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A legacy of exclusion means Australia’s medical system is fundamentally skewed, as it was built for and tested on men
A University of NSW researcher has found that despite some progress, women’s health challenges in Australia are still under-researched and undertreated.
The inaugural national director of UNSW’s Centre for Sex & Gender Equity in Health and Medicine Professor Bronwyn Graham says narrowing women’s health to ‘bikini medicine’ — issues that occur between the breasts and the pubic bone — has left women underserved in nearly every area of health, including disease, ageing and chronic illness.
“Australia is still decades behind its international counterparts when it comes to building health systems that account for sex and gender differences,” Professor Graham says.
Australia recently launched a series of high-profile strategies — the National Women’s Health Strategy, the LGBTQIA+ 10-Year Action Plan and the National Women’s Health Advisory Council — to improve outcomes for women and gender-diverse people.
Yet Professor Graham says much of the medical system is still fundamentally skewed because it was built for, tested on and validated through men.
“From the very basic fundamental research on cells and animals through to human clinical trials and healthcare delivery, we’ve systematically ignored half the population,” she says.
A legacy of exclusion
Australia still has no enforceable policy requiring researchers to consider sex and gender in clinical trials.
“The National Health and Medical Research Council only recently issued a statement encouraging a consideration of sex and gender,” Professor Graham says.
“But it’s not a mandate. There’s no requirement in funding applications to even show this — and that is where the real change needs to happen.
“There are very few instances where single sex studies could be justified.”
Costly ignorance
This has led to women being more likely than men to be misdiagnosed, experience adverse drug reactions and receive less effective treatment for common conditions.
“We’re still using drugs and interventions that were made before the 1990s — and they’ve never been tested on women,” she says.
This bias is even seen in first aid, such as how CPR mannequins lack breasts, which she says affects how health professionals and first responders are trained to save women’s lives.
“We still think of the male as the default human,” says Professor Graham.
“When it comes to doing things like administering CPR, people feel less confident when treating a woman.”
Retrofitted for women
The current model of evidence-based medicine is “actually mostly evidence-based for men.”
The clitoris — which is an entire organ in itself — remained absent from anatomy until 1998, when Australian neurologist Professor Helen O’Connell fully mapped it — in her spare time, unfunded.
But the lack of female research in medicine extends further. Common conditions that affect all people, such as heart disease or depression, manifest differently in women, yet treatment guidelines don’t reflect these differences.
“And even then, women are more likely to die from reproductive cancers than men are from male-specific cancers,” she says.
“This is largely due to later detection and less investment in early testing.”
When ‘bikini medicine’ is an afterthought
Women’s health concerns are still often dismissed or overlooked, with even basic lab research relying on male cells.
“There is a power dynamic in medical relationships still. It’s a real issue,” Professor Graham says.
Today, Professor Graham campaigns for better recognition of gender in medicine.
“As an example, we still don’t know why some antidepressants work for hot flushes in menopause,” she says. “And that’s because we don’t know why — or how — women’s bodies regulate temperature during menopause.
“Medical students aren’t aware that the evidence they’re learning is biased.
“They’re taught to treat everyone as if sex and gender don’t matter — unless it’s reproductive.”
Invisible populations
Professor Graham says one of the most urgent issues to address under the assessment is how little is known about health outcomes for LGBTQIA+ communities.
The clinical data for LGBTQIA+ communities is rarely collected, or analysed, in ways that differentiate between sex, gender and sexual orientation.
And studies that do include non-binary or LGBTQIA+ people are often excluded from published results, making it difficult to develop effective and inclusive treatment guidelines.
“We can’t improve care for communities we’re not even counting,” she says.
“If you take sex and gender into account, your research is just better. It’s more accurate, more reproducible, more useful.
“This isn’t just about fairness – it’s about good quality science and good quality healthcare.”
Nance Haxton was a journalist at the ABC for nearly 20 years. She’s also worked as an Advocate at the Disability Royal Commission helping people with disabilities tell their stories and as a senior reporter for the National Indigenous Radio Service.
In that time she’s won a range of Australian and international honours, including two Walkley Awards, and three New York Festivals Radio Awards trophies.
Now freelancing as The Wandering Journo, Nance is independently producing podcasts including her personal audio slice of Australia “Streets of Your Town”.
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