Autonomy is a concept that we, in the United States, are more or less obsessed with. It is the right of an individual to make his or her own decisions, and a concept that is highly emphasized in modern American medical practice. At 18, we become solely responsible for the disclosure of our medical records and attain the right to make health decisions independently, and it is a liberty we take for granted. If it has to do with my body, it is my choice. Makes sense. Why would we think otherwise?
But what if religion, culture, or society affected the way you interact with health professionals, or prevented you from having the first say in health decisions concerning your body? It may seem incredible, it may seem preposterous, so now let us consider the global scope of women’s health. Personally, I never consider my gender when I walk into my doctor’s office; let’s be honest who does? I don’t greet the receptionist wondering whether my gender will prevent me from making good health decisions. But while working in rural India, I saw firsthand how reliant women were on male-counterparts for decision-making in the clinical setting. Questions as simple as “would you like me to prescribe vitamins?” would prompt a pregnant woman to call out into the waiting room for her husband’s input. Needless to say, the role of a female patient in the United States is nothing like the experiences of women in clinics abroad.
Religion could influence the role a female patient takes in the clinic. Onyinye Enyia Daniel, a Research Data Manager for the Multicenter Aids Cohort Study at Feinberg School of Medicine, shared a few of her experiences from working in Nigeria. “It is possible a devout practicing Muslim woman would need permission from her husband in most circumstances for her appointment,” she told me. “On one particularly memorable occasion in Nigeria, I was shadowing a physician encounter with an HIV positive female patient who was several months pregnant. The entire physical exam was conducted with the woman fully clothed, complete with socks and sandals. The only exposure of the woman’s body occurred when the attending consultant checked for the baby’s pulse. This differed starkly from our usual visits here in the U.S., where we are issued hospital gowns, or at least told to undress to a certain degree to optimize the examination.” Definitely a different take on the typical check-up experience.
Culture could even influence female decision-making in the global health setting. Enyia Daniel provided some key examples of this point during our interview based on her experiences. “Under the Nigerian Constitution, a woman is legally afforded all the rights as a patient. Cultural values, for example an unwillingness to disrespect her husband, could deter a woman from fully exercising her rights in decisions concerning surgery, disruptive procedures or reproductive health. The woman may, instead, defer to her husband’s authority.“
Sometimes the nature of the society can also contribute to the decision-making process. In the United States, we highly emphasize individualism as a society. But the Native American perspective of autonomy in clinical care, for example, is dependent not on the individual, but on a more complex, communal setting. Women then would be expected to consult members of the family, or the community to make decisions, even if it concerns their own health. While in India, I met women who would bring their husbands, parents, in-laws, and even grandparents to the clinic, just so they could all weigh in whenever a decision concerning a disruptive or expensive procedure was to be made.
Not what I would generally consider when visiting the doctor, but I find it incredible that, on a global scope, so many social factors can influence the role of a female patient in a clinical setting. Something to keep in mind next time your doctor hands you your file. Because, compared to the rest of the world, we have it almost a bit too easy.