Ending all-male panels is not tokenism

Public debate is in a bad way when efforts aimed at achieving a better gender balance can be dismissed.

The debate about the lack of women in public life has been reignited by poor female representation at last week’s gathering of the world’s financial, political and media elite in Davos. Just 17 per cent of delegates and only a quarter of panel speakers at the annual schmooze fest were women. Earlier this month Rebecca Rosen, at the Atlantic, suggested that men should sign up to a pledge not to speak on all-male panels after another technology conference featured an all-male line up. Rosen’s ‘panel pledge’ received a stream of abuse and she faced accusations of tokenism.

Public debate is in a bad way when getting a better gender balance can be dismissed like this. After all, these are not symbolic attempts to give the appearance of sexual equality, but efforts to ensure that half the population is represented in influential discussions that shape economic and political priorities with a direct impact on people’s lives. And while it is sadly true that there are fewer women in top positions to choose from – this cannot be an excuse to exclude women from public debates altogether.

While Rosen’s panel pledge generated much heat in the US, similar appeals have been made in the UK. A prominent group of women recently challenged the organisers of a number of apparently ‘men only’ Westminster-based events, highlighting for example a debate on the impact of the recession and spending cuts (which will hit women hardest)which featured no female speakers. Meanwhile, a series of Policy Fight Club debates (complete with macho red and blue corners) attracted attention when they featured three all-male line ups on the EU, legalising drugs and Scottish independence with as many as six guest speakers (including chairs)on the panel (hard to believe in this case they had tried but failed to secure women speakers).

Of course this has to change. But who exactly is responsible? Should men being invited to speak in public debates refuse to do so unless there is a woman on the panel? Should audiences boycott events with all male line-ups?

Refusing to take part in an all-male panel is not without its dilemmas, but as one man who is a panel regular suggests men can at least ask whether the line-up is likely to be all-male and suggest some women alternatives or decline to take part if there is no good justification. And while we shouldn’t place an unfair burden on event organisers, few buy the idea there are not enough talented women equipped to speak on almost any area of public life. So if organisations in politics, media, business and civil society aim to contribute to the public debate, they should think first about whether they are including a properly mixed range of voices in discussions.

This includes Westminster-based organisations like the think tank, IPPR, where I work. Particularly in areas like economics, relying on existing networks can lead to the same male, pale and stale debates. Changing this, as IPPR is now committed to doing, means seeking out new and more diverse voices and having a greater appetite for risk in bringing new voices to debates. At heart it is no more complicated than that. For the status quo to really change however, holding a large event with no women speakers will need to start being seen as a reputational risk.

The other question, of course, is whether this is a problem of women not being asked or not being able to participate. It is not always as easy for women to drop domestic duties for an after-work TV appearance or overseas conference, so many women who would like to take part find themselves having to say no. As long as women have primary responsibility for care, particularly childcare, this is unlikely to change.

Some may ask why we should stop at all-male panels. Why not challenge the appalling absence of ethnic and class diversity on panels and in public life, when last year’s census data showed the proportion of the population that is white has now fallen to 86 per cent? The answer is that we should. This can open up closed networks and enrich our politics, which is exactly what we need if we are to engage more people in the public debates they feel so alienated from. If this is tokenism, I’m all for it.

Just 17 per cent of delegates and only a quarter of panel speakers at Davos were women. Photograph: Getty Images.

Clare McNeil is a senior research fellow at IPPR.

Twitter: @claremcneil1

Flickr/Michael Coghlan
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Why does the medical establishment fail to take women in pain seriously?

Women with mesh implants have been suffering for years. And it's not the only time they have been ignored. 

Claire Cooper’s voice wavered as she told the BBC interviewer that she had thought of suicide, after her mesh implant left her in life-long debilitating pain. “I lost my womb for no reason”, she said, describing the hysterectomy to which she resorted in a desperate attempt to end her pain. She is not alone, but for years she was denied the knowledge that she was just one in a large group of patients whose mesh implants had terribly malfunctioned.

Trans-vaginal mesh is a kind of permanent “tape” inserted into the body to treat stress urinary incontinence and to prevent pelvic organ prolapse, both of which can occur following childbirth. But for some patients, this is a solution in name only. For years now, these patients – predominantly women – have been experiencing intense pain due to the implant shifting, and scraping their insides. But they struggled to be taken seriously.

The mesh implants has become this month's surgical scandal, after affected women decided to sue. But it should really have been the focus of so much attention three years ago, when former Scottish Health Secretary Alex Neil called for a suspension of mesh procedures by NHS Scotland and an inquiry into their risks and benefits. Or six years ago, in 2011, when the US Food and Drug Administration revealed that the mesh was unsafe. Or at any point when it became public knowledge that people were becoming disabled and dying as a result of their surgery.

When Cooper complained about the pain, a GP told her she was imagining it. Likewise, the interim report requested by the Scottish government found the medical establishment had not believed some of the recipients who experienced adverse effects. 

This is not a rare phenomenon when it comes to women's health. Their health problems are repeatedly deprioritised, until they are labelled “hysterical” for calling for them to be addressed. As Joe Fassler documented for The Atlantic, when his wife's medical problem was undiagnosed for hours, he began to detect a certain sexism in the way she was treated:

“Why”, I kept asking myself, when reading his piece, “are they assuming that she doesn’t know how much pain she’s feeling? Why is the expectation that she’s frenzied for no real reason? Does this happen to a lot of women?”

This is not just a journalist's account. The legal study The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain found that women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively. 

An extreme example is “Yentl Syndrome”. This is the fact that half of US women are likely to experience cardiovascular disease and exhibit different symptoms to men, because male symptoms are taught as ungendered, many women die following misdiagnosis. More often than should be acceptable, female pain is treated as irrelevant or counterfeit.

In another significant case, when the news broke that the most common hormonal birth control pill is heavily linked to a lower quality of life, many uterus-owning users were unsurprised. After all, they had been observing these symptoms for years. Social media movements, such as #MyPillStory, had long been born of the frustration that medical experts weren’t doing enough to examine or counter the negative side effects. Even after randomised trials were conducted and statements were released, nothing was officially changed.

Men could of course shoulder the burden of birth control pills - there has been research over the years into one. But too many men are unwilling to swallow the side effects. A Cosmopolitan survey found that 63 per cent of men would not consider using a form of birth control that could result in acne or weight gain. That’s 2 per cent more than the number who said that they would reject the option of having an annual testicular injection. So if we’re taking men who are afraid of much lesser symptoms than those experienced by women seriously, why is it that women are continually overlooked by health professionals? 

These double standards mean that while men are treated with kid gloves, women’s reactions to drugs are used to alter recommended dosages post-hoc. Medical trials are intended to unearth any potential issues prior to prescription, before the dangers arise. But the disproportionate lack of focus on women’s health issues has historically extended to medical testing.

In the US, from 1977 to 1993, there was a ban on “premenopausal female[s] capable of becoming pregnant” participating in medical trials. This was only overturned when Congress passed the National Institutes of Health (NIH) Revitalisation Act, which required all government funded gender-neutral clinical trials to feature female test subjects. However, it was not until 2014 that the National Institutes of Health decreed that both male and female animals must be used in preclinical studies.

Women’s exclusion from clinical studies has traditionally occurred for a number of reasons. A major problem has been the wrongful assumption that biologically women aren’t all that different from men, except for menstruation. Yet this does not take into account different hormone cycles, and recent studies have revealed that this is demonstrably untrue. In reality, sex is a factor in one’s biological response to both illness and treatment, but this is not as dependent on the menstrual cycle as previously imagined.

Even with evidence of their suffering, women are often ignored. The UK Medicines and Healthcare Regulatory Agency (MHRA) released data for 2012-2017 that shows that 1,049 incidents had occurred as a result of mesh surgery, but said that this did not necessarily provide evidence that any device should be discontinued.

Yes, this may be true. Utilitarian thinking dictates that we look at the overall picture to decide whether the implants do more harm than good. However, when so many people are negatively impacted by the mesh, it prompts the question: Why are alternatives not being looked into more urgently?

The inquiry into the mesh scandal is two years past its deadline, and its chairperson recently stepped down. If this isn’t evidence that the massive medical negligence case is being neglected then what is?

Once again, the biggest maker of the problematic implants is Johnson&Johnson, who have previously been in trouble for their faulty artificial hips and – along with the NHS – are currently being sued by over 800 mesh implant recipients. A leaked email from the company suggested that the company was already aware of the damage that the implants were causing (Johnson&Johnson said the email was taken out of context).

In the case of the mesh implants slicing through vaginas “like a cheese-wire”, whether or not the manufacturers were aware of the dangers posed by their product seems almost irrelevant. Individual doctors have been dealing with complaints of chronic or debilitating pain following mesh insertions for some time. Many of them just have not reported the issues that they have seen to the MHRA’s Yellow Card scheme for identifying flawed medical devices.

Shona Robison, the Scottish Cabinet Secretary for Health and Sport, asked why the mesh recipients had been forced to campaign for their distress to be acknowledged and investigated. I would like to second her question. The mesh problem seems to be symptomatic of a larger issue in medical care – the assumption that women should be able to handle unnecessary amounts of pain without kicking up a fuss. It's time that the medical establishment started listening instead. 

 

Anjuli R. K. Shere is a 2016/17 Wellcome Scholar and science intern at the New Statesman

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