By: Silke Schoch, Senior Manager, Research & Programs

March is Women’s History Month and is intended to be a time to discuss, honor, and participate in women’s contributions to American history. However, it is important to acknowledge the historical context of women’s medical treatment by ancient historical sources.

Humankind has moved forward admirably from many of the medical misconceptions harbored during the Classical Age in Ancient Greece. Yet, some tenacious theories and rumors persist such as the overreliance of using emotional and psychological diagnoses to explain women’s symptoms. Although there was certainly debate in Ancient Greece, Plato and Aristotle famously had many incorrect opinions on the female body.^1,2 Plato, believing that the uterus roams through women’s bodies, thought that women were thrown into disequilibrium and disease due to their uterus. Aristotle generally saw women as malformed men. Medical historians and others have noted that Aristotle found that “female nature was a mutilated kind of male nature and more or less monstrous, perceived in any case as very negative.”² Ancient attitudes such as these are some of the culprits to our current problems in the health care ecosystem. Various studies have demonstrated that women wait longer for care due to perceptions that women embellish their pain or symptoms.³ Other literature has focused on the way female patients have poor outcomes due to their “abnormal” symptom presentation (those differing from male patients).¹ Research on patients going to the emergency room with abdominal pain found that “women were 13%–25% less likely than men to receive opioid analgesia.”⁴ Other widely quoted findings have shown that after heart surgery “female patients were administered sedative medication significantly more frequently than male patients” rather than pain relief.⁵

The United States has been the originator of many medical advancements, studies, and innovations in the health ecosystem. However, many sex and gender disparities still exist, evidenced by the blatant, recurrent, and endemic poor treatment of women by the medical field. In an interview with the Washington Post, a female patient from Georgia stated that during a uterine biopsy, “[t]he pain was so intense that I couldn’t keep myself from screaming. I asked my doctor afterward why they don’t administer any sort of anesthesia for that procedure, and the answer was, “We just don’t.”⁶ This dismissal of female pain often starts from childhood. A study conducted with adults who were asked to determine the amount of pain being experienced by a child found that the participants rated “a child undergoing a medical procedure as experiencing more pain when the child was described as a boy… [in contrast] to a girl – despite identical behavior and circumstances.”⁷ Another study showed that female adolescents “are more likely to report a pain dismissal” from medical professionals than their male counterparts.⁸ Moreover, there have been repeated studies that demonstrate pervasive, interdisciplinary repudiation of women’s pain. This rejection of women’s perspectives is both historical and omnipresent.

Women of color face even worse outcomes. Compounded with physicians and public health officials who do not listen to their needs and a medical system that has not caught up to conditions such as Long COVID-19, many African American women have created their own communities to address their concerns around Long COVID-19. Chimére L. Smith shared in an NBC news article that she joined a “BIPOC Women Long Covid ‘Long Hauler’ Support Group” after she experienced Long COVID-19 symptoms⁹. Smith noted in the article that doctors “would treat me as if I was a child and I didn’t know my body, adding, “I wanted to die because I could not eat. I could hardly drink. I couldn’t think.”⁹ Groups like Body Politic, a queer feminist wellness collective, have sprung up to address shortcomings in the health ecosystem and “[break] down barriers to patient-driven whole-person care and well-being, particularly for historically marginalized communities.”¹⁰ Resources from groups like these include peer support, assistance in navigating social and disability benefits, and how to manage pain.¹¹

Although scientific progress is generally held as linear and remains high in the American’s view and opinion of themselves, many outcomes in women’s health continue to worsen. This is especially apparent in outcomes for pregnant women and people. The United States is regarded as the worst high-income country for maternal mortality rates. African American women face deadlier odds as maternal mortality is 2.5 times greater compared to white women, and three times greater than for Hispanic/Latina women.¹² Currently, there is a combination of factors that contribute to poor outcomes for pregnant people in the United States. These include a fragmented medical system, chronic complications that arise during pregnancy (such as high blood pressure and blood clots), difficulties during birth itself, such as hemorrhage, prevalent intimate partner violence, suicide, substance use, and post-birth care problems like infections and heart issues.^12–14 Different racial and ethnic groups also have specific needs with “American Indians and Alaska Natives (AIANs) and Asian Pacific Islanders (APIs), accounting for twice the proportion of deaths as seen among white or Black people” during bleeding events.¹² One study found that “more than 60% of pregnancy-related deaths in the United States are preventable.”¹⁵ Many women have also noted mistreatment during pregnancy, childbirth, or post-birth care. A publication on pregnant women in the United States found that over 15% of women “experienced one or more types of mistreatment”; the most common types “[b]eing shouted at or scolded by a health care provider” as well as“ health care providers ignoring women, refusing their request for help, or failing to respond to requests for help in a reasonable amount of time.”¹⁶

There are thousands of words, studies, issues, and anecdotes that could be shared from women to discuss historical and current gender issues. The dearth of women as subjects in research is a glaring oversight.¹ It was not until 1993 that the Food and Drug Administration “rescinded its 1977 guideline that banned all women capable of becoming pregnant from Phase I and Phase II clinical research.”¹⁷ Women’s bodies are often treated as interchangeable to men’s, although women have different biological processes and functions. Further, incorrect theories are still rampant in the medical community, as evidenced by the way women are treated when they present with heart attack symptoms or pain.¹⁸ As patient advocates, nonprofits, pharmaceutical and device manufacturers, policymakers and physicians think of women’s history month they should consider that the word history comes from “[t]he Greek word historia…” which “originally meant inquiry, the act of seeking knowledge.”¹⁹ As the medical and public health community increase their knowledge of female bodies and female-centered health they should actively and meaningfully listen to the women both in history and the ones standing before them.

References

1. Criado-Perez C. Invisible Women: Data Bias in a World Designed for Men. Abrams; 2019.
2. Bonnard JB. Male and female bodies according to Ancient Greek physicians. Clio Women Gend Hist. 2014;(37). doi:10.4000/cliowgh.339
3. Hoffmann DE, Tarzian AJ. The Girl Who Cried Pain: A Bias against Women in the Treatment of Pain. J Law Med Ethics. 2001;28(4_suppl):13-27. doi:10.1111/j.1748-720X.2001.tb00037.x
4. Chen EH, Shofer FS, Dean AJ, et al. Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal Pain. Acad Emerg Med. 2008;15(5):414-418. doi:10.1111/j.1553-2712.2008.00100.x
5. Calderone KL. The influence of gender on the frequency of pain and sedative medication administered to postoperative patients. Sex Roles. 1990;23(11):713-725. doi:10.1007/BF00289259
6. Bever L. From heart disease to IUDs: How doctors dismiss women’s pain. Washington Post. Accessed March 22, 2023. https://www.washingtonpost.com/wellness/interactive/2022/women-pain-gender-bias-doctors/
7. Featured Article: Gender Bias in Pediatric Pain Assessment. J Pediatr Psychol. 2019;44(4):403. doi:10.1093/jpepsy/jsy104
8. Gender differences in the experience of pain dismissal in adolescence. J Child Health Care. 2017;21(4):381-391. doi:10.1177/1367493517727132
9. Black Covid long-haulers say doctors dismissed their symptoms, so now they’re relying on one another for support. Accessed March 22, 2023. https://www.nbcnews.com/news/nbcblk/black-covid-long-haulers-felt-invisible-health-care-system-formed-supp-rcna44468
10. Our Story. Body Politic. Accessed March 21, 2023. https://www.wearebodypolitic.com/about-body-politic
11. For Patients. Body Politic. Published December 9, 2021. Accessed March 23, 2023. https://www.wearebodypolitic.com/resources
12. Declercq E, Zephyrin L. Maternal Mortality in the United States: A Primer. The Commonwealth Fund. doi:10.26099/ta1q-mw24
13. Wallace ME, Friar N, Herwehe J, Theall KP. Violence As a Direct Cause of and Indirect Contributor to Maternal Death. J Womens Health 2002. 2020;29(8):1032-1038. doi:10.1089/jwh.2019.8072
14. The U.S. Maternal Mortality Crisis Continues to Worsen: An International Comparison. doi:10.26099/8vem-fc65
15. Slomski A. Why Do Hundreds of US Women Die Annually in Childbirth? JAMA. 2019;321(13):1239-1241. doi:10.1001/jama.2019.0714
16. Vedam S, Stoll K, Taiwo TK, et al. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health. 2019;16(1):77. doi:10.1186/s12978-019-0729-2
17. Timeline – SWHR. Accessed March 23, 2023. https://swhr.org/about/history/timeline/
18. Jackson G. The female problem: how male bias in medical trials ruined women’s health | Women | The Guardian. Published November 13, 2019. Accessed March 23, 2023. https://www.theguardian.com/lifeandstyle/2019/nov/13/the-female-problem-male-bias-in-medical-trials
19. This Is Where the Word “History” Comes From. Time. Published June 23, 2017. Accessed March 23, 2023. https://time.com/4824551/history-word-origins/