The Women’s Healthcare Gap

Last Saturday, a group of Lib Dem Women attended a conference in Oxford to discuss the women’s healthcare gap.

Despite working in the pharmaceutical and healthcare sector for 20 years, it was not a concept I was very familiar with until recently. During lockdown, I read Caroline Criado-Perez’s ground-breaking book, Invisible Women, which spelled out the issue using examples of how women’s health is put at risk because medical research has been dominated by men and male biology. Since then, I have had personal experience of the issue.

Speaking to a professor about his PhD on platelets, cells in the blood that are crucial for clotting, he described 40 years ago taking blood samples from eight women at different times during their menstrual cycle to look at the clotting characteristics. Over the course of a woman’s menstrual cycle, how those platelets behaved varied enormously as the hormones involved in menstruation did their delicate dance. Platelets have an oestrogen receptor, so it is unsurprising that their behaviour is affected by fluctuations in oestrogen levels. However, for the professor researching platelet function, this variability made it significantly harder to do his research.

He reverted to studying men, telling me “What you need Zoe when studying human biology is to reduce the variables, so I needed to study men as their biology is boring and very predictable.” Such an approach to understanding ‘human’ biology is very common, which leads to a massive gap in understanding the basic biology of women, half the world’s population.

The conference in Oxford was well attended with four eminent women speakers. The first speaker was Dr Ann Furedi, who spoke about her work as CEO of BPAS (British Pregnancy Advisory Service). She recounted a decades old story where two doctors based their decisions on abortion access on perceived ‘class.’ One doctor decided if a woman was ‘working class’, he would allow them to access abortion services because of the financial burden associated with raising children, but he would deny requests from ‘middle class’ women, as he felt they would have sufficient resources.

His colleague decided women who were ‘working class’ already had challenging lives so one more burden would be easily absorbed, so would deny their request; whereas he thought an unwanted pregnancy would cause too much disruption to the ‘middle class’ women who came to him, and so granted their request. One of the doctors realised with horror what they were doing and so began to press hard for women, as fully morally aware beings, to be given the right to make their own choices about their own body.

Hibo Wardere was the second speaker, and she gave a moving account of Female Genital Mutilation. Hibo has written about her personal experience and fight to end this practice in her book Cut: One Woman’s Fight Against FGM in Britain Today. Milli Hill then spoke passionately about obstetric violence, giving a particularly harrowing account of a woman who had given birth in handcuffs after the doctor ordered her arrest because she had refused to get on the bed as instructed.

The evening was finished by Dr Jessica Taylor who spoke about her new book Sexy but Psycho. This book discusses the fact women are much likelier to be given a mental health diagnosis compared with men, and often when they actually have a physical health condition. Women are too frequently dismissed and told their condition is ‘in their head.’ Endometriosis for example takes 7 to 9 years to diagnose, with many women feeling ignored, despite enduring excruciating pain.

One of the most moving parts of the evening occurred when a young doctor in the audience spoke about her recent rotation to a psychiatric ward. She told us that she felt most patients there were exhibiting perfectly normal trauma responses given the traumas they had experienced, but this was being pathologised and women were being diagnosed and medicated rather than being given the counselling she felt they needed.

The recent work by the Women’s and Equalities Committee on menopause and the impact of this on women, including their employment, is a positive step forward. However, there is much to do – all the way from fundamental science, to better understand women’s biology, up to a cultural shift in how women are perceived and treated in the healthcare system. With a recent report showing that women are 32% more likely to die after being operated on by a male surgeon compared to a female surgeon, this work cannot come soon enough.

* After her PhD, Liberal Democrat member Zoe worked for a pharmaceutical company as a research scientist, before working as a life sciences consultant for 10 years. Most recently she is working for a medical charity, running a COVID19 clinical trial. She is passionate about evidence based medicine.

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  • Martin Eggleston 21st Jan '22 - 7:14pm

    Thank you, Zoe H and LDV. More reports from current, important events, especially ones written by women, please!

  • Victoria Lax 21st Jan '22 - 7:21pm

    Zoe’s article contributes strongly and clearly to a critical debate around the reality of women’s health and why sex matters. It remains deeply concerning that women have poorer healthcare outcomes in many cases, purely based on our sex. This has to changes and is an issue I would hope a progressive political party would champion. Of further great concern is the women recovering from trauma, including sexual violence can feel further stigma through unnecessary pathology rather than being given the space to explore their trauma and understand trauma responses are natural. Zoe presents these arguments in a clear, concise manner, I hope we can hear more from her in this environment – her voice is needed.

  • Wonderful compelling piece, highlighting just some of the ways healthcare for women is impacted by a combination of lack of research specifically on our sex class and by lack of respect for us and our needs as individuals.

  • Wonderful piece!
    The remark about treating women “as fully morally aware beings” is particularly jarring, as not being able to do that seems to be underlying many of the issues raised in this article.
    I am greatly looking forward to the release of Dr. Jessica Taylor’s book “Sexy But Psycho” in March.

  • Kathy Fletcher 21st Jan '22 - 7:40pm

    So pleased to see this. Restricting research to men’s bodies has limited women’s healthcare for far too long. So much so that many people are unaware of the different diagnostic markers &/or treatment plans for conditions as diverse as asthma & kidney failure. I’m hoping that the rumours I’ve heard that say medical schools no longer teach about such differences are false.

  • Thank you for writing this. The issues resulting from inadequate research in to women’s healthcare needs must be disseminated to a wider audience.

  • Claire Loneragan 21st Jan '22 - 7:42pm

    Fascinating column, Zoe. I read Invisible Women in 2020, and so much of it has stuck with me. Women’s healthcare should not be based on men’s physiology for reasons of convenience. The reverse would not be tolerated (nor should it be).

  • A very interesting article, thanks Zoe. Unfortunately, I couldn’t make the event, which I regret further having read this excellent overview of the topics and discussion. The women’s healthcare gap is such an important issue and needs far more attention to address the disparities mentioned.

  • Catherine Smart 21st Jan '22 - 9:14pm

    Before anyone criticises what is in this article, they ought to read the book mentioned – Invisible Women by Caroline Criado-Perez: fascinating and horrifying when you consider the implications of what she is saying – on health, on road safety (think seat-belts), on living in the real world.

  • Freda Davis 21st Jan '22 - 9:24pm

    As a mental health advocate I can vouch for the situation where women are diagnosed with mental health issues instead of trauma. I saw this several times. On one occasion a woman found it impossible to speak. Her male phychiatrist diagnosed schizophrenia. She sat with me for some time before finding the courage to tell me she had been raped by a family member on Christmas day, with her children in the next room. We composed a letter together to her psychiatrist as she still could not speak to a man.

  • Freda Davis 21st Jan '22 - 9:30pm

    However the question of the meaning of statistics showing women are twice as likely to die when the surgeon is male was examined today on the Radio 4 program “More or Less”. This needs much more detailed research. There are several possible avenues to explore, such as whether male surgeons are more senior, get to work on more difficult cases, specialise in different types of surgery and so on. This can’t be taken at face value.

  • Sharon Baxter 21st Jan '22 - 10:42pm

    A very interesting article. Speaking as a short person I’ve always felt that I would most likely be decapitated by my seat belt if I was ever in a car crash. I do hope that research specific to the female sex is in the pipeline, particularly in the field of medicine and medical care.

  • Brad Barrows 21st Jan '22 - 11:04pm

    Please allow an alternative viewpoint: average female life expectancy is 82.9 years, average male life expectancy is 79 years – that is the real gap that we should be seeking to close.

  • As a friend remarked, the world of medicine treats women like it’s the Middle Ages still. Male health is straightforward compared to the different phase the female body goes through. Pregnancies made huge impacts on my personal health, let alone the births and the feeding.
    “Hysteria” and similar words were invented to blame women for their exhibiting behaviour for centuries yet evidence here points to real traumatic experiences to explain womens distress that is conveniently overlooked.
    I wish I could have attended as it sounded insightful and shocking, and highlights huge jumps needed in the way women are listened to, understood and treated in all aspects of life, as well as those illustrated above. After all the world of medicine appears to be a microcosm of how women are viewed in the bigger picture of our World. Shame many men don’t realise they need to address this and listen and assist.

  • Andy Boddington 22nd Jan '22 - 6:49am

    Life expectancy is too crude a measure and it is necessary to look at quality of life years (QOLYS). Although females live an average of 3.6 years longer than males, most of that time (3.3 years) is spent in poor health. Disability-free life expectancy is almost two decades shorter than life expectancy and is higher among males (62.7 years) than females (61.2 years).

  • Nonconformistradical 22nd Jan '22 - 7:53am

    @Brad Barrows
    That seems a very simplistic view.

    There might be many other reasons for the difference in life expectancy apart from healthcare.

    Men are more likely than women to die in a road crash. More men than women are murdered.

  • Zoe Hollowood 22nd Jan '22 - 8:03am

    Thank you to everyone for your comments. It is so interesting to hear how some of the issues raised have touched your own lives in many ways. Invisible Woman was my own jumping off point into this and I have spoke to many people who found this book has opened their eyes. Whether it is crash test dummies or snow clearing! What I also found interesting from the book is that when women’s needs were also taken into account in policy making and design there were economic benefits in addition to the more obvious societal ones.

  • One very important point has been missed by the excellent article and fascinating follow ups.

    The gender healthcare gap – prevalence of disease, outcomes, access – varies from country to country. In many, men come off worse than women.

    But the UK has the largest heathcare gap against women in the G20.

    This suggests that significant improvements could come from learning from practice in other countries.

  • Sam Underwood 22nd Jan '22 - 8:21am

    Excellent piece highlighting the importance of clear language and recognising the physiological differences between men and women. Thank you

  • I attended this event it was really informative and this piece really covers it well. Fascinating and important subject I’d like to read and hear more on. Thank you Zoe.

  • Nigel Scott 22nd Jan '22 - 9:07am

    A welcome revelation of some of the real challenges women face today and hopefully a pointer for party policy. A male biased approach to medicine almost killed my mother, many years ago. Only the intervention of my grandmother, who insisted on a second opinion, revealed that she was suffering from TB meningitis and not an imagined headache. The family moved to a different GP after that.

  • Charlotte Revely 22nd Jan '22 - 11:57am

    Quite shocking how women are written off – I read an article by Caroline Criado Perez and remember that they used a male crash test dummy to see if seatbelts were safe for pregnant women! Have also read Milli Hill’s book Give Birth Like a Feminist, which is excellent, even for women like me who never wanted children. Really wish I could have attended this event but thanks to Zoe for this report.

  • Thank you Zoe, for this summary.
    ‘Invisible Women’ is a real eye-opener and anyone involved in making or debating policy should read it.
    A photograph of a very elderly woman was circulated on social media this week. She had been kept in a psychiatric hospital since the age of 14 after having a baby – not an uncommon fate for young unmarried mothers, often victims of rape and/or incest. It might have been hoped that wrongly diagnosing women with psychiatric disorders would be a thing of the past – shocking to read that it continues to happen in the third decade of the 21st century.

  • Science really ought to make use of trans women here, who have changed their bodies from biologically male to biologically female. I know several trans women who have spoken about the differing effects medications have on them now that their bodies match their gender and it could be a fruitful avenue for research.

  • Jennie (she/her) 23rd Jan '22 - 3:19pm

    I’d agree, Richard.

    The excuse lots of (mostly cis male) medical types give for not using women for researching medicines is that their hormonal fluctuations make for inconsistent results (having been brought up by a scientist I would have thought that made for more interesting research myself – how do they fluctuate? how much and how often and in what ways? – but perhaps that’s hoping for too much)

    Of course research needs to be done far far more into cis women, but if you want to puncture the excuses the medical profession use as to why they don’t: do your research on trans women who are endocrinologically completely stable and medically fit the ideal female profile far more than the majority of cis women.

    And ALSO do that research I mentioned above into how and why menstrual cycles affect things.

    The problem with all of these suggestions, of course, is persuading the (majority cis male) funders of scientific research that the well over 50% of the population that comprises women are worth researching into.

  • Zoe Hollowood 23rd Jan '22 - 4:42pm

    As an advocate of evidence based medicine I fully concur that more research on transgender medicine is needed so that instead of using medicine off-label for instance, clinicians have high quality studies on which to base treatment decisions.

    In terms of understanding the biology of females, you need to study biological females. If you do not then you will have to extrapolate any data you get by making assumptions, these assumptions may or may not turn out to be valid. This is what has been done for decades, by making men the ‘default human’ on which to base diagnosis and treatment decisions about women and is part of the reason for the healthcare gap discussed.

    Take one example, the immune system in females is slightly different to males, this stems from the x chromosome which has many genes relating to the immune system. This means in general that females are less prone to infectious disease than males but more prone to autoimmune conditions. Many of these autoimmune conditions have very little treatments beyond steroids, a blunt instrument with many side effects including increased risk of type 2 diabetes and cancer, and there is a real need for better treatments.

  • Susan Dixon 23rd Jan '22 - 5:27pm

    Thank you for this article. It is incredibly important that research is done on females as we are so differently affected by disease and pharmaceuticals.

    Having worked in CNS pharmaceuticals for 2 decades, it is frightening to imagine the broadening of the gap in conditions such as Parkinson’s/dementia/schizophrenia et al as testosterone plays such a significant factor in dopamine occupancy levels within cells all not just in the brain but all over the the body.

  • Jacci stoyle 23rd Jan '22 - 6:55pm

    I thought this was an excellent article, brilliantly written and extremely interesting. I also read Invisible Women and was shocked at just how much of women’s lives have been made the poorer and often placed in danger due to their female data not being taken into account (and often not even known). A recent example is the PPE equipment used in the pandemic, which was designed for a default male body, despite 78 % of NHS staff being women. The ill-fitting visor was not only uncomfortable, but put them at greater risk from Covid. There is a terrible irony that scientists are now creating individual genetic therapies for cancer, whilst much of the disease pathology of 50% of the population remains unknown by those employed to medically treat them. Well done Zoe for such a thoughtful article.

  • Jennie (she/her) 23rd Jan '22 - 7:18pm

    … don’t even get me started on supermarket shelves being designed around the 5’8″ average male body when I am 5′ and quarter of an inch…

    Most humans of whatever gender don’t actually fit the average. Grand Central train seats, for example, designed around a person of male shape of average size and build are incredibly uncomfortable for me as a tiddler, but also anybody over 6 foot.

    We should be taking much more account of the variability of human shapes and sizes as well as hormone balance, fat/water ratio, and all the other things that gender approximates but doesn’t actually map to a shorthand for

  • Ruth Bright 24th Jan '22 - 9:25am

    Zoe it is good to address the ongoing trauma of poor health treatment of women. Even 18 years later I am haunted by the thought of the clinician who refused me stronger pain relief after a c-section. I don’t think many men who had experienced emergency abdominal surgery would have been told it was best for them to feel pain because otherwise they might be silly and do too much ☹️

  • Thank you Zoe. It sounds like a fascinating event and I’m grateful you could share some key points with us.

    I have massive sympathy with researchers wanting to limit the variables. This itself is not unreasonable, especially in the early phases of research with limited participants, but the use of women, with all of our peculiar variabilities, seems like something that should be accepted as a required step by the latter stages for drugs and interventions to be used by women. Or if they think they’ve got enough to data for something to be safe for mass use, please continue to collect data in sufficient volume from women to account for our hormonal cycles, and differences from men.

    A point made by Criado-Perez is that it’s all very well to say ‘what about tall men, but they fit into the tail of the bell curve. Not that I think you need to go that far into the tail to find men (and women) who want more leg room.

    I welcome consideration of how drugs behave differently on inter-sex, or trans people, but we need to be clear that women are 50% of the population and not some rare special interest case.

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