Gender Bias in Medicine & its Impact on Women's Healthcare
Medicine seems like a field that is made for everyone, regardless of their sexuality, race or gender. Sadly, this is not entirely true, as contemporary medicine is a discipline with a way to go to reach equality.
In recent years, more work has been done to eradicate inequality, especially within the realms of gender. The research explored in this article has found that medicine is an area riddled with gender bias and unfair access to medical treatment for women. Let’s take a look at what gender bias is and why it is so important to eliminate it in medicine.
What is gender bias (in medicine)?
Gender bias is something we encounter daily. According to Medical News Today, gender bias is ‘a preference for one gender over another’. Gender bias against women means that they are overlooked due to prejudices and stereotypes.
Here, it is also important to explain the difference between gender and sex. A study by the Food and Drug Administration (FDA) described gender as ‘rooted in biology and shaped by environment and experience’ and sex as ‘the classification of living things, generally as male or female according to their reproductive organs’.
Sex is based on biological characteristics such as reproductive organs, hormones and chromosomes. Gender, on the other hand, is the word used to describe how you feel inside. It is the way you carry yourself, influenced by societal and cultural norms often based on sex.
For example, a typical gender stereotype, that influences gender bias, is that women are caring and empathetic while men are ambitious and driven, although we know that all of these qualities can be attributed to both men and women.
Of course, gender stereotypes heavily influence the way we are perceived in society; they impacts things like recruitment procedures and education. In medicine, however, gender bias is incredibly dangerous because it often leads to unequal and unfit treatment of women. Let’s now explore why gender bias developed in a discipline seemingly made for everyone.
How did gender bias in medicine develop?
Gender bias in Western medicine has always existed and there is one clear reason for this: the patriarchy. Until 1990, when the US National Institute of Health issued guidelines around clinical trials, women did not have to be included. Therefore, up until 1990, every medical diagnosis and recommended treatment was based on the Caucasian, male body.
This is undoubtedly problematic as women’s bodies are biologically different. For example, women’s hormones are different to men’s hormones. This leads to a different interaction with substances and therefore different side effects and success rates. However, even once this was determined, the world of medicine used these differences as an excuse to exclude women, in particular pregnant women, from clinical trials once again.
At first sight, the exclusion of pregnant women for the sake of their health and safety seems completely valid. However, it led to women shying away from medical trials where there was insufficient access to birth control. Women’s non-participation in medical trials is often due to the systemic lack of access to contraception.
All of this combined leads to an underrepresentation of female bodies in medicine which can have serious implications. We will now look at exactly how gender bias affects women’s health.
How does gender bias affect women and their health?
Gender bias in medicine can actually be life-threatening. For example, a research article published in 2008 by Katarina Hamberg, a professor at Umeå University in Sweden, revealed that women are not offered the same medical treatment as men. This is because of something the BBC calls pain bias. It is often assumed that women are quicker to complain about pain than men, meaning that doctors might dismiss their health concerns. Moreover, studies have proven that women have a higher pain sensitivity, leading to medical professionals not taking their pain seriously enough. Sadly, this leads to women suffering more chronic pain due to untreated conditions.
"Gender bias in medicine can be life-threatening."
Another shocking result of gender bias is that, up until recently, it was not known that women experience different heart attack symptoms to men. While they sometimes also have the same defining symptom of chest pain or discomfort, they are much more likely to exhibit seemingly less severe symptoms such as shortness of breath, dizziness and nausea. These symptoms are often overlooked because of their perceived harmlessness. However, overlooking them can prove fatal. As with pain bias, it has been found that women’s experiences are often downplayed in the medical field on the basis of gender stereotypes. It therefore shouldn’t come as a surprise that heart attacks are the most common cause of death in women.
It must be mentioned that professionals in the field of medicine are making big efforts to abolish the concept of gender bias in medicine. A lot of research is currently happening around gender bias and how it can be eradicated.
How do we eliminate gender bias in medicine?
Nowadays, women must be included in clinical trials. Since 1994, trials also require analyses of outcomes based on sex. Nonetheless, many studies still do not include the exact division of sex, i.e. male to female distribution. If we want to thoroughly evaluate if a treatment is adequate for women, this must change.
Many treatment recommendations are still based on outdated research which fail to take sex into consideration. These recommendations need to be reworked to overcome gender bias. Here, it is important to mention that the terms ‘gender’ and ‘sex’ are often used interchangeably in the scientific community (the difference between the two was explained earlier in this article). Some trials ask the participants for their gender, others for their sex. Scientifically speaking, medication given should be dependent on the biological characteristics of a person to ensure that the illness is effectively treated and to anticipate how the medication will interact with the person’s body. Nevertheless, it is important to work towards a future where transgender people can feel fully represented in medicine and trials: a future in which the distinction between sex and gender is clear to all.
The FDA also has many ongoing projects to prevent gender bias. For example, the Critical Path Initiative aims to modernise drug development through the technological use of biomarkers that estimate safety or likely outcomes. It has also published an Action Plan to Enhance the Collection and Availability of Demographic Subgroup Data, which is comprised of 27 action items with three main priorities:
1. Quality - to improve collection, reporting, and analysis of subgroup data
2. Participation - to identify barriers to enrolment for members of subgroups and implement programs to encourage enrolment
3. Transparency – to make data by demographic subgroup more available
Lastly, we must ensure that women are aware of said clinical trials and that they are included in their elaboration. Research has shown that women are less likely to be aware of clinical trials because they are not included in the discourse and/or not approached to participate in them.
Additionally, women’s personal circumstances are usually not considered in the planning of clinical trials. Women are sometimes not able to participate in trials because of childcare responsibilities. If they cannot find adequate childcare, they are unable to participate in trials. Therefore, the organisation of trials needs to drastically change to accommodate this. Flexible clinic opening hours to fit around the busy day of a modern, working woman might also improve female participation.
Gender bias in medicine is an incredibly important topic to talk and educate about. It is something that affects everyone, since the health of women is fundamental to the functioning of our society. Women are an essential part of our social system. Therefore, women’s health is society’s health.
For more resources on this topic, head to our dedicated Gender Issues & Feminism section.