Over the last 20 years, a significant effort has been made to improve women’s health overall. However, there are still many issues faced by millions of women across Australia every day. This Women’s Health Week, I would like to highlight the issue of gender inequality in healthcare and discuss how we, as nurses and healthcare professionals, can make a positive difference in the lives of women.
Recent studies have shown that the research, diagnosis, and treatment of numerous conditions have historically been biased against women and girls (Yates et al., 2021). This variation in healthcare delivery significantly impacts the diagnostic process for women, which many rely on to obtain a sense of belonging and improved self-view (Green et al., 2019).
As nurses and healthcare professionals, we are change-makers that must address this issue in order to improve the quality of life and health outcomes of women. This article will focus on some of the healthcare challenges faced by women, and the actions we can take to support women across Australia.
The effects of gender inequality on diagnosis
One area where women suffer stark inequality is in reproductive health.
An example is Polycystic Ovary Syndrome (PCOS), which affects over one in ten women in Australia. Despite its high prevalence, many women remain undiagnosed or may wait over three years to receive a diagnosis (Gibson-Helm et al., 2017). A delayed diagnosis of PCOS is associated with symptoms of anxiety and depression, with 65% of women dissatisfied with the diagnostic experience (Gibson-Helm et al., 2017). This experience is also common for women with Endometriosis and Adenomyosis who face the same diagnostic barriers and challenges.
Another area that women are also susceptible to misdiagnosis is cardiovascular disease (CVD), one of the leading causes of death in adults. Studies have found that physicians often underestimate risk burden in women, and have shown that women receive minimal CVD preventative care, are less likely to be referred for diagnostic cardiac catheterisation, and even remain untreated in some cases (Kouvari et al., 2020).
Misdiagnosis is often attributed to the historically male-dominated and gender-biased medical system which influences the diagnostic process (Kouvari et al., 2020). This is especially evident in the diagnosis of Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) where women commonly experience delayed or incorrect diagnosis due to presenting with different symptoms to men (Green et al., 2019).
Many women who received a delayed diagnosis of ASD reported feeling dismissed and victimised by health professionals that weren’t familiar with the female phenotype, causing further roadblocks to treatment and services (Green et al., 2019).
Furthermore, women represent just 37% of participants receiving disability services and funding through the National Disability Insurance Scheme (NDIS) despite representing 49% of the NDIS-eligible disability population (Yates et al., 2021). This lack of representation is likely due to women being under-diagnosed with various disabilities, such as ASD and ADHD, and more commonly diagnosed with disabilities that are challenging to get funding for from the NDIS (Yates et al., 2021). These conditions include autoimmune disorders such as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia (Yates et al., 2021).
The effects of gender inequality are faced by countless women around Australia, with some women brave enough to tell their stories through disability advocacy. Susie Ray, a 24-year-old Brisbane woman, shares her story online to raise awareness of her ‘invisible illnesses.’
“I live with illnesses that predominantly affect females and I feel this drastically impacts the healthcare and treatment I receive. After years of telling doctors my symptoms I was constantly dismissed… [It] made me believe I was weak when in fact I was unknowingly suffering from debilitating conditions.”
It took healthcare professionals eight years to diagnose Susie with Endometriosis and 14 years to discover that she had Postural Orthostatic Tachycardia Syndrome (POTS). Susie also suffers from ME/CFS, another condition that is commonly misunderstood and misdiagnosed in women.
“I experienced symptoms [of POTS] from as young as preschool and didn’t receive a diagnosis until it was too late and I was bed bound at 18. My whole life has been impacted by doctors not being aware of my condition, and not listening to how much I was suffering.”
Despite her frustrating experience, Susie shares a message of positivity and a call to action for all people suffering from illnesses and struggling to receive a diagnosis.
“You know your body better than anyone else. Don’t doubt yourself, advocate for yourself. We deserve to be heard and deserve proper treatment.”
Our role in improving women’s health
So, how can we create positive change in our roles as nurses and healthcare professionals?
Increasing healthcare providers’ awareness and understanding of disabilities and unconscious bias will help to facilitate early diagnosis and better meet the needs of women (Yates et al., 2021; Kouvari et al., 2020). This can be achieved through staff training that evaluates women’s experiences and focuses on gender and structural changes to directly improve practice (Yates et al., 2021).
Additionally, the implementation and promotion of a ‘women’s health’ multi-disciplinary team comprising of general practitioners, specialists, allied health, and nurses will provide women with individualised care to meet their specific needs (Green et al., 2019).
On a larger scale, policy-makers need to allocate resources and funding to facilitate research focusing on gender-specific differences in the diagnosis and treatment of various conditions. Although this has already begun in Australia with Endometriosis, significantly more attention needs to be given to the multitude of other conditions and issues faced by women.
Also, government bodies and healthcare organisations should continue to partner with women’s disability organisations, through funding and promotion, to positively impact women (Yates et al., 2021).
Let’s work together this Women’s Health Week and beyond to take action against gender inequality in healthcare and create positive change to improve the lives of millions of women across Australia.
Aya Torbey MACN
Aya is an early career nurse and a Stage Four Emerging Nurse Leader (ENL). She has worked in Intensive Care Units in both the QLD and NSW public health systems. Aya is passionate about supporting and mentoring nursing students and graduate nurses and hopes the ENL program will develop her leadership skills for future roles in education and clinical support. You can follow Aya and learn more about her on LinkedIn.
Gibson-Helm, M., Teede, H., Dunaif, A., & Dokras, A. (2017). Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. The Journal of Clinical Endocrinolgy and Metabolism, 102(2), 604-612. https://doi.org/10.1210/jc.2016-2963
Green, R., Travers, A., Howe, Y., & McDougle, C. (2019). Women and Autism Spectrum Disorder: Diagnosis and implications for treatment of adolescents and adults. Current Psychiatry Reports, 21(4), 22. https://doi.org/10.1007/s11920-019-1006-3
Kouvari, M., Souliotis, K., Yannakoulia, M., & Panagiotakos, D. (2020). Cardiovascular diseases in women: Policies and practices around the globe to achieve gender equity in cardiac health. Risk Management and Healthcare Policy, 13, 2079-2094. https://doi.org/10.2147/RMHP.S264672
Yates, S., Carey, G., Hargrave, J., Malbon, E., & Green, C. (2021). Women’s experiences of accessing individualized disability supports: Gender inequality and Australia’s National Disability Insurance Scheme. International Journal for Equity in Health, 20(243), 1-14. https://doi.org/10.1186/s12939-021-01571-7
To find out more about Susie’s story: https://findyourownhope.com/