'Living with Pain: Gender Inequality in Healthcare' - Ellie Owen

'Living with Pain: Gender Inequality in Healthcare' - Ellie Owen

Navigating healthcare provision as a person of a marginalised gender can be a stressful and sometimes degrading experience. This can manifest itself in a number of ways across intersections of class, race, gender identity, sexual orientation and age, among others. This article will focus on the experience of cisgender women in accessing reproductive healthcare.

This is a topical issue with the recent overturning of Roe vs Wade in America, in addition to the ninety million women of reproductive age worldwide who are unable to access an abortion. These rights are even under threat in the UK: in July 2022, the British government removed its commitment to abortion and sexual health rights from a statement on gender equality. Abortion is only partially decriminalised in mainland UK and two women are currently facing life imprisonment in England for illegal abortions. In Northern Ireland, although abortion was decriminalised in October 2019, the service is still heavily restricted and difficult to access. The pushback against Labour MP Stella Creasy’s amendment to protect abortion in the Bill of Rights further demonstrates that these rights are not unconditionally protected, with the potential for further erosion as the NHS is increasingly privatised.

For those who go through with a pregnancy, risks of serious complications persist and each day, 830 women across the globe lose their lives to complications in pregnancy and childbirth. Individual experiences of childbirth are affected heavily by socioeconomic factors across the globe: 94% of these deaths occur in low and lower-middle income countries. In 2017 the maternal mortality rate ranged from 11 per 100,000 live births in high income countries to 462 in low-income countries. In the US, African American women are 243% more likely to die from pregnancy and childbirth-related issues. In the UK, women in prison are five times more likely to have a stillbirth and twice as likely to give birth to a premature baby needing special care. Access to safe childbirth should not be restricted for women in the developing world, or according to race and class, but this is systematically the case across the globe.

Similarly, women should be able to choose not to become mothers at all, but women who seek permanent sterilisation often face years-long delays while being dismissed and patronised. Guidelines for procedures such as endometrial ablation and hysterectomies generally require the patient to be over 21 years old, be declared mentally sound, be informed of all the risks and outcomes of the surgery, rational requirements for a permanent procedure of this nature. However, under a provision known as medical paternalism, healthcare practitioners can overrule a patient’s wishes, even when they have reached these thresholds. In some cases, these refusals are based upon a societal expectation that women should both be and want to be mothers.

In others, women seek such surgeries to relieve symptoms of PMS (premenstrual syndrome) or endometriosis, a process which is equally difficult as doctors continue to disbelieve women’s pain and symptoms. Endometriosis is a long-term condition wherein the uterine lining grows outside of the uterus, with effects ranging from debilitating pain during menstruation to issues with infertility. It is a condition which affects one in ten women of reproductive age, but it is poorly treated and understood. It takes an average of eight years to diagnose in the UK and ten years in the US. This problem is rooted in systematic dismissal of women’s pain existing for decades, with studies finding that while men who reported pain tended to receive pain medication, women were more likely to receive sedatives or antidepressants. For endometriosis patients, 49.5% were misdiagnosed with a mental health condition and 42% were told by healthcare professionals that their symptoms were normal, before being correctly diagnosed.

Simultaneously, women are consistently under-represented in medical drug trials, and the effect of the menstrual cycle on medication prescribed to women has been woefully under-researched, although it has been found to affect antipsychotics, antihistamines, and antibiotic treatments as well as heart medication. The lack of representation of women on medical boards reduces the chances of drug trials targeting women’s issues getting funding and approval. In 2013, a trial led by Dr Richard Legro discovered that sildenafil citrate, more commonly known as Viagra, could provide near total relief from period pain across four consecutive hours. However, when he applied to the National Institute of Health in America twice for a more extensive study, he was rejected, twice. The basis for this rejection was that dysmenorrhea, or period pain, something suffered by 90% of women, as not a public health priority. Moreover, this potential treatment for dysmenorrhea may have been found much sooner, had the original trials of sildenafil citrate in the early 1990s not been tested on an all-male test group. Who knows how many treatments have been dismissed because they had no effect on the exclusively or predominantly male cells on which they were tested?

While medical professionals do amazing work every day around the globe, there are systematic issues which are undermining women’s autonomy and endangering their health. Moving forward, it is imperative that women are better represented both on medical boards who approve drug trials to treat women’s issues as well as in the trials themselves. Women deserve to be listened to and taken seriously when they describe their pain and their reproductive choices. These changes must take place as an integral part of the move towards a gender equality.

[Ellie Owen is a second year Historian at Merton College.]