Gender Discrimination

Gender Discrimination

How to Handle Harassment

In 1994, women earned 76 cents for every dollar men earned. More than half had been sexually harassed on the job or knew someone who had been.

In 1993, one in four women in a national poll said she was "talked down to" by doctors. One in six was told a medical condition was "all in her head." One in ten said she had been sexually abused as a child. One in five had low self-esteem.

Editors of the Journal of Women's Health pointed out a huge gap: Women spend two out of every three health-care dollars in America, yet the bulk of medical research has focused on men. "Now," they said, "catch-up work must be done."

Sometimes, it seems, being female can be hazardous to your health and well-being.

Getting Mixed Messages

"Women must deal continually with society's mixed messages," says Georgia Witkin, Ph.D., assistant clinical professor of psychiatry and director of the Stress Program at the Mount Sinai Medical Center in New York City and author of The Female Stress Syndrome.

"We are most often expected to be sexy but not sexual," Dr. Witkin says. "To have a child but remain childlike; to be assertive but not aggressive; to hold a job but not neglect the home."

Gender bias? You bet. And it's more than just a hot topic for the TV talk-show circuit.

Subtle or blatant, unequal treatment can take a psychological and physical toll on any woman--whether she's just discovered she earns less than a male colleague or is a working mom who's rushing home to start the "second shift," caring for a family and household. And many women feel a nagging suspicion that dealing with a male auto mechanic, banker or boss might be a little easier if she were one of the guys. Dr. Witkin says these strains are "hidden stresses that distress, distract and deplete us." The impact? Bias contributes to unhealthy levels of stress, poor self-esteem, depression rates that are twice as high among women as among men, and the fear of failure. With all these can come physical difficulties ranging from stomachaches to insomnia, from panic attacks to skin rashes, from headaches to anorexia.

"The good news is, you can retrain yourself," says Dr. Witkin. "You can treat yourself well and boost your self-esteem. You can take risks and satisfy your desire for accomplishment. You can change things."

Rooted in Our Pasts

Psychologists trace gender bias and its impact to childhood, a time when Dr. Witkin says some girls learn "nonassertiveness." When University of California psychologists followed 91 young people through their teens and early twenties, they saw girls lose self-esteem while boys gained it. Why? Perhaps because girls are given less autonomy as they mature. "In crasser terms," they wrote, "females are socialized to get along in society and males are socialized to get ahead."

Girls who are self-confident and outspoken at age 7 become unsure of themselves by 15 or 16, and less willing to discuss their feelings and observations. The American Association of University Women's landmark report "Shortchanging Girls, Shortchanging America," notes that while 60 percent of elementary school girls told researchers they were "happy as I am," just 29 percent of high school girls felt that way.

"Moving from 'young girl' to 'young woman' involves meeting unique demands in a culture that both idealizes and exploits the sexuality of young women while assigning them roles that are clearly less valued," says Susan Bailey, Ph.D., a social scientist and director of the Wellesley College Center for Research on Women in Massachusetts. Her report charges that schools don't do enough for female students, who take fewer advanced math courses and for the most part see few women role models in their textbooks.

It struck a chord in grown women. "Everyone I talked to had a story of her own," Dr. Bailey says. The stories concerned "either being discouraged from pursuing math and science, confronting sexual harassment or finding it suddenly was not okay to be a tomboy anymore."

Where We Stand in Medicine

From a family doctor who says "it's all in your head" to medical research that has historically focused on men, bias in the medical profession can influence the quality of your health care, doctors say.

"Medical school doesn't prepare doctors for women patients," says Lila A. Wallis, M.D., clinical professor of medicine at Cornell University Medical College in New York City and director of the American Medical Women's Association's advanced curriculum on women's health.

"Historically, women have not been treated kindly by the established medical profession, either as health-care consumers or as health-care providers or as subjects of medical research."

In fact, when researchers looked at diseases affecting both men and women, many studied only males and later applied the results to women.

Heart disease, for instance, kills 250,000 women a year, yet major studies of heart attack prevention excluded women--including the 1989 Physician's Health Study of the effects of low-dose aspirin, which focused on 22,071 male doctors.

AIDS is the fifth leading cause of death among women of childbearing age, but fewer than 10 percent of the participants in large, government-funded studies between 1987 and 1991 were female.

Many researchers omitted women because of concerns that fluctuating hormones would compromise test results. But it's precisely those fluctuating hormones, along with other factors, that influence the health, course of illness and response to treatment in a woman, says Dr. Wallis.

This lack of research means that women's unique symptoms are often overlooked.

"I had a woman come to me with a terrible yeast infection. She had been to three gynecologists and had a bag full of pills," says Dr. Wallis. "None realized she had a systemic disease. It turned out to be AIDS. Often, AIDS in women is not diagnosed because it manifests itself differently than in men, and the differences have not been studied much."

Hope for the Future

While doctors disagree as to whether there has been gender bias in the treatment of heart disease, there is evidence that women receive less care than men. In a University of Tennessee study, men with heart disease were twice as likely as women to have had bypass surgery. In 1991, Harvard University researchers found that for 80,000 cardiac patients in Massachusetts and Maryland, the odds of undergoing certain medical procedures were 27 to 45 percent higher for men.

But the research gap may be closing. In 1991, the National Institutes of Health in Bethesda, Maryland, launched a 14-year, $625-million Women's Health Initiative to study prevention of osteoporosis, cancer and heart disease in postmenopausal women. In 1993, the federal government pumped $5 million into a large-scale investigation of women with HIV.

But to beat the odds and get the best health care, Dr. Wallis suggests that women choose family doctors and internists who understand the whole female body and can perform medical checkups that include gynecological exams.

"A woman who is sophisticated enough to know that she exists not just from the waist down but that she has a head, a heart and lungs, knows she needs her whole body considered," Dr. Wallis says.

A Woman and Her Doctor

Should that doctor be a woman?

Probably.

"While there are some male doctors who are better than some female doctors at listening and communicating, taken as a whole, female doctors appear to be doing a better job," notes Debra Roter, Dr.P.H., professor of health policy and management at Johns Hopkins School of Hygiene and Public Health in Baltimore.

Dr. Roter analyzed audiotapes from office visits to 100 doctors--half male, half female--with men and women patients. The women physicians spent more time taking patient histories, got more information from patients and seemed to draw patients further into a partnership to meet their medical needs.

"Women doctors gave women patients the most time, and men doctors gave women patients the least," she says. "So gender does make a difference. Female doctors also asked more often what was going on in other parts of a patient's life." A woman who appreciates the connection between her daily routine, her feelings and her physical health "may do better with a female doctor," says Dr. Roter.

When Minnesota researchers looked at care received by 97,000 women in 1990, they found that those who saw female doctors were more likely to have regular Pap smears and mammograms. "Women doctors often feel they are advocates for women patients," notes Dr. Wallis, "and have honed their skills to serve them."

In the doctor's office, at home or on the job, doctors say the following tips can help you take control.

Consider your body. Ask your doctor how a treatment or drug affects a woman's body. For instance, will a medication have an impact on fertility or bone density? Could a treatment cause birth defects now or in the future? Will a prescribed drug interact with birth control pills?

Pay attention to your cycle. Some drugs used for migraines, depression, hypertension and insomnia have different effects at various points in the menstrual cycle. Ask if the dose can be tailored to your needs.

Ask what men get. Researchers say women may not be tested as aggressively as men for problems like heart and lung disease. Find out what tests are available for your health condition and ask if they're appropriate.

Dissolve denial. "Many of us deny the truth of our painful experiences as much as possible," says clinical psychologist Ellen McGrath, Ph.D., executive director of the Psychology Center in Laguna Beach, California, and author of When Feeling Bad Is Good. "But denial robs us of our energy." Look into your past for signs of emotional, economic, physical or sexual abuse. Write them down.

Safely release anger. Releasing feelings can repair emotional damage. Dr. McGrath suggests ripping the pages of a telephone book or smashing a pumpkin. "Think about the person you're angry at while you do this," she says. "Any time you can make it more real by doing it, you've got more power over your situation."

Do a reality check. You were passed over for a promotion; a male co-worker got it. Was it bias? "Get the facts, and try not to take it personally," says Dr. Witkin. "I tell women, at all times, 'see yourself as someone in business for yourself. Your company is your client. Take necessary action to right what is wrong. Be forceful and tactful--but don't overreact.' "