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Ain't I a Woman?

March is ‘Endometriosis Action Month.



According to Endometriosis UK, March is the month to raise awareness, act by writing to your MP, wear yellow and sharing your story. All very admirable, I agree we should be raising awareness of this debilitating condition, especially since more than 1 in 10 women experience it (14). All women should share their stories and share them loudly and relentlessly until things change because change is needed and needed now!

A few years ago, I learnt the appalling fact that women of colour are less likely to receive help with complications in pregnancy, birth, or genealogical issues. This led me to do some digging, and what I found left me thinking about my own experience and who matters in our healthcare system.

In America, there is a higher death rate related to complications in childbirth or pregnancy for women of colour, in some cases 5 times higher compared to white women (1).

I mean really what the hell is going on?

Are women in the 21st century still receiving the same mistreatment that our immigrant mothers had to put up with, treated as second-class citizens when it comes to health and care?

A recent Welsh study examined the relationships between immigrant women and midwives, it does not read well. It found midwives generally negatively stereotyping Pakistani women. Both sets of women find it difficult to build positive relationships with each other for a whole host of reasons. Now we are not saying here that all midwives are the same, we are highlighting some common facts here that only women of colour may resonate with. Cultural differences are just part of the issues, lack of communication or a tendency to follow more traditional practices are all being cited as adding to women’s poor health during and after childbirth. (2) I must say this is a very limited study with a very small cohort of women. However, it does not take away from the stark fact that women of colour are more likely to either experience more complications, through lack of care or understanding and die (1).

It goes on. In the UK endometriosis can take up to 9 years to diagnose for all women (3), this highlights the need for more research and specialist training and care. However, women of colour are less likely to ever receive a diagnosis (4,7). Left to drift through their reproductive years suffering and not knowing what is going on. Even worse race and its implications are not often researched in the medical profession, especially for women’s issues (4,7), hence the lack of any scientific medical evidence on death rates in the UK. This is not very reassuring, the lack of support combined with no explanation for the often painful symptoms associated with endometriosis can leave women feeling marginalised and ignored.




At the time of writing, the TAPP project also found ‘no peer-reviewed piece of research’ documenting ‘lived experiences of Black women seeking gynaecological healthcare.’ It goes on to question how services can then become culturally sensitive and be improved (10).

Kate Chapman's 2011 article says it all, a stark recording of negative experiences gives anyone reading it a sense of how women feel and how they are ignored (11).

Improvement in healthcare services for women of colour is highlighted in a recent British Medical Journal report. It highlights how racist and ‘unconscious bias' plays out in women’s health services, calling for better education amongst healthcare professionals but also admitting there is a lack of funding and research for ethnic communities (9).

There are some thoughts that some women, in particular Asian women, are more likely to suffer from more severe endometriosis symptoms than white women, difficult to know if this is true, especially considering the limited availability of scientific literature (7). It is also said that women may not be believed by doctors when they discuss symptoms of endometriosis (4).



The patriarchal approach to women’s health is a whole other subject. For those of us who have suffered or who are suffering from painful periods let alone any other gynaecological issues know all too well the often dismissiveness of some doctors, not being taken seriously is all too common.

The lack of investigation into how race affects women’s health is historic. Whilst mistreatment of women of colour in the name of science is nothing new.  J. Marion Sims a 19th century gynaecologist did not use anaesthetics before performing painful surgery on African American slaves. Honing his skills before utilising them on white women, believing that black women did not feel pain (5). The history of the oral contraceptive pill is also gruesome, with the misuse of Puerto Rican women in clinical trials, without consent, before the pill was rolled out to wider communities (6)

Gaining consent gives women the right to make their own decisions about their bodies, however, a lack of diagnoses leaves women confused and unable to make an informed decision. An official diagnosis is the start of being supported by your doctor whilst being left alone desperate for a child can lead to judgement and poor mental health.

It is not just endometriosis that has some shocking facts, there are other conditions such as fibroids, again it would seem data in the UK is hard to find. American Black women are 3 times more likely to suffer from fibroids than their white counterparts. Often this data depends on who and what the scientists are measuring. Some studies do not always accurately represent health conditions (that is a discussion for another time).

Disparity in treatment was also shown. Women of colour received more aggressive treatment with fibroid, often removed only to return and as a final resort women can be given a hysterectomy (8). This can be hugely traumatic, especially if the women in question are from a culture where childlessness is frowned upon or not accepted within their community. This can lead to poor mental health, and sometimes divorce.

Many agree that menstrual health education in the UK is substandard (9,10) In 2020 menstrual health education became mandatory in secondary schools, however, it often does not address the emotional aspect let alone the social impact.  Women often feel unheard and regularly experience negative outcomes (10).


Is there an alternative?

The womb is the source of creation

There are healthcare practitioners who take an individualised approach to health. Looking at the person and their connection to the world around them. These practitioners believe the patient should have an active role in their own health decisions, (13) the practitioners’ approach is finding the root cause of the illness whilst working closely with whoever they are treating.

What you eat and your thoughts all have an impact on your physical, mental, and emotional well-being. Many practitioners also consider a patient’s spiritual health when under their care.

Looking at food intake is a key component towards better gynaecological health. The tendency towards a low-fat diet and lack of diversity in food choices can all impact health, whereas good quality proteins and unrefined carbohydrates are all recommended alongside many other foods for a healthy reproductive system (12).

There are alternatives to the dogma. You need to trust the process and be prepared to be astonished!!

 

 


 
 
 

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