ANMF (Vic Branch) submission to the Inquiry into Women’s Pain

ANMF (Vic Branch) recently surveyed members to help inform our submission for the Allan Labor Government’s landmark Inquiry into Women’s Pain.

With more than 90,000 ANMF (Vic Branch) members who are women, representing 89 per cent of our membership, the Branch is in a unique position to provide both professional and personal feedback to the Inquiry. Most members, wherever they work, assist women and have experienced, professionally and personally, the impact of the attitudes towards women’s pain.

The Branch received almost 800 survey responses in just four days. ANMF officers also conducted interviews and focus groups with nurse/midwife leaders working in women’s health and wellbeing.

The responses and feedback overwhelmingly support the existing evidence that chronic pain affects a higher proportion of girls and women than men, but that women are less likely to receive appropriate treatment for it.

Treatment of women’s pain – normalisation and dismissal

The impact of mismanaged pain was clear in the responses we received from members. Especially telling is that members’ firsthand experiences of pain reveal that, despite being experienced at dealing with the health system and with medical staff, even health-literate nurses and midwives are feeling dismissed or having difficulty accessing comprehensive healthcare for their own pain conditions.

They are also very aware that the inequity and bias extends to their female patients. Of the members who responded to the survey:

• 73% indicated that in their professional experience women’s pain is treated differently to men’s pain.
• 78% indicated that women face barriers accessing clear and comprehensive healthcare planning to assist in diagnosing their chronic pain.
• 76% indicated that women face barriers accessing clear and comprehensive healthcare planning to assist managing their chronic pain.

Just some of the many comments we received:

• ‘Work on a mixed specialty surgical ward. PRN paracetamol for gynaecology patients who describe 10/10 pain as first line and to “wait and see if that helps”, whereas all other surgical patients get 2-3 lines of analgesia charted immediately at any instance of pain.’
• ‘Multiple colleagues judging young female patients subjective pain scores, calling them “precious”, “princess” or “overreacting”.’
• ‘Men are believed and treated a lot sooner. They’re often given more options. I’ve watched a man with a carpal tunnel be written up for 20 mg of iv morphine but a woman with a full reproductive system removal gets written up for only a max of 10 mg of iv morphine. We are treated different and are often labelled as emotive or anxious.’
• ‘Women are often treated in a dismissive manner by male medical professionals.’

The nurse/midwife leaders who attended the focus groups identified four main explanations for the inequity:

1. The normalisation of women’s pain that then results in women ignoring their pain, or ‘soldiering on’.
2. Gender bias: many practitioners dismiss a woman’s pain as either overrated or psychological. The stereotype still exists that men are less likely to complain and/or have a higher tolerance to pain, yet the evidence is to the contrary.
3. Lack of funding and research into women’s health and their health response to treatments.
4. The stigma associated with women’s reproductive health and the social bias and stereotyping women are subjected to in relation to pain.

The feedback also revealed that when a woman is from a marginalised community or group, or is isolated by health, social or geographical circumstances, their ability to access comprehensive healthcare planning for their pain is further encumbered due to additional biases. Women from culturally and linguistically diverse backgrounds, for instance, face racism in our health system in addition to sexism.

Implications of the mismanagement of women’s pain conditions

We also asked nurses and midwives how the misdiagnosis or mismanagement of their pain, and their patients’ pain, had impacted their personal and professional lives, and the results were concerning and costly:

1. 89% of respondents said they had experienced acute pain and over 66% of those felt dismissed by health professionals in relation to their acute pain.
2. 74% of respondents suffer with a chronic pain condition and 59% said they had either a negative or mixed response from health professionals. Only 20% had a positive response from health professionals overall. Twenty-six per cent had not yet had the cause of their pain diagnosed and 60% said they had experienced barriers in accessing clear and comprehensive healthcare plans to help manage the pain. Many of the barriers were associated with cost and GP prejudice to women’s pain and women’s health conditions.
3. Of those women who indicated that they had experienced pain, 57% said the mismanagement of their pain had affected their professional career and 72% said it affected their personal life. Finally, 80% of those members who responded said that they had taken personal leave due to their pain.

Improving women’s access to comprehensive pain management

Nurses and midwives are very well placed to be part of the solutions associated with this issue, not least because they deliver healthcare to people across their lifespan, but also because they make up the largest professional workforce in health and they predominantly have a lived experience of the problems that create barriers to women receiving quality healthcare in relation to their pain conditions.

There were four principal recommendations from those members who took part in the survey and focus groups:

1. Improve women’s access to diagnostics and treatment where women live, through properly funded and resourced women’s health services that include wrap-around, multidisciplinary services like specialist physiotherapy, counselling, family violence and sexual health specialists and pregnancy care.
2. To reduce gender bias in healthcare, increase funding for women’s health research and enhance and educate medical, nursing and midwifery staff about women’s health, including reviewing the curriculum for medicine to address inequity in healthcare.
3. Work to reduce social stigmas related to women’s health and educate the community about women’s health and the inequity in the treatment of women’s pain, and the significant social and economic impact of the social biases that normalise or trivialise women’s pain.
4. Work with marginalised groups to develop and provide additional resources to assist them to navigate and access health services, including CALD education resources for women and their families, bulkbilled health services and access to self-referral clinics.

Next steps

ANMF has made a submission to the Inquiry, and plans to organise a women’s pain forum to connect members directly with the Victorian Health Minister and other representatives from the Department of Health and Safer Care Victoria to communicate their experiences in person.

We will update you with more details as soon as possible.