We need to talk about the gender pain gap
Over the last few years, ‘The Gender Pay Gap’ has become part of our modern-day vernacular - and a tangible example of how our patriarchal systems are literally shortchanging women in the workplace. Only this week, the gap in the medical profession came under the spotlight, with the government revealing plans to address the pay disparity between men and women in the sector. However, there is another, less talked about, the gender gap in the world of medicine – and that’s the gender pain gap.
The gender pain gap refers to the myriad of ways in which women – particularly black women and women of color – are being let down by their healthcare providers due to gender discrimination. It’s the reason women are 25% less likely than men to receive pain relief. It’s the reason we are 50% more likely to be misdiagnosed when having a heart attack. It’s also part of the reason that black women are 5 times more likely to die in childbirth. When the issues of gender and race intersect, leaving many women in these communities unbelieved and untreated.
To put it bluntly, the gender pain gap is not just a feminist issue, it’s an issue of life and death – and something that needs to be talked about more. But, the conversation is slowly changing and gathering momentum, thanks to researchers, doctors, and campaigners who refuse to let this inequality of care impact more women in the future.
Galvanizing the conversation
Feminist health blog Hysterical Women and education, media, and research platform, The Femedic collaborated to host a webinar, all around the topic of closing the gender pain gap. Almost 200 people signed up for the event, showing just how pertinent this issue is right now. Panelists Dr. Omon Imohi, GP and founder of Black Women in Health, Dr. Hannah Short, a GP specializing in menopause and premenstrual disorders, and Dr. Katy Vincent, Honorary Consultant Gynaecologist at the University of Oxford, joined hosts Sarah Graham and Monica Karpinski to dissect exactly what is causing the gender pain gap – from male-centric research to systemic misogyny – and the actions needed to close it.
Having worked at the heart of women’s health for years hosts Sarah and Monica understand the true extent of the gender pain gap. They decided to organize the event to bring the issue to a broader audience and to galvanize the conversation around this important topic. “The gender pain gap is social discrimination which functions within the institution of medicine,” Monica, founder, and editor of The Femedic explains. “That means that it informs clinical decisions, which affect the quality of care people receive. This includes longer wait times for women, misdiagnosis, longer diagnosis times, and not being taken seriously when presenting with symptoms in the doctor's office - all of which can have a knock-on negative impact on that person's health.”
“For me, closing the gender pain gap is all about getting women the healthcare they deserve,” says Sarah, award-winning health journalist and founder of the Hysterical Women blog. “Women are dying needlessly because they receive worse care than men and many conditions that impact women – from endometriosis to fibromyalgia – are less understood than many 'gender-neutral' conditions.”
The medical-research gap
This lack of understanding of the female body was a key theme of the webinar. We’ve talked before about the long, frustrating history of male-centric medical research, and it’s evident that this millennia-old bias is a huge contributing factor to the gender pain gap.
During the webinar, Dr. Katy Vincent explained that in the main journal that pain researchers referred to historically, at least 80% of the studies published only looked at male animals. “If we now know that the mechanisms underlying pain in men and women, and male and female animals, are probably different, then we’ve had a really biased view of what pain is for the last however many years."
This fundamental flaw in medical research is really the starting point of the gender pain gap – as it trickles into so many areas of the medical profession. “I think that in the immediate future, having access to research that includes and is specifically focused on female bodies — rather than on male mice or humans — will make a substantial difference,” says Monica, when asked what the most important factor in closing the gender pain gap is. “This research is what is used to inform clinical guidelines and then can be passed on through education - which is critical.”
Sarah also believes that changes in medical research are an essential first step in closing the gender pain gap and can also change attitudes as well as treatment plans. “Research can inform medical education, it can provide understanding and treatments for conditions that are currently not well understood. And in doing so it can help to tackle the unconscious biases that some doctors have about women with "medically unexplained" symptoms,” she says. “ Research has to be gender-informed though, it has to look at sex and gender differences, and it has to go hand-in-hand with social change, with education and training on recognizing and tackling unconscious bias, and with doctors taking personal responsibility for listening to and believing their patients.”
The issue of unconscious bias
This unconscious bias, and the heartbreaking stories of women not being believed when they self-report pain, was another recurring talking point during the event.
Dr. Omon Imohi spoke passionately about this issue during the event, drawing on both her experience as a GP and as a black woman accessing healthcare. “I think first and foremost, doctors need to be thoroughly trained, or retrained if needed, to overcome their own biases in diagnosing and treating women’s health and self-reported pain, because historically pain in women has not been taken seriously,” she explained on the evening. “We need to listen to women when they say they are in pain and not just say it’s in their head or it’s something that they’re just imagining - because the pain is real and it should be taken seriously.”
“Women are often left suffering from long-term symptoms because doctors either don't believe them or don't understand their condition – or both,” says Sarah, when I ask her about this worrying trend for belittling women’s pain. “Women with endometriosis wait for an average of 8 years in the UK to be diagnosed, and women with conditions like ME and fibromyalgia regularly tell me that they've been told their symptoms are 'all in their head.'"
This dismissive approach to healthcare is something Sarah had previously explored through her Instagram campaign, #ShitMyDoctorSays, which highlighted not only the disbelieving nature of some medical professionals (a term used lightly in this context) but also the pure misogyny at play. One particularly poignant post described how a male doctor described all women with endometriosis as “f**king mental.”
Of course, this attitude towards women is disheartening, but not as surprising as it should be. There is a huge systemic issue that we need to address and rebuild if we want gender gaps – of any kind – to become a thing of the past. But in the meantime, it’s clear that we need to challenge these archaic mindsets when we see them - and that unconscious bias training should become a bigger part of becoming a qualified medical practitioner.
“The belief that women's bodies are lesser, unruly, and inherently defective, unfortunately, has a long history, so those attitudes are going to take a long time to reverse,” says Monica. “But in the shorter term, I think that retraining clinicians about the impacts social biases can have on their practice would have a really positive and substantial impact as well. Part of this could even be achieved by raising awareness of the gender pain gap and encouraging medics to reflect on their practices and clinical attitudes.”
Change is on the horizon
We may not be able to overturn centuries of medical gender disparity overnight, but this event and the ripple effect that it created are signs that progress is being made – albeit gradually. “I think when women come together and speak out, that's very powerful, and that's where the change (however slowly) begins to happen,” says Sarah.
Monica shares Sarah’s optimism, and the reaction the webinar received has bolstered her belief that change is on the horizon. “Having more people talking openly about their experiences and, crucially, having medics and researchers involved in that conversation is what's going to drive this process,” she says. “It will take time – and a lot of people chipping away at various processes, beliefs, and attitudes - to close the gap, but it is happening. More people are starting to question and challenge these ideas and legacies and the more of us that are part of the conversation, the faster change will happen.“