Two Sides of the Same Coin - Addressing the Root Cause of Barriers for Women in Healthcare. - By Pia Wahi-Singh
The apparent contradiction in the question is that barriers for women doctors and barriers for women achieving good health are separate issues. They are in fact two sides of the same coin - that of systemic gender inequality. It is impossible to adequately address one barrier without also addressing the other.
Despite best efforts, gender inequality has proved persistent. In fact, the 2023 United Nations Gender Social Norms Index revealed no improvement in global biases against women in a decade1. Why is it so difficult to create change? The culprit is the system that women are navigating - a system almost exclusively created in a "masculine, heteronormative view of the world2." As Caroline Criado Perez states in her book Invisible Women: Exposing Data Bias in a World Designed for Men3, healthcare is
"systemically discriminating against women, leaving them chronically misunderstood, mistreated, and misdiagnosed."
Ample evidence shows the systemic nature of the issue. Scientific study designs commonly assume that findings from males apply to females4. Many animal studies include only males, with male single-sex animal studies outnumbering those of females 5.5 to 14. Clinical trials historically underrecruited women, despite widespread evidence of sex differences in human disease4. The ill-effects of the masculine-favouring default are clear. One example is the "Yentl syndrome" which describes the underdiagnosis of ischemic heart disease (IHD) in women because of "atypical" presentation different from the common presentation in males5. In women under 50, mortality from IHD is two times higher than in age-matched men5. An example of the effect of systemic barriers for women professionals is in the "leaky pipeline" of career progression for women. In the US, 51% of doctor educators are women, but only 20% climb the career ladder to become professors6. Clearly such large numbers cannot be failing to progress due to a lack of merit. The unequal system has been described as a "glass obstacle course" of unseen barriers affecting women7. Another example of systemic bias can be understood from a comparison to urban planning of metros. With scarce exception, most city transportation emphasizes efficiency and affordability while not addressing gendered ramifications of the design8. Planning decisions including dim lighting in less trafficked areas inadvertently creates areas where women commuters are more vulnerable to sexual assault and harrassment8,9. In
clinical environments, unacceptable levels of sexual violence exist (reported by The Working Party on Sexual Misconduct in Surgery10 and the BMA's Sexism in Medicine
Report11) and may signify similar systemic failures to account for and address the unique situations women professionals might face, thus leaving them vulnerable to this misconduct. Clearly, healthcare is not adequately accommodating for the unique needs of women. And women on both sides of the healthcare system - patients and professionals - are facing the consequences.
To create lasting change, it is important to reprogram the system. Initiatives that focus on women and their own behaviour without also addressing the system are inherently
bound to fail or only partially succeed. Tackling only barriers for women doctors or only barriers for women patients is falling back into the trap of framing the woman as the "problem" to be aided. How can a woman doctor truly be without barriers if her woman patients are not? Similarly, how can women patients access equal healthcare if there are not women doctors to advocate for their point of view? Empowered and educated women patients can better advocate for their own health. Loud and insistent patient voices hold significant weight in healthcare policy creation. This is already being seen from the nearly 100,000 patient responses to the English government's 2021 "Women’s Health – Let’s Talk About It" survey, which resulted in the development of the first-ever English government Women's Health Strategy12. On the doctor side, women doctors in leadership positions bring their perspective to further support women employees and patients, resulting in a positive feedback loop.
The MWF is uniquely positioned to create powerful impact with its ethos as the largest body of women doctors in the UK. MWF is already active in the myriad facets of gender
inequality in healthcare. Examples include championing less than full time training and working for doctors, endorsing the Hatfield vision for the unique health needs of women, and supporting the MESSAGE initiative to integrate sex and gender considerations into research. Future work could encourage even more collaboration from multidisciplinary stakeholders including patient advocates, government officials, medical students, and doctors of all stages of training. The possibilities are endless - from government petitions, to informative webinars for patients and doctors, to mentorship schemes. The MWF has set itself an ambitious mission worth fighting for. As the Lancet editorial "Feminism is for Everybody" passionately declares, "gender equity is not only a matter of justice and rights, it is crucial for producing the best research and providing the best care to patients13".
References:
1. A Decade of Stagnation: New UNDP data shows gender biases remain entrenched. United Nations Development Programme. June 2023. https://hdr.undp.org/content/decade-stagnation-new-undp-data-shows-genderbiases-remain-entrenched
2. Coe IR, Wiley R, Bekker L-G. Organisational best practices towards gender equality in science and medicine. Lancet. 2019;393(10171):587-593. doi:10.1016/S0140-6736(18)33188-X
3. Criado-Perez C. Invisible Women : Exposing Data Bias in a World Designed for Men. London: Chatto & Windus; 2019. Print.
4. Beery AK, Zucker I. Sex bias in neuroscience and biomedical research. Neurosci Biobehav Rev. 2011;35(3):565-572. doi:https://doi.org/10.1016/j.neubiorev.2010.07.002
5. Merz CNB. The Yentl syndrome is alive and well. Eur Heart J. 2011;32(11):1313-1315. doi:10.1093/eurheartj/ehr083
6. James-McCarthy K, Brooks-McCarthy A, Walker D-M. Stemming the ‘Leaky Pipeline’: an investigation of the relationship between work–family conflict and women’s career progression in academic medicine. BMJ Lead. 2022;6(2):110 LP- 117. doi:10.1136/leader-2020-000436
7. Welde K De, Laursen S. The glass obstacle course: Informal and formal barriers for women Ph. D. students in STEM fields. Int J Gender, Sci Technol. 2011;3:571-595. http://genderandset.open.ac.uk/index.php/genderandset/article/viewArticle/205.
8. Priya Uteng T. Chapter Two - Gender gaps in urban mobility and transport planning. In: Pereira RHM, Boisjoly GBT-A in TP and P, eds. Social Issues in Transport Planning. Vol 8. Academic Press; 2021:33-69. doi:https://doi.org/10.1016/bs.atpp.2021.07.004
9. Buckley R. The shocking ways data bias makes women “irrelevant,” and what we can do to stop it. Entrepreneur. April 2022. https://www.entrepreneur.com/leadership/the-shocking-ways-data-bias-makeswomen-irrelevant-and/421800
10. Begeny CT, Arshad H, Cuming T, et al. Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living
different realities: observational study using NHS population-derived weights. Br J Surg. 2023;110(11):1518-1526. doi:10.1093/bjs/znad242
11. Sexism in medicine Report. BMA. August 2022. https://www.bma.org.uk/adviceand-support/equality-and-diversity-guidance/gender-equality-in-medicine/sexismin-medicine-report.
12. Results of the ‘Women’s Health – Let’s talk about it’ survey. Department of Health and Social Care. April 2022. https://www.gov.uk/government/calls-forevidence/womens-health-strategy-call-for-evidence/outcome/results-of-thewomens-health-lets-talk-about-it-survey.
13. Feminism is for everybody. Lancet. 2019;393(10171):493. doi:10.1016/S0140-6736(19)30239-9