Women have historically been excluded from research. Where are we now?

By Jules Murtha | Fact-checked by Jessica Wrubel
Published November 7, 2022

Key Takeaways

  • Women have been calling attention to their absence as subjects in medical research—and the effects this has had on women’s health issues—since the 1970s.

  • Despite a notable increase in women’s participation as subjects in medical studies, findings show there is still a gender gap in medical literature.

  • To address the gender gap in clinical research, physicians should work with medical journals to encourage gender-balanced research, mentor young physicians on avoiding gender bias, and teach about gender and sex differences in medicine.

Women subjects have traditionally been excluded from medical research. Despite the efforts of activists and lawmakers to improve gender equity in this area, women subjects are still largely underrepresented in medical literature, according to a study published by JAMA Network Open.[]

Physicians can meet this challenge head-on through journal participation, mentorship of young clinicians, and teaching to help eliminate gender bias in medical research.

Influence of gender gap, misogyny on research

After decades of fighting for equal medical representation, women secured a “win” in 1993 when Congress wrote the National Institutes of Health inclusion policy—which requires clinical research to include women and minorities—into federal law, according to the NIH.[]

Yet the ongoing exclusion of women from medical research continues to have very real consequences. The JAMA Network Open study states that women deal with suboptimal healthcare and health outcomes when they’re left out of research.

Although women’s participation as subjects in medical research has increased since the first outcry for support in the 70s, the JAMA Network Open researchers looked at whether sex equity has been reached.

To do so, they conducted a cross-sectional study using information from the Clinical Trials Transformation Initiative database for all studies registered between March 1, 2000, and March 9, 2020.

Of the 20,020 studies that met their criteria, 99.2% included sex statistics. The researchers found that among those, women were consistently underrepresented in studies pertaining to oncology, cardiology, neurology, immunology, and hematology. This was concerning since cardiologic and oncologic illnesses are leading causes of death among US women.

Related: Real Talk: Dismantling sexism in medicine

An article published by Women’s Health Reports looked at sex inequity in medical research using studies published by PubMed, Science Direct, APA PsycInfo, and Google Scholar between January 2009 and December 2019.[]

The findings showed that 12 of the 17 selected articles inspected the gender gap in medical research. On top of that, five articles displayed misogyny, which the authors defined as “assessing female attractiveness for alleged medical reasons.”

The authors elaborated on the negative impacts of misogyny on female patients, writing, “Women reportedly feel a sense of distrust in the medical profession, with many professing acute awareness that doctors have the power to label them as ‘anxious’ or ‘depressed’ rather than address their physical pain or symptoms.”

The gender gap in research may therefore lead to adverse outcomes for patients.

Addressing gender bias in research

More women are still needed in medical research. But as it turns out, physicians are in a strong position to effect positive change in the realm of clinical research.

According to an article published by the American Medical Association, physicians can address the gender gap in medical research with a three-pronged approach:[]

  • Sponsorship, the guiding force behind how medical journals select content.

According to Neelum Aggarwal, MD, chief diversity and inclusion officer for the American Medical Women’s Association, sponsorship is a fine way to ensure that medical journals publish material that accounts for sex and gender differences.

"If we don’t hold these journals accountable to how they are reviewing the papers and how they are demanding that sex considerations are being discussed in the paper, we will not be able to really learn through scholarship what is out in the literature."

Neelum Aggarwal, MD

  • Mentorship. If you’re an experienced physician, you may want to consider mentoring a newer one.

As a doctor who’s been “around the block,” you’ve likely seen gender bias in action. You can pass along what you’ve learned—what the hurdles of bias look like, and how to overcome them—to support future clinicians and researchers.

  • Scholarship. Help current medical students by teaching them about known sex and gender differences in medicine—as well as how to address them in the exam room.

Education, research, and workforce development are also central to overcoming implicit gender biases in medicine.

"Unless the effect of sex and gender are studied, we are at risk for misunderstanding human physiology and function."

Neelum Aggarwal, MD, as per AMA

What this means for you

Research shows women have commonly been excluded from medical research. Resulting activism has led to the mandated inclusion of women in clinical trials, and an uptick in women’s participation since the early 2000s. But a gender gap—and misogyny—still exist in medical research. Help bridge this gap by sponsoring medical journals, mentoring young doctors on the effects of implicit biases, and teaching about the differences between varying sexes and genders in a medical context.

Read Next: Where’s the ‘real’ doctor? Dealing with gender bias from patients

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