When I graduated from medical school, I genuinely believed medicine was gender-neutral, and everyone received equal treatment. It was the idealistic view of a young doctor who had not yet grasped the profound influence of societal structures on healthcare. During my training, I don’t think we were ever exposed to the gendered aspects of medicine or taught to question how medical practice itself is fundamentally shaped by patriarchy, racism, and colonialism.
This blind spot in my education left me unprepared for the realities I would later encounter in my career.
In 2017, I found myself working on the Greece-Macedonia border among Syrian refugees escaping the civil war in Syria1,2. For the first time, I witnessed how mass displacement profoundly impacts women. Imagine being stuck at a border for months, pregnant, and delivering a baby in a foreign land with an entirely unfamiliar healthcare system3. The future for these women and their families often seemed bleak, overshadowed by uncertainty and trauma. Many women were still expected to fulfil their sexual obligations to their husbands, and they were often the ones burdened with managing contraception. In the cramped and precarious conditions of refugee camps, I saw how intimate partner violence was exacerbated, with women bearing the brunt of this oppression.
Photo 2: Dr Nadirah Babji at a mobile clinic in Greece providing basic medical care to the displaced Syrian refugees.
Later, my work in the refugee camps of Cox’s Bazaar in Bangladesh brought me face-to-face with the horrifying reality of rape as a weapon of war4. The Rohingya women I treated carried visible and invisible scars of gender-based violence (GBV)5. These experiences cemented my understanding that healthcare professionals are often on the frontlines of responding to GBV, whether we recognise it or not6. Survivors of violence come to us not only in designated spaces like One Stop Crisis Centres (OSCC) but also in primary health clinics and outpatient settings. The onus is on us to identify and support them.
Photo 3: Common view in Cox’s Bazaar refugee camp that host over 1 million Rohingya refugees.
As healthcare workers—doctors, nurses, midwives, clinic helpers—we all have roles to play in combating GBV. Beyond clinical care, our responsibilities extend to challenging the systems and power dynamics that perpetuate inequality. For instance, who holds decision-making power in our healthcare systems? Whose voices are heard when policies are made? It is crucial to critically examine these dynamics because they determine how inclusive and equitable our care can be.
This realisation led me to pursue a master’s degree in Gender Studies at the Universiti Malaya, Malaysia’s first full master’s coursework programme in this field. During my studies, I discovered the prevalent issue of obstetric violence in Malaysia and chose it as the focus of my master’s thesis.
Obstetric violence refers to the mistreatment of women during childbirth and prenatal care by healthcare providers. It encompasses a range of behaviours, including physical abuse, verbal humiliation, non-consensual medical interventions, neglect, and coercion7. This form of violence is rooted in power imbalances within healthcare systems and reflects broader societal inequalities, including gender, class, and racial disparities.
In Malaysia, obstetric violence remains a largely unaddressed issue despite increasing awareness globally. Women have reported instances of being scolded or shamed during labour, receiving medical procedures without proper consent, and experiencing dismissive attitudes from healthcare providers. Such practices not only violate women’s rights but also discourage them from seeking care in future pregnancies, potentially endangering their health and that of their children. Moreover, these experiences are often normalised within the medical field, with systemic barriers preventing accountability or reform.
Over time, I learned that many gender-related issues persist in Malaysia, including female genital cutting (FGC), the gender pain gap, and period poverty, all of which remain insufficiently discussed. Female genital cutting is often framed as a cultural practice, but it has significant health implications, including chronic pain, infections, and psychological trauma. The gender pain gap, on the other hand, highlights how women’s pain is frequently dismissed or underestimated in medical settings, resulting in delayed diagnoses and inadequate treatment8.
Period poverty, which refers to the lack of access to menstrual hygiene products, education, and facilities, disproportionately affects women and girls from lower-income households in Malaysia9,10. This issue not only impacts their health and hygiene but also perpetuates stigma, limits educational and economic opportunities, and underscores systemic gender inequalities.
In my journey, I have learned that advancing gender equality in healthcare requires more than individual acts of care. It demands systemic change. This involves integrating gender-sensitive training into medical education, recognising the intersecting oppressions of race, class, and gender in health outcomes, and advocating for policies that empower women and marginalised groups. It also means creating spaces within healthcare for survivors to feel safe, heard, and supported.
The work is not easy, and it requires unlearning much of what we have been taught. But as healthcare professionals, we are uniquely positioned to drive change. By addressing the root causes of inequality11 and leveraging our roles as trusted figures in communities, we can contribute to building a healthcare system that genuinely serves everyone, regardless of gender. It is not enough to treat the symptoms; we must address the structures that allow these inequities to persist.
References:
- Lee A. Medic grad finds her calling at the Syrian refugee frontlines. Malaysiakini. Published December 10, 2017. Accessed December 10, 2024. https://www.malaysiakini.com/news/405015
- McVeigh K. What’s in it for them? The volunteers saving Europe’s refugees. the Guardian. Published June 9, 2016. Accessed December 10, 2024. https://www.theguardian.com/world/2016/jun/09/whats-in-it-for-them-the-volunteers-saving-europes-refugees
- Nadhifa K, Fahadayna AC. Sexual Gender-Based Violence in Greek Refugees Camp. Transformasi Global. 2020;7(2):176-200. doi:https://doi.org/10.21776/ub.jtg.2020.007.02.1
- Abdelaziz S. “It would be good if I too died”: Rape as weapon of war against Rohingya. CNN. Published November 17, 2017. Accessed December 10, 2024. https://edition.cnn.com/2017/11/17/asia/myanmar-rohingya-rape/index.html
- Anwary A. Sexual violence against women as a weapon of Rohingya genocide in Myanmar. The International Journal of Human Rights. 2021;26(3):1-20. doi:https://doi.org/10.1080/13642987.2021.1931136
- Colombini M, Mayhew SH, Ali SH, Shuib R, Watts C. An integrated health sector response to violence against women in Malaysia: lessons for supporting scale up. BMC Public Health. 2012;12(1). doi:https://doi.org/10.1186/1471-2458-12-548
- Edward MM, Kibanda Z. Obstetric violence: A public health concern. Health Science Reports. 2022;6(1). doi:https://doi.org/10.1002/hsr2.1026
- Ismail N. When Women’s Pain Is Not Taken Seriously — Ova. Ova. Published January 15, 2024. Accessed December 10, 2024. https://ova.galencentre.org/when-womens-pain-is-not-taken-seriously/
- Tan D. Period Poverty Isn’t Just About Free Sanitary Pads – CodeBlue. CodeBlue. Published December 26, 2022. https://codeblue.galencentre.org/2022/12/period-poverty-isnt-just-about-free-sanitary-pads/
- The Price of Being a Woman: Pink Tax and Period Poverty | Taylor’s University. Taylors University. https://university.taylors.edu.my/en/student-life/news/2024/the-price-of-being-a-woman-pink-tax-and-period-poverty.html
- Baciu A, Negussie Y, Geller A, Weinstein JN. The Root Causes of Health Inequity. National Library of Medicine. Published January 11, 2017. https://www.ncbi.nlm.nih.gov/books/NBK425845/
