How can reframing women’s health improve outcomes? An interview with Dr Marieke Bigg

Summary

In this interview, we speak to sociologist Dr Marieke Bigg about why she decided to write her debut non-fiction This won’t hurt: How medicine fails women. Marieke discusses how societal ideas about the female body have restricted the healthcare system’s approach to women’s health and describes the impact this has had on health outcomes. She also highlights areas where the health system is reframing its approach by listening to the needs of women and describes how simple changes, such as allowing women to carry out their own cervical screening at home, can make a big difference.

Content

Hi Marieke! Can you tell us a bit about yourself?

My name is Marieke Bigg and I’m an academic. I did my PhD in the sociology of reproductive technologies, looking at the way that new technologies like IVF changed the way humans reproduce and the implications that has for society. 

Since then I’ve started writing non-fiction. My debut book is called This won’t hurt and it’s about all the ways in which medicine is not gender-neutral—I look at research, how patients are treated, policy and funding. In the book, I show how the field of medicine has formed around a male default that excludes women.

Why did you decide to write This won't hurt?

I had the idea for This won’t hurt after a jarring personal experience with a doctor. I went to see a gynaecologist and shared some symptoms that he was unable to explain. But the main issue for me was that he said some quite problematic things that I couldn’t really make sense of in the moment.

Sometimes these encounters feel quite insidious, they take you by surprise and you’re not always sure how to respond. But because I was doing my PhD at the time, I had formed a kind of sociological ‘toolkit’ for understanding sexism. It helped me reflect on what had happened and make sense of my own experience, and I realised how useful that sociological perspective can be when it comes to medicine. I wanted to share what I had found with other women as a way to help tackle the internalised stigma and shame that many carry when they feel that their bodies aren’t ‘normal’ or acting in a way that’s expected. Understanding where these ideas come from helps shift the feeling of blame away from individual women.

As a society, what underlying views do we have about women's health, and how does this affect how certain conditions are approached by the healthcare system?

There are two key ideas attached to the female body that I talk about in the book—the first is the idea of the female body as a baby-making vessel. There’s this very persistent idea that the only difference between male and female bodies is the reproductive system, and that a woman is defined by her childbearing capacity. Often when we talk about women’s health, we’re referring to obs and gynae, but we need to think about women’s health in much broader terms. This idea can also foster unhelpful complacency around the process of childbearing, for example, there’s this view that any pain women feel is just a natural part of being a woman. This has led to countless reported cases of women not receiving the pain medication they need during labour. 

The second idea is the idea that women have to be ‘sexy’. For many women, there is an internalised stigma around problems that are perceived to be unsexy, and that can make them feel uncomfortable to go to the doctor. Doctors also may not have a language to discuss these issues in a way that is comfortable for women. There’s a huge cluster of so-called ‘invisible diseases’ that affect women, that aren’t fatal but have a big impact on quality of life. For example, prolapse is a debilitating issue that causes a lot of discomfort, and endometriosis has come to light as a condition that requires much more research and attention.

Gender inequality in medicine is really serious—there are lives at stake and it really matters that we understand and inform people about how women’s diseases present themselves. I look at an example in the book of how bias can affect how we view women’s symptoms. When men and women put the same symptoms into a diagnostic app, the algorithm told men to go to A&E in case they were having a heart attack. It told women they were suffering from anxiety. 

What impact would broadening our idea of women’s health have on patient safety?

Researching women’s bodies across the different fields of medicine will have a big impact on patient safety. Cardiology is a good example, as women’s heart attacks can present differently to mens. There’s a lack of awareness amongst both women and medical professionals about this. A lot of the symptoms of a heart attack in women are similar to those associated with menopause, so many women have their symptoms—such as hot flashes and pain between the shoulder blades—dismissed. 

It’s also really important to establish the links between different fields to bring to light female-specific symptoms and causes of disease. There have been several pioneering cardiologists who have worked on the link between gynaecology and cardiology, including Dr Angela Maas, who researches the link between female hormones and the heart. Medical specialties have formed over centuries around the questions that matter to the male body—in order to improve outcomes for women, we need to put them at the centre of medicine, which means reshaping those fields.

How can listening to women and taking on their views have a positive impact on patient safety?

Cervical screening is a great example. It’s a relatively simple intervention that has the potential to prevent something like 70% of cervical cancer deaths. Although it’s a crucial test, a third of women don’t attend their screenings. Research into the reasons for this showed that many women don’t feel comfortable to go to the doctor to have the procedure. 

There’s a really simple solution to that which is being trialled at the moment, sending test kits to women’s houses. It’s a very straightforward intervention that has the potential to save many lives, and it shows that listening to women can help healthcare address their needs and improve safety in quite simple ways.

What changes do policy makers need to make to their approach to women’s health?

In the book, I list some quite cutting-edge research, but there are also simple bureaucratic changes that can make a huge impact. I talk about efforts in the UK to shift to a life-course approach to women’s health, which is part of that movement away from the idea of the female body as a baby-carrying vessel. When the health system understands that a woman’s health matters across her lifespan, it can identify predictable moments in her life when it can intervene to prevent health complications.

Part of this is acknowledging that when a woman has been pregnant, it can have a significant long-term impact on her body. Pregnancy unmasks different vulnerabilities—for example, if you have heart issues while pregnant, you are more likely to develop heart issues later on. It’s about thinking about women’s health in a different frame, and that can change the way that we approach healthcare in sometimes quite straightforward ways.

What advice would you give to healthcare professionals as they speak to women seeking help and treatment?

Much of the work needs to be done before meeting with patients—it’s about being aware of research in areas that matter to women’s health. Looking outside of traditional medical academia and reading sociological studies on women’s views will further help healthcare professionals understand what’s important to their patients. Awareness of the role that biases have played in research and medical practice is also key. All this takes an investment of time, but doing due diligence to understand the social dimensions of healthcare will enable better outcomes for women.

Continually questioning the assumptions you are making as a healthcare professional is a difficult challenge, but when it comes to meeting women in a consultation, doctors should take time to listen so that they really understand the problem being presented. Sometimes you will need to think outside the box about less obvious or instinctive solutions. Angela Maas was motivated to embark on her research as she found she was unable to answer her patients’ questions; she felt an ethical imperative to investigate the link between cardiology and gynaecology. When doctors take the time to really listen to their patients, they might be struck by their own blind spots or gaps in their education. It’s an uncomfortable process, but it’s crucial.

Related reading

Blog - The pain gap: Gender bias in endometriosis pain management (7 September 2022)
“Brave men” and “emotional women”: A theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain (February 2018)
Medicines, research and female hormones: a dangerous knowledge gap
Patient Safety Learning’s Top picks: Women's health inequity

About the Author

Marieke holds a PhD in Sociology from the University of Cambridge, where she studied the technological transformation of human reproduction. In addition to writing fiction and non-fiction books, Marieke collaborates with scientists and biologists to imagine the future of reproductive science.