How Sexism and Racism in Medicine Create the Pain Gap

Bangladeshi American writer Anushay Hossain's book, The Pain Gap, explores the devastating effects of medical misogyny and racism.

Split screen image of the book cover to The Pain Gap and its author, Anushay Hossain
After nearly dying giving birth, Anushay Hossain began examining how women’s pain and maternal health have shaped her own life. Courtesy images

It can take between seven and ten years for people with a uterus to get diagnosed with endometriosis. Research has shown that it can take women of color, especially Black women, even longer to get diagnosed with this painful chronic health condition. This statistic is a cruel reminder of how women’s health, and particularly women of color’s health, is often overlooked and dismissed as women being “hysterical.”

Anushay Hossain, a Bangladeshi American writer and activist based in Washington, D.C., advocated for women’s health and rights around the world as part of her policy work at the Feminist Majority Foundation. After nearly dying giving birth, Hossain began to examine how the issues of women’s pain and maternal health have shaped her own life.

In her first book, The Pain Gap: How Sexism in Healthcare Kills Women, which comes out Tuesday, Hossain details how medical misogyny and racism not only lead to women waiting longer to get diagnosed and treated for health issues, but can also cost them their lives. Hossain told Rewire News Group that it is essential that people of every gender work to improve women’s health, as “we should all care about women’s health because it impacts all of us and impacts our economies and countries.”

Rewire News Group spoke with Hossain about the pain gap that women in the United States experience. This conversation, which has been edited for content and clarity, touches on how Hossain’s experience influences her work, how common it is for women’s pain to be dismissed, and how racist stereotypes about Black women affect the health care they receive.

Rewire News Group: Personal experiences can greatly impact what journalists choose to research and write about. How did your own experience nearly dying in childbirth cause you to focus more on maternal health?

Anushay Hossain: When you have a personal experience, and you’re a journalist, and you have that bug, you just want to know more and more. It’s interesting because there’s quite a few women that I quote in the book who have done the same. Maya Dusenbery, the author of Doing Harm, her book was so instrumental to my book, and she was saying she had rheumatoid arthritis, and she’s like, “Why is it taking so long to get diagnosed?” I never once knew that America has such terrible maternal mortality statistics, but then we are in the middle of a maternal health crisis.

From Bangladesh, where you’re from, to the United States, how is the “pain gap” that women experience a global issue?

AH: What really is interesting is that women all over the world, from very poor parts of Bangladesh to rural America to corporate America, all have a story. We know someone who has been dismissed medically, it was all “in their head,” their pain wasn’t believed. Every woman I spoke with had a story and had been dismissed.

The reason I zero in on America is not only because I live here, but now my kids are American. This is the main health care I’ve had an experience with. At the very end of the book, I talk about this Bangladeshi woman I met last year in my father’s constituency who was kind of like, “Great that you’re writing this book in America, but how does that impact us?” I said because if women’s health in America doesn’t get it right, we are all effectively screwed through American foreign policy.

When looking at the state of maternal health in the United States, why is it important to approach it from an intersectional angle? I found it crucial that you highlighted that Black women are more likely to die in childbirth from preventable causes than white women.

AH: Black women in America, you hear that they’re three times more likely to die in childbirth than their white counterparts. As a statistic, that is 243 percent more likely to die in childbirth than their white counterparts. So you have to ask, “What the eff is going on?” For a really long time, we were told that is because Black people are poor, all these racist stereotypes about welfare queens, but now we know that it’s racism and not race.

The image of motherhood in America is very white, but look at the statistics and look at the stories. I left my policy and analyst job at Feminist Majority and kind of went full time into media because I was like, “Where are the stories of Black and brown women where we’re not charity basket cases, or a fundraiser for Africa or Bangladesh. What is happening?” The other really disturbing statistic is that for a really long time, Black women were seen as uneducated and that’s why they’re dying so much in childbirth, but now we know that the more educated a Black women is, the higher the chances of being mishandled or dying in the American health-care system. So what the heck is going on there? We don’t listen to women.

Similar to women not being included in clinical trials in the 1990s, how is the exclusion of pregnant people from COVID-19 clinical trials indicative of maternal and women’s health continuing to be overlooked?

AH: It was so infuriating because the standard for health and the model for health in America is a middle-aged white man. It kind of gets sorted in the 1990s that there’s a mandate, you have to include testing women in clinical trials and all this stuff, but they still don’t. We know that there’s deep sexism in any sector, in any field you work in, and we know it’s especially prevailing in medicine and science.

We know it gets established by the doctors and the medical experts that pregnant women are more at risk for … getting sick if they contract COVID, or if you will die, it will be a more painful death. Basically what happened was that we tested on pregnant women in an uncontrolled environment. I have five pregnant friends who wanted to be tested on. They eventually tested on themselves because they decided yes with their doctor, but they had to make the decision to be vaccinated or not. Now we know no pregnant woman has died from taking the COVID vaccine, and now it’s pretty much recommended by the World Health Organization to get vaccinated.

In what ways do you have hope that women’s pain and maternal health can improve in this country?

AH: I have a lot of hope because I really believe in women. We just have to be informed, and we organize so well, and we’re such good natural connectors. This is a solvable issue. Women’s health is not an enigma. The issue is that it is not a priority. No one gives a shit, that’s a problem. It’s always an afterthought and not a focus, and this is happening in the world’s richest democracy. It’s just unacceptable.