Three key issues facing women’s healthcare – and three ways to help

In honor of National Women’s Health Day this September, we hope to shed light on a pressing issue that affects the well-being of women across the globe: gender-based disparities in healthcare. Women face persistent obstacles when it comes to the quality of healthcare they receive. One such barrier exists in the failures of the medical system to rigorously study the effects of diseases and drugs on women or to fund studies on women’s health conditions. Biases can also occur at the point of care and affect how well doctors listen to women or how severe women’s symptoms are perceived to be. Taken together, such oversights result in unnecessary sickness, disability, and death among individuals assigned female at birth.

This post will discuss three of the top problems contributing to gender-based inequalities in health care and propose three actionable steps you can take to help address them. 

3 key issues plague women’s healthcare

Several crucial issues stand out as disproportionately contributing to the gender-based disparities in healthcare. These include: 

1. Male research bias 

There are two main ways that healthcare research is biased against women. First, health conditions that uniquely affect the female anatomy, including many reproductive disorders, have long suffered from inadequate research funding, both in the United States and abroad. Even a condition as common as endometriosis, which affects up to ten percent of people assigned female at birth and can cause chronic pelvic pain and infertility, remains woefully understudied. Without research interest and funding, fewer treatments and cures for these disorders can be identified. 

Second, even the research which has been conducted on common medical conditions and treatments has largely excluded women. In fact, it was only in 1993—less than 20 years ago–that the FDA lifted its 1977 ban on the participation of women of childbearing potential in early clinical trials. While the restriction was active, countless research studies using primarily men were conducted on conditions that also affect millions of women. Even today, women constitute just thirty-three percent of participants in clinical trials for cardiovascular diseases, and a 2014 study likewise found that four in ten neuroscience studies used exclusively male animals. 

2. Underdiagnosis of common (and deadly) diseases

In part due to the historical exclusion of women from important medical research, many common diseases that affect the general population are underdiagnosed in women.  Researchers at Johns Hopkins University School of Medicine found that emergency room doctors misdiagnosed stroke more often in women and people of color than in white men. Specifically, women suffering from strokes were one-third more likely to receive incorrect initial diagnoses. These findings were corroborated in a 2019 study, which found that women were ten percent less likely to be correctly diagnosed with minor strokes compared to men, even after controlling for so-called “atypical” symptoms. This is especially dangerous given that women–and particularly Black women–actually face a higher risk of stroke than men.   

Just as concerning, researchers discovered that, compared to men, women face a seven-fold risk of being incorrectly diagnosed and discharged from the hospital while experiencing heart attacks. In fact, less than one-quarter of primary care physicians–and under one-half of cardiologists–reported feeling well-equipped to diagnose women with cardiovascular disorders. These shocking statistics reflect the work that remains to be done within the medical and scientific professions before deeply ingrained health disparities are reversed.  

3. Disbelief and undertreatment of women’s pain 

It is perhaps a familiar anecdote among women that their pain is discounted by health care providers. In one case from 2018 that rattled France, a local emergency operator mocked a young woman describing her pain, telling her, “You’ll definitely die one day, like everyone else.” The young woman ultimately died from a stroke and multiple organ failure after waiting five hours for transportation to a hospital.

As it turns out, studies have confirmed this dangerous phenomenon. A 2008 study from the University of Pennsylvania demonstrated that, in emergency departments, women were up to 25 percent less likely to receive opioid pain medication than men and waited over 30 percent longer to receive it. This finding held even after researchers controlled for the severity of pain patients self-reported. Another study confirmed that healthcare providers prescribe less pain medication after surgery to women than men. 

(Note: The overprescription of opioid pain medications has generated a devastating overdose epidemic. This article does not advocate the use of opioids. However, the prescription of opioids in the above study served as a proxy for how acute a doctor believed a patient’s pain to be, and it showed that the severity of women’s pain was often undervalued.) 

This perilous pattern traces back centuries to when “hysteria” was first used as a catch-all diagnosis for women, for everything from shortness of breath to loss of appetite. Hysteria remained an officially recognized psychiatric disorder until 1980, and its history casts a long shadow on women’s health up to the present day. Women’s symptoms, compared to men’s, are still more often assumed to be psychosomatic–that is, caused by stress or anxiety–rather than rooted in a physical cause. And this cycle produces detrimental effects on both the way providers deliver care to women and on how women themselves seek out care. Notably, a 2015 study showed that women with symptoms of a heart attack avoided seeking care for fear of being labeled hypochondriacs. 

Help address gender-based healthcare disparities

By keeping these biases at the forefront of our minds, we–as patients, caregivers, and clinicians–can help mitigate the health care disparities women face today. Here are three practical steps you can take:

•  Know your rights as a patient. You are entitled to make your own decisions about whether a particular treatment or intervention is right for you and to consent to or refuse treatment accordingly. You also have the right to ask your doctors questions and to consult second opinions. Don’t forget: If you do not feel you are being given the proper standard of care, you should feel free to change providers. 
• Be insistent about your (or your loved one’s) care. Know your risk factors–including the risk of misdiagnosis–and be sure to communicate these to your provider. Consider bringing a friend or family member along with you to your appointments; that person can help you remember what was discussed and advocate on your behalf if needed. Stand up for yourself if you believe that you are experiencing a health emergency. You know your body better than anyone else.  
• Take women’s pain at face value. If you are in a position of caring for female patients, take a moment to stop and really listen to what your patient is saying. Make sure to pay attention to both verbal and nonverbal cues. Perform due diligence in assessing your patient, and resist the urge to discount physical health complaints before completing your differential diagnosis. Last, remember to consider atypical presentations of common illnesses. 

Women have faced centuries of bias from the medical profession, and regrettably, this trend has continued to the present day. However, empowered with concrete statistics on exactly how damaging health care disparities are to women around the world, you can help turn the tide and fight for a more inclusive, equal healthcare system. 

For additional resources, check out the following:

• Chen, E. H., Shofer, F. S., Dean, A. J., Hollander, J. E., Baxt, W. G., Robey, J. 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. doi:10.1111/j.1553-2712.2008.00100.x
• The mounting crisis in Women’s heart health. The Mounting Crisis in Women’s Heart Health | Columbia University Department of Surgery. (n.d.). https://columbiasurgery.org/news/mounting-crisis-women-s-heart-health. 
• ER doctors commonly miss more strokes among women, minorities, and younger patients (2014). Johns Hopkins Medicine, based in Baltimore, Maryland. (n.d.). https://www.hopkinsmedicine.org/news/media/releases/er_doctors_commonly_miss_more_strokes_among_women_minorities_and_younger_patients. 
• Hoffmann, D. E., & Tarzian, A. J. (2003). The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain. SSRN Electronic Journal. doi:10.2139/ssrn.383803
• Kiesel, L. (2017, October 9). Women and pain: Disparities in experience and treatment. Harvard Health. https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562#:~:text=These%20gender%20biases%20in%20our,of%20having%20a%20heart%20attack.
• Lichtman, J. H., Leifheit-Limson, E. C., Watanabe, E., Allen, N. B., Garavalia, B., Garavalia, L. S., … Curry, L. A. (2015). Symptom Recognition and Healthcare Experiences of Young Women With Acute Myocardial Infarction. Circulation: Cardiovascular Quality and Outcomes, 8(2_suppl_1). doi:10.1161/circoutcomes.114.001612
• Nature Publishing Group. (2021, August 4). It’s time to expand the definition of ‘women’s health’. Nature News. https://www.nature.com/articles/d41586-021-02085-6. 
• Newman-Toker, D. E., Moy, E., Valente, E., Coffey, R., & Hines, A. L. (2014). Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample. Diagnosis, 1(2), 155–166. doi:10.1515/dx-2013-0038
• Yu, A. Y. X., Penn, A. M., Lesperance, M. L., Croteau, N. S., Balshaw, R. F., … Votova, K. (2019). Sex Differences in Presentation and Outcome After an Acute Transient or Minor Neurologic Event. JAMA Neurology, 76(8), 962. doi:10.1001/jamaneurol.2019.1305