Every day, millions of women across the United States find themselves in predicaments confronting the quality of their appearance. And their makeup. While this may seem a non-issue in the emergency medicine world, it is something that you, as a female professional, or that your female colleagues, have no doubt encountered. Before walking out the door, you have to consider not just what means of transport to take to work, but also what color of eyeshadow to wear. (Will this be too ostentatious?) You have to consider what to have for breakfast but also what shade of lipstick to don. (Is this shade natural enough?) And you might have to consider what shoes to put on your children, in addition to deciding between the foundation or the bronzer? Makeup. You decide on whether to use it, how much to put on, what shades to wear, or not. And why so much of a fuss about makeup?

We can trace the history of makeup in the U.S. as far back as the early 20th century or before. And probably earlier in other cultures. At the turn of the century, women in this country were striving for a pale-skinned Edwardian look, telltale of a lifestyle safe from the sun. And where a tanned look was actually disfavored implying a lower class status. While the goals of a made up look may have changed over time, the struggle still remains.

Currently, $382 billion goes to the global beauty business sector annually, and the majority of that is spent by women. So why do women feel the need to spend so much? It is a classic case of the chicken and the egg. Some would argue that women can opt out of wearing makeup just as easily as they wipe off the lipstick from rosy lips at the end of each day. That is somewhat true. The media and entertainment industry (amongst other pressures) have told women that in order to be at their best, they need to wear makeup. A reminder of this being the constant bombardment of makeup advertisements, with new brands to fit every flavor everywhere you look, up to and including chocolate-based edible wares.

Furthermore, research has shown time and again that those perceived as better looking tend to fair better economically. Enter makeup. In a recent study, they built on some of these notions, and found that amongst both women and men, women with makeup were perceived as more attractive, higher in dominance (by other women) and higher in prestige (by men). So while you may think that this is a choice granted solely to you or your female friends, think again. The odds are not in your favor. Society and industry around you want us to buy makeup and use it whether we are innately choosing to or not.

On the other hand, I have female friends who are genuinely passionate about wearing makeup, and I laud them for this. My concern is the choice to enjoy it as a novelty rather than something one participates in being the path of least resistance. I empathize that we as women are running out the door, doing makeup in our rear view mirrors, or in the bathroom at work before the day has even started with worries of its own.

I am acutely aware of this difference in my own day-to-day, since I have started to wear makeup, whereas not too many years ago, as a trainee specifically, there was no makeup. And I am still licking my wounds from the experience walking up to the MAC counter as a novice, sensing all kinds of judgment over my bare face from these contoured and tweezed artistes, “I … I … don’t usually wear a lot of makeup …” I managed to mumble, feeling sharply self-aware, and with a non-reassuring, “mmhhh …” we got to work looking for some products.

So in a day and age when a female professional is judged based on her attire, hair being perfectly coiffed and her makeup, why do we expect there not to be disparities in macro issues like equal pay, hiring and promotion? These are outdated conversations for a progressive time, and unrealistic expectations when others should be taking priority.

Christine Ngaruiya is an emergency physician who blogs at FemInEm. She is a former public voices fellow, Op-Ed Project, and can be reached on Twitter @calmesante.

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