Hysterical
How women experience the healthcare system differently from their male counterparts
Where there is an abundance of suffering, there is also abundant room for healing. Feminists and other scholars are now investigating the areas in history when women have suffered the greatest. The pay gap is frequently discussed in political and academic circles, as well as in the media. Women’s roles in society, from mothering to domestic duties, have been undervalued, and in turn underpaid, for all of human history. But what about healthcare? A lack of funding, historical sexism, and minimal research means that physicians do not always uphold the same standard of care for their male and female patients. This is known as the health gap.
The differences between men and women have been popularly documented throughout history. “Men Are from Mars, Women Are from Venus” and “Act Like a Lady, Think Like a Man” are two popular books outlining differences between the sexes in society. Women tend to work less physically demanding jobs, like teaching or administration, while men often work more physically demanding jobs, like carpentry or construction. But examination into the differences between men and women have only recently begun in healthcare. Only as of the 1990s did it become mandatory to include females in healthcare studies. There are a variety of differences between cisgender men and cisgender women. Cis-gender refers to people who identify with the gender they were identified at birth, as opposed to someone who is transgender.
Women’s College Hospital (WCH) the only research hospital in Canada dedicated to treating and studying female patients. According to WCH research, cisgender women are more likely to suffer from heart attacks than cisgender men, but only 35% of cardiothoracic clinical study practice patients are women. This means little is know about how these different conditions like heart disease and heart attacks present differently in men and women. Female adults are also more likely to suffer from chronic conditions, and co-chronic conditions like chronic pain, diabetes, and heart disease. In fact, heart disease mortality rates have seen improvement for every group in the past few decades, except for young women. Data from the hospital also found that the amount of women age 80 and over who have two or more chronic conditions is twice as high as the number of men reporting the same.
Women are also often ignored in mental health studies. WCH found that most therapy and mental healthcare trials have been carried out on male patients, even though several mental health ailments are more prevalent in females. Between ten and 15% of women suffer with mental health ailments, with around half of new mothers developing postpartum depression.
Studies from the National Institute of Health have found that from the onset of puberty until menopause, women are twice as likely to be diagnosed with anxiety conditions as their male counterparts. Eating disorders are also more common in females than males. The National Eating Disorder Information Centre found that 3.5% of women are diagnosed with an eating disorder over their lifetime, compared to 2% of men. Mental health conditions can be caused by a variety of factors such as genetics, trauma, and living environment. While the last decade has seen global interest in mental health rise, very little is known about how the conditions present differently in male and female patients.
Historically, it was believed that women are frail and wrought with emotions. This stereotype also translated into doctors’ treatment of their female patients. When women experienced extreme emotions doctors would often diagnose them with a condition called hysteria. Doctor’s would tie this to a genetic weakness caused by an overproduction of hormones in the uterus. Studies by Harvard University show that women are more likely to report chronic pain, yet doctors often treat chronic pain in men more aggressively than in female patients. Harvard’s study found that doctors were more likely to diagnose women’s pain as psychological, and men’s as physiological. Doctors would often perform hysterectomies — procedures that remove part or all of the female reproductive system — in order to treat this. These are examples of gender-based discrimination found in healthcare. Women at the intersections face further complications in accessing doctors and medical care.
Marginalized groups of women encounter niche barriers in accessing proper care. For instance, Black women are five times more likely to die in childbirth than their white counterparts in North America. Black women in history have faced excruciating treatment at the hands of medical professionals, none more so than the experiments of one Dr. J Marion Sims. Sims conducted early gynecological experiments on enslaved Black women from the 1830s through the 1860s. These experiments were done without anesthetic because Simms believed that Black women didn’t feel pain the same way as White women. In Nazi concentration camps sterilization experiments were performed on Jewish women, with genetic experiments performed on pregnant women and their babies. Heinrich Himmler began to perform experiments on Jewish women in Auschwitz concentration camp in 1942 as part of Nazi efforts to eradicate the Jewish population. This included giving female prisoners uterine injections and exposing them to large doses of radiation without their knowledge. Many women also report having doctors who don’t have an understanding of their culture, making following doctors' orders as well as their own cultural practices difficult. For instance, Indigenous women have reported feeling conflicted with the idea of taking medication for their mental health due to the stigma it carries in their communities. The American Psychological Association found that many doctors, when faced with patients who don’t want to take antidepressants or antipsychotics, fail to refer their patients to alternative treatments like therapy or rehabilitation programs.
Social factors, employment, and citizenship status can also affect how people access healthcare. Even in countries like Canada and the U.K. where healthcare systems are tax-payer funded, it can be more difficult for people without jobs or proper housing to see a doctor. In Canada precarious employment has increased 50% in the last two decades. Studies show that living in poverty affects your quality of life and in turn your health. Poor living conditions can leave people susceptible to problems like respiratory issues, mental health conditions, and malnourishment, among other things.
There are factors that make women more likely to be poor than men, such as the pay gap. A 2016 Canadian Census found that in Canada women earn around 66 cents an hour on average compared to their male co-workers. The same census found that Indigenous women earn about 35% less than non-indigenous men in Canada, and other women of colour earn around 33% less than non-radicalized men.
In 2018, an Angus Reid study found that about 15% of Canadians are struggling economically. This means that they have difficulty paying bills, have precarious employment, and may rely on programs like social assistance and food banks. Of that 16%, 60% are women. In Canada, one in five women lives below the poverty line. More than half of women over the age of 65 and single mothers live in poverty. These women are also more often diagnosed with arthritis, substance abuse problems, heart conditions, and hypertension.
Socioeconomics also plays a role in the disadvantage women face in healthcare. For instance, according to research carried out by the World Health Organization (WHO) 311,000 women died in 2017 from cervical cancer. 85% of these women lived in underprivileged countries or societies. The same research found that around 810 women die of causes related to pregnancy and childbirth every day, or 295,000 in 2017 alone. Living in poverty poses significant challenges and health risks to men, women, and children. But, data from the Canadian Women’s Foundation shows that living below the poverty line poses specific threats to women and girls in areas like malnutrition, illness, and injuries sustained from domestic duties in unsafe living conditions like COPD and anemia.
According to UNESCO, in 2015 about 60% of girls in low-income countries finished school. Organizations like World Vision International (WVI) say that several barriers women and girls confront while living in poverty put them at a disadvantage when trying to break the poverty cycle. For instance, while 37% of girls do not finish school, every additional year of high school completed boosts a woman’s potential wages by 15–25%. They also found that in these developing countries, when a girl completes at least seven years of education she marries an average of four years later and has at least two fewer children. According to WHO, girls who become pregnant before they are finished developing face a series of additional hurdles. Pregnancy in young girls can cause both physical and mental health problems, including uterine relapse, labour complication, and postpartum depression and suicide.
The World Vision International lists education as one of the most important tools in breaking the cycle of poverty. WVI also found that women who are better educated tend to make better decisions about their futures. WHO has found that women in poverty often face barriers like domestic violence while accessing healthcare. and gender-based oppression in the home. In 2017 The United Nations reported that globally, 35% of women have experienced physical and/or sexual violence by a partner. Studies show that this results in women facing health consequences like unwanted pregnancy, injury, sexually transmitted infection, depression, and other chronic diseases like HIV/AIDS. When women do not have access to quality healthcare these complications can be life-threatening.
Women face a unique challenge when it comes to their reproductive role in most cultures. A popular topic in conversations centered around birth control is the ethics surrounding female hormonal contraceptives and the lack of a male equivalent. While “the pill” was first popular in North America in the 1960s after the invention of the first contraceptive pill Enovid. The first oral birth control, a mixture of the hormones of estrogen and progesterone, is not dissimilar to contraceptive pills used today. But why, ask many scholars, should it be up to women to prevent pregnancy? With an average gestation period of 40 weeks or ten months, a woman can only have one full-term pregnancy a year. But the average man could theoretically have sex with multiple women a day, every day, for a year, resulting in hundreds of pregnancies.
Also, many women facing reproductive health issues like endometriosis, or polycystic ovarian syndrome (PCOS), find their doctors value their ability to conceive over their physical or mental wellbeing. While conditions like PCOS and endometriosis do cause complications like infertility, they also have symptoms like chronic pain, depression, weight gain, anxiety, hair loss, etc. These symptoms play a negative role in many sufferers lives, however, doctors often attempt to preserve a patient’s fertility rather than perform a procedure like a hysterectomy or an ovariectomy (removal of one or both of the ovary) which could help with other symptoms of the disease like chronic pain and fatigue.
While medical facilities dedicated to women’s health are limited, opponents of inequalities in women’s health are not limited to Women’s College Hospital. Organizations like Endometriosis UK and Endo NZ are dedicated to creating equality for women in healthcare, with a focus on endometriosis.
On social media, creators across platforms like YouTube, Instagram, and TikTok are creating content to bring awareness to the issue. On Instagram, creators like Hiya Maia and Lara Parker work to dismantle stigmas around women’s health, infertility, and menstruation. Verkeya Speaks and Tiffany Lewis-English, two women from New York, use their social media platforms to highlight the struggles that women, particularly women of colour, face in healthcare.
While creators and activists are drawing attention to this crisis experts say there are further steps that need to be taken to change this inequity, and the future is promising. At 2019’s Women Deliver conference, Canada’s Prime Minister, Justin Trudeau, vowed to invest 1.4 billion dollars in global women’s healthcare initiatives starting in 2023. The focus is to invest in programs that focus on maternal and fetal care, sexual healthcare, reproductive medicine, and other things that directly impact women’s health. While addressing the investment, Prime Minister Justin Trudeau said “All women, no matter where they live, should have access to the safe, quality health care they need. By investing in sexual and reproductive health rights, and maternal, newborn, and child health, we can build a more just, equal, and prosperous world.”
