The Hidden Bias in Healthcare

In healthcare, change is constant, and there always seems to be something new right around the corner. Still, not all areas are advancing at the pace many women hope for. Women’s unique health needs have often been overlooked or not taken seriously enough to address meaningfully.

While progress has been made, persistent biases in women’s health continue to affect the quality of care. It’s telling that only 40 years ago a Public Health Service Task Force was needed to draw attention to women’s health issues; and it wasn’t until less than a decade ago that the NIH began requiring researchers to consider sex as a biological variable in studies. In 2023, President Biden authorized $200 million for women’s health research—an important step, but also a reminder that without active intervention, these gaps don’t close on their own.

The effects aren’t just theoretical. They show up in real, measurable ways across women’s healthcare. From underrepresentation in clinical trials to misdiagnoses and inadequate treatment protocols, the consequences of gender bias are far-reaching.

The following examples highlight just a few of the ways women’s health continues to be overlooked—and why more equitable research and care are urgently needed.

Heart Health: Underrepresented and Misunderstood

Did you know that Heart Disease is the #1 cause of death in women, yet many still believe it’s a “man’s disease.”? Despite heart disease being the leading cause of death among women in the U.S., women are significantly underrepresented in cardiovascular clinical trials. This disparity has led to treatments and guidelines primarily based on male physiology, potentially compromising the effectiveness of care for women.

COVID-19 Trials: Women Left Out of the Data

During the COVID-19 pandemic, only 4% of clinical trials explicitly aimed to recruit women, despite evidence indicating sex-based differences in infection rates and immune responses. This oversight may have resulted in treatments that are less effective or have unforeseen side effects in women.

Drug Safety: The Risks of Early-Stage Exclusion

Women, particularly those of childbearing age, are often excluded from early-phase (Phase I) clinical trials due to concerns about potential risks to fertility or pregnancy. This exclusion results in a lack of early safety and efficacy data for women.

Women experience nearly twice the rate of adverse drug reactions compared to men. This is partly due to the lack of sex-specific data in clinical trials, leading to dosing guidelines that do not account for differences in drug metabolism between sexes.

Urinary Health: Misdiagnosed and Underresearched

Despite women constituting a significant portion of UTI cases, they have historically been underrepresented in clinical research related to UTIs. This gap impedes the development of treatments tailored to women’s specific needs and may lead to generalized treatment approaches that don’t account for gender-specific responses.

Current urine tests for UTIs often yield false negatives, especially in cases where bacteria reside within the bladder wall, evading detection. This limitation can lead to underdiagnosis and inadequate treatment, particularly affecting women with recurrent UTIs. The lack of advancement in diagnostic tools reflects a broader neglect in addressing conditions predominantly affecting women.

Due to the high prevalence of UTIs among women, healthcare providers may also sometimes dismiss symptoms like blood in the urine (hematuria) as mere indicators of a UTI without thorough investigation. This bias can result in misdiagnoses, such as overlooking bladder cancer, which requires prompt and specific treatment.

A comprehensive study involving over 670,000 U.S. women aged 18–44 with uncomplicated UTIs revealed that nearly half received incorrect antibiotics, and more than 75% were prescribed antibiotics for longer durations than recommended. Such practices not only deviate from clinical guidelines but also elevate the risk of antibiotic resistance and adverse side effects.

Health Conversations Are Hard

Beyond being underrepresented in healthcare research, many common health conditions can be challenging for women to talk about, get properly diagnosed, and manage through insurance and treatment. These concerns are often minimized, misinterpreted, or stigmatized—dismissed as “just that time of the month,” blamed on something the woman did wrong, or brushed off with phrases like “she must be going through the change.”

This kind of language doesn’t just reflect cultural bias, it shapes the way care is delivered, and it can leave women feeling unheard, misdiagnosed, or even ashamed of seeking help.

One example is endometriosis. Endometriosis is under-researched, leading to delayed diagnoses and treatment for many women, even though it’s estimated that 1 in 10 women have the condition. The average time to diagnose endometriosis is between seven and nine years, during which women may suffer significant pain and health complications.

Because of this, many women feel pressure to simply endure their symptoms, believing they should accept what they’re experiencing without seeking help or answers. Studies show that up to 40% of women report feeling uncomfortable or embarrassed discussing certain health issues (especially reproductive or sexual health) with their doctors.

So how do we change this? How do we create space for women and healthcare providers to have open, judgment-free conversations—and build a system that validates women’s experiences and guides them toward real solutions?

Areas For Improvement

Empowering Women to Break Biases
While it’s clear we have made progress, there’s still a need to persevere to eliminate women-based healthcare biases. Here’s some simple ways that can help.

• Health Literacy: Provide resources to educate women about their health rights and encourage them to advocate for themselves in clinical settings.

• Community Engagement: Engage with communities to raise awareness about gender biases in healthcare and promote collective action to address them.

• Conversation Starters: We’ve never been better equipped to use tools to help patients start a conversation about a topic – sensitive or not- with their provider.

Maybe someday we’ll look back and marvel that there ever was such a thing. We should continue to aspire to eliminate these biases.