Women in medicine

Historically and presently, in many parts of the world, women's participation in the profession of medicine (as physicians or surgeons for instance) has been significantly restricted. However, women's informal practice of medicine in roles such as caregivers or as allied health professionals has been widespread. Most countries of the world now provide women with equal access to medical education. However, not all countries ensure equal employment opportunities,[1] and gender equality has yet to be achieved within medical specialties and around the world.

Modern medicine

Wafaa El-Sadr is an Egyptian epidemiologist and MacArthur Fellow, who directs two programmes at Columbia University Mailman School of Public Health.
Monique Frize (centre) is a Canadian academic and biomedical engineer known for her expertise in medical instrumentation and decision support systems (DSS).
Awa Marie Coll-Seck is Senegal's former Minister of Health and an international public health expert, Executive Director of the Joint United Nations Programme on HIV/AIDS and the Roll Back Malaria Partnership.

In 1540, Henry VIII of England granted the charter for the Company of Barber Surgeons Company of Barber-Surgeons ; while this led to the specialization of healthcare professions (i.e. surgeons and barbers), women were barred from professional practice . Women did, however, continue to practice during this time. They continued to practice without formal training or recognition in England and eventually North America for the next several centuries.[2] Women's participation in the medical professions was generally limited by legal and social practices during the decades while medicine was professionalizing.[3] However, women openly practiced medicine in the allied health professions (nursing, midwifery, etc.), and throughout the nineteenth and twentieth centuries, women made significant gains in access to medical education and medical work through much of the world. These gains were sometimes tempered by setbacks; for instance, Mary Roth Walsh documented a decline in women physicians in the US in the first half of the twentieth century, such that there were fewer women physicians in 1950 than there were in 1900.[4] However, through the latter half of the twentieth century, women had gains generally across the board. In the United States, for instance, women were 9% of total US medical school enrollment in 1969; this had increased to 20% in 1976.[4] By 1985, women constituted 16% of practicing US physicians.[5]

At the beginning of the twenty-first century in industrialized nations, women have made significant gains, but have yet to achieve parity throughout the medical profession. Women have achieved parity in medical school in some industrialized countries, since 2003 forming the majority of the United States medical student body.[6] In 2007-2008, women accounted for 49% of medical school applicants and 48.3% of those accepted.[7] According to the American Association of Medical Colleges (AAMC) 48.3% (16,838) of medical degrees awarded in the US in 2009-10 were earned by women, an increase from 26.8% in 1982-3.[7]

However, the practice of medicine remains disproportionately male overall. In industrialized nations, the recent parity in gender of medical students has not yet trickled into parity in practice. In many developing nations, neither medical school nor practice approach gender parity.

Moreover, there are skews within the medical profession: some medical specialties, such as surgery, are significantly male-dominated,[8] while other specialties are significantly female-dominated, or are becoming so. In the United States, female physicians outnumber male physicians in pediatrics and female residents outnumber male residents in family medicine, obstetrics and gynecology, pathology, and psychiatry.[9][10]

Women continue to dominate in nursing. In 2000, 94.6% of registered nurses in the United States were women.[11] In health care professions as a whole in the US, women numbered approximately 14.8 million, as of 2011.[12]

Biomedical research and academic medical professions—i.e., faculty at medical schools—are also disproportionately male. Research on this issue, called the "leaky pipeline" by the National Institutes of Health and other researchers, shows that while women have achieved parity with men in entering graduate school, a variety of discrimination causes them to drop out at each stage in the academic pipeline: graduate school, postdoc, faculty positions, achieving tenure; and, ultimately, in receiving recognition for groundbreaking work.[13][14][15][16] (See women in science for a broader discussion.)

History

Hildegard of Bingen, a Medieval German abbess who wrote Causae et Curae, a medical text.
Russian Empress Alexandra Feodorovna with Vera Gedroitz, 1915
Elizabeth Blackwell, MD, the first woman to graduate from medical school in the United States (1849).
Woman's Medical College of Pennsylvania in 1886: Anandibai Joshi, a Marathi Hindu from India (left) with Kei Okami, a Christian from Japan (center) and Thabat Islambooly, a Jewish woman from Syria (right). All three completed their medical studies and each of them was the first woman from their respective countries to obtain a degree in Western medicine.

Ancient medicine

The involvement of women in the field of medicine has been recorded in several early civilizations. An Egyptian of the Early Dynastic Period or Old Kingdom of Egypt, Merit-Ptah, described in an inscription as "chief physician", is the earliest woman named in the history of science. Agamede was cited by Homer as a healer in ancient Greece before the Trojan War. Agnodice was the first female physician to practice legally in 4th century BC Athens. Metrodora was a physician and generally regarded as the first medical writer.

Medieval Europe

During the Middle Ages, convents were an important place of education for women, and some of these communities provided opportunities for women to contribute to scholarly research. An example is the German abbess Hildegard of Bingen, whose prolific writings include treatments of various scientific subjects, including medicine, botany and natural history (c.1151-58).[17] She is considered Germany's first female physician.[18]

Women in the Middle Ages participated in many healing techniques and capacities. According to historical documents, small numbers of women occupied almost all ranks of medical personnel during the period.[19] They worked as herbalists, midwives, surgeons, barber-surgeons, nurses, and traditional empirics.[20] Women treated everyone, not only women as historians once thought. The names of 24 women described as surgeons in Naples between 1273 and 1410 are known, and references have been found to 15 women practitioners, most of them Jewish and none described as midwives, in Frankfurt between 1387 and 1497.[21] Women also engaged in midwifery and healing arts without leaving any trace of their activities in written records, and practiced in rural areas or where there was little access to medical care. Society in the Middle Ages limited women’s role as physician. Once universities established faculties of medicine during the thirteenth century, women were excluded from advanced medical education.[19] Licensure began to require clerical vows for which women were ineligible, and healing as a profession became male dominated.[20] Because surgeons and barber-surgeons were often organized into guilds, they could hold out longer against the pressures of licensure. Like other guilds, a number of the barber-surgeon guilds allowed the daughters and wives of their members to take up membership in the guild, generally after the man’s death. According to documents, Katherine la surgiene of London, daughter of Thomas the surgeon and sister of William the Surgeon belonged to a guild in 1286.[22] Documentation of female members in the guilds of Lincoln, Norwich, Dublin and York continue until late in the period. Midwives, those who assisted pregnant women through childbirth and some aftercare, included only women. Midwives constituted roughly one third of female medical practitioners.[20]

The southern Italian coastal town of Salerno was an important center of medical learning and practice in the 12th century. There, the physician Trota of Salerno gathered a number of her medical practices in several written collections. One work on women's medicine that was associated with her, the De curis mulierum ("On Treatments for Women") formed the core of what came to be known as the Trotula ensemble, a compendium of three texts that circulated throughout medieval Europe. Trota herself gained a reputation that spread as far as France and England. There are also references in the writings of other Salernitan physicians to the mulieres Salernitane ("Salernitan women"), which give some idea of local empirical practices.[23]

Dorotea Bucca was another distinguished Italian physician. She held a chair of philosophy and medicine at the University of Bologna for over forty years from 1390.[24][25][26][27] Other Italian women whose contributions in medicine have been recorded include Abella, Jacqueline Felice de Almania, Alessandra Giliani, Rebecca de Guarna, Margarita, Mercuriade (14th century), Constance Calenda, Clarice di Durisio (15th century), Constanza, Maria Incarnata and Thomasia de Mattio.[25][28]

For the medieval Islamic world, little specific information is known about female medical practitioners although it is likely that women were regularly involved in medical practice in some capacity. Male medical writers refer to the presence of female practitioners (singular, ṭabība) in describing certain procedures or situations. For example, the late 10th/early 11th century Andalusi physician and surgeon al-Zahrawi, in explaining how to excise bladder stones, notes that the procedure is difficult for male doctors practicing on female patients: because of the need to touch the genitalia, the male practitioner must either find a female doctor who can perform the procedure, or a eunuch physician, or a midwife who takes instruction from the male surgeon. In other words, even though direct evidence for female practitioners is rare, their existence can be inferred.[29] As al-Zahrawi's example also suggests, midwives played an important role in the delivery of women's healthcare. For these practitioners, there is more detailed information, both in terms of the prestige of their craft (ibn Khaldun calls it a noble craft, "something necessary in civilization") and in terms of biographical information on historic women.[30][31] To date, no known medical treatise written by a woman in the medieval Islamic world has been identified.

Western medicine in China

Traditional Chinese medicine based on the use of herbal medicine, acupuncture, massage and other forms of therapy has been practiced in China for thousands of years. However, Western Medicine was introduced to China in the 19th Century, mainly by medical missionaries sent from various Christian mission organizations, such as the London Missionary Society (Britain), the Methodist Church (Britain) and the Presbyterian Church (US). Benjamin Hobson (1816-1873), a medical missionary sent by the London Missionary Society in 1839, set up a highly successful Wai Ai Clinic (惠愛醫館) [32][33] in Guangzhou, China. The Hong Kong College of Medicine for Chinese (香港華人西醫書院) was founded in 1887 by the London Missionary Society, with its first graduate (in 1892) being Sun Yat-sen (孫中山). Sun later led the 1911 Xinhai Revolution, which changed China from an empire to a republic. The Hong Kong College of Medicine for Chinese was the forerunner of the School of Medicine of the University of Hong Kong, which started in 1911.

Due to the social custom that men and women should not be near to one another, women of China were reluctant to be treated by Western male doctors. This resulted in a tremendous need for female doctors. One of these was Sigourney Trask of the Methodist Episcopal Church, who set-up a hospital in Fuzhou during the mid-18th century. Trask also arranged for a local girl, Hü King Eng, to study medicine at Ohio Wesleyan Female College, with the intention that Hü would return to practise western medicine in Fuzhou. After graduation, Hü became the resident physician at Fuzhou's Woolston Memorial Hospital in 1899 and trained several female physicians.[34] Another female medical missionary Dr. Mary H. Fulton (1854-1927) [35] was sent by the Foreign Missions Board of the Presbyterian Church (USA) to found the first medical college for women in China. Known as the Hackett Medical College for Women (夏葛女子醫學院),[36][37][38][39] this College was located in Guangzhou, China, and was enabled by a large donation from Mr. Edward A. K. Hackett (1851-1916) of Indiana, US. The College was dedicated in 1902 and offered a four-year curriculum. By 1915, there were more than 60 students, mostly in residence. Most students became Christians, due to the influence of Dr. Fulton. The College was officially recognized, with its diplomas marked with the official stamp of the Guangdong provincial government. The College was aimed at the spreading of Christianity and modern medicine and the elevation of Chinese women's social status. The David Gregg Hospital for Women and Children (also known as Yuji Hospital 柔濟醫院) [40][41] was affiliated with this College. The graduates of this College included CHAU Lee-sun (周理信, 1890-1979) and WONG Yuen-hing (黃婉卿), both of whom graduated in the late 1910s and then practiced medicine in the hospitals in Guangdong province.

Historic women's medical schools

When women were routinely forbidden from medical school, they sought to form their own medical schools.

Historic hospitals with significant female involvement

Pioneers

Maria Cuțarida-Crătunescu, the first female doctor in Romania, 1857-1919. Stamp of Romania, 2007.

Women's health movement in the 1970s

The 1970s marked a great increase of women entering and graduating from medical school. From 1930 to 1970, a period of 40 years, about 14,000 women graduated from medical school. From 1970 to 1980, a period of 10 years, over 20,000 women graduated from medical school.[92] This increase of women in the medical field was due to both political and cultural changes.

Two laws in the United States lifted restrictions for women in the medical field -- Title IX of the Higher Education Act Amendments of 1972 and the Public Health Service Act of 1975, banning discrimination on grounds of gender. In November 1970, the Assembly of the Association of American Medical Colleges rallied for equal rights in the medical field.[93]

At the same time, women's ideas about themselves and their relation to the medical field were shifting due to the women's movement.

A sharp increase of women in the medical field led to developments in doctor patient relationships, changes in terminology and theory. One area of medical practice that was challenged and changed was gynecology. Wendy Kline [94] talks about the blurring of "clinical" and "sexual" that occurred in the medical field in the late 40s into the 60s, particularly in gynecology. Kline says that "to ensure that young brides were ready for the wedding night, they [doctors] used the pelvic exam as a form of sex instruction ."[95] In Ellen Frankfort’s book Vaginal Politics, Frankfort talks about the "shame" and "humiliation" felt during a pap test; "I was naked, he was dressed; I was lying down, he was standing up; I was quiet, he was giving orders "[96]

With higher numbers of women enrolled in medical school, medical practices like gynecology were challenged and changed. One medical student is quoted in Kline’s book as saying, "Since I experienced my own exams as a humiliating procedure, I feared inflicting the same humiliation on another person."[97] In 1972 the University of Iowa Medical School instituted a new training program for pelvic and breast examinations. Students would act both as the doctor and the patient, allowing each student to understand the procedure and create a more gentle, respectful examination. This method was quite different from the previous practice in which doctors were taught to assert their power over patients. With changes in ideologies and practices throughout the 70s, by 1980 over 75 schools had adopted this new method.[98]

With women entering the medical field and women’s rights movements came also the women’s health movement which sought alternative methods of health care for women. This came through the creation of self-help books, most notably Our Bodies, Ourselves: A Book by and for Women.[99] This book gave women a "manual" to help understand their body. It challenged hospital treatment, and doctors' practices. Aside from self-help books, many help centres were opened: birth centres run by midwives, safe abortion centres, and classes for educating women on their bodies, all with the aim of providing non-judgmental, warm, and comfortable care for women.[100] Kline speaks to this claim women were taking on their body in relation to the medical world; women felt that "not only should women have access to information about their bodies... they should also help to create this knowledge."[101] The women’s health movement, along with women involved in the medical field, opened the doors for research and awareness for female illness like breast cancer and cervical cancer.

The small island nation of Tuvalu in 2008 welcomed its first Tuvaluan female doctors as a result of Australian aid.

[102]

While scholars in the history of medicine had developed some study of women in the field—biographies of pioneering women physicians were common prior to the 1960s—the study of women in medicine took particular root with the advent of the women's movement in the 1960s, and in conjunction with the women's health movement. Two publications in 1973 were critical in establishing the women's health movement and scholarship about women in medicine: First, the publication of Our Bodies, Ourselves in 1973 by the Boston Women's Health Collective,[103] and second, "Witches, Midwives, and Nurses: A History of Female Healers", a short paper by Barbara Ehrenreich and Deirdre English also in 1973.[3] The Ehrenreich/English paper examined the history of women in medicine as the professionalization of the field excluded women, particularly midwives, from the practice. Ehrenreich and English later expanded the work into a full-length book, For Her Own Good, which connected the exclusion of women from the practice of medicine to sexist medical practices; this text and Our Bodies, Ourselves became key texts in the women's health movement. The English/Ehrenreich text laid out some early insights about the professionalization of medicine and the exclusion of women from the profession, and numerous scholars, such as Diana Elizabeth Long, have greatly built upon and expanded this work.

See also

Biographies

References

  1. ↑ See generally, "Women's Human Rights", 1998, Human Rights Watch (available online).
  2. ↑ The History of Women in Surgery, by Debrah A. Wirtzfeld, MD
  3. 1 2 See generally Barbara Ehrenreich & Deirdre English, Witches, Midwives, and Nurses (1973).
  4. 1 2 Walsh, 1977.
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Bibliography

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