Gender in Medical Education: Perceptions of Medical Educators in India

by Priya John, Amruta Bavadekar, Ameerah Hasnain, Asilata KarandikarCentre for Enquiry into Health and Allied Themes (CEHAT), 2015 ISBN: 978-81-89042-69-1 the Preface and Executive Summary:Over the last few decades, systematic critiques of medicine and public health curricula in India have highlighted many lapses in the inclusion of social determinants of health in medical education. Health is often predicated on social structures with prescriptive gender identities and associated power relations. Needless to say, gender is a pivotal determinant of health. In India, medical education, comprising training and curriculum, is often divorced from gender theory and perspective. There has, therefore, been a call for a re-orientation of medical education in India to include gender in the instruction and training of medical students.This situation analysis in 2014 explored the perceptions of medical educators regarding the relevance of gender in medical education, their perceptions regarding patients and gender sensitivity in teaching and practice on issues such as abortion, sex selection and violence against women. What emerged is the lack of understanding about relevance of gender in medical teaching, gender stereotyping of women in general and patients in particular and misconceptions about access to abortion. We hope that the report will be useful for those working in the field of women’s health and rights, public health and policy.Most respondents of the study were of the opinion that the content of the textbooks had not changed significantly over the years. Largely, the changes observed were the inclusion of [a] new technologies, [b] new legislations, and [c] new diseases. According to many medical educators, social determinants of health fall exclusively within the ambit of the PSM (preventive and social medicine) discipline. With regard to gender as a social determinant of health, nearly all respondents stated that there is limited discussion on gender in medical textbooks. The articulations of the respondents regarding gender were centred on issues related to anatomical difference, diseases and/or violence. There were a number of respondents who stated that the concept of gender was not included in the medical curriculum and further, there is no need to include the concept as it is irrelevant in medical education.Gender was understood by the respondents as [a] a demographic category; [b] health issues of women; [c] increased violence against women; [d] increased presence of women in the workforce and/or [e] gendered nature of medical institutions. The understanding was at best limited and at worst harmful.PSM educators identified more nutrition-related problems among women than in men who, according to them, came with complaints related to lifestyle or communicable diseases. Medicine, ObGyn and PSM educators identified anaemia as a common condition among women. Psychiatry educators claimed that women displayed ‘hysterical symptoms’ and ‘housewives’ in particular experienced ‘Intentional Hysterical Episodes’. A number of the educators held fairly stereotypical views of men and women who seek their care. In the presentation of complaints, many of the educators were of the opinion that women are not as straightforward as men. Women tend to seek medical attention for minor health complaints whereas men came in with ‘significant complaints’. Several ad hoc and informal conditions were applied in the provision of medical termination of pregnancy (MTP) at the health facilities. This was especially the case for abortions sought in the second trimester. The conditions for provision of MTP varied from case to case, depending on the stage of pregnancy, family size, number of daughters etc. Doctors claimed that in the case of unmarried major women seeking abortion, the consent of guardians is sought and a medico-legal case is registered. Based on the responses, clearly it was the doctor’s discretion [a] to provide the MTP services or not and [b] if the service was to be provided then under which condition of the MTP Act to provide the service.In conclusion, the study findings point to the need for a nuanced understanding of gender among medical educators and students. The introduction of gender could pave the way for an opening up of medicine to delve deeper into how signifiers such as class, caste, gender etc. have a bearing on health. The medical curriculum and training must undergo fundamental changes to integrate gender so as to ensure the creation of a gender-sensitive and socially-relevant medical force in the country.