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Women in medicine

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Historically and in many parts of the world, women's participation in the profession of medicine (as physicians, for instance) has been significantly restricted, although women's practice of medicine, informally, in the role of caregivers, or in the allied health professions, has been widespread. Most countries of the world now provide women with equal access to medical education. However not all countries ensure equal employment opportunities[1] and gender equality has yet to be achieved within the medical specialties and around the world.[citation needed]

Modern medicine

Wafaa El-Sadr is an Egyptian epidemiologist and MacArthur Fellow who directs two programmes at Columbia University's Mailman School of Public Health.
Monique Frize (centre) is a Canadian academic and biomedical engineer known for her expertise in medical instrumentation and decision support systems (DSS).
Awa Marie Coll Seck is Senegal's former Minister of Health and an international public health expert, Executive Director of the Joint United Nations Programme on HIV/AIDS and the Roll Back Malaria (RBM) Partnership.

In 1540 Henry VIII granted the charter for the Company of Barber Surgeons; women were barred. Women did, however, continue to practise during this time. They continued to practise without formal training or recognition in England and eventually North America for the next several centuries.[2] Women's participation in the medical professions was generally limited by law and practice during the decades while medicine was professionalizing.[3] However, women openly practicing medicine in the allied health fields (nursing, midwifery, etc.), and throughout the nineteenth and twentieth centuries, women made significant gains in access to medical education and medical work through much of the world. These gains were sometimes tempered by setbacks; for instance, Mary Roth Walsh documented a decline in women physicians in the US in the first half of the twentieth century, such that there were fewer women physicians in 1950 than there were in 1900.[4] However, through the latter half of the twentieth century, women had gains generally across the board. In the United States, for instance, women were 9% of total US medical school enrollment in 1969; this had increased to 20% in 1976.[4] By 1985, women comprised 14% of practicing US physicians.[5]

At the beginning of the twenty-first century in industrialized nations, women have made significant gains, but have yet to achieve parity throughout the medical profession. Women have achieved parity in medical school in some industrialized countries, since 2003 forming the majority of the United States medical student body.[6] In 2007-2008, women accounted for 49% of medical school applicants and 48.3% of those accepted.[7] According to the American Association of Medical Colleges (AAMC) 48.3% (16,838) of medical degrees awarded in the US in 2009-10 were earned by women, an increase from 26.8% in 1982-3.[8]

However, the practice of medicine remains disproportionately male overall. In industrialized nations, the recent parity in gender of medical students has not yet trickled into parity in practice. In many developing nations, neither medical school nor practice approach gender parity.

Moreover, there are skews within the medical profession: some medical specialties, such as surgery, are significantly male-dominated,[9] while other specialties are significantly female-dominated, or are becoming so. In the United States, female physicians outnumber male physicians in pediatrics and female residents outnumber male residents in family medicine, obstetrics and gynecology, pathology, and psychiatry.[10][11]

Women continue to dominate in nursing. In 2000, 94.6% of registered nurses in the United States were women.[12] In health care professions as a whole in the US, women numbered approximately 14.8 million, as of 2011.[13]

Biomedical research and academic medical professions—i.e., faculty at medical schools—are also disproportionately male. Research on this issue, called the "leaky pipeline" by the National Institutes of Health and other researchers, shows that while women have achieved parity with men in entering graduate school, a variety of discrimination causes them to drop out at each stage in the academic pipeline: graduate school, postdoc, faculty positions, achieving tenure; and, ultimately, in receiving recognition for groundbreaking work.[14][15][16][17] (See women in science for a broader discussion.)

History

Hildegard of Bingen, a Medieval German abbess who wrote Causae et Curae, a medical text.
Russian Empress Alexandra Feodorovna with Vera Gedroitz, 1915
Elizabeth Blackwell, MD, the first woman to graduate from medical school in the United States (1849).
Woman's Medical College of Pennsylvania in 1886: Anandibai Joshee from India (left) with Kei Okami from Japan (center) and Sabat Islambooly from Syria (right). All three completed their medical studies and each of them was the first woman from their respective countries, obtaining a degree in Western medicine.

Ancient medicine

The involvement of women in the field of medicine has been recorded in several early civilizations. An Egyptian, Merit Ptah (2700 BC), described in an inscription as "chief physician", is the earliest woman named in the history of science. Agamede was cited by Homer as a healer in Greece before the Trojan War. Agnodike was the first female physician to practice legally in 4th century BC Athens. Metrodora was a physician and generally regarded as the first medical writer.

Medieval Europe

During the Middle Ages, convents were an important place of education for women, and some of these communities provided opportunities for women to contribute to scholarly research. An example is the German abbess Hildegard of Bingen, whose prolific writings include treatments of various scientific subjects, including medicine, botany and natural history (c.1151-58).[18] She is considered Germany's first female physician.[19]

The southern Italian coastal town of Salerno was an important center of medical learning and practice in the 12th century. There, the physician Trota of Salerno gathered a number of her medical practices in several written collections. One work on women's medicine that was associated with her, the De curis mulierum ("On Treatments for Women") formed the core of what came to be known as the Trotula ensemble, a compendium of three texts that circulated throughout medieval Europe. Trota herself gained a reputation that spread as far as France and England. There are also references in the writings of other Salernitan physicians to the mulieres Salernitane ("Salernitan women"), which give some idea of local empirical practices.[20]

Dorotea Bucca was another distinguished Italian physician. She held a chair of philosophy and medicine at the University of Bologna for over forty years from 1390.[21][22][23][24] Other Italian women whose contributions in medicine have been recorded include Abella, Jacobina Félicie, Alessandra Giliani, Rebecca de Guarna, Margarita, Mercuriade (14th century), Constance Calenda, Calrice di Durisio (15th century), Constanza, Maria Incarnata and Thomasia de Mattio.[22][25]

For the medieval Islamic world, little specific is known about female medical practitioners although it is likely that women were regularly involved in medical practice in some capacity. Male medical writers refer to the presence of female practitioners (singular, tabība) in describing certain procedures or situations. For example, the late 10th/early 11th century Andalusi physician and surgeon Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi, in explaining how to excise bladder stones, notes that the procedure is difficult for male doctors practicing on female patients: because of the need to touch the genitalia, the male practitioner must either find a woman doctor who can perform the procedure, or a eunuch physician, or a midwife who takes instruction from the male surgeon. In other words, even though direct evidence for female practitioners is rare, their existence can be inferred.[26] As al-Zahrawi's example also suggests, midwives played an important role in the delivery of women's healthcare. For these practitioners, there is more detailed information, both in terms of the prestige of their craft (Ibn Khaldun calls it a noble craft, "something necessary in civilization") and in terms of biographical information on historic women.[27] To date, no known medical treatise written by a woman in the medieval Islamic world has been identified.

Western medicine in China

Traditional Chinese Medicine that is based on the use of herbal medicine, acupuncture, massage and other forms of therapy has been practiced in China for thousands of years. However, Western Medicine was introduced to China in the 19th Century, mainly by medical missionaries sent from various Christian mission organizations, such as the London Missionary Society (Britain), the Methodist Church (Britain) and the Presbyterian Church (US). Benjamin Hobson (1816-1873), a medical missionary sent by the London Missionary Society in 1839, set up a highly successful Wai Ai Clinic (惠愛醫館) [28][29] in Guangzhou, China. The Hong Kong College of Medicine for Chinese (香港華人西醫書院) was founded in 1887 by the London Missionary Society, with its first graduate (in 1892) being Sun Yat-sen (孫中山). Sun later led the 1911 Xinhai Revolution (Chinese Revolution (1911)), which changed China from an empire to a republic. The Hong Kong College of Medicine for Chinese was the forerunner of the School of Medicine of the University of Hong Kong, which started in 1911.

Due to the social custom that men and women should not be near to one another, the women of China were reluctant to be treated by male doctors of Western medicine. This resulted in a tremendous need for female doctors of Western Medicine in China. Thus, female medical missionary Dr. Mary H. Fulton (1854-1927) [30] was sent by the Foreign Missions Board of the Presbyterian Church (USA) to found the first medical college for women in China. Known as the Hackett Medical College for Women (夏葛女子醫學院),[31][32][33][34] this College was located in Guangzhou, China, and was enabled by a large donation from Mr. Edward A.K. Hackett (1851-1916) of Indiana, US. The College was dedicated in 1902 and offered a four-year curriculum. By 1915, there were more than 60 students, mostly in residence. Most students became Christians, due to the influence of Dr. Fulton. The College was officially recognized, with its diplomas marked with the official stamp of the Guangdong provincial government. The College was aimed at the spreading of Christianity and modern medicine and the elevation of Chinese women's social status. The David Gregg Hospital for Women and Children (also known as Yuji Hospital 柔濟醫院) [35][36] was affiliated with this College. The graduates of this College included CHAU Lee-sun (周理信, 1890-1979) and WONG Yuen-hing (黃婉卿), both of whom graduated in the late 1910s and then practiced medicine in the hospitals in Guangdong province.[citation needed]

Early modern era

Historic women's medical schools

When women were routinely forbidden from medical school, they sought to form their own medical schools.

Historic hospitals with significant female involvement

Pioneers

Maria Cuţarida 1857-1919. Stamp of Romania, 2007.

Women's health movement in the seventies

The seventies marked a great increase of women entering and graduating from medical school. From 1930 to 1970, a period of 40 years, about 14,000 women graduated from medical school. From 1970 to 1980, a period of 10 years, over 20,000 women graduated from medical school.[47] This increase of women in the medical field was due to both political and cultural changes.

Two laws in the United States lifted restrictions for women in the medical field -- Title IX of the Higher Education Act Amendments of 1972 and the Public Health Service Act of 1975, banning discrimination on grounds of gender. In November 1970, the Assembly of the Association of American Medical Colleges rallied for equal rights in the medical field.[48]

At the same time, women's ideas about themselves and their relation to the medical field were shifting due to the women's movement.

A sharp increase of women in the medical field led to developments in doctor patient relationships, changes in terminology and theory. One area of medical practice that was challenged and changed was gynecology. Wendy Kline [49] talks about the blurring of “clinical” and “sexual” that occurred in the medical field in the late 40s into the 60s, particularly in gynecology. Kline says that “to ensure that young brides were ready for the wedding night, they [doctors] used the pelvic exam as a form of sex instruction .”[50] In Ellen Frankfort’s book Vaginal Politics, Frankfort talks about the “shame” and “humiliation” felt during a pap test; “I was naked, he was dressed; I was lying down, he was standing up; I was quiet, he was giving orders ”[51]

With higher numbers of women enrolled in medical school medical practices, like gynecology were challenged and changed. One medical student is quoted in Kline’s book as saying, “Since I experienced my own exams as a humiliating procedure, I feared inflicting the same humiliation on another person. ”[52] In 1972 the University of Iowa Medical School, was one school that instituted a new training program for pelvic and breast examinations. Students would act both as the doctor and the patient, allowing each student to understand the procedure, and create a more gentle, respectful, examination. This method was quite different from the previous practice in which doctors were taught to assert their power over patients. With changes in ideologies and practices, throughout the 70s, by 1980 over 75 schools had adopted this new method.[53]

With women entering the medical field and women’s rights movements came also the women’s health movement which sought alternative methods of health care for women. This came through the creation of self-help books, most notably Our Bodies, Ourselves: A Book by and for Women.[54] This book gave women a “manual” to help understand their body. It challenged hospital treatment, and doctor’s practices. Aside from self-help books, many help centres were opened: birth centres run by midwives, safe-abortion centres, and classes for educating women on their bodies; all with the aim of providing non-judgmental, warm, and comfortable care for women.[55] Kline speaks to this claim women were taking on their body in relation to the medical world; women felt that “not only should women have access to information about their bodies... they should also help to create this knowledge. ”[56] The women’s health movement, along with women involved in the medical field opened the doors for research and awareness for female illness like breast cancer and cervical cancer.

The small island nation of Tuvalu in 2008 welcomed its first Tuvaluan female doctors as a result of Australian aid.

[57]

While scholars in the history of medicine had developed some study of women in the field—biographies of pioneering women physicians were common prior to the 1960s—the study of women in medicine took particular root with the advent of the women's movement in the 1960s, and in conjunction with the women's health movement. Two publications in 1973 were critical in establishing the women's health movement and scholarship about women in medicine: First, the publication of Our Bodies, Ourselves in 1973 by the Boston Women's Health Collective,[58] and second, "Witches, Midwives, and Nurses: A History of Female Healers", a short paper by Barbara Ehrenreich and Deirdre English also in 1973.[3] The Ehrenreich/English paper examined the history of women in medicine as the professionalization of the field excluded women, particularly midwives, from the practice. Ehrenreich and English later expanded the work into a full-length book, For Her Own Good, which connected the exclusion of women from the practice of medicine to sexist medical practices; this text and Our Bodies, Ourselves became key texts in the women's health movement. The English/Ehrenreich text laid out some early insights about the professionalization of medicine and the exclusion of women from the profession, and numerous scholars, such as Diana Elizabeth Long, have greatly built upon and expanded this work.

See also

Biographies

References

  1. ^ See generally, "Women's Human Rights", 1998, Human Rights Watch (available online).
  2. ^ The History of Women in Surgery, by Debrah A. Wirtzfeld, MD
  3. ^ a b See generally Barbara Ehrenreich & Deirdre English, Witches, Midwives, and Nurses (1973).
  4. ^ a b Walsh, 1977.
  5. ^ Morantz-Sanchez, Preface.
  6. ^ "Applicants to U.S. Medical Schools Increase; Women the Majority for the First Time", Association of American Medical Colleges, Nov. 3, 2003, press release ("Women made up the majority of medical school applicants for the first time ever").
  7. ^ [1][dead link]
  8. ^ [2][dead link]
  9. ^ Dixie Mills, "Women in Surgery - Past, Present, and Future" (2003 presentation), Association of Women Surgeons; available at AWS website.
  10. ^ AMA (WPC) Table 16 - Physician Specialties by Gender- 2006
  11. ^ AMA (WPC) Table 4 - Women Residents by Specialty - 2005
  12. ^ RNSS
  13. ^ Swanson, Naomi; Tisdale-Pardi, Julie; MacDonald, Leslie; Tiesman, Hope M. (13 May 2013). "Women's Health at Work". National Institute for Occupational Safety and Health. Retrieved 21 January 2015.
  14. ^ The term was coined by S.E. Berryman in "Who Will Do Science?", 1983; see Louise Luckenbill-Edds, "2000 WICB / Career Strategy Columns (Archive)", Nov. 1, 2000, WICB Newsletter, American Society for Cell Biology.
  15. ^ A. N. Pell, "Fixing the Leaky Pipeline: Women Scientists in Academia", Journal of Animal Science, v.74, pp. 2843-2848 (1996), available online at Journal of Animal Science, FASS.org.
  16. ^ Jacob Clark Blickenstaff, "Women and Science Careers: Leaky Pipeline or Gender Filter?", Gender and Education, v.17, n.4, pp. 369-386 (Oct. 2005).
  17. ^ National Academy of Sciences, Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering.
  18. ^ Hildegard von Bingen (Sabina Flanagan)
  19. ^ a b Gertrud Jaron Lewis (2006). "Hildegard von Bingen". In Richard K. Emmerson; Sandra Clayton-Emmerson (eds.). Key Figures in Medieval Europe - An Encyclopedia. Great Britain: Routledge. pp. 229–30. ISBN 978-0-415-97385-4.
  20. ^ Monica H. Green, ed. and trans., The 'Trotula': A Medieval Compendium of Women’s Medicine (Philadelphia: University of Pennsylvania Press, 2001).
  21. ^ JS Edwards (2002). "A Woman Is Wise: The Influence of Civic and Christian Humanism on the Education of Women in Northern Italy and England during the Renaissance". Ex Post Facto: Journal of the History Students at San Francisco State University. XI.
  22. ^ a b Howard S. The Hidden Giants, p. 35, (Lulu.com; 2006) (accessed 22 August 2007)
  23. ^ Brooklyn Museum: Elizabeth A. Sackler Center for Feminist Art: The Dinner Party: Heritage Floor: Dorotea Bucca (accessed 22 August 2007)
  24. ^ Jex-Blake S (1873) 'The medical education of women', republished in The Education Papers: Women's Quest for Equality, 1850–1912 (Spender D, ed) p. 270 (accessed 22 August 2007)
  25. ^ Walsh JJ. 'Medieval Women Physicians' in Old Time Makers of Medicine: The Story of the Students and Teachers of the Sciences Related to Medicine During the Middle Ages, ch. 8, (Fordham University Press; 1911)
  26. ^ Monica H. Green, "History of Science," Encyclopedia of Women and Islamic Cultures. Volume I: Methodologies, Paradigms and Sources, Suad Joseph, general editor (Leiden: E. J. Brill, 2003), pp. 358-61; Peter Pormann, "Female Patients and Practitioners in Medieval Islam," The Lancet 373 (May 9, 2009), pp. 1598-99.
  27. ^ Avner Giladi, "Liminal Craft, Exceptional Law: Preliminary Notes on Midwives in Medieval Islamic Writings," International Journal of Middle East Studies 42:2 (2010) 185-202; Jean-Pierre Molénat, "Priviligiées ou poursuivies: quatre sages-femmes musulmanes dans la Castille du XVe siècle," Identidades marginales, ed. Cristina de la Puente, Estudios onomástico-biográficos de al-Andalus, 13 (Madrid: Consejo Superior de Investigaciones Científicas, 2003), 413-30.
  28. ^ "回眸：当年传教士进羊城_MW悦读室之岭南话廊_凤凰博报- 博采众家之言 报闻公民心声-凤凰网". Blog.ifeng.com. Retrieved 2 July 2012.
  29. ^ "合信的《全体新论》与广东士林-《广东史志》1999年01期-中国知网". Mall.cnki.net. 3 February 2012. Retrieved 2 July 2012.
  30. ^ Inasmuch. "Inasmuch (9781140341802): Mary H. Fulton, The United Study of Forring: Books". Amazon.com. Retrieved 2 July 2012.
  31. ^ http://www.hkbu.edu.hk/~libimage/theses/abstracts/b15564174a.pdf
  32. ^ American Doctors in Canton: Modernization in China, 1835-1935 - Guangqiu Xu - Google Books. Books.google.com. 19 July 2011. ISBN 9781412818292. Retrieved 2 July 2012.
  33. ^ Hackett Medical College for Women, Turner Training School for Nurses, David ... - Hackett Medical College - Google Boeken. Books.google.com. 19 July 2011. Retrieved 2 July 2012.
  34. ^ "中国近代第一所女子医学院－－夏葛医学院-【维普网】-仓储式在线作品出版平台-http://www.cqvip.com". Cqvip.com. Retrieved 2 July 2012. {{cite web}}: External link in |title= (help)
  35. ^ A crusade of compassion for the healing of the nations: a study of medical ... - Belle Jane Allen, Caroline Atwater Mason - Google Boeken. Books.google.com. 1919. Retrieved 2 July 2012.
  36. ^ "柔济医院的实验室_新闻_腾讯网". News.qq.com. 17 January 2012. Retrieved 2 July 2012.
  37. ^ Michael Reiskind, "Hospital Founded by Women for Women", Jamaica Plain Historical Society (1995).
  38. ^ Scotland: Just the Medicine that the Doctor Ordered, August 2005.
  39. ^ http://www.bium.univ-paris5.fr/histmed/medica/femmesmed.htm
  40. ^ "Project MUSE - Science, Women and Revolution in Russia (review)". Muse.jhu.edu. doi:10.1353/bhm.2001.0204. Retrieved 2 July 2012.
  41. ^ "Doctor Aleu, the first woman doctor in Spain - 61 (Suppl 2): ii3 - Journal of Epidemiology & Community Health". Jech.bmj.com. 1 December 2007. Retrieved 2 July 2012.
  42. ^ Cohn, Scotti (2012). More Than Petticoats: Remarkable North Carolina Women. Globe Pequot. pp. 82–92. ISBN 978-0-7627-6445-7.
  43. ^ Edwards, Muriel, M.D., "Emma K. Willits," Journal of the American Medical Women's Association, 5/1 (January 1950): 42-43.
  44. ^ "Dr. Marie Diana Equi", NLM Changing the Face of Medicine.
  45. ^ http://www.nlm.nih.gov/locallegends/Biographies/Allen_Margaret.html. {{cite web}}: Missing or empty |title= (help)
  46. ^ "Dr. Barbara Ross-Lee". National Library of Medicine. Retrieved 17 May 2012.
  47. ^ Paludi, Michele A. and Gertrude A. Streuernage, ed., Foundations for a Feminist Restructuring of the Academic Disciplines (New York: Harrington Park Press, 1990), 236.
  48. ^ Paludi and Streuernage, Foundations for a Feminist Restructuring of the Academic Disciplines, 236.
  49. ^ Kline, Wendy. Bodies of Knowledge: Sexuality, Reproduction, and Women’s Health in the Second Wave (University of Chicago Press, 2010).
  50. ^ Kline, Bodies of Knowledge: Sexuality, Reproduction, and Women’s Health in the Second Wave, p 4.
  51. ^ Frankfort, Ellen. Vaginal Politics (New York: Vintage, 1970)
  52. ^ Kline, Bodies of Knowledge: Sexuality, Reproduction, and Women’s Health in the Second Wave.
  53. ^ Paludi and Streuernage, Foundations for a Feminist Restructuring of the Academic Disciplines, 241.
  54. ^ Boston Women’s Health Book Collective Staff, Our Bodies, Ourselves: A Book by and for Women (Boston: Simon and Schuster Trade, 1976).
  55. ^ Schulman, Bruce J. The Seventies: The Great Shift in American Culture, Society, and politics. (Da Capo Press, 2002), 174.
  56. ^ Kline, Bodies of Knowledge: Sexuality, Reproduction, and Women’s Health in the Second Wave, 3.
  57. ^ Australian Department of Foreign Affairs and Trade
  58. ^ Our Bodies, Ourselves (1973).

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  • Elisabeth Brooke, Women Healers: Portraits of Herbalists, Physicians, and Midwives (biographical encyclopedia)
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  • Deirdre English and Barbara Ehrenreich, For Her Own Good (gendering of history of midwifery and professionalization of medicine)
  • Julie Fette, "Pride and Prejudice in the Professions: Women Doctors and Lawyers in Third Republic France," Journal of Women's History, v.19, no.3, pp. 60–86 (2007). France, 1870–1940
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