Narrowing the Gender Gap in Care Disparity

By Matt Phillion

Despite healthcare advances over the past few decades, we know that wide gaps in the research and treatment for health issues unique to women continue to exist. This results in significant disparities in treatments not only for issues like maternal or menstrual health, but also for conditions that present differently in men and women.

It’s certainly not a new topic. The World Health Organization published a study nearly 10 years ago demonstrating that women in the European Union lived longer than men but spent more of their lives in poor health. The World Economic Forum focused on gender disparity in healthcare last year.

Innie Chen, MD, MPH, FRCSC, Associate Professor with the Department of Obstetrics & Gynecology at Ottawa Hospital, has been conducting research on menstrual pain and bleeding disorders and how they can adversely impact women’s health and quality of life, leading to further gender disparity.

“Even though we’re making a lot of gains to close the gap with more women in medicine, we need to continue to remind policy and decisions makers about the importance of women’s health research.”

Through her research, Dr. Chen uses data to highlight the specific issues that women with menstrual disorders may face.  For example, more than one in five women experience iron deficiency, and heavy menstrual bleeding is the most common cause.  Using data generated through MDClone at her hospital, Dr. Chen was able to identify that women with iron deficiency anemia were at increased risk of needing a transfusion at the time of gynecologic surgery.

“We have great literature on how, when patients go to surgery and are anemic, their outcomes are worse: they are more likely to need blood transfusions, likely to be sicker, more likely to die,” she says. “What we’re trying to do is prevent people from going through the operating room with anemia. We had access to institutional data to show that patients are anemic when they go into the operating room and the impact that has. It’s very helpful to be able to quantify things like how often they need a transfusion.”

“Having access to data for your own institution can make a more compelling case for quality improvements,” says Chen.

The research has helped get physicians on board with optimizing hemoglobin before surgery.  In collaboration with a multidisciplinary team at her hospital, she was able to create strategies to reduce anemia and blood transfusion by more than 50% in patients undergoing gynecologic surgery.

Some of these strategies included using an algorithm to suggest to the physician when they need to check hemoglobin and what to do with different hemoglobin parameters. It also points out how to facilitate access to IV iron, when to involve a hematologist, and leverages the EHR to create flags and popups for when hemoglobin is low to remind people when to take certain precautions.

“A lot of this work came from initial research on why it’s important to have patients optimized from an anesthesiology perspective. There’s not much literature from OB-GYN in this area, and women are particularly vulnerable of being anemic because of menstruation,” says Chen. “We need to do something different in OB-GYN and are looking for ways to work on this problem. Eventually, our results will be shared with departments worldwide, benefiting all the women with anemia around the world.”

Research like this project is pivotal for improving how healthcare addresses the needs of half the world’s population.

Traditionally, when the industry talks of women’s health, it focuses on maternal/fetal care or specific types of cancers.

“But there’s this part of women’s health not everyone would be able to relate to,” explains Chen.

As medicine was traditionally practiced by male physicians, Chen notes, the medical profession may not have been able to be truly empathetic in areas such as menstrual pain and heavy bleeding.

“I commonly see patients who describe many years of feeling dismissed regarding menstrual symptoms, being told what they are going through is normal and being made to feel that it’s all in their heads,” says Chen. “These are repeating patterns my colleagues and I see in many patients over time. Unfortunately, there are patients who may bleed so much that they require a blood transfusion and patients who are in such severe and chronic pain that they cannot keep their job, and this simply is not normal.”

These conditions can impact the trajectory of the patient’s school experience, career, and the rest of their lives.

“We now know that women don’t need to suffer from their periods. We’ve come a long way in taking all of women’s health seriously,” says Chen. “What’s more interesting is we believe these adverse health outcomes related to certain gynecological diseases also have strong ties to social determinants of health.”

The study found that patients coming from a lower education background may have worse outcomes, and ethnicity also played a part in worse clinical outcomes.  “At the end of the day, many things that impact care, the types of surgeries, their outcomes, are influenced by social determinants,” says Chen.

All this research depends on access to high quality data, Chen notes, and the increasing availability of patient data to study patient outcomes in real time has been a game-changer for the improvement in quality, safety, and equity in women’s healthcare.

Where the industry can improve

Across the country, and around the globe, there’s great work being done already, Chen notes, but much room for improvement.

“The part I see the most is on the front line, helping patients on an individual basis, but I also wear this quality improvement hat, and also the hat of a researcher, looking not just at individuals but at the bigger population,” she says.

Improving care for half the population will require all members of society to step up, Chen says.

“We need the patients themselves who have first-hand, lived experience, people who work on the front line and understand the problems the patients face, and we need researchers who use data—which is a key part of quality and safety research,” says Chen. “And then we need those who are in an administrative or policy/decision making role who can set priorities and allocate sufficient resources to improve healthcare for women.”

“The data tells us where the gaps are, where we’re doing well. Without good data, it’s very difficult to move forward in quality improvement,” she says. “We’re hoping to access more real-time data and continue to evolve our research methods to look at involving new approaches and new technologies.”

Women’s health is seeing positive trends right now.

“There’s so much that is encouraging: having more women in medicine, more women in leadership in medicine, not just on the clinical side but teaching and research and decision-making roles. That in itself will help put a focus on women’s health research,” says Chen. “The impact of women’s health has traditionally been overlooked, and it’s important to have all levels and all stakeholders involved in data-driven solutions and strategies.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at