Are women shortchanged in Healthcare?

I recently read an article in National Geographic that highlighted women being short-changed in the health care system. The author based the information on the statistics and data of the US population.

That got me a little curious to find out about Malaysia. I wondered if a developed nation such as America still struggles with such a compromise, wondering what countries like ours are facing.

The Malaysia Gender Gap Index (MGGI) score identifies the gap between women and men across four categories:?economic participation and opportunity, educational attainment, health and survival, and political empowerment. We have achieved a gender inequality A score of 1.0 (100%) indicates complete gap closure and we are now at??0.714 (71.4%) as of 2020.?

I was never a statically oriented person. Somehow numbers make less sense to me; however, I admit these numbers are a guideline.?

I decided to base my articles on real-life stories and experiences that I see in my day-to-day work as a GP and a coach who deals with holistic women's wellbeing and health issues.

What an apt topic in conjunction with International Women Day 2022 with its theme?#brealthebias

The Bias

1.?????Everything that happens around a woman is always due to her emotions or hormones.

From premenstrual syndrome to perimenopause, hot flashes and weight gain is all about the hormones and the emotions.

Unfortunately, all women's grievances and health complaints are disregarded and assumed to be simply an over-exaggeration of emotion and hormones. How sad!

Yes, women have more erratic hormone cycles that vary daily, monthly, cyclically, and in different phases of life.?

And yes, women are more emotionally intelligent and sensitive by their genetic makeup.?

But this does not overrule the fact that they are ordinary human beings with similar vulnerability and susceptibility.

Even more importantly, these attributes: hormones, and emotions actually make them more susceptible to many illnesses, for example, anxiety and depression.

The hormonal and emotional factors should not be looked upon as an advantage or disadvantage but rather factors that need to be considered when dealing with the health aspect.

The hormonal fluctuations create cyclical mental stress akin to bipolar-like conditions and depression-like episodes periodically, much more than men and it varies in every woman.

I still see women who shy away from addressing these issues in public or even sharing with close family members for fear of being labeled mentally weak and incapable.

This chronic emotional stress, anxiety, and depression lurks and grows in silence and pops its enormous ugly head as health and wellbeing issues during menopause, pregnancy, and aging.

2.???Women's health is not just reproductive health.

In medicine, we have many branches and specialties. To mention a few, adult medicine, pediatrics that deals with children and neonates, geriatric dealing with aged population, cardiology-heart, surgery, orthopedics, and Obstetrics and Gynaecology, which deals with women's health.

By women's health, we are talking?about pregnancy, fertility, menopause-related, reproductive system cancers, and diseases.

It is ironic that all other systems and diseases apart from the reproductive system are clumped into adult medicine. The research and development of many such disorders were based on the male population's study.

This inequity favors gender bias. From the beginning, male participants were preferred as research subjects because they are free of hormonal factors, monthly periods, pregnancy, and physiological changes associated with them.

Sexual physiology plays a significant role in the pharmacodynamics of any drug; that is, how a drug reacts in the body is influenced by many factors, including sex.?

Though we are becoming more conscious of this with the advent of pharmacogenomics, most current treatments and medications are based on research conducted in the early 20th?century, where the male population was the predominant subject.

It is about time we look at a woman past her assumed functionality as a reproduction unit and see her as a person who needs a customized and holistic approach to mental, emotional, and physical wellbeing.?

We need a special branch of medicine to attend to women's health holistically.

3.???Health symptoms differ in both sexes.

?I recently had a woman in her mid-fifties who had 2 episodes of idiopathic (cause not known) vomiting. She wanted to have a quick doctor's visit and grab some antacids and meds to stop the symptoms.

She looked fine, with no chest pain, no jaw pain, no shortness of breath, and sweating, but seemed rather dull and way too tired for a few vomiting episodes, which she blamed on her breakfast.

When I suggested an ECG (electrocardiogram) to check her heart status, she adamantly refused because she said she was aware of the common heart attack symptoms and she has none of those.

It took me some time to coax her to get one done, and fair enough; it was a heart attack- a major one. Later she confessed that she felt this abdominal discomfort for three days and never thought it could be a heart problem.

Not much research or work has been done in studying the various ways diseases present in a woman compared to men, and sadly, much less awareness is educated to the public.

Another example was a perimenopause lady on anti-anxiety medication who approached me as she was not getting any better. Careful history taking revealed that she was experiencing a condition called?"Relative hypoglycemia" – a state of low sugar episode that can mimic an anxiety attack, a condition prevalent in perimenopause.

A slight change in the way and timing of eating resolved the issue swiftly.

Many diseases' presentations are different in women, and we tend to miss them because of a lack of awareness.

4.???Free labor.

Forget about the inequity of pay amongst the gender. Let's look at the number of hours each gender spent on unpaid labor; it is shocking.?Close to 76-80% of the total unpaid work hours are born by women worldwide, worst in Asia and the Pacific region.

Women care for children, the sickly, spouse, and extended family, and these women can be with or without a permanent job. The covid pandemic had stretched that number to the max. Lockdown and erratic school schedules added on with online classes amplified the burden women had to go through as unpaid caregivers.

Many women had to give up their existing jobs to care more for the family stranded at home during the pandemic.

I see many worn-out, exhausted, and burnt-out moms taxing children to school and tuition. My usual ice-breaking question,?"what do you do?" is often answered with an "oh…I do nothing-I am just a stay-at-home mom."

The minimum pay for a Filipino helper now is RM 2000 and, here we have moms playing multiple roles as housekeeper-driver-cook-teacher who claims she does nothing and paid nothing.

To top all that, these moms now try to support their spouses who are struggling amidst the pandemic by running home-based businesses that further robs their time, health, and wellbeing.

Midlife women, "the sandwich generation" caring for the elderly parents and teenage children and occasionally for the partner as well, often disregard their health issues till it's too late.

I still have working couples coming to me with similar health issues, but the male counterpart almost always asks me to provide the instruction for good diet and lifestyle advice to the wife so that she can be responsible for it and take care of him, often at the expense of her health.

Many women still put aside their health issues until their spouse or children get sorted, neglecting their care.

The Solution.

"We can't solve problems by using the same kind of thinking we used when we created them." - Albert Einstein."

"We can't expect our problems to be identified and rectified by someone else. We can't seek an external solution to an internal problem."-Dr. Mugil

We, as women, need to create the solution, and we got to do it fast. Keeping in alignment with the theme for international women's day 2022-?#break the bias,?women should first acknowledge it and take full responsibility for it.

Women should strive to overcome the shame of being different and embrace themselves physically, mentally, and emotionally.?

The Malaysia Gender Gap Index (MGGI) score clearly shows that women still lack leadership roles and politics, where policies and change can be initiated and implemented.?

We are losing many intelligent, capable women in the pipeline to leadership roles.

We need more women up there, more women who are proud to own themselves as they are and bold enough to challenge the norm.

We need policymakers; we need women movers and shakers who embrace the women in them and are not insecure of another.

We need to remove the bias of associating women with?selflessness, sacrifice, and suffering in silence?and replace them with the empowerment of?self-care, self-acceptance, and, most importantly, Speaking UP.

We need to speak up our grievances and stay steadfast in that mission till it's heard and resolved.

This is not a war to be fought; this is the fundamental right that needs to be upheld and nurtured. The enemy is not the external circumstances; it is the #silence we held on to for far too long.

Speak Up and #breakthebias

Happy International Women's Day 2022.