Male-dominated funding panels may also explain why we have so few drugs available for uterine failure. Every day 830 women around the world die due to complications during pregnancy and childbirth101 (in some African countries more women die annually from childbirth than at the height of the Ebola epidemic102). Over half of these deaths are explained as being a result of problems with contractions, often because the contractions are too weak for the woman to give birth. The only medical treatment available for women whose contractions aren’t strong enough is the hormone oxytocin, which works about 50% of the time. Those women go on to give birth vaginally. Women who don’t respond to oxytocin are given an emergency caesarean. In the UK weak contractions are the reason given for a majority of the 100,000 emergency caesareans carried out each year.
We currently have no way of knowing which women will respond to oxytocin, which clearly isn’t ideal: all women, including those for whom it will result in a pointless and harrowing delay, have to go through the process. This happened to a friend of mine in 2017. After being in hospital in excruciating pain for two days (on her own for much of it as her partner had been sent home), she was only 4 cm dilated. Eventually she was taken off for a C-section, and she and the baby were fine. But the experience left her traumatised. She had flashbacks for the first few weeks after she gave birth. When she talks about the internal exams and procedures, she describes it as a violent assault. It was, she says, brutal. But what if it didn’t have to be this way? What if they’d known from the beginning that she was going to need a caesarean?
In 2016 Susan Wray, a professor of cellular and molecular physiology at the University of Liverpool, gave a lecture to the Physiological Society.103 Wray is also the director of the Centre of Better Births in Liverpool Women’s Hospital and she explained that recent research revealed that women with contractions that were too weak to give birth had more acid in their myometrial blood (the blood in the part of the uterus that causes contractions). The higher the levels of acid were, the higher the likelihood a woman would end up needing a caesarean, because oxytocin isn’t, it turns out, that effective on women with an acidic blood pH.
But Wray didn’t simply want to be able to predict the need for a caesarean. She wanted to be able to avoid it. Together with her fellow researcher Eva Wiberg-Itzel, Wray conducted a randomised control trial on women with weak contractions. Half of them were given the usual oxytocin; half were given bicarbonate of soda, and then given the usual oxytocin an hour later. The change was dramatic: 67% of women given just oxytocin went on to give birth vaginally, but this rose to 84% if they were given bicarbonate of soda an hour before. As Wray pointed out, the bicarb dose wasn’t tailored to body weight, it wasn’t tailored to the amount of acid in the blood, and the women weren’t given repeated doses. So the efficacy could turn out to be even higher.
This finding could not only be transformative for the tens of thousands of women a year who have what could turn out to be unnecessary surgery (not to mention saving the NHS a substantial amount of money). It could save women’s lives in countries where caesarean sections are risky or not readily available – not that you have to live in a low-income country for a C-section to be risky: you could just be a black woman living in the United States.104
The US has the highest maternal mortality rate in the developed world, but the problem is particularly acute for African Americans. The World Health Organization has estimated that the death rate of black expectant and new mothers in the US matches that of women in much lower-income countries like Mexico and Uzbekistan. Black women in America have worse health outcomes overall than white women, but when it comes to pregnancy and childcare the comparisons score off the charts: African American women are 243% more likely than white women to die from pregnancy and childbirth-related issues. And it’s not just because African Americans tend to be poorer: a 2016 analysis of births in New York City found that ‘black college-educated mothers who gave birth in local hospitals were more likely to suffer severe complications of pregnancy or childbirth than white women who never graduated from high school’. Even global tennis superstar Serena Williams is not immune: in February 2018 she revealed that she had almost died following an emergency C-section.105 African American women also have higher rates of caesarean section and a 2015 study from Connecticut found that – even when controlling for socio-economic status – black women were more than twice as likely to have to return to hospital in the month following surgery.106 So Wray’s research could be transformative here.
But it looks like we aren’t going to see the fruits of her labour any time soon. When Wray discovered that the British Medical Research Council was offering funding for research that would benefit low-and middle-income countries, she decided to apply. And yet, despite all the data about how dangerous weak contractions can be, she was turned down. The research was ‘not a high enough priority’. So currently we have only one treatment for women with weak contractions, and it doesn’t work half the time. Compare this, Wray says, to the around fifty drugs available for heart failure.
The evidence that women are being let down by the medical establishment is overwhelming. The bodies, symptoms and diseases that affect half the world’s population are being dismissed, disbelieved and ignored. And it’s all a result of the data gap combined with the still prevalent belief, in the face of all the evidence that we do have, that men are the default humans. They are not. They are, to state the obvious, just men. And data collected on them does not, cannot, and should not, apply to women. We need a revolution in the research and the practice of medicine, and we need it yesterday. We need to train doctors to listen to women, and to recognise that their inability to diagnose a woman may not be because she is lying or being hysterical: the problem may be the gender data gaps in their knowledge. It’s time to stop dismissing women, and start saving them.
PART V
Public Life
CHAPTER 12
A Costless Resource to Exploit
‘How much will it cost?’ This is the first question that any-one proposing a policy initiative must answer, swiftly followed by ‘Can we afford it?’ The answer to the first question will be fairly straightforward, but the answer to the second is a little trickier. It will depend on the current state of a country’s economy, and that figure is more subjective than many of us think.
The standard measure of a country’s economy is gross domestic product (GDP) and if economics has a religion, then this is its god. It is compiled from data collected in a range of surveys and represents the total value of goods (how many shoes were manufactured) and services (how many meals were served at restaurants) a country produces. It also includes how much we all got paid and how much we (including governments and businesses) have all spent. It all sounds very scientific, but the truth is that GDP has a woman problem.
The formulation of a country’s official GDP figure is an inherently subjective process, explains Diane Coyle, professor of economics at Manchester University. ‘A lot of people think that [GDP] is a real thing. But actually, it’s a confection, with lots of judgments that have gone into its definition. And a lot of uncertainty.’ Measuring GDP is, she says, ‘not like measuring how high the mountain is’. When you see headlines proclaiming that ‘GDP went up 0.3% this quarter’, she cautions, you should remember that that 0.3% ‘is dwarfed by the amount of uncertainty in the figures’.