This text is part of the special Health and well-being section
Word flouted, pain denied, consent not collected, abusive operations, obstetric mistreatment… in the In the medical field, many women also experience discrimination and violence, especially when they belong to minorities. Supported by researchers and social workers, the #MeTooSanté movement survey the veil over medical practices that they consider sexist and racist and which have serious consequences on the health and well-being of women.
Until recently, women were excluded from medical research protocols, and this has developed with reference to the male body “creating an androcentric system”, explains Caroline Arbour, women’s health physiotherapist and author ofInhabit our bodies. To put an end to the trivialization of women’s pain. According to her, women “are still perceived as flawed and complicated”. Medical research actually pays less attention to the female sex.
Consequences ? Delayed diagnoses: in fact, for 700 illnesses, women are diagnosed later than men.
Also misdiagnoses and normalization of female pain. “Most women who consult for problems relating to their genital tract, periods, pain during penetration, fibroids over the age of 40, are told that these pains are normal. It’s wrong. It’s the medical profession that doesn’t understand them,” says M.me Arbor.
Finally, chronic pain. However, a woman who returns two or three times to see her doctor for so-called normal pain will experience, and more quickly than a man, his impatience and “be told that the problem is in her head”. Thus invalidated, the latter has no other choice but to bear her pain.
If we add to this sexism the fact of being a marginalized woman, there is no doubt that 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 abused women have a diagnosis of borderline personality disorder (BPD) when in reality, according to Katharine Larose-Hébert, associate professor at TELUQ in the psychology and health program mentally, they “manifest normal behavior after trauma”. In the doctor’s office, if they cry or get angry, we will quickly suspect a mental health disorder. As “systems of oppression permeate public institutions, generating interactions between professionals and patients marked by prejudice,” these women are often less listened to, less believed, which further fuels their anger and despair.
If being a marginalized woman increases the possibility that the health system will harm her more than it helps her, believes Ms.me Larose-Hébert is partly because it does not take into account the social determinants which lead the woman to consult. It is not uncommon for an immigrant woman to leave a medical office with a diagnosis of a mental health disorder, even though it is “her migratory journey, her loneliness, the language barrier and poverty that explain her condition.” », Supports Nina Meango, health program coordinator at the Alliance of Cultural Communities for Equality in Health and Social Services (ACCESSS). Pathologizing the reactions generated 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 bias
According to Agnès Berthelot-Raffard, professor at the Faculty of Health at York University, abuse in the health system comes from sexism, ageism — the woman is either too young, therefore infantilized, or too old, and his experiential knowledge is then not respected — and racism. More victims of neglect, dehumanizing practices or non-compliance with protocols, black women generally wait longer in emergency rooms because there is this unconscious bias according to which “they endure more pain”. Furthermore, nursing staff try more to direct their decisions, because they have less confidence in their autonomy. They are also monitored more closely, because of a slavery prejudice which assumes that they have deviant sexuality, and their non-consent is less respected.
Tubal ligation or hysterectomy without consent “are more frequent abusive operations than we think,” assures Nina Meango, who adds that this is also the case among First Nations women. Research dating from 2022 on free and informed consent and sterilizations imposed on these women shows that, out of 35 respondents, 13 claim to have suffered imposed sterilization in addition to other forms of obstetric violence, and three mention having been subjected to forced abortion. “Women’s full rights over their bodies are at stake in our health system which, as long as it goes wrong, will make women suffer first,” says Ms.me Meango.
Decolonizing the medical system
A movement like #MeToo-Santé, invested by several women and initiated by Martine Delvaux, professor in the Department of Literature at UQAM and author, “allows women to question an experience that they thought was normal, as it is so imbricated in medical culture, and to legitimize their feeling of having been abused,” maintains the latter. Adapting medical interventions according to different cultures is also a step towards recognizing the experiences of women. “A doctor who tells a black patient “You’re still pregnant!” clearly doesn’t know this woman’s culture, according to which preventing pregnancy is unnatural,” says Nina Meango.
The teaching provided in medicine must also “catch up on centuries of delay”, ensuring that it takes into account the particularities of women in general and marginalized women in particular.
The health system has a bias: medicalization. Every symptom is interpreted through the lens of the disease, which grants significant power to doctors and “gives them a great responsibility for the well-being of the population,” maintains Katharine Larose-Hébert. Forging links between different networks to decentralize power, and “fostering a global interdisciplinary approach” is essential for the health system to adapt to intersectoral female realities.
Thus, “the decolonization of medicine involves the demedicalization of the discipline”, inevitable in the perspective of a decolonization of women’s bodies, concludes Agnès Berthelot-Raffard.
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