Gender bias in healthcare: A fatal — but preventable — condition

The UN’s Lakshmi Puri says it best: “Gender inequalities affect health outcomes and must be addressed accordingly.” 

If gender equality saves lives, then the opposite is also true. Gender inequalities can have fatal consequences, especially in healthcare. But what does that actually look like? Here are nine examples of gender bias in healthcare — and how Concern is working to undo those biases and create a healthier world for all.

It’s a phrase women are used to hearing: “You’re getting hysterical!” While now it sounds like an insult, for a long time it was a classified medical condition. A word used as far back as Ancient Greece, doctors in the 17th, 18th, and 19th centuries co-opted “hysteria” as a diagnosis. Initially, they used it for men and women. Eventually, it became almost exclusively used for women who came in with symptoms of everything from premenstrual tension (PMT) to anxiety to post-traumatic stress disorder (PTSD).

At the end of the 19th century, Parisians could buy tickets to watch the treatment of hysterics at the Salpêtrière Hospital as a form of entertainment. One of those spectators was a young Sigmund Freud, whose (faulty and biassed) research brought hysteria as a diagnosed condition into the 20th century. It was only in 1980 that the term was retired as a diagnosis. Its legacy, however, lives on. 

A 2017 Guardian article sums up the stereotype like this: “Men are silent stoics; women hysterical hypochondriacs.” 

Because women tend to go to the doctor more than men, many (including doctors) assume that they have a lower pain tolerance. The repercussions of this can be dire: Women are statistically more likely to receive inaccurate or inadequate treatment if their pain is not taken seriously. One study shows that, compared to men, women report more frequent pain, more severe levels of pain, and longer-lasting pain — but still receive comparatively inadequate pain treatment. The authors of this study attribute this to “a long history within our culture of regarding women’s reasoning capacity as limited.” 

Along with inadequate pain management, women often need more time to get an accurate diagnosis compared to men. The World Health Organisation estimates that 10% of women around the world suffer from endometriosis, a chronic illness related to menstrual cycles. According to the UK’s National Institute for Health and Care Excellence, this diagnosis takes an average 7.5 years to reach. This means that people seeking care for a monthly, chronic pain could spend an average of 90 menstrual cycles finding the right course of treatment. 

This is a common issue beyond endometriosis. One UK study examining over 18,600 people with 15 different types of cancer found that women consistently waited longer for a diagnosis after first noticing their symptoms. Women are also less likely to get adequate treatment for heart disease — or even CPR. One 2019 study shows that men can be as much as 50% more likely to survive a heart attack than women. 

In many countries, women’s legal rights are a threat to their health, particularly when it comes to reproduction. Often this has fatal consequences. The United Nations Population Fund (UNFPA) estimates that 6.5% of women around the world want to avoid pregnancy, but are unable to do so due to a lack of access, social stigma, and harmful gender norms. Among them, 172 million women are using no birth control method at all. Where data is available, the UNFPA also reports nearly 25% of all women feel unable to say no to sex with their partner. “These [circumstances] all reflect the pressure that societies place on women and girls to become mothers,” concludes the UNFPA. 

Pregnancy can be a death sentence for women and girls, often due to gender biases. An estimated 810 women die every day due to preventable causes related to their pregnancy or childbirth. Almost all of these deaths occur in low or lower middle income countries, often due to a lack of infrastructure (especially in rural and remote areas). In some cases, women are not allowed to leave the house without a man’s permission or accompaniment, which means missed opportunities for critical care.

As we’ve written before, gender-based violence is both a human rights violation and a public health crisis. Many forms of GBV have direct impacts on physical health, such as FGM and sexual assault. Survivors need — but often lack — critical resources after these attacks, such as STD screenings and psycho-social support.

The mental health impacts of GBV are also clear: Stigma surrounding sexual assault and other forms of GBV leave women reluctant to seek healthcare after an attack — even if there are specific laws against such behaviour in the country where they live. In Bangladesh, only 30% of cases were reported as of 2015, and less than 3% of survivors pursued legal action. A 2013 survey of 24 low-income countries showed that only 7% of cases went reported. Again, these gender biases can have fatal consequences. 

One of the issues underpinning many gender biases in healthcare is a lack of equity in medical research. Men’s and women’s bodies function differently from one another. Symptoms for the same condition or disease present differently depending on gender. Medications may have different side effects. 

“Much of medical science is based on the belief that male and female physiology differ only in terms of sex and reproductive organs,” says Dr. Janine Clayton, Director of the Office of Research on Women’s Health at the National Institute of Health (US). “Because of this, most research has been conducted on male animals and male cells. Because we have studied women less, we know less about them. The result is that women may not have always received the most optimal care.”

“Because we have studied women less, we know less about them,” Clayton added in a 2020 article for Duke University’s Health System. “The result is that women may not have always received the most optimal care.”

One way we could solve some of these gender inequalities is by establishing greater gender equity in the health sector. Women are predominantly on the frontlines of healthcare. However, few of them make it to leadership roles. The Organisation for Economic Co-operation and Development (OECD) reports that 75% of people working in health and social care are women. However, “women working in the health and social care sector are often in lower-paid jobs.” They represent less than half of all doctors in OECD member countries, and they often earn less than their male colleagues, even after accounting for factors like age and experience. 

In addition to being underpaid, many women also complain of gender discrimination within their own workplace. An independent investigation of the British Medical Association (the trade union for doctors and medical students in the UK) confirmed issues of “persistent undermining and undervaluing of some women doctors and staff,” along with “a corrosive and combative culture of ‘I’m right, and you’re wrong, and I know best, and you don’t know what you’re talking about.’” 

Even if these incidents happen behind the proverbial closed doors, their impacts can be felt by (and even fatal to) patients.

While women are statistically more likely to be discriminated against on the basis of their gender, not all inequalities are experienced equally. Weight bias in healthcare has become a topic of greater study in recent years. It is also more likely to affect women than men. 

Race, ethnicity, and income are also major issues that further impact gender bias in healthcare. In some countries, identities like marital status, caste, tribal affiliation, religion, sexuality, and immigration status (especially for refugees) may also make an already-discriminatory atmosphere even worse. 

Many of the studies we’ve cited on gender bias in healthcare are also limited in that they look at gender as a binary between male and female. Even in high-income countries, transgender and nonbinary people often have fewer legal protections than cisgendered people, and are more likely to face discrimination. 

A recent study of patients in the United States revealed that almost half of all trans adults in the country experienced discrimination from a healthcare professional based. Two-thirds worry that their diagnoses and treatment will be affected by this discrimination. A 2019 study revealed the lack of resources for reproductive healthcare for transgender people in South Africa. In Kenya, where homosexuality is against the law, there is also a lack of adequate resources and little support for the country’s transgender community. 

Based on decades of experience, Concern takes a gender-transformative approach to all of our areas of work. This is designed to not only correct the effects of gender bias, but to also address the causes. 

Concern has also adopted an integrated approach to healthcare, especially for maternal and child health. We believe that many factors influence the health of mothers and children, such as nutrition, hygiene and sanitation, environment, gender attitudes, access to healthcare, and culture. 

At the community level, we work with mothers (and their partners) to design solutions to the barriers they face in accessing quality, affordable healthcare. In Malawi, our innovative “Health Centre by Phone” project was integrated into the national health system. In countries like South Sudan and Chad, we have established a network of mobile health clinics providing health services to remote areas. 

In Bangladesh, Burundi, Niger, Kenya, Rwanda, Haiti, and Sierra Leone, our Child Survival programmes (funded by USAID) helped millions of mothers and young children over the past 20 years. Our research in these programmess contributed to life-saving advancements in community health, particularly related to gender equality.