By Ellie Henry
Gender inequality is visible in every facet of society. It is most obvious in cases of wage gaps or employment discrimination, but it is also present in the more subtle aspects of life, such as political representation and access to quality medical care. Throughout this semester we have explored the Southern Oral History Program’s interview database- specifically a collection titled “Stories to Save Lives: Health, Illness, and Medical Care in the South.” This project details the life experiences of over one hundred willing interviewees, each of whom has a unique perspective on the American healthcare system and the quality of medical treatment they have received. I chose to analyze these interviews through the lens of gender; more specifically, how gender influences the provider-patient relationship. I focused on the narratives of female patients as well as gynecological and women’s reproductive-health physicians, and I conducted additional research to further explore how gender biases impact modern medical practices. Ultimately, I believe that gender-related disparities in healthcare and medical treatment reflect the prevalence of sexism in American society.
Women have been the recipients of inadequate medical care for centuries. Since the earliest days of medicine, women have been considered inferior to men. In his “On the Generation of Animals” essay, Aristotle wrote that females are mutilated versions of males. Up until the mid-20th century, women were regarded as medical experiment subjects, and not as patients deserving of quality care. There existed a clear lack of knowledge about female health, so the affliction of “hysteria” became one of the most diagnosed disorders: used to explain away any symptoms or behavior that could not be explained by male doctors. The institution of medicine was not built to treat women, so female patients were dismissed as overdramatic and encouraged to swallow their pain. Rather than address the obvious gaps in scientific research about women’s health, medical communities rationalized their sexist treatments by branding women as bodies built for reproduction and made problematic by hysterical tendencies.
In Abby Norman’s Ask Me About My Uterus, Norman describes her quest to receive adequate treatment for her endometriosis through years of inadequate diagnoses and physician ambivalence to her pain. Norman too believes that historical power dynamics surrounding primarily female illnesses contributed to her prolonged suffering. She reflects on the centuries of medical practice based on the assumption that women are fragile and less intelligent than men, writing that:
“Even before it had a name, the concept of what hysteria would become was integral to how women were perceived: they were emotionally labile to a pathological degree” (Norman, 111).
Norman’s plights are not unique, and there is consistent evidence that genuine ailments are labeled as ‘women’s troubles’, and female patients are not treated with the respect or care that they deserve. Women are diagnosed as hysterical before they are diagnosed with a disease, and this inadequate care is directly linked to the institutional sexism in medical professions and the cultural stereotypes branded on a woman’s pain.
Dr. George Cosmos, a Stories to Save Lives interviewee, suggests that historically female patients were not viewed as capable of making informed decisions about their bodies. When hysterical women were deemed unable to effectively choose their own medical treatments, male physicians took matters into their own hands. Dr. Cosmos is a retired OBGYN who practiced in Warren County, North Carolina after graduating from Howard University Medical School. In his interview he recounts the chaotic state of reproductive healthcare in Warren County upon his initial arrival, and he describes numerous interactions with female patients who were unaware that they had been sterilized by male physicians:
“Early on, something that would disturb me quite a bit, the fact that I would talk to so many ladies who’d give me a history of never having any surgery at all, none. And I would examine them and I’d say, ‘Gosh, you said you didn’t have any surgery, but, you know, you do not have a uterus.’ And you question them, question them, question them, and they’d say, ‘Oh, when I had my last baby, the doctor told me that I was having babies too fast, so he would help me.’ This is what they knew. You see, at that point in time, they would have surgeries done without consent. Ladies would deliver a baby and they are put to sleep, so they really don’t know what’s going on. It would be a couple days afterwards they see the baby when they go back. And, of course, you know that North Carolina settled in the eugenics program, and that is all part of it. But there were quite a few people who did not know that they were involved in that program, and I saw quite a few of those people. They did not know, because they would swear that they never had any surgery. That’s something that used to disturb me quite a bit initially, that they did not know that they’d been sterilized” (Cosmo, 43:38 – 45:23).
There is no shortage of horror stories involving the medical mistreatment of female patients. Throughout history, many physicians publicly framed their research as beneficial to the medical community- ‘necessary’ sacrifices in the name of scientific advancement. Take the ‘father of modern gynecology’ James Marion Sims, for example: a physician in 1840s Alabama who conducted reproductive health research on enslaved black women. In pursuit of knowledge of the female sex organs, Sims invented various surgical tools intended to deconstruct and repair vaginas, and he pioneered a technique he claimed could reverse the 19th century childbirth complication of vesicovaginal fistula. He regarded the bodies of his female subjects as property, and he refused to give them pain medication or assist in any postoperative treatment. This physician’s actions are morally reprehensible, but in 1876 he was named president of the American Medical Association and in 1880 he became president of the American Gynecological Society. He founded numerous organizations dedicated to researching women’s health issues, and to this day his scientific findings are revered as key building blocks of modern medicine.
Physicians like Sims constructed medical institutions without empathy for the healthcare needs of women- institutions still in existence today! Gender bias in healthcare has recently been shoved under the national spotlight, with many women speaking up about their experiences with “medical gaslighting.” The prevalence of this “gaslighting” in modern medicine is both disappointing and dangerous. hen women are dismissed by health care workers, they are less likely to return for continued medical treatment. This is especially dangerous when women are pregnant, because it jeopardizes the health of both the mother and the unborn child. Before 2013, North Carolina reported reproductive health statistics indicative of both a lack of healthcare services for women and an unwillingness of women to advocate for their health.
In response to this, North Carolina allocated funding to improve its review of maternal deaths through the Association of Maternal and Child Health Programs (AMCHP), an initiative intended to address maternal health and actively participate in the Centers for Disease Control (CDC) national maternal mortality report. Since its opening, the AMCHP has radically shifted the direction of North Carolina’s female health care. Of the 46 states with available data, North Carolina currently ranks 30th for highest maternal mortality (at a rate of 18.6 deaths per 100,000 births). Additionally, North Carolina is ranked 44th for neonatal mortality, 43rd for low birthweight, and 36th for preterm births. Beyond pregnancy-related wellness, North Carolina has also drastically improved its preventative healthcare statistics for women. Women in North Carolina receive screening tests and routine checkups at a consistently higher rate than the national averages- a healthcare shift largely attributable to women-centered health organizations.
Of the interviews I listened to this semester, there were two that resonated with me most. The first was with a woman named Stephanie Atkinson, a nurse who discussed her experiences treating and observing young women. She reflected on times she watched women receive inadequate care, but her understanding of the gender gap in medicine was not rooted in blaming sexist practices on behalf of the provider. Instead, she commented:
“Women, I feel like everybody is more important than they are, so it’s more important to take care of their mates or their children or their parents or their aunts, uncles. Whoever it is, they’ll find somebody that’s more important than they are” (Atkinson, 23:40-24:50).
Atkinson believes that differences in treatment of male and female patients is, at least in part, because women are conditioned from a young age to care for others at the expense of their own wellbeing. Atkinson’s perspective on gender bias in medicine is undoubtedly a motivator for nation-wide efforts being made to promote equality in healthcare. She is one of many people who noticed the disparity in treatment, and her belief that socialized sexism influences medical practices is widely held.
Another woman motivated to increase female wellness in her community is Nellene Richardson. Richardson is a recovered addict who dedicated her life to supporting women with addictions by founding recovery houses and actively helping in their treatment. Her story is incredibly touching, and throughout her interview she repeatedly affirms that she is motivated by her love for the families living in her recovery houses and her belief that anyone can overcome addiction if they have a strong support system. Richardson continues:
“I’d say it’s like the butterfly syndrome. You watch a caterpillar come, and then you watch them bloom, then you watch them fly away, and that’s the syndrome I love the most about helping women. They come in, they’re broken, they’re scared, they been on drugs, they been abused. You know, with drugs come a whole lot of different areas and avenues. You help them to cope with the past because they’ve survived it, and help them build strength from their past” (Richardson, 30:29-32:03).
American and North Carolinian healthcare have made significant strides in becoming more accessible and treating all patients equally. Viewing patient-provider relationships through the lens of gender reveals flaws in a medical system created by and for men, but it is important that we recognize and address these flaws. Understanding the history behind institutionalized sexism in the medical field provides us with the knowledge we need to promote lasting change. There is always more work to be done, and it is important that members of the medical community continue to strive for providing the best possible care to all patients.
2020 women’s Health report card. (2020, July 20). https://www.med.unc.edu/cwhr/whrc/.
Cameron, K. A., Song, J., Manheim, L. M., & Dunlop, D. D. (2010, September). Gender disparities in health and healthcare use among older adults. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2965695/.
Exploring gender bias in healthcare. (2019, September 16). https://www.fiercehealthcare.com/sponsored/exploring-gender-bias-healthcare#:~:text=Gender%20bias%20creates%20dangers%20in,is%20seen%20across%20many%20specialties.
Female hysteria: The history of a controversial ‘condition’. (n.d.). https://www.medicalnewstoday.com/articles/the-controversy-of-female-hysteria#Vibrators-for-hysteria.
Newsome, M., Newsome, M., Joel Harder (2021, January 29). Tackling maternal mortality disparities. https://www.northcarolinahealthnews.org/2020/05/26/congresswoman-tackles-maternal-mortality-disparities/.
Parmar, Arundhati (2019, September 3). Exploring gender bias in healthcare. https://medcitynews.com/?sponsored_content=exploring-gender-bias-in-healthcare&rf=1.
The female problem: How male bias in medical trials ruined women’s health. (2019, November 13). https://www.theguardian.com/lifeandstyle/2019/nov/13/the-female-problem-male-bias-in-medical-trials.
Ungar, L., & Simon, C. (n.d.). Which states have the worst maternal mortality? https://www.usatoday.com/list/news/investigations/maternal-mortality-by-state/7b6a2a48-0b79-40c2-a44d-8111879a8336/.
Weaver , G. (n.d.). Sexism and racism in the American health care industry: A comparative analysis. https://pubmed.ncbi.nlm.nih.gov/730414/.