source : the age
Australian women are being blocked from accessing permanent contraception, as some doctors refuse to even discuss the option of sterilisation with female patients in their 20s and 30s, according to the findings of a landmark Australian survey into gender bias in healthcare.
The accounts of “demeaning interactions” with healthcare providers while seeking contraception are detailed in the findings of the End Gender Bias survey, developed by the Albanese government and the National Women’s Health Advisory Council.
Accounts from women who responded to the federal government’s End Gender Bias survey. Credit: Stephen Kiprillis
The headline findings of the survey were published last year, revealing that two-thirds of the 2570 people surveyed had experienced healthcare-related gender bias or discrimination. The latest report, released to this masthead, is more detailed about the respondents’ experiences.
One woman aged between 18 and 24, interested in permanent contraception, said a gynaecologist had knocked back her request to explain the procedure to her, and noted they would “need to meet your mother and your partner” to consider her eligibility.
“It’s quite depressing,” said Professor Gita Mishra, one of the report authors and director of the Australian Women and Girls’ Health Research Centre at The University of Queensland.
“Most women who responded to the survey said ‘nobody is listening to me … healthcare professionals don’t listen to me’, and basically disregard their pain, their symptoms,” Mishra said.
Mishra noted that people with negative experiences might be more likely to respond to the questionnaire, but the report is peppered with eye-opening first-hand accounts.
More than 70 per cent of the women surveyed said they felt like their opinions were either “not at all” or “not very” heard or considered.
That statistic struck Dr Sarah White, who is chief executive of not-for-profit organisation Jean Hailes for Women’s Health, and a member of the government’s women’s health advisory council.
“I think we need to get much better at communication,” White said.
“Sometimes a health professional can sit there and in their head they’re running through the diagnosis checklist, from really terrible through to not bad, and sometimes they’re just failing to communicate what else they’ve considered and then rejected.”
Women were most likely to report gender bias when seeking care for sexual and reproductive health issues, though on the matter of permanent contraception, doctors say the issue is complicated.
While some believe doctors could improve their approach to conversations with women about treatment options, they say sterilisation in women is an invasive procedure that may not be reversible. This suggests factors other than gender bias are also at play.
A 34-year-old survey respondent said she was repeatedly refused a hysterectomy, despite having a genetic condition that made pregnancy dangerous and “never waver[ing] about not wanting children”.
“But still, I have been refused … because I have not done my apparent social duty of having children … The medical profession apparently trusts me to choose that I do want children, but not choose that I don’t.”
Another woman, aged in her late 20s or early 30s, said she faced so many barriers to getting a tubal ligation that her partner ended up getting a vasectomy instead.
“Not once did the doctor ask him about whether his partner knows, he didn’t require a referral, he didn’t need to go through someone asking him over and over again whether he was sure,” the woman said.
“I was having so many issues getting even just information on getting my tubes tied.”
Dr Nisha Khot says doctors may be reluctant to perform sterilisation because it is an invasive procedure that carries a risk of complications.Credit: Justin McManus
Dr Nisha Khot, vice president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said there were many reasons why sterilisation in women typically requires more consideration than vasectomies in men.
“[It’s] a more invasive procedure than it is in men. Doing an invasive procedure, which involves a laparoscopy, will always be something that most doctors would caution against in the sense that it can be associated with complications,” she said.
“That’s not the same [as saying] that we shouldn’t do it, but we should be talking about it … For women who are in a long-term relationship, it might be easier to recommend that the male partner gets sterilised because it’s an easier procedure, [with a] quicker recovery, etc.”
Khot said it was easier to reverse sterilisation procedures in men, and that there had been a push towards removing women’s fallopian tubes altogether rather than ligation (clipping or cutting) because doing so reduces the risk of ovarian cancer.
When the fallopian tubes are removed, the only way a woman can subsequently fall pregnant is via IVF. Research also shows the younger you are at the age of sterilisation, the more likely you are to regret your decision later in life.
Khot also said that long-acting reversible contraception was considered more effective than sterilisation in women, though sterilisation did suit some patients. The obstetrician said she most commonly performed sterilisations during cesarean sections for women who had decided they did not want to have any more children.
“It adds a few minutes to the surgery and it can be done at the same time. Recovery is no different,” she explained.
Khot noted that Catholic hospitals often refused to allow sterilisation, even those receiving public funding.
Assistant Health Minister Ged Kearney at the National Women’s Health Summit last year.Credit: Alex Ellinghausen
Meanwhile, a group of Australian women who reported severe side effects from a permanent sterilisation device, which is no longer available in Australia, recently lost a class action against pharmaceutical giant Bayer.
Assistant Health Minister Ged Kearney said the survey results painted a shocking picture.
“Many [women] felt dismissed, disbelieved, and stereotyped as ‘hysterical’ or ‘dramatic’. Too often, their pain was minimised or misattributed to factors like menstruation, lifestyle choices, or even outright fabrication,” she said.
One middle-aged woman said when she was suddenly struck by extreme shoulder pain and some difficulty breathing, multiple GPs misdiagnosed her with panic attacks and anxiety.
“[Eventually] an older lady GP was the first doctor to listen to my chest and I was immediately told to get a chest X-ray ASAP,” the woman wrote.
It turned out she had haemothorax, a serious condition in which bloods collect between a person’s lungs and rib cage.
Reports of gender bias in healthcare were higher for those with a disability and those who identified as LGBTQI+, according to the End Gender Bias survey.
One woman reported that a surgeon said to her in a sarcastic tone before he was to remove a melanoma from her face: “Why would it matter anyway, you aren’t trying to get a guy?”
“He believed that since I am a lesbian my face can be mutilated with no consequence,” said the woman, aged in her late 50s or early 60s.
In contrast, some people spoke positively about finding a doctor, in several instances a young or female GP, who was willing to listen to them and answer their questions.
Those medical professionals were not rewarded by the health system, the survey report noted, pointing to a comment from one practitioner who believed her community saw her as a “lady doctor”.
“This means a lifetime of complex, chronic and mental health work, and day after day of mental trauma, but also the expectation that I will be kind, compassionate and cheap,” the doctor wrote.
Her patients told her they see a male doctor when their condition is “something simple”, “but I don’t want to bother him with my mental health, [so] I come to you”.
White said the Medicare system still incentivised fast appointments.
“We actually need to spend time with people to get that history [and] to understand all the other things going on,” she said.
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