The history of gender-based discrimination, both old and omnipresent, can be traced back to when humans started to develop agriculture. Thousands of years later, the Western world began to acknowledge this inequality and the suffrage movement initiated the codification of gender equality into law. Even more recent has been the discussion of “intersectionality,” which has involved recognizing how different individual characteristics such as race, class, and ethnicity intersect to influence how each person interacts with and experiences the world. And yet, despite years of debate and acknowledgement of these effects, we have failed to adequately apply this understanding to many of our systems, notably the health sector as it regards maternal health. Even with increased awareness of inequalities and advanced medical knowledge in Canada, certain areas of the health system remain neglected and require attention.
Since the early 2000s, we have become increasingly aware of the role of gender as a determinant of health. Gender bias influences healthcare both on the interpersonal and institutional levels. A study from 2018 showed that physicians are more likely to describe a male patient with chronic pain as “stoic” while their female counterparts are labelled as “hysterical.” Another survey showed that dentists and physicians believe that women exaggerate their pain. What is notable about this finding is that the sample of participating professionals included both men and women, which goes to show how pervasive and normative these gender biases have become. Furthermore, much of the medical research before the 1990s was conducted on exclusively male samples, so a significant portion of the results is not entirely generalizable to women.
These biases translate to real consequences for health outcomes, markedly in maternal health and mortality. According to Statistics Canada, 523 women have died due to complications of pregnancy or childbirth between the years 2000 and 2020. However, organizations including the World Health Organization and UNICEF, estimated that this number could be as much as 60% higher. In addition to this, Canada’s mortality rate remained largely constant throughout this period. Data from the U.S. shows that maternal deaths also increased during the pandemic, with COVID-19 contributing to a quarter of maternal deaths in 2021. We must question why no improvements have been made to address this issue in the past 20 years.
Yet, the problem seems preventable, and there appear to be two main issues contributing to this gender disparity. Firstly, there is a general lack of effective communication and sharing of information between different medical institutions. Secondly, there has been no reliable system implemented to prevent the gender health gap.
A large portion of the issue is caused by the lack of consistent monitoring or measuring of trends in women’s health– six of the 13 provinces and territories have mandated maternal death reviews. Many provinces define maternal deaths differently, considering postpartum to be different periods, making it difficult to compare results or gain a concrete understanding of the specific issues and patterns. The issue also concerns interhospital communication or the lack thereof on a systematic level. There are ample guidelines on transferring individual patient information between hospitals and internal reviews on adverse outcomes, but this information is not being shared with other institutions. Individuals like Rohan D’Souza are working on creating a national surveillance system to facilitate this communication and reduce maternal morbidity and mortality.
Canada needs to catch up to many other high-income countries to implement a system to reduce adverse health outcomes for women. The United Kingdom, for example, has the MNI-CORP MMBRACE programme that investigates maternal deaths up to a year before and after the end of the pregnancy, and enquires into cases of severe maternal morbidity. Australia has followed suit with programs such as the Victoria Perinatal Data Collection program. There are models to work from when designing a similar program for Canada, though there exist a multitude of challenges. Healthcare in Canada is provincially controlled, making it more difficult to enforce cooperation and coordination among them. Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynaecologists of Canada (SOGC), says it will likely take an act of parliament to implement such a surveillance system. However, such a system is vital to identify large-scale patterns and risk factors for maternal morbidity and mortality, such as mental health. Canada claims it is working on linking datasets on hospitalizations, vital statistics, and census to help create an intersectional understanding of maternal health. Still, we have yet to see this in action.
While designing our health systems and creating policies, we must also consider an intersectional approach. Ample evidence shows that various factors of an individual’s identity can interact to influence how they are treated by society. However, when it comes to health, this is a life-or-death matter. For example, 22% of women in the lowest income group report their health to be worse than last year, which is double what is reported by women in the highest income group. A recent study published in 2022 showed that race and ethnicity had significantly affected the extent to which socioeconomic variables influence health outcomes. Implementing a nationwide surveillance system will certainly provide the tools for an intersectional approach, but we must actively investigate and address the disparities. We can learn from nations like the U.S., which, despite having a national surveillance system for maternal health, has the highest maternal mortality rate among developed countries. Research attributes this to the high rates of obesity and heart disease, inadequate prenatal care, and high rates of Cesarean sections. Thus, we can see that it is not sufficient to merely collect this data but to use it to inform the design of our systems.
Gender bias and discrimination systematically pervade our healthcare. Both interpersonally and institutionally, gender inequalities in the health sector are perpetuated, acting as a barrier to the well-being of mothers and their families. These disparities worsen when the system is put under pressure, such as during the COVID-19 pandemic, and disproportionately affect marginalized groups. Reducing bias and disparities in health on a national level is certainly no easy feat, but it is necessary.
Edited by Ruqayyah Farrah
Setareh Setayesh is a second year student at McGill University, currently pursuing a B. Sc degree in Psychology. She joined Catalyst as a staff writer this year and is particularly interested in social epidemiology and the interaction between culture and politics in relation to human rights and development.