Emergence of Feminist Bioethics in the US

Our society's male-centered framework has essentially shaped the gender bias that persists throughout the US healthcare system, resulting in an underrepresentation of women in research, the trivialization of women's physical complaints and symptoms, and a lack of research funding. It wasn't until the emergence of feminist bioethics in the mid 20th century when gender disparities in healthcare and research, physical symptoms being misdiagnosed as psychology based, and the exclusion of women from research began to be identified and addressed (Scully, 2023). The overarching goal of feminist bioethics is to work toward equality for women by analyzing issues within gender health and identifying the unethical societal perspectives that cause them. Until this idea was introduced misdiagnosis and lack of women's research was not considered a relevant issue in medicine at the time due to a variety of historical factors. 

Misdiagnosis

The ancient practice of attributing female illness to the presence of a uterus was used as an explanation of the source of women's disease. This idea evolved into "hysteria", which was considered a sufficient explanation for women's physical and psychiatric symptoms, even when they were entirely unrelated to the hormonal imbalances that it implies (Mazumder, 2023). The concept of hysteria as a mental disorder, dating back 4,000 years, was commonly used to misdiagnose women in the US until 1980 when it was deleted from the Diagnostic Statistic Manual of Mental Disorders (Tasca et al. 2012). Unfortunately, female pain is often still minimized or dismissed as psychiatric disorders such as anxiety or stress-related. This leads to conditions being overlooked when they are, infact, treatable. For example, endometriosis is a condition that possesses similar symptoms to that of menstruation, however, is much more severe. In many women, it is chalked up to normal menstruation symptom, leading to a delay in diagnosis and treatment. 

Lack of Research and Funding

Historically, there has been an underrepresentation of women in health studies and clinical trials, compromising the quality and accuracy of health information in regards to women. This is due to the belief that the female physiology could result in unreliable data, due to the interference of hormone cycles. As a result, women were often excluded from clinical trials, leading to a lack of understanding of how disease affects women differently than men. For example, A 1980 study of whether aspirin reduces cardiovascular mortality included 22,071 participants that were all male, which failed to identify that females may have a higher risk of aspirin resistance (Mirin, 2021). Since then, the National Institutes of Health has begun to ensure that sex is taken into account as a biological variable in their research.  In 1986, they implemented an official policy requiring researchers to state whether or not women are included in trials and give an explanation of why. This policy, intended to encourage researchers to include women in their trials, was not properly enforced and the gender disparities in research persisted for several years until 1990 when the Office of Research on Women's Health was implemented and funded to monitor the inclusion of women in clinical trials (Thomas & Braus, 1998). Although such advancements have since been made, women’s healthcare research is still not held to the standard that it should be. 

Women's Health in India: A Historical Perspective

Ancient and Colonial Periods

The history of women's health in India begins with traditional medical systems like Ayurveda, Siddha, and Unani, which contained specific provisions for women's reproductive and general health. These systems recognized women's unique physiology, with Ayurvedic texts like Charaka Samhita and Sushruta Samhita including sections on gynecological conditions, pregnancy, and childbirth management. However, these practices existed within patriarchal frameworks that often limited women's healthcare autonomy.

The colonial era (1757-1947) brought significant transformations to women's healthcare in India. British colonizers introduced Western medical practices while often dismissing indigenous knowledge systems. Colonial medicine pathologized Indian women's bodies, viewing them through Orientalist perspectives that deemed traditional practices as backward. Meanwhile, the British established the first women's hospitals in urban centers, though these primarily served elite populations. Lady Dufferin's Fund, established in 1885, represented one of the first organized efforts to provide Western medical care specifically for Indian women, training female doctors and establishing women's hospitals.

During this period, traditional birth attendants (dais) continued to provide the majority of maternal healthcare, especially in rural areas. Colonial authorities viewed these practitioners with suspicion but could not replace their expansive networks. The training of female physicians began gradually, with women like Kadambini Ganguly and Anandibai Joshi becoming pioneers as India's first female doctors in the late 19th century, challenging both colonial and patriarchal restrictions on women in medicine.

Post-Independence Developments (1947-1980s)

Following independence, India incorporated maternal and child health services into its national planning. The First Five-Year Plan (1951-56) established primary healthcare centers that included maternal services, conceptualizing women primarily through their reproductive roles. This period saw the beginning of institutionalized healthcare delivery systems, though coverage remained limited, especially in rural areas.

The 1960s-70s marked a problematic turn toward population control policies, often targeting women with coercive contraceptive measures. The Emergency period (1975-77) witnessed forced sterilization programs that disproportionately affected marginalized women. These demographic-focused initiatives frequently prioritized population targets over women's health and reproductive autonomy, leaving a contentious legacy in Indian public health history.

The Community Health Volunteer scheme launched in the late 1970s began involving women in healthcare delivery, recognizing their potential as community health workers. However, women's comprehensive health needs beyond reproduction received minimal attention in policy frameworks during this period.

Shifting Paradigms (1980s-2000)

The 1980s witnessed emerging critiques of narrowly defined maternal healthcare approaches. Women's health activists and organizations began challenging population control policies while advocating for comprehensive women's health services. The Women's Health Movement in India gained momentum, establishing feminist health centers and producing critical research on women's health issues beyond reproduction.

The International Conference on Population and Development (1994) marked a theoretical shift from demographic targets toward reproductive rights. India's policies gradually reflected this change, with the National Population Policy (2000) acknowledging women's reproductive rights, though implementation remained inconsistent. During this period, women's health began to be understood through broader socioeconomic determinants, with recognition that factors like education, nutrition, and gender-based violence significantly impacted health outcomes.

Contemporary Developments (2000-Present)

The early 21st century saw expanded programmatic approaches to women's health. The National Rural Health Mission (2005) improved infrastructure for maternal healthcare while introducing incentive programs like Janani Suraksha Yojana to increase institutional deliveries. The establishment of Accredited Social Health Activists (ASHAs) created a cadre of community women working on maternal and child health issues at the village level.

More recent policies have begun addressing women's health beyond reproductive years, recognizing concerns like non-communicable diseases, mental health, and geriatric care for women. However, research indicates persistent gaps between policy frameworks and implementation, with historical neglect of comprehensive women's healthcare continuing to influence current disparities.

Throughout this history, women have demonstrated agency in addressing their health needs, establishing community-based initiatives and challenging problematic policies. Women's movements have consistently advocated for healthcare approaches that respect autonomy and address structural inequities affecting health outcomes.

References: 

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World Health Organization. (2018, February 22). Health inequities and their causes. https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes  

World Health Organization. (2021, May 24). Gender and health. https://www.who.int/news-room/questions-and-answers/item/gender-and-health 

Mazumder, H. (2023). Cleghorn Elinor. Unwell Women: Misdiagnosis and Myth in a Man-Made World: Penguin Random House, 2021, 386 pp. Women’s Studies, 52(1), 140–143. https://doi.org/10.1080/00497878.2022.2151444

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