Reflecting during Women’s History Month on the headway women have made in healthcare illuminates many areas of progress and also the many disparities that remain. Consider the “then” and “now” of five key issues facing women in medicine, both as professionals and patients themselves.
1. Women Physicians
Then: Prior to 1849, there were no formally recognized female physicians in the U.S. It was during this year that Elizabeth Blackwell became the first woman to obtain an MD degree. Blackwell pioneered women’s participation in medicine, as medical schools at the time rejected admission to female applicants. It was Blackwell’s challenging of the status quo that paved the way for future generations of women physicians.
Now: According to the Association of American Medical Colleges, women comprised 36.3% of all U.S. physicians in 2019. That year also marked the first in which the majority of medical students were women. Medical schools are no longer allowed to discriminate based on sex as they were in the past. With increasing numbers of female medical students will come a continued increase in the overall percentage of women physicians.
2. Access to Abortion
Then: Prior to the U.S. Supreme Court case of Roe v. Wade, access to safe and legal abortion was up to each individual state’s discretion. Women seeking abortion who lived in states where it was illegal were forced to either travel to another state where it was legal or carry out unsanctioned abortions, putting their health and livelihoods at risk.
Now: For decades now, women have been able to exercise their constitutional right to safe and legal abortion, including through federally funded institutions, such as Planned Parenthood. However, states such as Texas, Alabama, and Idaho seek to restrict women’s access to abortion with laws that amount to near complete bans. In 2021, Texas passed the Texas Heartbeat Act, which bans abortion after the detection of fetal cardiac activity without exceptions for rape or incest. The U.S. Supreme Court has allowed this law to remain in place, marking the first 6-week abortion ban since Roe v. Wade and signaling a consequential threat to the landmark case. Conversely, in December 2021, the FDA eased restrictions on abortion pill dispensing through the mail, granting easier access for many.
3. Access to Birth Control
Then: Birth control has been around for centuries, with condoms and spermicide dating back to ancient Egypt. The first oral contraceptive in the U.S. — “the pill” — was approved by the FDA in 1960; however, that didn’t mean all women were permitted to use it. It wasn’t until the 1965 Supreme Court case Griswold v. Connecticut ruled that married women have the right to use birth control, and later the 1972 Supreme Court case Eisenstadt v. Baird ruled that unmarried women also have this right.
Now: With the passing of the Affordable Care Act and the Obama administration’s inclusion of FDA-approved contraceptives in preventive care, birth control is now widely available and covered under most insurance plans at no cost. This has not been without challenge, though. In 2014, the Supreme Court ruled that employers with religious exemptions could refuse coverage in their insurance plans. In 2017, the Trump administration expanded this religious exemption and added moral objections as well, which was upheld in the 2020 Supreme Court case Trump v. Pennsylvania. This blocked access to birth control for thousands of Americans and disproportionately affected low-income women. Recently, North Carolina joined more than a dozen other states in allowing women to obtain birth control from a pharmacist without a physician’s prescription.
4. Sexual Harassment
Then: Women in medicine, both patients and providers, have long suffered from sexual harassment, many of them silently in fear of repercussions or retaliation and with no legal recourse. Sexual harassment wasn’t actually illegal until 1980, although the 1964 Civil Rights Act laid the foundation by prohibiting sexual discrimination. In 1980, the Equal Employment Opportunity Commission issued regulations defining sexual harassment as a form of sexual discrimination. In the 1986 landmark decision of Meritor Savings Bank v. Vinson, the Supreme Court ruled that sexual harassment could be classified as sexual discrimination prohibited by the Civil Rights Act, in addition to ruling that speech alone could violate the law. This legislation was expanded throughout the 1990s, granting further protection to victims of sexual harassment.
Now: In addition to the available legal recourse, the recent #MeToo movement has galvanized sociological shifts in our attitudes towards sexual harassment, further empowering women to address this issue. Still, sexual harassment remains a prominent issue in medicine. A 2020 study published in BMC Nursing found a 43.15% prevalence of sexual harassment among female nurses; 46.9% of them were harassed by patients, 41.10% by physicians, and a lesser percentage by patients’ families and other nurses. According to a 2018 report, 7% of physicians had experienced sexual harassment in the past 3 years. These findings demonstrate the continued need to address this problem, despite the progress that’s already been made.
5. Physician Gender Pay Gap
Pervasive gender pay discrepancies across industries remain a serious problem. For physicians, there’s actually some evidence showing the gap has even widened. “Then” is still “now,” as this inequity has persisted in spite of an increased public awareness. A 2021 study published in Health Affairs showed an estimated $2 million difference across a simulated 40-year career between male and female physicians, amounting to a 25% pay gap. In Doximity’s 2021 Physician Compensation Report, there wasn’t a single specialty in which female physicians earned equal or greater pay than their male counterparts. The pay gap it reported widened from 2019 to 2020 and from 2020 to 2021, indicating that much work remains to be done.
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