First published in The Star Malaysia on 17th October 2023.
In light of the recent International Day of the Girl Child on Oct 11, 2023, the International Islamic University Malaysia, the Endometriosis Association of Malaysia, Malaysian Doctors for Women & Children, Peduli Merah, and Projek Gadis Mekar collaboratively hosted an online forum to raise awareness about “Period Poverty, the gender pain gap, and endometriosis”.
The gender pain gap relating to menstrual health and issues of endometriosis are cultural aspects of period poverty that are often overlooked.
In recent years, Malaysia has placed significant attention on various aspects of gender equality. Girls are making strides in education, and women are taking on more managerial roles. However, beneath the surface of these visible achievements lies an issue that is often overshadowed: the gender pain gap. This silent and pervasive problem deserves our attention.
The gender pain gap refers to the differences in how men and women experience and manage pain, as well as the disparities in access to adequate pain management and healthcare services. It is an issue that goes beyond the visible, headline-grabbing inequalities, delving deep into the lives of Malaysian women who silently endure pain without proper acknowledgement or care.
Here are some of the facts that highlight the reality of the gender pain gap:
> Up to 25% of women are less likely than men to receive pain relief and wait longer for pain relief when presenting with abdominal pain at an emergency department.
> Women are 50% more likely to be misdiagnosed when having a heart attack due to the lack of awareness of atypical presentations of heart attack experienced by women and gender bias.
> Normalisation or trivialisation of women’s pain was the reason for Malaysian girls with dysmenorrhoea to not seek professional help.
The lack of awareness among Malaysians regarding endometriosis is mainly attributed to its commonly mistaken perception as normal menstrual discomfort. Consequently, this misconception hinders Malaysian women from accessing comprehensive information and assistance pertaining to their reproductive and menstrual well-being.
One reason for this bias is the persistence of gender stereotypes that cast women as “emotional” and “hysterical”. These stereotypes influence medical practitioners, sometimes unconsciously, to downplay the pain reported by female patients. The consequences of such biases are immense. Women with chronic conditions such as endometriosis, fibromyalgia, and migraines often struggle to find understanding and effective treatment.
Additionally, the gender pain gap extends into cultural norms and expectations. Women, particularly in more conservative or traditional settings, may be reluctant to openly discuss their pain, fearing the stigma associated with perceived weakness. This cultural silence can lead to women delaying seeking medical help until their conditions have progressed to critical stages, making treatment more challenging and costly.
In endometriosis, the delay in seeking treatment could immensely affect patients’ quality of life. The reasons for the long waiting times for women (six-12 years) to be diagnosed with endometriosis are multifactorial, but the gender pain gap plays a significant role. Although the evidence is limited, failure to diagnose and treat endometriosis on time may promote progression of the disease and a longer time between first clinical consultation and referral or diagnosis.
Findings indicated that one in 10 women suffer from endometriosis, which equates to 190 million women worldwide. In Malaysia, approximately 350,000 women have endometriosis. This implies a global emergency in addressing the unmet needs of women with endometriosis.
Typically, the stigma associated with endometriosis and its effects on patients’ psychosocial well-being serve as obstacles that contribute to the delay in diagnosing the condition, explicitly referring to the prolonged period between the emergence of symptoms and the subsequent diagnosis or treatment.
A 2020 study on Malaysian members of the Endometriosis Association of Malaysia Facebook page revealed that these patients encountered persistent challenges in effectively communicating and conveying the nature of their suffering to others. The results also suggested that women with endometriosis were not receiving sufficient information from healthcare providers, leading them to rely on online interactions with fellow patients for solutions.
These statistics and findings are alarming, and they highlight the need for action to address the gender pain gap in Malaysia. More studies need to be done to understand the impact of the gender pain gap on Malaysian women. Here we highlight some steps that can be taken to close the gap:
Increase awareness: Initiatives should be undertaken to raise awareness about the gender pain gap among healthcare providers, the public, and women themselves. Healthcare professionals in particular need to be aware of the gender pain gap and the biases that contribute to it. This can be achieved through training and education programmes that focus on gender sensitivity and cultural competence.
Conduct research: More research is needed to understand the biological and psychosocial bases of pain differences between men and women. This research can help inform the development of effective treatments and interventions.
Address systemic gaps in healthcare: There are systemic gaps in healthcare that contribute to the gender pain gap, such as the lack of representation of women in clinical trials. Addressing these gaps can help ensure that women receive the same level of care as men.
Empower women: Women need to be empowered to speak up about their pain and to advocate for themselves in healthcare settings. This can be achieved through education and awareness campaigns that encourage women to take an active role in their healthcare.
Establish support networks: Encourage and support the creation of support networks and safe spaces where women can openly discuss their experiences, fostering a culture of understanding and empathy. The main objective of the Endometriosis Association of Malaysia is to establish a conducive and impartial atmosphere that promotes the physical and emotional well-being of patients while facilitating open and effective communication regarding the management of their endometriosis-related concerns.
Policy changes: Advocate for policies that promote gender equality in healthcare and employment, ensuring that all individuals receive the same quality of care, regardless of their gender.
Closing the gender pain gap in Malaysia will require a concerted effort from healthcare professionals, policymakers, and the public. It is time to recognise that women’s pain is real and to take action to ensure that they receive the care and treatment they deserve. Let us work together to close the gender pain gap and create a more equitable society for all. This is a future we hope for our girls.
DR FATIMAH AL-ATTAS
Coordinator, Unit for Social Issues and Development Advocacy and Research,
International Islamic University Malaysia
ANNSLEY DASHAWNA STEPHEN
Member of the Youth Parliament Malaysia (Penang) 2023/2024 Session
Founding President, Pertubuhan Projek Gadis Mekar Malaysia
SURITA MOGAN
Founding president, Endometriosis Association of Malaysia
DR HANNAH NAZRI
National Institute for Health and Care Research, Academic Clinical Fellow in Obstetrics & Gynaecology, University of Warwick, Britain
Specialty Trainee Doctor in Obstetrics & Gynaecology, National Health Service, Britain
Founding director, Malaysian Doctors for Women & Children
PEDULI MERAH
Addressing period poverty in Malaysia
