What to Know About Gender Bias in Healthcare
Medically Reviewed By Francis Kuehnle, MSN, RN-BC
Gender bias in healthcare is widespread. Patients, doctors, researchers, and administrators can all hold biased views about gender. These views affect how the healthcare system works and have a serious impact on health outcomes.
Gender bias is a preference for one gender over another. This preference is often based on false beliefs or generalizations that make one gender seem better or worse than others.
Worldwide, the most common form is bias against women. In 2020, a United Nations global report found that close to 90% of all people have some form of gender bias against women.
In this article, we look at gender bias in healthcare, including examples, its impact, and some ways to tackle it.
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
What is gender bias?
Gender bias is a type of prejudice that favors one gender over another. Gender is based on how someone identifies, while sex refers to biological characteristics, such as genitalia. People can have biases about both sex and gender. Often, these biases overlap.
Almost everyone has some form of gender bias, whether or not they are aware of it. This is because bias can be conscious or unconscious.
Bias that a person recognizes is “explicit,” while bias that a person is unaware of is “implicit.” Implicit bias comes from the messages that people unknowingly absorb about gender throughout their lives.
Both explicit and implicit biases influence behavior, which leads to discrimination and reinforces inequity.
Because most cultures place a higher value on men and masculinity, gender bias affects women and girls most severely. Gender bias can also affect others whom people perceive as feminine, such as trans and nonbinary people. In addition, this bias can impact boys and men who feel pressure to conform to rigid gender norms. https://e6324924ed54bc47c85f09fdb79ec620.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html
Examples of gender bias in healthcare
Gender bias is present throughout the healthcare system, from the interactions between patients and doctors to the medical research and policies that govern it. Some examples include:
Disbelief in symptoms
Stereotypes about gender affect how doctors treat illnesses and approach their patients. For example, a 2018 study found that doctors often view men with chronic pain as “brave” or “stoic,” but view women with chronic pain as “emotional” or “hysterical.”
The study also found that doctors were more likely to treat women’s pain as a product of a mental health condition, rather than a physical condition.
A 2018 survey of physicians and dentists arrived at similar conclusions: Many of these healthcare professionals believed that women exaggerate their pain. This was true even though 40% of the participants were women.
Workplace harassment, bullying, and discrimination
Gender bias also leads to discrimination against health workers. A 2020 study of older women doctors found that age- and gender-based harassment, discrimination, and salary inequity persisted throughout their careers.
While these problems diminished over time, the participants’ levels of seniority and professional experience did not put a stop to them.
Other analyses have reached similar conclusions. A 2019 report on sexism at the British Medical Association discovered a culture of bullying and harassment towards women healthcare professionals and staff.
Gaps in medical research
Inequity in medical research reinforces gender bias. In the past, many scientists believed that males made the best test subjects because they do not have menstrual cycles and cannot become pregnant. This meant that a vast amount of research only involved male participants.
However, the important biological differences between the sexes can influence how diseases, drugs, and other therapies affect people. As a result, many studies from before the 1990s are flawed.
The lack of inclusivity in studies has left doctors with a more limited understanding of the health of female and intersex people.
Meanwhile, a lack of awareness about this disparity may fuel gender bias because it can contribute to misunderstanding between doctors and patients.
What are the consequences of gender bias in healthcare?
The overall consequence of gender bias in healthcare is that people receive worse care than they should, which increases health inequity.
Gender bias causes:
- Knowledge gaps: A lack of inclusivity in medical research has led to gaps in knowledge. This means that doctors know less about female, intersex, and trans health than male health. In one example, a report from the National LGBTQ Task Force found that 50% of respondents have had to teach their doctors about caring for trans people.
- Lack of women in leadership: A 2019 study found that in academic medicine, many people view men as naturally better leaders than women. This may explain why the number of women in leadership positions is disproportionately low.
- Delayed diagnoses: When doctors do not take a patient’s symptoms seriously, it can keep the person from receiving a correct diagnosis for many years. A 2019 analysis in Denmark, for example, found that in 72% of cases, women waited longer on average for a diagnosis than men.
- Inadequate symptom management: Doctors not believing patients also prevents people from getting help with symptom relief. For example, doctors who dismiss the severity of chronic pain may not provide women with pain medication.
- Avoidance of medical care: People who no longer trust medical professionals or organizations due to negative experiences may avoid getting necessary care. This may be a factor in vaccine hesitancy. A Harvard survey found that only 47% of nonpregnant women who did not trust public health agencies planned to get the COVID-19 vaccine.
- Abuse, neglect, and death: Gender bias can lead to actions that increase the risk of patients dying. For example, the idea that heart attacks mainly occur in males — and a lack of awareness about how they affect females — contributes to the higher rates of females dying from heart attacks.
Gender bias and sexism can also intersect with other forms of oppression, such as racism, ableism, classism, and heterosexism.
Learn more about racism in healthcare.
Ending gender bias in medicine
Everyone has a role to play in ending gender bias, but institutions have the most power to create widespread change. Here are some ways that institutions and organizations can end gender bias in medicine.
Education and awareness
It is important for healthcare professionals and the people they serve to understand what gender bias is, that everyone has these biases, and how they affect healthcare. People and organizations can only stop reinforcing inequity by recognizing their biases and taking action to unlearn them.
Some studies suggest that implicit bias training can help. Not all studies support the effectiveness of this approach, though. It is also worth noting that people addressing their own biases is only a first step.
Sex and gender diversity in research
Women now make up around half of the participants in clinical research supported by the National Institutes of Health (NIH). However, this does not cover all studies, and it does not account for the decades of research that only involved males.
Health organizations and researchers must commit to sex and gender diversity in all relevant studies and fund research to fill in the gaps in knowledge.
Accountability
It is crucial that workplaces hold people accountable for any form of biased or discriminatory behavior. This reduces the likelihood of harassment and bullying.
It is also essential for healthcare institutions to become accountable for the ways that their policies, systems, and practices uphold gender bias.
Equitable treatment guidelines
As a 2017 review notes, many studies have found gender-based variations in how doctors diagnose and treat patients. Some found that doctors asked women fewer questions about their symptoms or prescribed women less medication.
Having standardized, equitable, and evidence-based rules for treatment may reduce the risk of implicit bias affecting healthcare.
Equitable workplace policies
Similarly, clear policies about how institutions should address systemic inequity are essential. This may include rules that correct imbalances, such as unequal pay or career advancement opportunities. It may also include policies that support women who are new parents or caregivers.
In addition, standard procedures for how organizations should respond to gender discrimination, harassment, and abuse are crucial.
Self-advocacy
If a person believes that they are receiving inadequate care due to gender bias, there are steps they can take. Try:
- seeking second or third opinions from other doctors
- speaking with a specialist
- getting doctor recommendations from others who have faced similar situations
There are also ways to advocate for oneself. People can:
- Bring an ally to an appointment for support and to act as a witness.
- Ask why a doctor is not pursuing tests or treatments.
- Ask a doctor to memorialize their decisions, and the reasons for them, in their patient records.
- Report bias or discrimination that is obvious or severe.
Many hospitals have patient advocates who may be able to help. And in some cases, it might be appropriate to report malpractice stemming from bias to a state medical licensing board.
Summary
Gender bias in healthcare is a critical, well-documented problem that endangers people’s lives and well-being. It is a component of sexism, which is a major cause of inequity worldwide, including health inequity.
Gender bias affects diagnosis, treatment, and health outcomes, reducing the quality and effectiveness of healthcare. In order to stop it, organizations and institutions need to commit to changing their policies and practices.
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