By Isabel Ringrose
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Institutional sexism puts women’s health at risk

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Misdiagnosis, mistreatment and longer wait times are all symptoms of a sexist health system. Isabel Ringrose investigates the gender health gap
Issue 2787
Sexism in health article picture. Parents full a NHS maternity ward in Scotland.

Parents fill a NHS maternity ward in Scotland. (Photo: Scottish Government)

Sexism is putting women’s lives at risk. Britain has the largest female health gap in the G20 and the 12th largest globally.
The reality of the gender health gap means women are more likely to be misdiagnosed and less likely to be taken seriously. 
Pains are often dismissed, so the wait for painkillers is longer.
But the gender health gap is not random. It is the result of institutional sexism that is reflected within the NHS.
Jackie Applebee, chair of Doctors in Unite, told Socialist Worker that the gender gap in healthcare is “shocking”.
“How society is set up feeds back into the idea of women’s problems,” she said. “There’s little ­understanding in society, so women are regularly given tokenistic support.
“But it’s about the way society is set up. The system makes it so that health workers can hold sexist or racist ideas.
“Medicine is built on an ‘old boys’ ­network’. That’s about class—­paternalism of the establishment.”
From being more at risk in surgery to being underdiagnosed, women’s mistreatment in health is widespread.
Women are 32 percent more likely to die when their surgery is carried out by a male than a female.
Women also have a 16 ­percent greater risk of complications, 
11 ­percent greater risk of readmission, and are 20 percent more likely to stay in hospital longer when treated by a man. 
The health gap extends to women with dementia, who receive worse medical treatment than men, make fewer visits to the GP and take more potentially harmful medication.
Girls and women with autism are also underdiagnosed as less research is done on them.
Social stereotypes mean girls and women acting “shy” or “quiet”—symptoms of autism—is seen as not a concern.
Even before women make it to a doctor’s surgery, they are underrepresented in clinical trials. 
Research proposed by women for women is not allotted the same ­funding as research proposed by men for men.
Historically, women were excluded from clinical drug trials based on unfounded concerns that female hormone fluctuations make women difficult to study.
Women are more likely than men to suffer adverse side effects of medications because drug dosages have been based on trials conducted on men.
From 2015-16 women made up 43 percent of participants in trials globally—an increase. Yet in 2015 Women’s Health Research at Yale University in the US found a drug intended for women tested on 25 participants—23 being men.
“Women can have horrific periods every month and during menopause face real problems, but they’re pushed into the arms of big pharma,” Jackie said.
“If society was set up differently, they could be supported through these physiological processes, not be exposed to drugs linked to things like a higher rate of breast cancer.”

Black women are far more likely to die in childbirth
Female-specific health conditions such as endometriosis and pregnancy-related issues are overlooked.
On average it takes seven to eight years for women to be diagnosed with endometriosis
Around 40 percent of women need over ten GP appointments before being referred to a specialist.
Although maternal death in Britain is rare, there are disproportionate outcomes, particularly based on race.
Black women are four times more likely to die in childbirth. And women in deprived areas are twice as likely to die during or after pregnancy than women living in affluent areas.
Maternity organisation Mbrrace found that seven of 100,000 white women died in pregnancy, while 12 in 100,000 Asian, and 32 black women died.
Black women routinely report being badly treated, with concerning symptoms dismissed. 
A reason for this is that medical research focuses on experiences of white women. Mars Lord is a doula, workers who support people to have a positive experience of pregnancy, birth and the early weeks with a new baby. 
She told the BBC, “When you start to talk about the way you felt you’ve been treated people say no it’s not racism, it’s not black women it’s all women. You’re shut down and silenced.
“We need to dismantle the stereotypes of the angry and strong black woman—we need to allow people the freedom to say ‘I’m struggling’ rather than shutting them down.”
Lack of research is combined with racist stereotypes. “A recent study found the NHS is institutionally racist,” Jackie said. 
Jackie thinks restrictions and charges on health care for immigrants “plays into poor outcomes in childbirth.”
“People have to fly under the radar and don’t register for antenatal care,” she said.
“Women who don’t speak English are more reliant on husbands or kids to be an interpreter, so the details won’t get through.”

Research ignores women
Coronary heart disease is the single biggest killer of women, yet it is often considered a “man’s disease” as it is more common among men.
“Women won’t always get the symptoms of crushing central chest pain—they’re often told what they have is something else like stress,” Jackie explained.
So, women are 59 percent more likely to be misdiagnosed following a heart attack.
Jackie said that when looking at clinical trials, “most are done on men”. Women only made up 25 percent of participants across 31 landmark trials between 1987 and 2012.
Jackie pointed to a Whitehall study that examined civil servants over decades—but only men.
“This means a lot of heart treatments are geared towards white men. They’d take the findings that informed treatment for heart disease and extrapolate them, but it’s not appropriate.”

High gender pay gap
Women workers in healthcare also face sexism. Around 86 percent of senior surgeons in Britain are men.
The median gender pay gap across the NHS was 16.7 percent in March 2020, despite 55.2 percent of NHS England workers being women.
But sexist ideas aren’t planted into the minds of male health workers.
Jackie said, “Society is run by white middle class men, so their perspective is the predominant perspective.
“Together they reinforce each other’s ideas. We now know more diversity is important, but it still doesn’t seem to be changing enough.”
But Jackie added that simply putting middle class women in high roles doesn’t solve the issue, because it “relies on a shared experience of women.”

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