International Women’s Day 2022 #BreakTheBias

Happy International Woman’s Day! For those of you who may be new here, the two things I talk about are sewing and female healthcare. The theme for IWD 2022 is #BreakTheBias. This theme encourages us to consider the myriad ways in which women experience bias and to challenge those biases. As is probably obvious from my overarching theme this month, I want to talk about bias in female healthcare.

It’s fitting that we are talking about gender bias in healthcare in Endometriosis Awareness Month. Endometriosis affects an estimated 176 million women worldwide, approximately 1 in 10 women or those observed female at birth. Despite its high prevalence, Endometriosis is massively under-researched and under-funded. A significant reason for this lack of attention is the normalisation of extreme female pain and the stigma that still persists around the discussion of menstrual health (As-Sanie et al. 2019)

Social stigma towards menstruation causes women to feel like their pain is something to be borne quietly and something that everyone suffers from. A 2012 study showed that the stigma attached to discussing menstrual issues caused women to delay seeking help for up to 2.5 years(Hudelist et al. 2012). One study investigating public perceptions of endometriosis in both male and female populations found that women with endometriosis were more likely to discuss their condition with their physician than women without the condition, leading to a lack of awareness in the wider female population (Shah et al. 2010). 

When women do seek treatment, the response from their physician can still be skewed by gender. While men with chronic pain are often described by physicians as ‘brave’ or ‘stoic’, women are more likely to be described as ‘emotional’ or ‘hysterical’ (Samulowitz et al. 2018). In addition, 74% of Endometriosis patients have received at least one false diagnosis and the social normalisation of dysmenorrhea was shown to dramatically increase diagnosis time (Hudelist et al. 2012). 

It’s sad to say that female pain is treated differently even when its nothing to do with gynaecology. Despite exhibiting the same pain scores, women are less likely to receive opioid analgesia (opioid painkillers) in A&E across both gender and non-gender specific diagnoses. Women also have to wait longer to receive painkillers in these situations(Chen et al, 2008). Furthermore, when presenting with chest pains, men are 2.5 times more likely to be referred to a cardiologist than women despite presenting similar symptoms and pain scores(Clerc-Liaudat et al. 2018). Women have a lower chance of receiving emergency  CPR from a stranger and women are 22% less likely to survive hospital admission for cardiac arrest – men have a 55% chance of survival whereas women only have a 37% chance (Macdonald, 2019).

So what can we do to improve the situation for women?

  1. We break the cycle of menstrual shame and go to our doctors straight away when something isn’t right.
  2. When other women tell us their experiences we can listen openly and accept that our own experience isn’t universal.
  3. We can complain loudly if something isn’t right. If you’ve had a bad A&E experience, complain to your hospital trust. Don’t let them get away with providing sub-standard biased care.

Together we can fight for systemic reform. Together we can break the bias.

References:

As-Sanie, S. Black, R. Giudice, L.C. Valbrun, T.G. Gupta, J. Jones, B. Laufer, M.R. Milspaw, A.T. Missmer, S.A. Norman, A. Taylor, R.N. Wallace, K. Williams, Z. Yong, P.J. Nebel, R.A. (2019)

Assessing research gaps and unmet needs in endometriosis. American Journal of Obstetrics and Gynecology. [221:2] 86-94.

Chen, E.H. Shofer, F.S. Dean, A.J. Hollander, J.E. Baxt, W.G. Robey, J.L. Sease, K.L. Mills, A.M. (2008) Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal Pain. Academic Emergency Medicine [15:5] 414-418.

Clerc-Liaudat, C.C. Vaucher, P. De Francesco, T. Jaunin-Stalder, N. Herzig, L. Verdon, F. Favrat, B. Locatelli, I. Clair, C. (2018) Sex/gender bias in the management of chest pain in ambulatory care. Women’s Health [14] 1-9.

Hudelist, G. Fritzer, N. Thomas, A. Niehues, C. Oppelt, P. Haas, D. Tammaa, A. Salzer, H. (2012) Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Human Reproduction. [27:12] 3412–3416.

McDonald, A. (2019) ‘Women less likely to receive bystander CPR than men, research shows’ British Heart Foundation Website. 22nd May. Available from: https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2019/may/women-less-likely-to-receive-bystander-cpr-than-men-research-shows

Samulowitz, A. Gremyr, I. Eriksson, E. Hensing, G. (2018) “Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Research and Management. 1-14.

Shah, D.K., Moravek, M.B., Vahratian, A., Dalton, V.K., Lebovic, D.I. (2010) Public perceptions of endometriosis: perspectives from both genders. Acta Obstetricia et Gynecologica Scandinavica. [89:5] 646-650 

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