A few weeks ago, thousands of women in London marched in protest against sexual inequality and women’s rights. As I watched women and girls demand to be valued and respected, I wondered if the #TimesUp movement would reach an arena where women still find themselves fighting for their voices to be heard.
The field of medicine quite often finds itself slow to reflect the progressive changes in wider society. In particular, it can be slow to recognise the negative impact of an historically patriarchal system, which continues to have an unconscious, and at times, conscious, negative bias against women within the health system.
In a recent interview with Vogue, Serena Williams, one of the greatest tennis champions of all time, described the complications she experienced after giving birth to her first child, Alexis Olympia. Serena’s pregnancy was a high risk one. Having previously suffered from blood clots in the lungs, Serena was likely to develop further clots during and after her pregnancy. Following an emergency caesarean section, Serena had symptoms highly suspicious of a recurrence of this often fatal condition. Serena voiced her concerns - after all, she had experienced these symptoms before and knew the possible outcome - but her concerns were initially dismissed. In fact, Serena was thought to be “confused” and anxious rather than facing possible grave danger. Follow up investigations proved Serena’s fears and more importantly, her informed concerns, correct. Thankfully, she received the correct treatment and made a full recovery, despite further complications following on from this initial drama. As a Gynaecologist dedicated to delivering holistic care in early pregnancy, I of all people initially dismissed the article as an unfair critique of the health professionals. Serena survived, didn’t she? The clots in her lungs were detected quickly. She didn’t die and she has a healthy baby. The doctors did their job. Well. But did they?
As a woman, I eventually realised that this was not the point. Serena’s story was one that I unfortunately recognised equally from the vantage points of caregiver and care receiver. This was the story of women within the healthcare system whose symptoms and complaints are not always given the same platform as complaints from their male counterparts. Her story highlighted the frequently ignored issue of the differences in health outcomes between men and women and the disempowerment of women within the health system. It is hard to imagine Serena Williams, winner of 24 Grand Slam titles, businesswoman and philanthropist - the epitome of an empowered woman with a voice - disempowered at the bedside. Research however, shows that this is what women experience in our GP surgeries and hospitals on a daily basis .
A recent study by the British Heart Foundation and researchers from the University of Leeds found that women were three times more likely to die from a heart attack within the first year of the study compared to the men in the same study. Researches discovered that women were not receiving the same recommended treatment as men, in part because of the incorrect assessment of the severity of their symptoms. More often, chest pain in women was deemed not as severe as the symptoms experienced by the men and less likely to represent a heart attack. Clearly the doctors were wrong. Whilst the narrative has commonly been that men suffer worse outcomes due to their reluctance to report their health concerns to a health professional, it would seem that once they pluck up the courage to do so, their concerns are taken more seriously than reports of the same clinical symptoms by women.
Time and time again, research shows that women regularly suffer from chronic pain for far longer, and rather patronisingly, are more likely to be incorrectly treated with antidepressants and sedatives rather than with adequate pain relief medication. Health professionals - irrespective of gender - frequently view women who complain of pain as anxious or ‘emotional’, often missing more sinister disease and delaying diagnosis. This is somewhat reflected in the updated NICE guidance on the diagnosis and treatment of endometriosis, a potentially debilitating gynaecological condition, reminding my colleagues to “listen to women”. We need reminding.
For Black and ethnic minority women, the picture is even bleaker. Continually the victims of the “double whammy” of sexism and racism, Black and ethnic minority women find themselves at the back of queue when it comes to having their voices heard. The effect on their health outcomes can sometimes prove fatal. A 2010 study by The National Perinatal Epidemiology Unit reviewing the outcomes and experiences of over 24,000 women receiving maternity care in the UK, found that ethnic women “were less likely to feel spoken to” or be “treated with kindness”. Even more worryingly, Black African women were least likely to receive pain relief in labour and more likely to deliver by emergency caesarean section. Consider all of this against the backdrop of static maternity mortality in this population. Black African women in the UK are more than four times likely to die during or soon after pregnancy compared with caucasian women. Serena was lucky. She eventually received the care that she needed, but for the rest of us mere mortal women, the gender and racial gap in health outcomes can have terrifying implications on the care we receive.
Whilst we continue to highlight the unfair gender pay gap and fight against sexual harassment, we must not forget the negative disparities in healthcare. As health professionals, it would do us well to consider more what the person is saying rather than who is saying it. We must encourage women to speak up in all spheres of society and more importantly, listen to what they have to say, placing it on an equal platform as others. As a woman, I do not want to have to shout, or worse, die before I am heard at the bedside. Maybe it is now time for men and women to shout Time’s Up for gender inequalities in healthcare.