Friday, August 01, 2008

A bias against women in the treatment of pain

The assertion by "natural" childbirth advocates that childbirth is not inherently painful, or that the pain of childbirth is best managed by preparation dovetails quite well with sexist notions about women and pain. A large body of scientific literature shows that women's pain is much less likely to be taken seriously than men's pain.

The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain, Journal of Law, Medicine & Ethics, 29 (2001): 13–27, provides a disturbing description of the ways in which the pain of women is systematically devalued, disbelieved and undertreated.
Given that women experience pain more frequently, are more sensitive to pain, or are more likely to report pain, it seems appropriate that they be treated at least as thoroughly as men and that their reports of pain be taken seriously. The data do not indicate that this is the case. Women who seek help are less likely than men to be taken seriously when they report pain and are less likely to have their pain adequately treated...

The study by McCaffery and Ferrell of 362 nurses and their views about patients' experiences of pain found that while most of the nurses (63 percent) agreed that men and women have the same perception of pain, 27 percent thought that men felt greater pain than women. Only 10 percent thought that women experienced greater pain than men in response to comparable stimuli. This result has no justification in the literature ... The same study also found that almost half of the respondents (47 percent) thought that women were able to tolerate more pain than men as compared to 15 percent who felt that men were able to tolerate more pain than women...
These erroneous attitudes are particularly prevalent in regard to childbirth:
Bendelow found that "the perceived superiority of capacities of endurance is double-edged for women — the assumption that they may be able to 'cope' better may lead to the expectation that they can put up with more pain, that their pain does not need to be taken so seriously." Crook and Tunks point to the influence of the psychoprophylaxis movement in the United States with its implicit assumption that it is good to experience childbirth without the aid of analgesia. As a result, some women who have "gone through psychoprophylaxis classes, feel guilty if they relent at the last minute and ask for an epidural"; according to the authors, "these attitudes imply that we have a value system endorsed by some parts of our population that suggest women should be encouraged to keep a stiff upper lip."
The authors believe that people discount women's expressions of pain.
A deeper examination of why women are treated this
way is explored by several feminist authors. They attribute it to a long history within our culture of regarding women's reasoning capacity as limited and of viewing women's opinions as "unreflective, emotional, or immature." In particular, in relation to medical decision-making, women’s moral identity is "often not recognized..."

Some researchers have argued that a "bias toward psychogenic causation for disorders in women has occurred even in well defined painful biological processes: 'Despite the well documented presence of organic etiologic factors, the therapeutic literature is characterized by an unscientific recourse to psychogenesis and a correspondingly inadequate, even derisive approach to their management.'" These findings are consistent with studies reporting that female pain patients are less likely than their male counterparts to be taken seriously or are more likely to receive sedatives than opioids for the treatment of their pain.
It is not a coincidence that the philosophy of "natural" childbirth was promulgated by white, male physicians steeped in the ethos that women's pain was not worthy of serious consideration. Their claims that childbirth pain is socially constructed, that women can and should manage pain through psychological means, and that women are "empowered" by pain are simply elaborate justifications for not acknowledging and not treating the pain of women. It is also not a coincidence that the ONLY form of pain thought to be "empowering" is a type of pain that ONLY women can experience.

Those claims can and should be rejected as expressions of sexism. Women's experience of severe pain in labor is real, authentic, and biologically based. Respect for women demands that we acknowledge that pain, not minimize it, and not suggest that it should be psychologically managed. There is no reason take the word of a bunch of middle aged white men, steeped in a medical culture that minimized and ignored pain in women, for what women are "supposed" to feel in labor.


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