How a Lack of Data and Patriarchal Attitudes Intersect to Undermine Women’s Health Care
And what can be done about it
Welcome back Chaise Lounge readers and an especially warm welcome to our newest subscribers! This week we will dive into the many reasons why women’s health is in need of attention, STAT! We will take a look at why we are where we are and make suggestions for changes going forward. In the meantime, let’s take a look at some other news around the world with a focus on South Korea.
Global News - Spotlight on South Korea
The feminist movement is asserting itself in South Korea and is facing strong backlash on a number of fronts including the government. It appears that men in South Korea are ready to quash any semblance of feminism by arresting women who dare to step out of their assigned cultural role of chief cook and bottle washer. According to Kwak Geum-joo, a professor of psychology at Seoul National University regarding the gender wars enveloping South Korea,
“It began as the voice of a small group of young men but it is now growing and snowballing with gender issues and division in society. These issues existed in the past of course but it is worsening, causing gender wars over something trivial and the vicious cycle continues,” Kwak said.
Last month, over 12000 women marched in solidarity around the issue of prosecuting those who share spycam upskirt photos and revenge porn. While these types of photos have been shared for years by men, it was not until a female model shared a nude photo of a male model that the police took any action. While her behavior was also out of bounds, women were incensed that hers is the only prosecution in years.
Comedian, Park Na-rae, offended men in South Korea when she used a male doll to imitate masturbation as part of her comedy routine. The backlash was so strong that she has stepped away from her show on YouTube. The South Korean police are investigating her for sexual harassment. Her supporters claim a double standard because sexual harassment and men bragging about sexual conquests are daily events in Korean culture.
A bizarre movement of Korean anti-feminists has created a stir around advertisements that they believe show images that belittle men’s penises. One advertisement promoting collaboration between an online fashion store, Musinsa, and the Hyundai credit card shows a hand in a pinching motion reaching for the card, much the way one would naturally. The company’s website says, “There has been no other intention than to promote the event behind the making of the image.”
National News
Despite the fact that the practice is illegal, many mortgage lenders are denying loans to couples or single women when the woman is on maternity leave, even when the leave is fully paid. The mortgage industry has a long history of discrimination and apparently, these beliefs continue to affect decisions. In spite of a successful class action suit by women who were discriminated against while on maternity leave, many lenders continue the practice. I would love to know if they discriminate against men on paternity leave?
Beginning in August, incarcerated mothers and their babies will no longer be separated in Minnesota. Governor Tim Walz signed a law that allows mothers and babies to placed in a community-based setting for up to a year, although the details of what the looks like have not been revealed. The majority of women are in prison for minor, non-violent offenses. “For the infant in those early hours, days and weeks, they are rapidly taking in information and making connections,” said Carolyn Sufrin, a professor of gynecology and obstetrics at Johns Hopkins School of Medicine and the project director of Advocacy and Research on Reproductive Wellness of Incarcerated People. “Being with the person who is going to care for them and who will feed them, that all has an important impact on their neurodevelopment.”
Keep an eye on the Ohio state budget as Republican senators there inserted new language regarding SNAP (food stamp) benefits that drastically change who is eligible for benefits. According to Lisa Hamler-Fugitt, "Families are going to have to sell their cars to keep their SNAP benefits ...," she said. "Senior citizens who may have a modest burial insurance policy would have to liquidate that policy in order to feed themselves."
How a Lack of Data and Patriarchal Attitudes Intersect to Undermine Women’s Health Care
What do you think of when you hear the phrase “women’s health”? For most people, their minds immediately jump to reproductive health. But women are more than just their reproductive organs and deserve medical care that recognizes their entire bodies. Understanding some of the reasons that women receive inferior healthcare can lead us to solutions. We are just beginning, but there is hope on the horizon.
Over the past five years, attention to women’s health outcomes has increased. Several fabulous books like Maya Dusenbery’s Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed and Sick and Elinor Cleghorn’s Unwell Women: Misdiagnosis and Myth in a Man-Made World tell the history of medicine’s attitude toward women and the effect that has on women’s health. But is that attention leading to better care? As we continue to muddle through the pandemic, we can see that there is a lot of work to be done. From worsening maternal healthcare to years of waiting for a diagnosis, women are tired of waiting.
How did we get here?
Maya Dusenberry posits that there is a history of cultural apathy toward women’s health. Dusenbery’s model explains the problem as a knowledge gap created by the lack of research and a trust gap between female patients and doctors. These feed into one another in that the less a doctor knows about the female body, the more like they are to blame the symptoms on emotion, creating a neverending circle. The unspoken cultural belief that women are more emotional creates a situation where their complaints are dismissed as emotional rather than true medical issues. Women continue to report being told that their pain is a result of stress or told to lose weight. This is a form of medical gaslighting making women second-guess their own knowledge of their bodies.
Autoimmune diseases are much more common in women than men. But the symptoms can be hard to see. As a result, women are sent home with diagnoses of stress. It can take seven years for a woman to get a diagnosis and treatment. All the while, she is wondering if she really is exaggerating, although she knows she is not.
There is a tremendous lack of information regarding how drugs and other treatments affect women because all research was done with male subjects until recently. Scientists thought that the monthly fluctuation of hormones in women would create issues in their data. Somehow they didn’t acknowledge that hormones fluctuate in men on a daily basis as well. As a result, we have very little data on differences between the sexes in terms of disease manifestation or drug efficacy.
Until recent decades, the vast majority of doctors were white men. As a result, their own knowledge of women’s reproductive systems came from textbooks rather than personal experience. Male doctors have never had a period or a cramp and therefore cannot understand what a woman is expressing when she tells him that the cramps have become unbearable as in cases of endometriosis. For many women with endometriosis, it takes years to get a diagnosis and treatment. And typically, the doctor who gives her the diagnosis is a female doctor.
These cultural biases get transmitted to new doctors through their medical school training. It is not that doctors intentionally teach that women’s pain is psychological in nature, it is through subtle practices and observation. Recognizing the problem is just the beginning.
What improvements have we seen?
When the Affordable Care Act (ACA) passed in 2010, health insurance companies were banned from discriminatory pricing based on sex. Additionally, all health insurance companies were required to provide contraception coverage. Just being able to see a doctor became a reality for many women.
In 2016, the National Institutes of Health and other grantors adopted the Sex As a Biological Variable policy stating that in order to receive funding, researchers had to include subjects of all sexes and be able to disaggregate information by sex in order to be funded. The Sex and Gender Equity in Research (SAGER) guidelines were published to provide “a comprehensive procedure for reporting of sex and gender information in study design, data analysis, results and interpretations of findings. They are primarily designed to guide authors in preparing their manuscripts but they are also useful for editors to integrate assessment of sex and gender into all manuscripts as an integral part of the editorial process.”
While these look like gains for women to receive better health care, it is always hard to change long-standing practices.
What is getting in the way?
Some researchers are pushing back on the guidelines saying that they will need twice to four times as many subjects. They don’t seem to want to make the changes necessary to understand women’s bodies. Additionally, prestigious academic journals like Nature and Science, which are necessary to be published in for tenure or promotion reasons, favor articles that are deep dives on topics using male-only subjects. And, few journals have adopted the SAGER guidelines.
How this manifests in women’s health - some facts, but not the whole story
The maternal mortality rate in the United States is the highest of developed countries, over twice as high as the nearest two countries.
Women die more often from heart attacks because the symptoms are not well known.
Women are more prone to autoimmune conditions and chronic pain. Both are difficult to diagnose and many women are dismissed by their initial doctors or told to wait. They end up with many unneeded tests and visiting a host of doctors before getting a diagnosis. The average amount of time a woman spends before getting an autoimmune condition diagnosis is seven years.
70% of people with chronic pain are women. Yet, female patients are more likely to be told that their pain is psychological in nature.
1 in 6 women reported that they did not feel safe or listened to during childbirth, reporting being ignored, yelled at, shamed, and losing their autonomy of the birth process.
Women reported anecdotal issues with their menstrual cycles when they had COVID-19. Because this was not studied, it came as a surprise to researchers. Since then, some studies have come out confirming that as many as 25% of women with COVID will have menstrual changes.
Women are 17% more likely to die and 70% more likely to be severely injured in a car wreck than men. Part of the problem is that the NHTSA’s star safety rating new car assessment program does not test women in the drivers’ seat. Therefore, cars are built to specifications that are safest for the average man. I know that when airbags first came out, I was disappointed to learn that as a 5’2” woman, the airbag could actually be more harmful to me because I have to sit so close to the steering wheel.
How can we move forward?
We can start by acknowledging the issue. Fortunately, there are a host of books and articles (like this one) shining a light on the lack of research on women’s health. We can advocate for change by letting scientific journals know that we want them to adopt the SAGER guidelines. We can welcome legislation like the work that Senator Gary Peters is pushing called the Fair Crash Tests Act that would force crash tests that include female crash dummies. We can encourage our Congressional Representatives and Senators to vote for the Momnibus package addressing maternal health outcomes. We can let doctors know when they were wrong about our diagnosis. If we don’t tell them, they will never know or change their attitudes. These are just a few suggestions. We’d love to hear yours! Add them to the comments!
