Women are being prescribed drugs that were never tested on women’s bodies. Or when they experience uterine pain or migraine headaches, their concerns are sometimes downplayed by male doctors.
The phenomenon is called medical misogyny, or the ingrained prejudice against women in the health care space.
While it has generated sporadic headlines in the U.S., the U.K. Parliament has taken up the issue with an aim toward making measurable progress over the next decade.
Experts across the Pond say a dearth of investment in women’s health has created the problem. As the U.K. looks for ways to fix it over the next decade, the debate and the resulting policy solutions in Britain could serve as a template for lawmakers in Atlanta and Washington to follow.
The debate got underway in December, when a parliamentary committee hearing in London found that women experiencing painful reproductive health conditions — such as endometriosis, adenomyosis and heavy menstrual bleeding — are frequently dismissed or told to “suck it up” by doctors.
Endometriosis is a condition in which tissue that lines the uterus grows uncontrolled. Adenomyosis occurs when endometrial tissue, the tissue that lines the uterus, grows into the muscular wall of the uterus. Both conditions can cause intense pain, infertility and other symptoms.
As women in the U.K. begin speaking out, their counterparts in the U.S. are nodding in affirmation — because medical misogyny is just as much a problem across the Atlantic, said Justina F. Avila-Rieger, a research scientist at Columbia University.
Sexism in many spheres of American life appears to be damaging women’s health. But researchers have only recently begun to quantify the cost in terms of stress on women’s bodies. There’s also the economic damage: When women are brushed off by the U.S. medical industry, the cost of missed work and complications from unsuitable treatments stacks up. But it’s encouraging that the U.K. is addressing the issue, and maybe the U.S. will as well, Avila-Rieger said.
“We are a bit behind the U.K.,” Avila-Rieger told The Atlanta Journal-Constitution. “The U.K. took the first big step of acknowledging that there are these issues.”
In December, Avila-Rieger and colleagues released a landmark study that found sexism seemed to be a factor in women developing dementia later in life. Black women were most affected of all American women.
The state where it was the worst was Mississippi; the least worst, Connecticut.
A study by Georgetown University ranked Mississippi last in a study looking at 12 factors that affect quality of life for American women.
Women born in the highest “structural sexism” states had memory declines similar to those who were about 9 years older in age.
The Columbia University data linking sexism to dementia was seen as particularly alarming, given that American women account for two-thirds of U.S. Alzheimer’s cases.
It’s part of a growing body of evidence that has ignited a debate on both sides of the Atlantic.
A separate, earlier study at Florida State University came to a similar conclusion. It found that women living in states with the highest levels of structural sexism, such as Utah, Wyoming, Mississippi, Louisiana and Oklahoma, reported higher levels of chronic conditions, worse self-reported health and had worse physical function at age 40 and 50.
The Institute for Women’s Policy Research gave Georgia a “D” for women’s health and well-being. The most highly ranked states were Minnesota (A-) and North Dakota (B+).
Other metrics looking at women’s health status in the U.S. have found that:
- The U.S. has the highest rate of women dying during childbirth of any wealthy country, and especially poor outcomes for Black women. Nearly all of the deaths are preventable.
- The U.S. government overfunds research dealing with male-linked illnesses and underfunds those afflicting women.
- Women are significantly underrepresented in the majority of heart disease research studies.
- And because women were not enrolled in U.S. drug trials until 1993, thousands of products that are still on the market today are based on male bodies, meaning the medical field still doesn’t know how well many drugs and medical devices work for women.
Thirty years ago, Atlanta cardiologist Dr. Nanette Wenger and colleagues pushed the National Institutes of Health to include women in government-funded research, the AJC reported. Still today, women remain underrepresented, comprising just 29% to 34% of participants in drug safety trials.
In March, President Joe Biden signed an executive order to increase federal government spending on women’s health research.
Experts say one relatively quick policy response would be better training for doctors so that they can correctly diagnose and then prescribe pain management for conditions like endometriosis.
On average, American women spend 11.7 years visiting doctors before being correctly diagnosed for endometriosis, compared to 8 years in the U.K., and 6.7 years in Norway, according to researchers at the University of Surrey.
Credit: Kay Hinton
Credit: Kay Hinton
The lag in diagnoses is more often than not because women’s symptoms are dismissed, said Dr. Sejal Tamakuwala, an obstetrician and a gynecologist at Emory Women’s Center at Emory University Hospital Midtown. “Pain is more likely to be labeled psychosomatic or attributed to stress or anxiety in women compared to men,” she said.
Tamakuwala said doctors who lack training, or who maintain racial and gender biases, can create additional barriers. “On top of that, high health care costs, poor insurance coverage, and a disjointed system make it often difficult to get the right care. For many women, especially in rural areas, these challenges are worsened by limited access to specialists and restrictive health policies,” she said.
It was an experience that Curtisha Johnson of Atlanta saw first hand. She was diagnosed with fibroids in 2008, after noticing a growth on the right side of her pelvis. She saw three doctors before finding a fourth who offered her a myomectomy — a surgery to remove fibroids from the uterine muscle while leaving the uterus intact. Her first three doctors insisted she needed a hysterectomy, or the removal of the entire uterus, including the fibroids. She said they dismissed her concerns about the procedure.
“I had to utilize strategic self-care strategies — to ask, ‘What is it I need, and how can I find that support system?’” she said.
Fibroids are tumors that grow in the uterus, or womb, and are typically noncancerous but can be painful. They affect about 70% of females between ages 35 and 49. This increases to 80% for Black females, according to researchers at Augusta University in Georgia.
When Johnson asked her previous providers if the personal care products she had been using could be contributing to the fibroids, she said she was met with blank stares.
A study at Northwestern University has linked phthalates — found in many personal care products — with the growth of uterine fibroids. Johnson later went on to found her own cosmetics company.
Phthalates are a group of chemicals used to make plastic packaging more flexible and transparent, and are often not listed on product labels, the Environmental Working Group said.
The risk from personal care products also can extend beyond packaging to the products themselves.
Women use more personal care products than men, and for that reason, face greater exposure to chemicals in soaps, hair straighteners and hair dyes. Some of the chemicals have been linked to cancer, genetic mutation or reproductive harm, according to a study published in the Journal of Exposure Science & Environmental Epidemiology.
Credit: Self supplied
Credit: Self supplied
The U.K. parliamentary committee also found that a lack of trauma-informed protocols in routine gynecologic procedures often leave women feeling dismissed or retraumatized.
Experts like Dr. Tamakuwala of Emory say greater investment in research and prevention, along with integrating women’s health into broader health care policies, could help close the gap and reduce costs.
Despite American women spending $15 billion more each year on health care costs than men, they are still, like women around the world, “second-class citizens when it comes to health,” according to the World Economic Forum.
For just one malady, heart disease, closing the gap between men and women could boost the U.S. economy by $28 billion annually by 2040, a report by McKinsey Health Institute found. The savings would come from reduced neonatal mortality and extending women’s working lives, McKinsey said.
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