstrual pain within healthcare. Due to this outdated notion that has persisted through generations, endometriosis demonstrates an average delay of 8 years between the onset of symptoms and diagnosis for women in the UK. This delay leads to women accepting the belief that the discomfort they experience is an inevitable aspect of ‘being a woman’; a phrase I’ve often heard when seeking clarity about the normalcy of the pain and its impact on my daily life.
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Despite possessing extensive knowledge about the potential causes of pain, many women, including myself, face dismissal by doctors—a widespread issue. Women often find themselves not just educating themselves through extensive Google searches but also burdened with the responsibility of informing the supposed "experts." Instead of receiving a thorough examination, we risk being misinterpreted as hypochondriacal or perceived as overly emotional, hysterical, or dramatic. While self-diagnosis may seem a viable option, the persistent dismissal by doctors can discourage women from developing hormonal health literacy. This cycle of suffering has profound implications, including increased concern, feelings of worry and anxiety, relationship difficulties, reduced quality of life, financial strain due to time off work, and consequently lower socioeconomic status compared to men.
Addressing the suppression of women's voices in healthcare requires a fundamental shift in clinical research practices. The inclusion of more women in trials is essential to accurately inform clinical practice and eliminate the need for women to plead, argue, or resort to legal action for their health concerns. The healthcare system must recognize women's bodies as equal to male bodies in their own right, moving beyond reducing them solely to reproductive parts. It's time for a comprehensive re-evaluation to ensure equitable representation, understanding, and care for women's health globally.