Women face discrimination on a variety of fronts in health today ranging from the battle to include contraceptives in basic health plans, to biases inherent in the male-dominated medical establishment. This has created an atmosphere of growing resentment that has spawned a campaign toward a better understanding of the critical issues women face when making medical choices. Identifying and drawing attention to the problem areas is the first step to overcoming gender bias in medicine. Sexism in research, insurance, diagnosis, and treatment has created a situation where women make uninformed decisions, receive inferior care, and in some instances endure downright neglect.
One of the most difficult and troubling examples of sexism is in medical research. Women are often excluded from participating in research into new drugs, medical treatments, and new surgical techniques. There is a widespread practice in the medical community of using exclusively male subjects in the study of disease. The raw data garnered from these studies are then “interpreted” to include women. Using males as experimental subject not only ignores the fact that females may respond differently to the drugs and mechanisms tested, but may ironically lead to less accurate models even in the male. One glaring example of this can be found in the study of heart disease. Physicians consider research into heart disease as primarily addressing men; it is considered applicable to older women only. This is despite the fact that the incidence of heart disease has steadily increased among women since at least the 1950s.
Research has also provided one of the most frightening instances of the total disregard by the medical establishment of women’s unique vulnerabilities while pregnant. From the early 1940s till 1971, obstetricians prescribed the drug known as diethylstilbestrol (DES) to pregnant women who were suspected of being prone to miscarriages. Some women, who took the drug experimentally, were not told the truth about what they were taking and were instead told that they were taking a vitamin. DES is now known to be a carcinogen and has left a time-bomb legacy in the daughters and, in some cases, sons of DES mothers. Their daughters suffer vaginal and cervical cancer at a rate far in excess of the rest of the female population in their age range. Worse still, there may be no way to tell how many more will develop cancer later in life.
Research, however, has also given us a glimmer of hope with one of the most positive and visible examples of the changes women are instituting in medical research. Women have been primarily responsible for the increase in funding for research relating to breast cancer. Until recently breast cancer research received less funding and study than AIDS, despite the fact that breast cancer kills twice as many people. In the early 1990s women pushed for a national policy shift that culminated in congressional mandates to increase funding for breast cancer research by 40% annually.
Women’s efforts have impacted other areas characterized by blatant sexism. When the removal of mammography screenings from Medicare coverage was threatened in 1989, women successfully lobbied Congress to prevent this action. The importance of providing adequate coverage for breast cancer screenings has led to 39 states requiring at least some form of third-party coverage for mammography screenings at some level.
Medical institutions and practices are not the only areas where discrimination has impacted women’s health. Insurance companies have bitterly contested and fought the inclusion of prescription contraceptives and related medical visits and exams in their basic health care packages. As a result, women are sometimes denied vital and basic health access and coverage, which seriously compromises and endangers their health. Half of all fee-for-service health plans do not cover any contraceptive methods at all, and only a third cover oral contraceptives. Of the five leading Food and Drug Administration (FDA)-approved reversible contraceptives, only 39% of health maintenance organizations (HMOs) cover all five. This discrimination has been recognized by the U.S. Equal Employment Opportunity Commission that issued a ruling in its December 2000 findings that the exclusion of the costs of prescription contraceptives from health care packages (while at the same time covering vasectomies and Viagra prescriptions) amounted to discrimination based on sex.
When diagnosing women, doctors (primarily men) many times fail to thoroughly examine female patients and often disregard important and useful information that female patients provide to them. Women constantly have to fight against the assumption that their ailments are “all in their head.” Male doctors frequently tend to dismiss women’s complaints as psychosomatic, but there is a deeper reason for this than is readily apparent. This is because so little direct research is done focusing on women and how to best treat the ailments that afflict them. Frequently, women with symptoms similar to those of men are taken less seriously; the women’s examinations are less extensive than a comparatively performed exam on a male. In addition, women may not be provided with information on how to best diagnose and treat the symptoms.
These shortcomings can be contrasted with the overdiagnosis and overtreatment of women as obstetrical and as gynecological patients. In this setting, women undergo humiliating and often unnecessary exams and procedures. Pelvic exams, in particular, are a major source of anxiety among women of all ages. One major problem in properly diagnosing women is that women many times have very little direct knowledge of their own bodies and as a result completely defer their judgment to their doctor. This can have terrible repercussions on their personal health choices because medicine has the potential to become an institution of dogmatic social control. An example of this can be found in obstetricians-gynecologists who are official and legitimate experts in the female reproductive tract. Some of these doctors have broadened their influence beyond the scope of their training and experience and now advise women on the female sex role, psychology, and sexuality, notwithstanding a lack of expertise in these fields and their tendency to interpret their findings from a primarily male point of view.
Treatment is perhaps the domain in which women endure the most harsh and terrible form of discrimination. One of the most commonly recommended breast
cancer treatments is the removal of the entire affected breast (a mastectomy) despite the fact that over 90% of women may be eligible to receive lumpectomies instead. As a result, many women needlessly undergo the more radical treatment when a viable alternative is often readily available. Often, a male physician does not understand the psychological and emotional impact of the loss of such a vital part of a woman’s body and, consequently, may provide no assistance in dealing with the trauma that is associated with the loss.
Similar issues arise with respect to two other surgical procedures: hysterectomy and removal of the ovaries. The frequency with which hysterectomies are performed may be due to gynecologists’ perception of the uterus as an expendable organ, useless for purposes other than childbearing. Ironically, one of the reasons given for performing a hysterectomy at a gathering of the American College of Obstetricians and Gynecologists was that it reduced the frequency of unpleasant, humiliating pelvic exams and tests. This underscores a complete lack of understanding and empathy on the part of the medical community toward women. It is very difficult to imagine any group of doctors ever recommending the removal of a male’s reproductive system simply to save him the humiliation of having to cough twice for his doctor. As stunning as all of these revelations about sexism in medicine are, it should be noted that the problems and issues confronted here address only a small fraction of the problems that women face in the health care industry today as patients and consumers.
It is critical that women inform themselves about their own bodies, and their treatment options and fight against the traditional sex-role learning, which encourages women to be passive and dependent on male doctors. As a nation we need to push the insurers to fairly cover women. While this may sound simple, implementing it will not be due to the general lack of information or understanding in the greater medical community and the reluctance of insurance companies to provide adequate affordable care to women. There is hope that these issues will be addressed more thoroughly because an increasing number of women are choosing a career in medicine. We must ensure that discrimination in women’s health becomes the subject of discussion among historians, and not debate among legislators.
SEE ALSO: Affirmative action, Birth control, Pelvic examination, Sexual harassment, United States Civil Rights Act of 1964
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