By Abigail Pugh
Introduction
Within the United States, 1 in 5 women report experiencing gender-based discrimination when visiting a doctor or healthcare professional with 9% of these women asserting that they have avoided seeking health care for themselves or their family due to this discrimination even in times of need.[1] In fact, women only make up around one-third of the physicians in the United States with many of these professional women reporting that they are often mistaken for other roles in the healthcare setting.[2] Gender discrimination is very real and prevalent within the healthcare system, whether a woman is the patient or the provider. Exemplifying this trend, Stephanie Atkinson, a long-standing medical professional, details her own experience in an Emergency Room in which her providers at the time didn’t believe her or make any efforts to understand her pain within an interview conducted in 2018. Atkinson goes on to describe not only the physical agony of waiting in the ER, but also the mental agony she wrestled with as she fought to receive adequate care.[3] Simply put, women just do not receive the same evidence-based care as their male counterparts, which leads to poorer outcomes in extreme cases. Sexism, defined as the prejudice, stereotyping, or discrimination, typically against women, on the basis of sex, has been structurally and systemically built into healthcare practices and many healthcare providers contribute to the continuance of gender-based stereotypes unconsciously.[4] While intentional discrimination is present, it is not the core cause of sexism within healthcare. Often, unconscious and subconscious biases affect healthcare providers to a higher degree, mostly yielding women to be perceived as less “competent” in terms of mitigating their own care and utilizing their own explanatory models to communicate pain and illness. A woman’s expression of pain is often perceived as dramatic, manipulative, or suspicious as though she must be mishandling or misinterpreting the experience of her own body, a stereotype that is exclusive of men, who continue to dominate the field of medicine. While women of all racial identities experience gender-based discrimination, such discrimination is exacerbated with the additional onset of racism that is also extremely prevalent in the healthcare systems of the United States.
History’s Role within Structural Elements of the Healthcare System
While gender is often neglected in healthcare systems, the United States healthcare system is in no way gender neutral. Within healthcare, gender functions as a key social stratifier, a factor promoting society’s categorization of its people into rankings of socioeconomic tiers, which affects the needs of health systems, individual experiences, and prognoses.[5] Within the United States, the past seven decades have witnessed a heavy increase in the desire for equitable healthcare within national health policy. This is due to hospitals becoming desegregated and women and minorities gaining access to inclusion within federally funded medical research/trials.[6] However, policy changes are not directly proportional to changes in societal perception and biases; This negative trend continues today, where women’s medical concerns and complaints are much more likely to be attributed to emotional factors, reducing the amount of patient autonomy that is present in their healthcare. A direct link between historic exclusions of women from medical research and treatment based on false assumptions can be drawn as there is a sufficient gap of knowledge that does not give healthcare professionals adequate tools to recommend care for women. This lack of medical information may push healthcare professionals and physicians to rely on sex stereotypes, or gender-based stereotypes, to make medical decisions. Exemplifying this idea is the statistic that women are more likely than men to die after experiencing a heart attack either before or within the ER. [7] Laura Huang, PhD, believes that a key explanation behind this trend lies in medical training as such training is based on the average patient being a male, 75-kilogram white patient. This failure to understand the differences in male and female biology harms everyone, but is especially detrimental to females.
Gender Discrimination As a Whole
Gender discrimination, defined as discrimination based on gender or sex, is a common civil rights violation that can exist in many forms, such as sexual harassment, pregnancy discrimination, and unequal pay, which is demonstrated in the significant pay gap between men and women. Women who have been the victims of discrimination in the past are much more reluctant to seek future health care as they may perceive it as a setting for an increased risk of discrimination. Evidence documents that for no apparent medical reason, women are not offered the same treatment as men, with many studies going further to assert that women are even less likely to receive more advanced diagnostic and therapeutic interventions.[8] Exemplifying these assertions, Lori Hinga details her own experience with ignorance of healthcare providers as she describes the ignorance of her pre existing health care condition which led to severely dilated and delayed care. Lori Hinga is just one example out of millions that document the ignorance of women’s explanatory models when utilized to convey health-related concerns and information. Explanatory models, or the culturally determined process of making sense of one’s illness, are greatly influenced by societal expectations of the sick role.[9] Therefore, it’s important to acknowledge additional pieces of a woman’s identity that may impact the discrimination they face and contributors to their explanatory processes, such as the intersection of an individual’s gender identity and racial identity.
Intersection of Race and Gender
Intersectionality refers to the interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage.[10] Intersectionality allows for the assumption to be made that all oppression and discrimination are linked. Within healthcare specifically, it’s clear that gender-based discrimination is easily exacerbated with the additional onset of racial-based discrimination. For example, black neighborhoods are 67% more likely to lack a local primary care physician in the United States. Going further, structural racism is defined as the systems, social forces, institutions, ideologies, and processes that interact with one another to generate and reinforce inequities among racial and ethnic groups.[11] Just as sexism has been structurally embedded into healthcare, racism is similarly embedded as well. Over a century ago, Congress ratified the 19th amendment, which legally asserted that women could not be denied the right to vote on the basis of their sex. The 19th amendment provided an additional significance to black women as despite the prior ratification of the 15th amendment, which promised voting rights regardless of race, they still could not vote based on their gender until the 19th amendment. The observation that it took two constitutional amendments, almost half a century apart, to legitimize voting rights for black women, demonstrates how the antagonists of racism and sexism collaborate to exacerbate challenges for women of color. Both racism and sexism have been institutionalized in ways as systems that have allowed the establishment of patterns, procedures, and policies within organizations that consistently penalizes and exploits people because of their gender, race, or both.[12] The intersection of race and gender within healthcare provides a unique synergistic form of discrimination that deeply affects women of color to a different degree than white women, whether these women are the patient or the provider. For example, while 36% of doctors identify as a woman, only 3% of doctors are black women.[13] The maternal mortality rate within the United States is the highest of any developed nation, yet it should also be noted that the mortality rate for babies born to black women with a doctorate or professional degree is higher than the rate for babies born to white women who never finished high school.
In the present, the COVID-19 pandemic has forced professionals and the world to acknowledge these health disparities as women of color are one of the highest risk groups when it comes to COVID-19.[14] Unlike most high risk groups, women of color are not at risk due to a significant proportion of preexisting conditions, but instead, due to sexism and racism working in a synergistic fashion. Dr. Roopa Dhatt, Founder and Executive Director of Women in Global Health, discusses seeing a “multiplier effect of burdens” due to the pandemic as those who are most impacted by COVID-19 are those who the health system of the United States has historically failed to protect and adequately care for.[15] In New York, black individuals are twice as likely to die from the COVID-19 virus as white people, while additionally, ⅔ of the U.S minimum-wage workers identify as females who are either being forced to exit the workforce or jeopardize their life and safety on the front lines.[16] It’s not to say that sexism itself is more intense for women of color, it’s that a synergistic interaction of sexism and racism produces a unique, high-level inequity that pushes women of color further down into areas of unfair disadvantage.
Implications
Similarly to racism, sexism is structurally and systemically built into healthcare practices and many healthcare providers contribute to the continuance of gender-based stereotypes unconsciously. Racism is often rooted in hate, but sexism is rooted in the division of power and the desire of power by various individuals. Intentional discrimination is present, but is not the core cause of sexism within healthcare. Often, unconscious and subconscious biases affect healthcare providers to a higher degree, yielding women to be perceived as less competent. Within healthcare, all individuals will experience gender-based discrimination, or sexism, of differing degrees, yet racism, or race-based discrimination, may exacerbate any discrimination faced by said women. Exemplifying this concept, Lisa McKeithan, a healthcare worker for over 25 years, relates discrimination in healthcare to being a layers as she reveals that as you look more or peel back such layers, you find more and more discrimination. Through her analogy, she is able to affirm the necessity to analyze healthcare practices through expanded perspectives in order to see the full extent of discrimination, especially when looking at gender-based limitations and biases. Women are correct in their perceptions of gender biases within healthcare as the medical standard is tailored to the male. Women do not receive the same evidence-based care as their male counterparts leading to poorer or fatal outcomes in some cases. These negative outcomes are magnified when an individual’s race is marginalized within society as well.
References
[1] “Sexism in Health Care.” MultiCare, www.multicare.org/health-equity-toolkit-sexism/.
[2] Manzoor, Fizza, and Donald A Redelmeier. “Sexism in Medical Care: ‘Nurse, Can You Get Me Another Blanket?”.” CMAJ : Canadian Medical Association Journal = Journal De L’Association Medicale Canadienne, Joule Inc., 3 Feb. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7004221/.
[3] Kameny, Maddy. “Y-0003 Interview with Stephanie Atkinson.” Southern Oral History Program, University of North Carolina Chapel Hill, 25 June 2018. Southern Oral History Program, https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/27930/rec/72. Accessed 11 Apr. 2021.
[4] “Sexism.” Merriam-Webster, Merriam-Webster, www.merriam-webster.com/dictionary/sexism.
[5] Morgan, Rosemary, et al. “Gendered Health Systems: Evidence from Low- and Middle-Income Countries.” Health Research Policy and Systems, BioMed Central, 6 July 2018, https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-018-0338-5.
[6] “Gender Discrimination.” Findlaw, www.findlaw.com/civilrights/discrimination/gender-discrimination.html.
[7] “Examining Gender Bias in Medical Care.” Cedars, www.cedars-sinai.edu/research/news/cedars-science/2019/examining-gender-bias-in-medical-care.html.
[8] Manzoor, Fizza, and Donald A Redelmeier. “Sexism in Medical Care: ‘Nurse, Can You Get Me Another Blanket?”.” CMAJ : Canadian Medical Association Journal = Journal De L’Association Medicale Canadienne, Joule Inc., 3 Feb. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7004221/.
[9] Dinos, Sokratis, et al. “Assessing Explanatory Models and Health Beliefs: An Essential but Overlooked Competency for Clinicians: BJPsych Advances.” Cambridge Core, Cambridge University Press, 2 Jan. 2018, www.cambridge.org/core/journals/bjpsych-advances/article/assessing-explanatory-models-and-health-beliefs-an-essential-but-overlooked-competency-for-clinicians/F99D9D36838A8207D377730DEB445F7B.
[10] Coaston, Jane. “The Intersectionality Wars.” Vox, Vox, 20 May 2019, www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination.
[11] Gee, Gilbert C, and Chandra L Ford. “STRUCTURAL RACISM AND HEALTH INEQUITIES: Old Issues, New Directions.” Du Bois Review : Social Science Research on Race, U.S. National Library of Medicine, Apr. 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC4306458/.
[12] “Institutional Racism in the Health Care System.” AAFP Home, www.aafp.org/about/policies/all/institutional-racism.html.
[13] Searing, Linda. “The Big Number: Women Now Outnumber Men in Medical Schools.” The Washington Post, WP Company, 23 Dec. 2019, www.washingtonpost.com/health/the-big-number-women-now-outnumber-men-in-medical-schools/2019/12/20/8b9eddea-2277-11ea-bed5-880264cc91a9_story.html.
[14] Potts, Faith O. “COVID-19 Forces Us to Confront Racism and Sexism in Healthcare.” Medium, Medium, 7 Aug. 2020, medium.com/@fpotts/covid-19-forces-us-to-confront-racism-and-sexism-in-healthcare-bf16809d518a.
[15] “COVID-19 Shines Spotlight on Race and Gender Inequities in Healthcare.” New Security Beat, www.newsecuritybeat.org/2020/05/covid-19-shines-spotlight-race-gender-inequities-healthcare/.
[16] “COVID-19 Pandemic Highlights Preexisting and Underlying American Racism and Sexism.” Feminist Majority Foundation, https://feminist.org/news/covid-19-pandemic-highlights-preexisting-and-underlying-american-racism-and-sexism/.