Women and the Healthcare System

According to biology, there are two sexes: female and male, with XX and XY chromosomes respectively. Both sexes are nearly similar, yet they have significant differences. Both have entirely different reproductive systems, different hormones, a menstrual cycle in women along with a wider pelvis, and higher muscle mass and denser bones in men. Hence, there are different physiological processes taking place inside their bodies. This does not imply that one is superior or inferior; nature and evolution created this diversity to continue the reproduction cycle. 

Naturally, all humans, irrespective of social status, are prone to various diseases and other health disorders because of identical organs and similar environmental conditions. Although it is not surprising that one sex has been more privileged in the medical field. Guess who? The male one, of course!

History of Healthcare Studies

Healthcare study has been primarily concerned with how different diseases affect different body parts. Historically, societies considered male the default gender, with no consideration of differences in female bodies. The resultant exclusion of women has always led to a lack of research and unscientific claims.

One of the oldest mentions of women's health comes from ancient Egypt. The Kahun Gynaecological Papyrus, one of the largest manuscripts from 1850 to 1700 BC, contains accounts of symptoms and how physicians should deal and treat them using fumigation, massage, and medicines. The common belief was that illness resulted from conditions of the womb.

Ancient Greece too had the prevalent concept of the "wandering uterus" theory, attributing various illnesses to the womb moving around the body.

In the 19th century, women's health was still being ignored and mistreated. Pseudoscience created the "hysteria" diagnosis, linked to the Greek word for uterus. It was applied to various symptoms ranging from anxiety to blindness, dismissing women's legitimate health concerns.

The Dark Accounts of Gynaecology

Gynaecology, as we know, is the branch of medical science that deals with diseases affecting girls and women, primarily the female reproductive system. 

J. Marion Sims is a highly controversial figure, known as the "father of modern gynaecology." He owned female Black slaves and operated on the most delicate part of their bodies without anesthesia. His actions were motivated by a racist belief that Black people had higher tolerance to pain compared to white people.

His primary subjects were enslaved women with vesicovaginal fistulas, a debilitating childbirth complication. Three of the women were known by the names: Anarcha, Lucy, and Betsey. Anarcha, for instance, endured 30 surgeries as he experimented to perfect the "art of surgery." Those women could not consent or deny the procedures either, as it was dependent on their owner. These procedures were a gross violation of consent and bodily autonomy. Sure, his works contributed to the field of gynaecology, but there were better ways to learn those techniques without such brutality.

Women as Doctors

Medicine has been dominated by men historically, yet women have played pivotal and pioneering roles in the same fields. Some examples include:

• Aspasia: She founded the origins of obstetrical practice and performed "venesection, hysterectomy, open subinguinal varicocelectomy and hydrocelectomy," making her one of the best surgeons of her times.

• Metrodora: An extremely competent gynecologist in the 2nd century AD who created the oldest medical text written by a woman, titled "On the Diseases and Cures of Women."

• Rebecca Lee Crumpler: An African American who attended the New England Female Medical College in Boston, Massachusetts. After working for eight years as a nurse in Charlestown, she completed her education in 1864, becoming the only Black graduate in the school's history. Following the American Civil War, she moved to Richmond, Virginia, to provide care for the former slaves.

Reproductive Rights

There has been a lot of social stigma around discussions related to reproduction, even today. Sex education is viewed as immoral by many in conservative spheres. A girl hitting puberty experiences one of the biggest moments in her life, especially with the beginning of the menstrual cycle. It consists of four phases:

• Menstruation: The shedding of the uterine lining, or endometrium, resulting in bleeding that lasts 3 to 7 days.

• Follicular phase: The pituitary gland releases FSH, prompting the ovaries to develop follicles containing ova, or eggs. This phase lasts for 13 to 14 days on average.

• Ovulation phase: The dominant follicle ruptures and the egg is released, ready for fertilization. This occurs around day 14 of the cycle.

• Luteal phase: The empty follicle transforms into the corpus luteum, which produces progesterone and estrogen hormones to maintain the thickened uterine lining in case of pregnancy. In case of no fertilization, the corpus luteum degenerates after 14 days. The uterine line is shed and menstruation begins. The entire cycle repeats until menopause is attained.

Apparently, period blood becomes a "concern" for many, which is despised by many. As a quote often attributed to Maia Schwartz and Jovanny Ferreyra states, "Menstruation is the only blood that is not born from violence, yet it is the one that disgusts you the most." Moreover, boys are often sent out of classrooms when discussions on periods occur, when they should know about it as well, especially in cases of emergency.

Period cramps and pain, along with mood swings due to hormonal fluctuations, leading to frustration and irritability, are very valid responses for any human being. Yet women are often labeled as dramatic, annoying, or too emotional for expressing these emotions.

Pregnancy, an inherently risky condition, is chosen by some women, while not by others. Even if sexual intercourse between the couple is consensual, no man has the moral right to demand babies from the woman. That is why countries provide abortion rights. Many European countries, Canada, Australia, and some US states have legalized it, though in other states it still remains controversial. In countries like India, abortion is legal only if pregnancy is a result of sexual assault, which enforces the notion that "women can be helped only when abused."

Moreover, a disease called endometriosis, in which cells similar to the lining of the uterus, or endometrium, grow outside the uterus, is incurable and receives less funding. It is a chronic condition affecting around 10% of women worldwide. It can be diagnosed via laparoscopy but it is sometimes ignored and confused with intense period pain being normal. Imagine that a condition like male baldness is researched more. The male hairline is more important than the uterine line!

Modern Developments

Traditional biases persist. Women remain underrepresented as doctors, with more women working as nurses. When visiting doctors, women are often ignored and considered too emotional when expressing pain. Similar symptoms in men are taken more seriously. Women report not being taken seriously by doctors many times, irrespective of the doctor's gender.

Some notable developments have taken place. The women's health movement had already begun in the 1960s and 1970s, with the main focus on body autonomy and reproductive rights. The Public Health Service Task Force on Women's Health Issues highlighted a lack of research on women's bodies. In response, the NIH established guidelines for including women in clinical studies, which led to the 1993 NIH Revitalization Act which made their inclusion mandatory. The Women's Health Initiative was launched in 1991 to study of postmenopausal women's health on a huge scale.

The 2016 Sex as a Biological Variable policy mandated the consideration of sex as a biological variable in both human and animal studies. Took so late to understand this, but better late than never! In 2017, a policy was implemented to include individuals and women (and girls) of all ages, especially older women, in clinical research. Organizations like the Society for Women's Health Research have continued to advocate for women's health research while simultaneously addressing issues like sex differences in diseases.

A Discussion on Mental Health

Mental health problems, from depression to anxiety on a broad scale, affect both men and women. By statistics, depression rates are higher among women, being 1.5 times more common. Reasons often come from hormonal changes related to pregnancy and the menstrual cycle. Social factors around sexism play a big role as well. In many cultures and societies, depression is not even considered a medical condition. Women often become targets of shame, accused of being over dramatic, which prevents them from seeking professional help or seeking medical advice. This can lead to isolation and loneliness.

The effects of loneliness are, however, more profound in men, with higher suicide rates and substance abuse, but this fact is sometimes used to derail discussions about women's mental health and dismiss their concerns, leading to what we perceive as the "gender wars." The truth is that everyone's mental health matters. It is this simple!

Final Thoughts

Healthcare is a right, not a privilege. Yet the system has historically been built around male bodies, leaving women's health under researched and often dismissed. The biases persist even today, with women's pain minimized and their concerns ignored. Progress has been made, but much work remains. Understanding women's unique physiological needs is not just about fairness, it is about providing competent, life saving care. Real change requires dismantling the patriarchal structures in medicine that still treat male bodies as the norm and female bodies as the exception.