Access to healthcare remains one of the most critical social determinants of health in modern society. Despite tremendous advances in medical science and technology, the ability to receive quality, timely healthcare services varies dramatically across populations. These disparities not only reflect broader social inequities but also perpetuate cycles of disadvantage that affect individual health outcomes and community wellbeing. Knowing these disparities exist within healthcare, my group and I researched the multifaceted barriers that prevent equitable healthcare access across diverse populations within the North Carolina area. To bring lived experience into this analysis, we incorporated oral histories from the Southern Oral History Program, including testimonies from healthcare workers like Stephanie Atkinson and patients such as Sabra Jane Hammond, whose narratives shed light on the human impact of systemic failures. These personal accounts add essential depth to the data, illustrating how barriers to care play out in real people’s lives. Within this broader framework, my specific focus will be on gender disparities in healthcare access. Despite progress in many areas of gender equality, significant gaps persist in how healthcare systems respond to and serve people of different genders. These disparities manifest in various ways, including differences in diagnostic approaches, treatment options, pain management, research representation, and provider responsiveness to symptoms.
Diagnosing Inequality: How Gender Shapes Medical Treatment and Outcomes
Gender-based healthcare disparities often reflect deeper societal biases and structural inequalities. Women frequently face longer wait times for diagnoses, particularly for conditions that present differently than in men. They are more likely to have their pain dismissed or under-treated, and historically have been underrepresented in clinical research, creating gaps in medical knowledge. Additionally, transgender and non-binary individuals encounter unique challenges in accessing affirming, competent healthcare that recognizes their specific needs. By examining these gender-based disparities in healthcare access, we can better understand how social constructs and systemic biases influence health outcomes and work toward developing a more equitable healthcare system that serves everyone effectively.
Medical research has long treated men as the default recipients of treatments, resulting in clinical protocols that fail to account for sex-specific physiology and pharmacology. It’s been proven that sex differences in pharmacokinetics (the bodies reaction to pharmaceutically administered medication) can influence drug safety and success, yet female animals and cells are still underrepresented in preclinical research (Galea et al. pg. 574). These omissions mean that critical care algorithms that have been developed and validated are primarily tailored to male cohorts and aren’t applicable to women. For example, women experiencing indications of a heart attack frequently present with atypical symptoms such as nausea, back pain, or fatigue instead of the “classic” chest-pressure symptom. When emergency departments adhere to criteria derived from predominantly male data, women endure what’s known as longer door-to-needle times (time passed from hospital arrival to drug administration) and as a result suffer higher morbidity rates.
Inclusive Care: Reforming Healthcare for Gender-Diverse Populations
Addressing these gaps requires comprehensive solutions that target both research methods and clinical practice. In terms of research methodology, mandating sex-balanced study cohorts represents a critical first step toward ensuring that medical knowledge accurately reflects biological differences between sexes. As stated before, many clinical trials continue to overrepresent male subjects, leading to treatments and dosage recommendations that may not be optimized for female physiology. By requiring appropriate gender representation in research, we can develop more effective treatments for all patients. One significant clinical practice that requires transformation is the intake and assessment process in healthcare settings. Current standard intake forms and assessment protocols typically operate within a binary gender framework that fails to capture the diversity of gender identities and specific health needs of transgender and non-binary individuals. Revising these foundational clinical tools would create a more inclusive healthcare environment. An improved approach would include intake forms that allow patients to specify their gender identity, pronouns, and anatomical inventory separate from legal documentation, ensuring appropriate screenings regardless of gender markers. Such changes would not only improve the healthcare experience for gender-diverse individuals but would also enhance the quality of care through more accurate and complete patient information, ultimately leading to better health outcomes for all gender identities.
Intersecting Barriers: The Compounded Challenges of Race, Language, and Immigration Status Alongside Gender
Gender disparities do not exist in isolation but intersect with race, income, language, and geography to create compounded barriers. The European Institute for Gender Equality reports that “women with disabilities, ethnic minority women, and migrant women face particularly high hurdles in accessing healthcare services” (EIGE 102). In North Carolina’s remote counties, low-income Latina women confront linguistic challenges, fear of immigration enforcement, and lack of reliable transportation that together discourage utilization of prenatal and primary care. Sabra Jane Hammond describes how, “out of an engrained systemic fear of healthcare systems, undocumented patients fear even entering the emergency room when they need serious care due to their past experiences/generalized presumptions of how medical institutions will treat them if they are undocumented” (0:33:24.5–0:34:27.4). These delays contribute to elevated rates of preterm birth, low birth weight, and maternal morbidity outcomes that could be mitigated by policies ensuring prenatal coverage regardless of immigration status. To address these intersecting barriers, North Carolina should implement inclusive healthcare policies that guarantee prenatal and primary care access regardless of immigration status, while expanding community based services with multilingual staff.
Obstetric Racism and Bodily Autonomy: Violations in Black Maternal Healthcare
Cultural and historical mistrust also deepens gendered disparities. As Stephanie Atkinson observes, “the most critical contributions to this mistrust are historical exploitation and structural racism, specifically highlighting the lack of trust in the CDC institution regarding vaccines and drugs” (0:42:12.0–0:43:27.1). This skepticism can lead women, especially older Black women to forgo preventive services or delay treatment, worsening chronic disease outcomes and maternal health. The violation of Black women’s autonomy during childbirth remains a pressing concern. Research indicates that Black women are significantly more likely than white women to experience non consensual medical procedures during labor, such as the administration of epidurals without explicit consent. This disparity reflects a profound disregard for their bodily autonomy and decision-making capacity. A comprehensive review by the Maternal Health Task Force concluded that the dismissal of Black women’s explicit refusal of epidural anesthesia represents a particularly egregious form of obstetric racism that has contributed directly to preventable maternal deaths . Such dismissals, whether based on gender or race, exacerbate acute suffering and erode long-term trust in the healthcare system, which directly undermines Black women’s access to healthcare by discouraging engagement with medical providers and deterring the use of essential services. To change this negative trajectory in modern medicine we should utilize culturally competent outreach programs in order to rebuild trust by directly engaging with marginalized communities to provide clear accessible information about medical services, making healthcare accessibility not a privilege but a right.
Conclusion
By centering both biological sex and gendered social realities in research, policy, and practice and by amplifying the very words of those most affected, North Carolina can move toward a healthcare system in which every person receives timely, respectful, and effective care. The gender disparities documented in this analysis are not inevitable but reflect systemic choices that can be addressed through comprehensive reform. Women’s healthcare needs must be recognized not as deviations from a male norm but as equally valid requirements deserving of equitable research, resources, and respect. Only through such transformative change can we fulfill the promise of healthcare as a universal right.
Works Cited
European Institute for Gender Equality (EIGE). Gender and Intersecting Inequalities in Access to Health. Gender Equality Index 2021 Report, 2021, https://eige.europa.eu/publications-resources/toolkits-guides/gender-equality-index-2021-report/gender-and-intersecting-inequalities-access-health?language_content_entity=en.
Galea, Sandro, et al. “Sex as a Biological Variable in Emergency Medicine Research and Clinical Practice: A Brief Narrative Review.” Western Journal of Emergency Medicine, vol. 23, no. 4, 2022, pp. 574–581. PMC, doi:10.5811/westjem.2022.3.55835.
“Gender Bias in Healthcare.” Medical News Today, MediLexicon International, https://www.medicalnewstoday.com/articles/gender-bias-in-healthcare.
McLemore, Monica R. “Black Women’s Autonomy in Childbirth.” Journal of Perinatal & Neonatal Nursing, vol. 37, no. 1, 2023, pp. 6–9. PMC, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9914526/.
Southern Oral History Program. The Southern Oral History Program Collection, University of North Carolina at Chapel Hill, https://sohp.org. Accessed 2025.