To this day, the world is still grappling with pervasive and inexcusable gender inequalities that are underpinned by bias and sexism. It is well established that women are under-represented in positions of power and leadership, and experience discrimination and gender-based violence. This has an undeniable and significant impact on healthcare delivery and has a deleterious effect on the health of women worldwide.
According the WHO, some of the sociocultural factors that prevent women and girls to benefit from quality health services and attaining the best possible level of health include:
- unequal power relationships between men and women;
- social norms that decrease education and paid employment opportunities;
- an exclusive focus on women’s reproductive roles; and
- potential or actual experience of physical, sexual and emotional violence.
You can read more sobering facts from WHO about the global state of Women’s Health here.
Considering the factors outlined above through the lens of intersectionality, and the picture becomes even more complex. Unfortunately, here in Australia we see the effects of gender discrimination play out all too often, despite decades of recognition. This RACGP report that compares the health of male and female Australians side by side paints an excellent picture of the current state of affairs in Australia.
Within the Australian medical system, it’s no different. You don’t have to search very hard to find proof of the gender pay gap, the gross under-representation of women in surgery, under-representation of females across the majority of specialist-in-training programs, and inequalities in paid parental leave, despite females making up more than half of Australia’s annual medical school graduates.
Equity is giving everyone what they need to be successful. Equality is treating everyone the same. We need to level the playing field. It is becoming increasingly recognised that actions must be directed at transforming the systems women work within, and pushing for institutional-level change.
Yes, we’ve come a long way. But we still have a long way to go. I’m not asking anyone to light their bra on fire and vociferously denounce the patriarchy here. All I ask of you, is this: consider your unconscious biases and how this might affect your medical practice. Consider your privilege, and what steps you might take to promote equity in healthcare. As medical practitioners, we have a role in changing the system.
IN A NUTSHELL:
- Pervasive gender inequalities affect the health outcomes of women worldwide.
- Gender inequalities affect women everywhere, including in the medical industry.
- We all must strive for gender equity, and consider our unconscious biases, if we are to reduce the impact of gender discrimination both in Australian society and beyond.
Collection #1: The ‘Father of Modern Gynaecology’
Dr J Marion Sims (1813-1883), aka the ‘Father of Modern Gynaecology, was an American physician and ‘surgical pioneer’. His most significant work was the development of a surgical technique to repair vesicovaginal fistula (a severe complication of obstructed delivery). How did he go about developing his skills? By operating without anaesthesia on enslaved black women. According to Sims, the women had no better option and were willing to go under the knife. The ‘Sims Speculum’ (pictured) is still used today (allbeit rarely).
Collection #2: Get Cliterate
Ever noticed that anatomy is typically taught exclusively using the male body? When Professor Helen O’Connell (pictured) (Australia’s first female urologist) was a medical student, she certainly did. Studying the 1985 edition of Last’s Anatomy, she found that there was no mention of the clitoris, despite there being two full pages on the penis. Additionally, female genitals were described, word for word, as a ‘failure’ of male genital formation. Prof O’Connell got to work on characterising the clitoris and its relation to the remainder of the female reproductive tract, work which culminated in the publication of her paper, Anatomy of the clitoris (2005). How is it, that the clitoris was only fully discovered in 1998? Read more about Prof O’Connell her story here.
How about the anatomical image of female breast tissue that went viral earlier this year? It seems as if, over the course of history, the female body and it’s anatomy has been ignored, and is still to this day a taboo topic. This tells us something about the society in which we live, and the status of women within that society. (images sourced here, here and here)
Collection #3: The Affliction of the Wandering Womb
It turns out that the practice of labelling women as ‘crazy’ has deep historical roots. Hysteria takes its etymological roots in the greek word ‘hystera’ meaning uterus, coined by Hippocrates in 5th Century BC. Subsequently, female hysteria was an official medical diagnosis used to explain symptoms including nervousness, hallucinations, emotional outbursts and various urges of the sexual variety (excessive vaginal lubrication, erotic fantasy, the list goes on). Interestingly, the cure for female hysteria involved ‘pelvic massage’ leading to ‘physician-assisted paroxysm’ (aka orgasm). Female hysteria actually led to the development of an ‘electromechanical medical instrument’ to provide therapy for these suffering women; enter the modern vibrator. Other therapies included, clitoridectomies, hydrotherapy (pictured), and wafting sweet meats and flowers between the legs of affected women. Hysteria as a term was not dropped until 1980.
Unfortunately, this is still happening today, the most recent example in the media hitting very close to home: earlier this year, a young surgical trainee was dismissed as being “an emotional female” after being exploited and overworked at Bankstown Hospital, Sydney. Read more here.
Collection #4: Out of the Kitchen, into the Asylum
Throughout the 19th century, prior to womens suffrage, it was generally expected that a woman’s place was in the home. Psychiatrists shared this view that women should be subordinate to their husbands and dedicated to their domestic responsibilities. Women who rebelled against their domesticity risked being declared insane and as a result being committed to an asylum. This was usually at the request of their husband or father. There was no right to contest or appeal the decision. The list of reasons detailing why these women were locked away is equal parts bizarre and chilling.
Elizabeth Packard (1816-97) (pictured) is one such woman who suffered in asylums throughout her life for ‘publicly expressing radical religious views’. Her so called ‘brain fever’ was deemed a risk to her husbands career and reputation. After convincing hospital staff of her sanity, her husband subsequently imprisoned her in her own home, by locking the doors and nailing the windows shut. After taking her husband to court for divorce, Packard was instrumental in instigating much needed reform – read about the Packard Laws here. Read more about lunacy in the 19th century here and here.
Image 1: Elizabeth Packard (see above, sourced here). Image 2: A list of reasons why women were admitted to in the 19th century, sourced here. Image 3-5: Women in the 19th Century asylums, sourced here, here and here.
Collection #5: What a mesh!
You’ve likely all heard about the pelvic mesh scandal that left thousands of women irreversibly harmed. The mesh was used for transvaginal or transabdominal repair of pelvic organ prolapse (including cystocele), and the associated symptoms (stress urinary incontinence). Women have experienced a range of outcomes after receiving mesh treatment, including:
- chronic pelvic/back/hip pain;
- PV bleeding;
- haematuria secondary to erosion of mesh into the bladder, urethral obstruction leading to urinary retention, and recurrent UTI and/or vaginal infection;
- fistula formation, wound breakdown, and mesh exposure.
Earlier this year in April, the FDA recalled all mesh products due to insufficient evidence assuring the benefits of these products outweigh the risks. An investigation uncovered a convoluted web of payoffs and dodgy dealings that allowed the use of transvaginal mesh without having solid evidence behind it. This issue sheds light on much bigger issues around the utilisation of implants and devices in our medical industry – particularly the overwhelming lack of regulatory systems allowing for product quality control, tracking, and recall.
Collection #6: Contraception
“Somewhere along the way, a woman’s right to use birth control translated into a woman’s responsibility to use birth control.” – Lawrie James-Hawkins
The OCP became available for use in the 1960s (initially only for married women with a prescription). The feminist movement initially celebrated female contraceptives for giving women the power to control if and when they became pregnant. As the years passed, and the initial glow and joy brought by the pill and its reproductive freedom began to wane, as women realised that birth control was becoming both a right and a responsibility. Read more about this here.
Why is it, that birth control is still the sole responsibility of women? Yet another result of a patriarchal system and a pharmaceutical and medical industry where men hold all the power. Here’s a few facts for you:
- although available to both men and women, sterilisation is cheaper, more effective, reversible and less invasive for males
- clinical trials for male oral contraceptives were stopped because of adverse side effects including acne, mood disorders and raised libido
It’s likely the female OCP would have had the same fate if it were invented today! Read more about the contraception options available to men here, and about the process undertaken by the FDA in approving the pill for use here.
Collection #7: No gloves? Big problem
Stewart Geoffrey Moroney (image 7.1), a 69yo general practitioner from Wangaratta, was accused of capturing sensitive female examinations on film and performing said examinations without gloves. He faced a string of charges including sexual assault and capturing intimate images. A total of 19 female victims have come forward during the investigation, aged between 17 and 60 years. He was found deceased prior to the formal conclusion of court proceedings. Read more here.
Dr George Tyndall (image 7.2), a former gynaecologist at the University of Southern California health centre, has been accused of sexually abusing hundreds of female students during is 30 year tenure at the clinic. Tyndall has been accused of performing unnecessary, often lengthy pelvic exams, without using gloves. Tyndall has been thoroughly investigated by the Los Angeles police and has subsequently had 650 law suits filed against him. There is considerable evidence that he preyed on foreign students who were vulnerable due to their age and poor english language skills. What’s even more despicable, is that USC was aware of his medical misconduct and looked the other way for years. Read more here.
These gentlemen are just two of many similar examples of doctors abusing their position of power in the doctor-patient relationship. Never forget the privilege afforded to us as medical professionals to be involved in the lives of our patients. Our interactions with are patients are often at times when they are at their most vulnerable. Tantamount to this, never forget the incredible ways in which we can influence the experience of our patients, both for the better and the worse. (images sourced here, here, here and here).
Image #8 (sourced here): A real ‘lady-killer’
Harold Shipman (1946 – 2004), also known as ‘Dr. Death’ and ‘The Angel of Death’ is one of the most prolific serial killers in history. He hid behind his status as a caring, family doctor, and was able to conceal his crimes for years. Eventually, he was found guilty of the murder of 15 patients under his care; however reports suggest that he killed up to 260 patients in total. 80% of his victims were elderly women. You can read more about his story here.
Image #9: Gynaecologist in Disgrace
Disgraced gynaecologist, Dr Emil Shawky Gayed, mutilated and performed unnecessary operations on dozens of women over the course of decades (dating back to 1997). What is similarly shocking, is that doctors and coworkers, to some degree, were aware of his disgraceful medical practices. Numerous investigations were conducted by the NSW medical board which ultimately found Gayed’s conduct ‘reasonable’. Read all about it here. Some of Gayed’s criminal conduct include:
- removing three-quarters of a patients cervix without obtaining consent
- completing a total hysterectomy on a patient without obtaining consent
- perforating a patients bowel and uterus in multiple places, cuts ranging in size from 1cm to 5cm
- breaching protocols for infection control
- altered medical records
Read more about issues with dealing with medical malpractice suits in Australia here. (image sourced here).
Image #10: Dr Margaret
James Miranda Steuart Barry (1789 – 1865) was a successful British Army surgeon who served in India and Cape Town (SA). He started life as Margaret Ann Bulkley. Her uncle conspired to help her get into medical school, posing as as ‘James Barry’, during a time when women had limited career opportunities. Her secret was only discovered when she died of dysentery in 1856, at which time she had successfully spent 46 years masquerading as a man. This story illustrates the extreme lengths that some women were willing to go to to be able to enjoy the same privileges as their male counterparts.
Check out The Vault’s reading & film recommendations.