I set out to find out whether women receive inadequate healthcare, if so why, and what can be done about it? This project is largely focusing on implicit gender bias, defined here as: “[gender] bias that results from the tendency to process information based on unconscious associations and feelings, even when these are contrary to one’s conscious or declared beliefs” (Dictionary.com). While I am only focusing on the United States I hope this encourages people worldwide to think critically about the issue of bias in healthcare. Here I take a look at the past as an explanation for the treatment or lack thereof that women receive today and present tangible solutions moving forward that would advance the quality of care that women and many others receive.
The principles of bioethics help us understand implicit bias in healthcare; here are the main four principles: justice – treating everyone alike, beneficence – to promote well – being, autonomy – the right to self determination, maleficence – to avoid doing harm. Implicit bias means that decisions were made based on assumptions or underlying beliefs which violates the principle of justice. Medical professionals are the ones with training in diagnosis and treatment and, therefore, have a responsibility to the patient to provide them with all available options so they can make an informed decision. However, implicit bias can lead to the exclusion of options taking away a patient’s right to autonomy. In order to promote well – being and avoid doing harm medical professionals must take all facts into account rather than jumping to conclusions based on assumptions.
For centuries women’s pain has been largely neglected and undertreated by the healthcare system. It comes down to one main idea: women have been historically declared as hysterical, crazy or overly emotional and thus their pain is now viewed as less credible. As stated in Abby Norman’s Ask Me About My Uterus: A Quest to Make Doctors Believe in Women’s Pain “if women have become synonymous with hysteria, malingering and hypochondria in a clinical setting, then it has far less to do with the natural inclinations of women and behavior than it does with the history of medicine” The history of medicine includes everything from ancient rituals to eliminate menstruation to gynecology experiments on slaves. One of the dangers of this complicated history is that it creates a knowledge gap and a trust gap between the doctor and the patient that reinforce each other and can harm women in a number of ways. Knowledge gap meaning “the average doctor does not know as much as women’s bodies and the health problems that afflict them” (Dusenbery, 11) and conditions that disproportionately affect women have often not been deemed worth for research funding and time. Trust gap meaning “women’s accounts of their symptoms are too often not believed…for centuries, Western medicine tended to throw many of women’s inexplicable symptoms into the catchall diagnosis category of hysteria” (Dusenbery, 11). The trust gap and knowledge gap are tightly interwoven:
“Are women’s complaints so often dismissed because doctors simply don’t know enough about women’s bodies, their symptoms, and the diseases that disproportionately affect them? Or are the women’s complaints so often dismissed because doctors hold an unconscious stereotype that women are unreliable reporters of their symptoms? Is it a lack of knowledge or a lack of trust? It seems to be both…women’s symptoms are not taken seriously because medicine doesn’t know as much about their bodies and health problems. And medicine doesn’t know as much about their bodies and health problems because it doesn’t take their symptoms seriously.”
Maya Dusenbery, Doing Harm: The Truth about How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick
In the 1980’s there was a wakeup call. The Society of the Advancement of Women’s Health Research reviewed all NIH-funded studies, and found that ⅕ didn’t mention the gender of the study subjects, and ⅓ claimed to include women but failed to specify how many. This led to legislation mandating the inclusion of women in research sponsored by NIH in 1993.
Without a mandate, women were almost completely excluded from clinical studies. In 1977, an FDA policy forbade women of “childbearing potential from participating in early-phase drug trials” (Dusenbery, 26). This policy was met with harsh criticism for implying that women couldn’t be trusted to know their risk of unintended pregnancy and take steps to prevent it. Furthermore, it presents a double standard: men of reproductive age could also be exposed to drugs that harm the genetic material they contribute to their future offspring.
Currently, the FDA doesn’t require that drugs are approved for pregnant women, and most are not, even though 90% of pregnant women take some medication during pregnancy and 70% take a prescription drug, according to the CDC. For example, women with depression are often urged to go off their antidepressants which leads to a risk of relapse, but untreated depression during pregnancy is linked to premature birth, low birth weight, and other conditions. Because of the lack of research on the effects of antidepressants either choice you make could prove to be dangerous to you and the baby.
Since then, numerous studies have been done to further understand the role gender bias plays in the treatment women recieve. One particularly troublesome study from 2001 indicated that women are more likely to be given sedatives while men are more like to be given pain medication, this suggests that women are treated less aggressively in their initial encounters until they “prove” that they are as sick as other male patients (Hoffman and Tarzian). Giving women sedatives instead of pain medications goes directly against the principle of justice stating to treat everyone alike.
I hope this project makes you think critically about any bias you may have and what you can do about it. While all women deal with inadequate health care because of gender bias in the healthcare system, women of color, transgender women, immigrants and low-income women are more likely to suffer from deadly consequences. This is a problem that needs to be solved and together we can make a difference.
Wondering what can be done about it? I encourage you to take the implicit bias test to see where you fall: Implicit Bias Test . I have also listed some steps below to help overcome your own bias. Progress will only be made if we address both personal and institutional bias.
- The hardest part is recognition that you have some form of bias, everyone does
- Please remember that it’s a process that doesn’t happen overnight.
- Look into all the facts, not just the ones that fit the narrative you have created
- Commit to improving inclusivity in everyday life whether that be in the jokes you make, the people you hire or the body language you project.
- Put yourself in someone else’s shoes; understand where they are coming from
- Interact with people who have various backgrounds and experiences
- Get comfortable with being uncomfortable; in order to have hard conversations you have to first accept that they won’t always sit inside your comfort zone
- Learn and understand the words necessary to hard conversations i.e the difference between prejudice and discrimination
- Listen, like truly listen to what others have to say, as much as you hate to believe it, you are not always right.
- Lastly and most importantly: Don’t stay silent. It won’t go away on its own if you just ignore it. Overcoming bias is a constant and necessary fight.
View my full bibliography here: Gender Bias in Healthcare Bibliography
Please leave any thoughts you have in the Padlet listed below. Thank you for reading, I look forward to any feedback you have.