Examining medicine through the lens of women’s rights

I’ve always had a hard time identifying myself as a feminist.

I work for healthcare equality and human rights. Women’s rights seemed to me a part of human rights work (and as Hilary Clinton and others have said, woman’s rights are human rights). Tying myself to the feminist movement then seemed to be looking backwards – clinging to a term that was anachronistic, divisive and too narrowly defined in what activism or womanhood should be. Furthermore, I’m uncomfortable defining myself by a cause. I prefer making plans and strategies for achieving concrete goals rather than the idealistic fervor of “health care for all” campaigns.

And yet.

I’ve found myself questioning my stance towards feminism in the past few weeks. As a medical student and future physician, feminism is rarely discussed in school. However, the more I learn about woman’s health and inequities that women face in the workplace, I’ve realized that there are issues that I cannot address without the lens of feminism and a focused push specifically for woman’s rights.

For example, women are increasingly becoming the face of medical care. Yet, major disparities exist in how much they are paid – $24,000 less in the UK and $17,000 less in the US.

When I brought up these issues on KevinMD.com, everyone from family practitioners to policy wonks were unconcerned by the trend and did everything they could to explain it away. Clearly, my commentators claimed, women were just working less based on some unmeasurable trend, seeking nonmonetary benefits, or spending more time with patients.

No one examined the lens through which they were making these statements – the implied societal pressure for women to be in charge of the household (even when the household includes two working adults) and our tendency as both patients and professionals to see women as nurturers. Of course, some of that is based on the choices that individual women are making, but much of it is also the way that we as women are viewed in society, a way that feminism strives to change by women for women.

At the same time, I found myself unable to ignore that women’s health issues are being treated differently than those that affect men and not always to the benefit of women. For example, many will still claim that the disease that kills the most women is breast cancer, when women pass away far more frequently of lung disease and heart disease – areas that are poorly researched when it comes to the treatment of women! For years, women’s health focused on the woman’s reproductive system. Clinical trials for drugs that were not directly related to reproduction enrolled mostly men, and many drug’s differential effects on women went unstudied and unobserved until too late. Though that thankfully is changing through the work of Susan Blumenthal, Teresa Woodruff and others, there is still so much work to be done.

My basic anatomy course barely included a consideration of the woman’s reproductive system and focused on the male reproductive system as the “default” system of study. Petitions had to be made to make sure that contraceptives that could also be used in abortion would be included in the pharmacology curriculum. My female colleagues still consider ruling out surgery because they are thinking about having a family.

All of this is to say that I’ve realized that it is simply inadequate for me to consider women’s health to be somehow addressed within the greater effort towards better health equity and quality. I’ve realized that as a social activist, a medical student, and a feminist, I cannot ignore the issues surrounding women’s health and gender equality in the hospital.

I still don’t know what to do with this realization, how it will figure into my future work as a physician and a community activist, but I do know that I will find a way.

Emily Lu is a medical student who blogs at Medicine for Change.

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  • alex

    Waiting for your analysis of how the per-capita funding of breast versus prostate cancer funding reflects the invisible hand of the patriarchy…..

    • kim

      What are most men more interested in preserving, their prostate or their wives breasts?

      • Sideways Shrink

        All insurance company’s formularies pay for some quantity of generic viagra, but insurance formularies are allowed to not cover birth control in most states for religious reasons. In my state, insurance companies could refuse to cover birth control for no reason at all until a female pharmacist filed suit 4 or 5 years ago and won based on gender discrimination.
        I bring this up because the question of saving one’s own prostate can sometimes mean facing the specter of impotence with radical prostatectomy. It adds a twist on the question of which to save: prostate or breast.

  • Fam Med Doc

    It’s good you are taking time to think these complex issues. Even better to not want to define yourself thru ” a cause”. Although i am not opposed to the goals of Feminism, surely you are more than just what “Feminism” means. But I applaud your drive to seek out a more equal society. Equality is important for all of us. And I’m disappointed in how your medical school training seems to be so male-centric. Shows poorly on your school, and bad for your education. Half of my patients are women & being prepared to provide care to that gender is essential. And I’m a male, btw.

    Although I’m aware of the wage disparity in regard to women and society in general, I’m certainly in the adamant belief wage gaps in medicine specifically are from womens choices, not inherent gender discrimination which may be the case from the general society at large. I’m in private practice. I assure you, Medicare, Aetna, Blue cross, all of them pay the same lousy reimbursement they do the female physicians as men. But I do see alot of my female colleagues working part time.

    • http://www.movingforwellness.com Bobby Fernandez

      The contempt held by the feminists for powerful women who choose to raise a family and “give in” to the “social pressure” of the patriarchy is difficult to stomach even as a man. I am proud of the “D” grade I got in my women studies class for writing that in general, men define themselves by their careers and women by their relationships. I’m sure the author would disagree with me:

      “our tendency as both patients and professionals to see women as nurturers.”

      I’m sorry but if you deny that there is nothing nurturing inside a baby girl that is absent in a baby boy, you are in the vast minority. Give a boy a toy truck and he’ll make motor sounds and tear around the rug with it. Give a girl a truck and she’ll give it a name and a blankey. I know feminists will blame “social norms” but the latests stats show that 40% of female physicians work part-time.

      http://www.nytimes.com/2011/06/12/opinion/12sibert.html?_r=1&scp=1&sq=female%20doctors&st=cse

      If we have to have this conversation ignoring sound statistics and instead looking towards feminist/queer theory then our efforts will do little to erase any income or professional disparity present in the industry.

  • Sideways Shrink

    Even if you marry someone who can pay for your student loans while you have children or pay for your $800 Mirena IUD, you will still be a woman when you graduate medical school. How the word “feminist” became a derogatory term for women our age and younger I am not sure. Regardless, your cursory glance at the playing field of the life ahead of you and those you seek to serve has apparently shown you that women are at a stark disadvantage. Why this is so difficult to opening discuss I am not certain. For anyone who thinks that a single generation of women from 1960-1975 could accomplish all the goals of modern women, I point them toward the African American civil rights movement. No one would suggest that in 15 years all of the goals of that movement were or have yet to be met.
    But, it is 2011 and a medical student does not, for some reason, want to call herself a feminist because to her it points to some past that holds us all back. The new economy is such that most women have to work outside their homes to support their families. Feminism is part of the past that has allowed women into medical school in such large numbers. By standing up for ourselves, call it “feminism” we have found more and more meaningful ways to work outside the home. I don’t think we would be where we are by any other means. Ask the women who work at Wal-Mart. But we don’t have anything in common with them, do we? Do they even have health insurance?

  • Rebecca

    I’d like to see US law change to even out wages, similar to what we have from the Equal Employment Opportunity Commission that requires reporting on opportunity for minority job applicants, to be sure companies are not disproportionately hiring whites. We need a law that makes sure that companies are not disproportionately paying their employees. Should a woman-owned company in the U.S. be able to pay women workers 20% more than male workers? The law I dream of would be to require companies to fully disclose their statistics about the wages they are currently paying, by job grade, job title, by gender, by race, and by minority status. If companies had to show that they are paying men 20% more than women, for instance, it would be a black mark on them from a hiring standpoint. What women would want to apply there? If a company could show that men and women make within 2% of each other, then it would be a good place for women to apply. Same with race and other minorities. Why can’t we have full transparency in this matter? Why haven’t companies stepped up and disclosed this information voluntarily? Because the disparities would make them look bad. I’d like to see legislation that would require that all companies disclose these numbers by 2013. We’d see a lot of evening up, a lot of women and minorities getting equity raises. And that could only be a good thing.

  • Sideways Shrink

    I agree Rebecca. There is a reason that this transparency has not come about. I snuck my way in the back door (via scholarship) of the white boys Ivy clubs and at every level
    there is a great ballyhoo that there is no discrimination against women–if it were ever brought up.
    If something is never brought up it can never be addressed. Welcome to being a woman in American medicine–unless you’re a nurse, in which case what you say doesn’t count because you are only a nurse.

  • http://about.me/michaelbmoore Mike Moore

    Excellent post Emily. As the husband of a Pediatrician (who is now mid-career, dealing with career/lifestyle issues) and a PA turned medical student who has been on the front lines of the demographic shift in medicine that has occurred in the past decade, I really appreciate your resolve to approach these issues and the discussion you have started. The reality is that is order for us to grow as a civilization we have to become more fair, more inclusive, and more able to care for all of us, where ever we are. We are more inter-related now than we even have been, we have to learn to be fairer to each other or we will self destruct. Big issues to be sure, but we in health care are just a reflection of that. Just as Emily senses “feminism” just doesn’t capture the problem…I would have to agree with her, “feminism” as I see it represents some sort of zero sum game against “white boys Ivy clubs,” when in reality is much more complex. (Not to say that I think this is Emily’s point about “feminism.”)

    I have had the same realization as Emily, it’s part of why I went to medical school at this point of my life. I am also committed to leave medicine and health care better, much better than I found it. Period.

  • Sideways Shrink

    Bobby

    I agree that women in our culture generally display more nurturing traits. Your last statement I interpret as indicating that it is the unequal reimbursent for nurturing behavior that must be addressed rather than denying or trying to change people’s perception of women as nurturers. I completely agree with thus. I also believe that if women want to become neurosurgeons and orthopods they should not be steered toward more “nurturing” kinds of medicine”.
    I am the full time bread winning supporter of a stay at home husband and two daughters. I am very proud of myself. I have gotten critical comments from my daughter’s super-religious

    kindergarten teacher. Oh, well, that is her problem. Not mine. I would last 2 days as a kindergarten teacher….
    Women should quit apologizing for their own choices and get off each other’s backs. Feminists are focusing on pay equity, universal daycare, extending maternity leave time, and working on legislation to improve the federal rights of all women in the work place.

  • Brian

    Feminism will never obtain its true goal of female empowerment until it stops focusing on how women are oppressed by men as the sole issue. I would agree that society sees women as more nurturing and that feminism is pushing to empower women in the work place. What is lacking with feminism or any other movement is the corresponding push to empower men in the nurturing roles. Family courts do not see men as nurturing in the same way as they see women. Also, men in nursing or education are not seen as nurturing but as potential predators. As long as men get these conflicting messages they will default to the status quo or disengage completely. This is playing out in society today where black women are increasingly more educated than their male counterparts and yet more likely to live in poverty. By focusing on women’s issues only and not considering or advocating for the corresponding male issue simultaneously, feminism is not espousing equality and has a long battle to fight. It would be much easier to realize they need to work on both sides of the issue to really make progress. This is why I think the author’s original thought of working on civil rights (and women’s rights are a subset) is the right idea.

    • http://www.medicineforchange.com/ Emily Lu

      I totally agree with this. I wonder at how many discussions I get into about women working part-time to take care of their children and how few of those discussions also include the acknowledgement that this phenomenon is partly because we do not have a culture where it is prevalent and accepted for a father to also stay at home and care for their children. Or for men to worry about work-life balance.

      You and Mike are right to say that I haven’t identified with feminism as a movement for a long time because of this feeling that we need to pursue a greater equity. Part of what I’m struggling with in this post though is the realization that even as I and others strive for a more equal, more accessible, more fair health care system, there are still these clear gender inequalities that remain unaddressed in favor of other, more palatable and less controversial concerns. Fact is we live not only in a gendered society, but one in which one gender is privileged over the other.

      I would be a poor advocate for equity if I did not recognize that — no matter how uncomfortable that may make some feel.

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