The systemic issues ingrained within the healthcare system perpetuate medical misogyny

Like several other developing countries, the Indian healthcare setting is plagued with gendered disparities. Women face layered disadvantages owing to their positionality as part of a vulnerable category, societal structure, patriarchal upbringing and institutions such as marriage that place them in a secondary status to men. Within domestic settings, more often than not, women experience differential treatment, like unequal division of labour and resource allocation, in terms of nutrition, education and healthcare. They are also increasingly susceptible to domestic abuse and intimate partner violence, regardless of urban-rural differences.

The National Family and Health Survey (2019-21) reported that 32% of ever-married Indian women have been subjected to physical, sexual, or emotional violence by their husbands. While women facing domestic abuse is a normalised part of our culture, their experience in medical settings too becomes analogous to that of their experiences within domestic settings.

Within healthcare settings, women often encounter situations where their reports of bodily discomfort are disregarded or minimised by healthcare providers, resulting in delays in diagnosis and treatment (Loughnan et al, 2020). Studies have shown that women are 2.8 times more likely to die from heart attacks than men (Maas & Appelman, 2010) due to delayed or denied health services. Meanwhile, men remain overdiagnosed for the same.

Culture-Pain Correlation

Culture greatly influences how pain is expressed and experienced by communities. In many Southeast Asian countries, the increased ability for pain tolerance is glorified and has much cultural significance attached to it. Societal roles and expectations guide the health-seeking behaviours of those communities (Campbell & Edwards, 2012). Although this forbearance is expected of both sexes, the quality of endurance to physiological suffering earns them respectability in their community.

The indulgence to live in excruciating pain then becomes a performative narrative in their lives, leading to its internalisation. This category of women may find seeking help from formal medical settings unnecessary, thereby imposing constraints or inhibitions that deter them from seeking professional medical assistance promptly (Wong & Thwaites, 2015). The result? The prevalence of menstrual disorders is about 22.7% in Southeast Asian populations (Dhar et al, 2023). Thus, women’s upbringing is rooted in societal norms, which causes a great deal of conditioning that influences their health-seeking behaviours.

Social conditioning, which suggests that women ought to bear pain, stems from gender (female) socialisation, which leads to internalised prejudice towards women’s pain and discomfort. This then becomes responsible for the formation of unconscious bias in healthcare providers since they, too, are a part of the society that propagates such attitudes. Women who do seek help for their health concerns may often encounter unconscious bias, thus experiencing a loss of autonomy/control over their health outcomes due to the lack of supportive care. Such exposures may lead to motivational deficits, characterised by delayed initiation of voluntary responses and reduced motivation to control their health outcomes (Holenstein, 2015). As a result, they may perceive that their efforts to seek help are in vain.

Women often encounter situations where their reports of bodily discomfort are disregarded or minimised by healthcare providers

When women are repeatedly made to endure aversive stimuli, such as dismissive attitudes from healthcare providers, they may internalise a sense of helplessness. This propagates an attitude that diminishes their motivation to seek help and control their health outcomes (Loughnan et al, 2020). This contributes to a cycle of disempowerment and dis/continued reliance on a healthcare system that fails to adequately address their needs, worsening/ accentuating their sense of powerlessness and submitting to the phenomenon of “learned helplessness”. (Fisher, 2015; Holenstein, 2015)

Medical Misogyny

Like many other societal institutions, the medical system, too, is inherently patriarchal. Aristotle, the father of biology, designated the female body as a distorted or mutilated form of the male body. This notion has persisted in Western medical culture, which has led to women and their bodies being historically excluded from knowledge-production activities, including trials, experiments and other forms of research (Jackson, 2019).

Even today, in contemporary healthcare settings, the patriarchal instinct to control female bodies, as per the idea of Foucauldian biopolitics, takes a front seat/is very prevalent. The persistence of outdated attitudes and practices continues to undermine patient care and satisfaction levels. From body shaming remarks that could amplify body dysphoria to a judgmental stance towards patients’ reproductive choices, the healthcare system often fails to provide compassionate and respectful treatment to the patients. Furthermore, misusing their authority, medical practitioners also often offer women unsolicited advice, particularly regarding marriage and childbearing, while overlooking health issues like dysmenorrhea, endometriosis and PCOS.

Over time, when women are repeatedly made to endure bias, dismissive attitudes and traumatic instances of violence from healthcare providers, they internalise a sense of helplessness (Loughnan et al). Research has shown that such feelings contribute to depressive symptoms, which indicates why there is a female predominance in such psychological distress in India (Gururaj et al, 2016; Santos et al, 2012).

It’s All in Your Head!

In 2019, a Guardian article observed that “medicine expected women to take control (with their minds) of their disease (in their body) by accepting their illness, making ‘lifestyle’ changes and conforming to their gendered social roles”. The higher prevalence of chronic pain coupled with higher susceptibility to mental health issues suggests how women live in constant pain. And what do doctors consistently tell female patients approaching with pain or any discomfort? That it is all in their head! Its invisibility and unverifiability are used to gaslight women into believing they are overthinking.

Pushed into self-doubt, they trivialise their own lived experience (Merone et al, 2022; Paul-Savoie et al, 2018). Of course, pain can be triggered by mental health conditions like anxiety and depression. Recently, a study published in Nature states that approximately 80% of autoimmune disease cases are reported in women due to rogue antibodies being attracted to x chromosomes (Dolgin, 2024). But, to think that it might be the only sane explanation for a woman’s pain has become the norm.

As Elaine Scarry noted in her The Body in Pain, “[t]o have great pain is to have certainty; to hear that another person has pain is to have doubt”. The systemic issues ingrained within the healthcare system perpetuate medical misogyny, resulting in the dismissal and gaslighting of women. Hence, it is crucial to establish a safe and trusting environment for all patients, regardless of gender. And healthcare should never be an act of generosity. It is well beyond time for providers to recognise that it is a fundamental human right and ensure they receive the care, support and respect they deserve.

Authors: Devabala Smitha is an undergraduate student, and Dr. Moitrayee Das is Faculty of Psychology at FLAME University.