How Inequality Damages Women’s Health in Unexpected Ways
The deeper you look, the more pervasive (and frustrating) its impact becomes
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We reached the moon quite a few years before we made it mandatory to include women — ‘only’ half the world’s population — in clinical trials. Over two decades, to be exact.
After all, for centuries, women were considered as ‘the other’ — inferior, not fully human, ‘deformed’ and ‘mutilated males’ (thanks for those gems, Aristotle) — and so not really worth the trouble of medical professionals. (Or, at least, not the kind of medical professionals who got to shape history instead of being burned at the stake for witchcraft.)
Things have certainly improved since then, that’s true. In 2023, for instance, period products were finally tested using actual blood. But the broader culture of disregard for women’s health remains alive and well. Too often, women and girls are still seen — even by some in the medical field — as unreliable narrators of our own bodies and pain. (Are you sure you’re not imagining it? Have you tried just losing weight?) And there are still not enough clinical trials including women, not enough studies that disaggregate data by sex and gender, and not enough attention — and funding — dedicated to reproductive health and female-specific conditions.
This inequality has a very real, very direct impact on our health outcomes — it makes us sick. Or rather sick-er than we would be if we instead had bodies considered the ‘neutral’ default.
But a growing body of research exploring the links between structural gender discrimination and health reveals that it frequently takes a hidden, and perhaps unexpected, toll as well.
The cliché that ‘brain is like a muscle’ holds some truth because, just like muscles, the brain adapts and changes depending on how it’s used. But as it turns out, it might also change depending on where you live.
In a first-of-its-kind study published in 2023 in the Proceedings of the National Academy of Sciences, a team of academics across more than 70 institutions analysed over 7,800 MRI scans of healthy adults — 4,078 from women and 3,798 men — from 29 countries, including the UK, the US, China, Brazil, India and South Africa. Their findings revealed that only in countries with higher levels of gender inequality — measured using the UN Gender Inequality Index and the WEF’s Global Gender Gap Index — women exhibited thinning brain structures, particularly in the limbic region. This area, responsible for regulating emotions, motivation, and memory, is also similarly affected in stress-related disorders like depression and post-traumatic stress disorder.
The researchers didn’t investigate the exact mechanisms behind these changes but suggested, based on prior studies, that they’re likely the result of women experiencing higher stress levels, disruptions during early development, and reduced access to enriched environments such as quality education. In other words, discrimination on account of being women in societies that fail to treat them as equals.
The study also cautioned that these brain changes, triggered by inequality, could have ‘hazardous effects’ on women’s mental and cognitive well-being.
A couple of recent studies point in a similar direction, too. One study, published in Nature Medicine last year, analysed neuroimaging data from 5,306 people — both healthy and those with neurodegenerative conditions — across 15 countries and found that various socioeconomic inequalities, including gender inequality, can also accelerate the brain’s ageing process. Women in countries with higher gender inequality, such as those in Latin America and the Caribbean, exhibited higher brain age gaps — the difference between the estimated biological age of the brain and the actual chronological age — compared to men. However, women diagnosed with dementia showed even more pronounced brain age gaps.
As you might already suspect, accelerated brain ageing isn’t a good thing. It’s well-documented that it predicts impaired cognitive performance and is a risk factor for diseases like dementia and Alzheimer’s.
And, as you might also suspect, it’s women who have greater incidence rates of both. In fact, two-thirds of clinically diagnosed cases of dementia and Alzheimer’s disease are women, according to most reports.
Another study published last year in The Journal of The Alzheimer’s Association investigated the memory performance of over 20,000 people in the US and found that women born in states with greater structural sexism experienced faster memory decline in later years compared to those born in states with less structural sexism. The difference between being born in the most versus the least sexist state was equivalent to… nine years of cognitive ageing. The researchers also disaggregated data by race and uncovered that the links between gender inequality and memory performance were strongest among Black women. After all, they experience the compounded impact of two forms of discrimination — structural sexism and racism.
These two factors have also been shown to affect postpartum women’s weight. In another groundbreaking study published in the American Journal of Epidemiology, researchers followed 313 pregnant individuals from their second trimester through one year postpartum, tracking their weight and everyday experiences, including experiences of stress and discrimination. And they found that Black patients were two to three times more likely to retain or gain additional weight — which, in postpartum, is linked to increased cardiovascular risk and other long-term health issues — compared to their white counterparts, even when pre-pregnancy weight and gestational weight trajectories were similar.
The stress of experiencing gender-based discrimination and racism may not be the sole cause, but as the study’s findings suggest, it could indeed largely explain this disparity in postpartum health outcomes.
Just as it does in so many other areas.
None of this is particularly surprising, of course.
Structural discrimination is bound to impact the health of those whose bodies have not been afforded equal consideration in science and society, including in ways we might not expect it to.
Still, these lesser-known consequences for women’s mental, cognitive, and maternal health are just additional burdens piled onto all the other systemic inequalities we have to deal with, which, though perhaps slightly more familiar, remain equally harmful.
Women are, for instance, far less likely than men to receive painkillers — one US study found they are half as likely to be prescribed them after surgery — even though we are more likely to suffer from chronic pain. Due to not enough clinical trials and healthcare planning policies including women, we are also diagnosed significantly later than men for over 700 diseases, in some cases waiting up to 10 years for a correct diagnosis, and are often overmedicated and suffering excess side effects as a result. Women are also less likely to receive a lung transplant and more likely to die during coronary surgery or from a heart attack — particularly if a male surgeon treats us.
Overall, women live longer, sure, but we spend significantly more years living with sickness and disability, with one recent estimate suggesting we spend 25% more of our lives in debilitating health than men.
Even the rapidly expanding field of longevity has largely excluded women from research, too. I guess discovering immortality is yet another thing humanity is set on accomplishing before achieving equality. Of course.
But systemic inequality, as massive and deeply entrenched as it is, might be just part of the reason why women face worse health outcomes. The inequality we experience on an individual level, though not frequently acknowledged either, also likely plays a role.
Take romantic relationships, for instance. Women’s experiences of sexism in relationships with men — whether in the form of overtly hostile attitudes or seemingly ‘benevolent’ ones — don’t just lead to lower relationship satisfaction but have been linked to psychological distress, cognitive decline, and overall diminished well-being. Even when sexism masquerades as adoration or protection, it remains harmful because, at its core, it reinforces the discriminatory idea that women need to be dominated by men.
Both in and outside relationships, women’s health can also suffer from the pressures of conforming to socially prescribed norms of ‘traditional’ femininity. I explored the toll these gendered pressures can take on our health just a few months ago, actually.
And as I wrote then:
The link between conforming to ‘traditional’ feminine norms and mental health struggles was first identified in the late 1980s by psychologist Dana Jack. Her research showed that patterns like compulsive caretaking, people-pleasing, and inhibited self-expression — behaviours she referred to as ‘self-silencing’ or ‘the activity required to be passive’ — are risk factors for poor mental health, especially depression, among women. Later studies confirmed this correlation as well, with more recent ones also linking self-silencing to heightened anxiety and eating disorders.
But self-silencing is tied to physical illness, too. Women who frequently engage in it might find themselves at an increased risk of heart attacks, chronic conditions — such as irritable bowel syndrome and chronic fatigue syndrome — and even mortality. There’s growing suspicion that it may also contribute to autoimmune diseases, where women make up nearly 80% of all cases. It’s hard to tell, though, because they still remain poorly understood and understudied.
And it’s not difficult to see why that might be, is it?
I wish I could say that things can only get better from here and that, at some point in the near future, women will no longer have to suffer under a system stitched together with threads of bias and neglect.
But, alas, that wouldn’t reflect the reality we’re living in.
The recent global trend of democratic backsliding has been accompanied, unsurprisingly, by a rollback of women’s rights — particularly reproductive rights — pushing us several steps backwards rather than forward. The latest Hologic Global Women’s Health Index survey confirms this grim trajectory: women’s health has stagnated or even deteriorated in many countries over the past few years. More women are in physical pain, facing health issues, and worrying about their health than before. Meanwhile, in states that enacted abortion bans, maternal and child mortality rates have spiked.
The widespread framing of reproductive rights as being primarily about abortion has, additionally, led to decreased funding for other areas of reproductive healthcare — cervical cancer screenings, contraception, treatment for menstrual disorders, prevention and care for sexually transmitted infections, childbirth services, etc.
For example, following Donald Trump’s 2016 presidential victory, the US government ended all funding for the UN Population Fund, an agency dedicated to improving reproductive and maternal health worldwide. This decision, framed as ‘protecting life in global health,’ resulted in an estimated 108,000 deaths of children and mothers in impoverished countries during Trump’s four years in office, according to a study by The National Academy of Sciences. And while President Joe Biden later restored this funding, its future now hangs in the balance, as does financial support for reproductive care providers in the US.
Our world’s shift away from democracy and into the clutches of anti-egalitarian populists and authoritarians has devasting consequences for the lives and health of women, girls, and people assigned female at birth.
This isn’t a matter of someone’s opinion or feelings or political stance.
This is simply a pattern confirmed by a wealth of research — the erosion of rights and increase in systemic social inequality inevitably leads to worse mental and physical health outcomes and preventable suffering on a massive scale.
It’s equal parts ridiculous and tragic that a woman’s ability to live with dignity, good health, freedom of choice, and even survival itself depends on whether she was born in a place that (somewhat) values equality and human rights or one that clings to outdated patriarchal hierarchies.
If we were to estimate the total death toll caused by centuries of systemic neglect of women’s bodies and the demonisation of reproductive healthcare, it would surely reach into the tens of millions, if not more.
Is that not enough to finally take this issue seriously?
Or will we keep prioritising going to the moon over figuring out how to improve this planet for everyone living on it?
Many women's health issues are directly tied to pregnancy and birth. Like a stunning proportion of them. It significantly increases your odds of everything from having a cardiovascular event to developing an autoimmune disease and even going blind. So I've been advocating for years that women all over the world collectively stop having children. That is our bargaining chip. If enough of us decide to withhold babies from society until the medical field starts taking our health seriously and governments/cultures start showing us respect and equal treatment, we could literally upend the system. No more new wage slave labor. No more new taxpayers. No more new voters or soldiers or caretakers until we get what we want. It'll never happen because far too many women are brainwashed into the patriarchy or focused on themselves and their own desire for children, but it would likely work if we tried it.
Unfortunately, it starts before pregnancy and childbirth. Parents are often not equally invested in health of their sons and daughters