Photo: Getty Images Being a marginalized woman increases the likelihood that the healthcare system will harm her more than it helps her, believes Katharine Larose-Hébert, associate professor at TELUQ in the psychology and mental health program.
Silenced voices, denied pain, unobtained consent, abusive operations, obstetric mistreatment… in the medical field too, many women experience discrimination and violence, especially when they belong to minorities. Supported by researchers and social workers, the #MeTooSanté movement lifts the veil on medical practices they consider sexist and racist, which have serious consequences for women's health and well-being.
Until recently, women were excluded from medical research protocols, and medicine developed with reference to the male body, "creating an androcentric system," explains Caroline Arbour, a physiotherapist in women's health and author of Habiter nos corps. Pour en finir avec la banalisation des douleurs des femmes. According to her, women "are still perceived as flawed and complicated." Medical research, in fact, pays less attention to the female sex.
Consequences? Delayed diagnoses: for 700 diseases, women are reportedly diagnosed later than men.
Also, misdiagnoses and the normalization of female pain. "Most women who consult for problems related to their reproductive system, periods, pain during penetration, fibroids after 40, are told that these pains are normal. This is false. It is the medical profession that does not understand them," says Ms. Arbour.
Finally, chronic pain. However, a woman who returns two or three times to her doctor for so-called normal pain will experience, and more quickly than a man, his impatience and "will be told that the problem is in her head." Thus invalidated, she has no choice but to bear her pain.
If we add to this sexism the fact of being a marginalized woman, undoubtedly neglect and abuse are common.
"All crazy?"
A woman who consults a doctor following domestic or sexual violence in most cases sees her symptoms overpathologized, and even more so when she is an immigrant or racialized. Thus, more than three-quarters of women who consult an organization for battered women have a psychiatric diagnosis, whereas in reality, according to Katharine Larose-Hébert, associate professor at TELUQ in the psychology and mental health program, they "exhibit normal behavior after trauma." In the doctor's office, if they cry, get angry, a mental health disorder will quickly be suspected. As "systems of oppression permeate public institutions, leading to interactions between professionals and patients tinged with prejudice," these women are often less listened to, less believed, which further fuels their anger and despair.
If being a marginalized woman increases the likelihood that the healthcare system will harm her more than it helps her, believes Ms. Larose-Hébert, it is partly because it does not take into account the social determinants that lead women to seek consultation. It is not uncommon for an immigrant woman to leave a medical office with a diagnosis of a mental health disorder, while it is "her migratory journey, her solitude, the language barrier, and poverty that explain her condition," says Nina Meango, program coordinator for health at the Alliance of Cultural Communities for Equality in Health and Social Services (ACCESSS). Pathologizing reactions caused by a system that oppresses women creates an overrepresentation of women "in certain diagnostic categories, such as BPD and
depression," says Katharine Larose-Hébert.
Unconscious biases
According to Agnès Berthelot-Raffard, professor at York University's Faculty of Health, abuse in the healthcare system stems from sexism, ageism—women are either too young, therefore infantilized, or too old, and their experiential knowledge is not respected—and racism. More often victims of neglect, dehumanizing practices, or non-compliance with protocols, Black women generally wait longer in emergency rooms because there is an unconscious bias that "they endure pain more." Furthermore, healthcare staff are more likely to try to direct their decisions, as they trust their autonomy less. They are also monitored more closely, due to a prejudiced, slave-era belief that they have deviant sexuality, and their non-consent is less respected.
Tubal ligation or hysterectomy without consent "are abusive operations more frequent than one might think," assures Nina Meango, who adds that this is also the case for Indigenous women. A 2022 study on free and informed consent and forced sterilizations on these women shows that, out of 35 respondents, 13 claimed to have undergone forced sterilization in addition to other forms of obstetric violence, and three mentioned having been forcibly aborted. "Women's full right over their bodies is at stake in our healthcare system which, as long as it goes wrong, will first make women suffer," says Ms. Meango.
Decolonizing the medical system
A movement like #MeToo-Santé, embraced by many women and initiated by Martine Delvaux, a professor in the Literature Department at UQAM and author, "allows women to question an experience they believed to be normal, so intertwined is it with medical culture, and to legitimize their feeling of having been abused," she argues. Adapting medical interventions to different cultures is also a step towards recognizing women's lived experiences. "A doctor who tells a Black patient 'You're pregnant again!' clearly doesn't understand that woman's culture, according to which preventing a pregnancy is unnatural," says Nina Meango.
Medical education must also "catch up centuries of delay," by ensuring that it takes into account the specificities of women in general and marginalized women in particular.
The healthcare system has a bias: medicalization. Every symptom is interpreted through the lens of illness, which grants significant power to doctors and "gives them great responsibility for the well-being of the population," says Katharine Larose-Hébert. Building bridges between different networks to decentralize power, and "promoting a comprehensive interdisciplinary approach" is essential for the healthcare system to adapt to intersectoral female realities.
Thus, "the decolonization of medicine involves the demedicalization of the discipline," which is inevitable in the perspective of a decolonization of women's bodies, concludes Agnès Berthelot-Raffard.
Whose bodies are women's bodies?
"We're going to give you Pitocin, you're going to have real contractions." "My dear lady, stop screaming like that! All women hurt when they give birth!"
Obstetric and gynecological violence sometimes hides in demeaning language, but it is sometimes blatant, explains Lorraine Fontaine, who has collected several testimonies during her career at Regroupement Naissances Respectées, a community action organization that acts as a force for social change for the humanization of the perinatal period.
She notably recounts the story of a woman who was taken by the legs by two male attendants who forcibly laid her on the hospital bed, after the doctor saw her crouching next to the bed, which helped her manage the pain of contractions.
"The medical profession has great power and believes it knows better than the patient what is good for her, which creates a system where a woman's body no longer fully belongs to her," adds Ms. Fontaine, who summarizes another testimony in which a medical student confides that a professor, palpating the belly of a willing student, abruptly put his hand into the young woman's pants, while stating, in response to the student who asked if permission should be obtained first, that being a doctor was the only profession that allowed one to put one's fingers into all holes without permission.
Article published in Le Devoir on May 25, 2024
Author: Roxanne Bélair