Read this book if you'd like to become more informed (and therefore more furious) about the state of women's healthcare in the ugly political landscape of today.

The Pain Gap: How Sexism and Racism in Healthcare Kill Women is okay. As other reviewers have pointed out, the marketing is a bit off. The title and description should have made it more clear that Hossain's dominant focus is sexism and racism within maternity healthcare. Most of the stories, policies, statistics, and suggestions related specifically to maternal health which is just one aspect of women's health and a facet that many women do not experience! She's also notably focused specifically on cisgender women's experience; at no point are there stories or reference points that introduce how anti-trans bias affect women's healthcare (or, on the flip side, care related to pregnancy).

There's also no substantive exploration of how either anti-fat bias affects healthcare access for women or women of color, especially black women. This is a huge point of health inequity and there are resources available to address it; it's a glaring omission and weakens the overall introduction and analysis of the topic. The primary mention of it was towards the end when she quotes Regen Chastain's advice about avoiding anti-fat bias at the doctor's office (which just amounts to ... look up doctor's ahead of time? lmao). For a more helpful resource for this specifically, I really recommend What's Wrong with Fat? by Abigail Saguy.

Finally, there's very little exploration of how financial inequity within healthcare and how that negatively impacts women and women of color. Again, really surprising especially given that she correctly identifies and highlights how much the United States underperform when it comes to maternity health. But believing women and women's pain isn't the only point of inequity within women's healthcare. The prohibitive cost of healthcare in the United States is part of the inequity that is almost completely ignored in The Pain Gap<.

If this book were to serve as an introduction to the topic, it would be missing major facets of the issue. I wouldn't recommend it, unfortunately. I had much higher hopes!

My thanks to NetGalley and Tiller/Simon and Schuster Element for an eARC of this book to read and review. My thanks to libro.fm and Simon and Schuster Audio for an advanced Audio of this book to listen to and review.

Other reviewers complained that the title and subtitle, what the reader is promised, is not what the reader is provided once a few chapters into the book. I would tend to agree. I got 75% of the way into the book and decided that police brutality had next to nothing to do with how sexism and racism in health care is killing women and DNF'd this.

That is sad, as this book had great potential to bring the difference between how women are treated by the medical establishment and how men are treated is incredibly different and how that difference is killing women.

I am ok with politics coming into play within the scope of the thesis expressed in the title, but I did not sign up for social justice/racism/police brutality too. Those things have their place, and that place does not seem to be this particular book. Yes, I know that the author has little say in what the title of the book is, but from her introduction, the title seemed to be the thesis. Then she got distracted and that is where she lost me.

I fully believe and support her thesis, but we need clear and concise reasoning to have those who are on the fence or even opposed to that thesis to listen and maybe even understand, if not agree with it. But when tangents that have nothing to do with it are brought in, you lose even those who would follow you.

2, this had promise, stars.

This is probably a fine book, if you're looking at an introduction to women not being heard by their medical team, especially Black women whose pain is often ignored. But if you want to learn something deeper than what is well known and well documented, this isn't the book for you.

A good introduction to the shortfalls of women's healthcare to those who do not have prior knowledge, but quite repetitive. Heavy focuses on maternal health and COVID 19. Pandemic material seems a bit premature, especially given the significant amount of coverage it gets in the text.

Thank you to NetGalley & the publisher for providing an eARC for review.

This survey of differential treatment of women, and especially women of color, in United States healthcare presents stories and statistics that really should be shocking. Perhaps the saddest reality is that they are not, or at least won’t be to women of color and other readers who’ve followed the state of healthcare in this country. This book is just one more account of how bad things have become, blending a plethora of women’s personal stories with chilling statistics and accounts from non-profit leaders, other writers in the field, and healthcare professionals on the front lines.

Focusing primarily on maternal health, most of the challenges this book shares are not new, but the need for awareness is as crucial as ever and presented here specifically through the lens of the COVID-19 pandemic. Hossain offers an important reminder that the US is unnecessarily the worst Global North country when it comes to maternal mortality, that women’s pain is routinely dismissed by doctors with horrifying consequences, and that race and gender intersect to make the statistics particularly abysmal for women of color.

While I’ve read a fair bit about the horrors of hospital birth in this country and have personally experienced the way doctors dismiss feminized pain, I still had some of my own assumptions challenged. For example, I learned that pregnant women aren’t prescribed most drugs not because of known risks but rather because it’s expensive and inconvenient to include pregnant women in clinical trials. This is just another example both of how profit dominates healthcare in the US and birthing parents are objectified as carriers of the all-important future child, rather than treated as humans capable of making choices and in need of consideration. Though current narratives around choice center the imminent reversal of Roe v. Wade, it’s also important to understand that denial of choice in pregnancy is about the autonomy to make all medical care decisions, not only the choice of whether to carry to term.

While privilege is a huge factor in medical outcomes, readers may be surprised to read stories of even wealthy women of color in leadership positions, including women who are doctors themselves, being denied care and harassed by male staff. Hossain uses these examples and confirming statistics to show that while access to care is an important issue, racism alone creates massive disparities and status saves no one. Racist beliefs about Black women having higher pain tolerance and a greater likelihood of abusing pain medication, for example, remain common among medical professionals.

Hossain interviewed over a hundred women for the book, and you’ll find heartbreaking stories of women of color being ignored in emergency rooms while bleeding to death, shouted at to shut up while in excruciating pain during childbirth, and “dismissed to death” when experiencing pain they intuitively recognize as a major warning signal. In Louisiana, for example, 59% of Black maternal deaths were found to be preventable compared to 9% of white deaths. It’s hard to miss that this isn’t just about sexism or even access—it’s about systemic racism.

Hossain covers women of color’s experiences with refreshing specificity. She highlights issues for individual communities including the dramatic impact of the pandemic on Filipino nurses in New York, how maternal depression disparately impacts Black women experiencing cultural pressure against therapeutic support, and how Asian-American victims of domestic violence may find it even harder to access care in the fact of racist beliefs about the virus. Hossain also considers the anti-Black history of banning community midwives, questioning the norm of hospital birth, and points out that early pandemic policies disproportionately affected Black women, who often need a doula to advocate against medical racism and were not allowed to have both a doula and a partner present.

Hossain does make a strategic choice not to focus exclusively on racialized women, though they form the center of her narrative. As she points out from her own experience lobbying for the Feminist Majority Foundation, policy conversations in DC are exceedingly white, and white policymakers frankly tend not to care about issues framed as a “Black woman’s problem” or a woman-of-color problem. I personally worked for several years in this space, and while I’m not sure I ever met Hossain I suspect we were in some of the same rooms (full disclosure, several of the folks she interviewed were colleagues, including my first boss in DC). I made similar observations, noting that the folks in the room (especially senior leaders) tended to be white and that discussions of women’s health frequently placed racial disparities as a sidebar to issues that affect all women. It’s a sad fact, but treating women of color as canaries in a coal mine that white women should pay attention to for their own self-interest really is likely the most effective strategy at the federal level.

Hossain makes an effort to show that healthcare issues are part of a much broader problem of systemic sexism and racism. COVID in particular has shown how the US model of “no support systems, women as the backup” can be devastating. She points out that even successful career women are staying home in droves so higher-earning male partners can earn an income while the kids are at home, with many essentially sacrificing their careers. Women with abusive partners not only found it harder to leave during lockdown, but often experienced greater violence given the mental health impact of lockdown on those partners, and continue to risk infection in shelters. And of course frontline workers (largely women of color) have no choice but to risk serious illness and death, with no safety net if they do contract the virus. While these aren’t new issues, Hossain’s hope is that their exacerbation during this crisis is waking more US residents up to how bad things really are.

The author’s personal lens is somewhat unusual, as her interest in maternal mortality stems from the shock of having her own pain dismissed and barely surviving childbirth in a country she’d seen as the gold standard growing up in Bangladesh. She makes a direct comparison in telling the story of a beloved nanny who died in childbirth and was only even able to access healthcare due to luck—something that we might see as a “development issue,” but is in fact very similar to the US, where positive birth experiences are more about luck of the draw than American prosperity or superiority.

I found Hossain’s writing compelling and accessible on the whole, if a little unfocused at times. I think the book would have been served by limiting the scope to maternal health, as its overall flow doesn’t build as clearly as it could towards the conclusion that birth justice is a crucial part of the fight against systemic racism. Readers expecting broader coverage of the issues women of color face in healthcare may be confused and frustrated by the fact that maternal health is the primary focus of the book, since that’s not fully evident from the title or introductory chapters.

As written, chapters are a little uneven and the reader may occasionally get slightly lost. It might have served the flow of the book to introduce up front some of the broader context including police brutality, the history of medical experimentation on Black subjects, and how female subjects are excluded from medical research even around gender-specific health conditions before going into examples. I needed to make certain connections across chapters on my own—for example, how the theme of women’s choices connects the global gag rule, the tough decision pregnant people had to make around getting vaccinated in the absence of any medical guidance, and the tendency of hospitals to mandate unnecessary C-sections and other procedures. I expect most readers will ultimately draw the necessary conclusions, but the “hit” isn’t as strong as it could be with more guidance.

That said, I really appreciated how towards the end Hossain brings things back to the fundamental need to believe women of color. She calls this a “radical” proposal, highlighting the connections between #MeToo, medical denial of female pain, and the larger problems of systemic racism. But she also frames justice as “possible and so within our reach,” and suggests that COVID has created an opportunity by shining a spotlight on “parallel pandemics” including racism, police brutality, maternal health, and domestic violence.

The specific solutions she proposes to get there vary, and what’s challenging is that we have to admit as one expert does in the solutions chapter that women of color often simply don’t have options. Self-advocacy can be framed as drug-seeking or rebellious behavior, while silence leads to abuse. Hossain attempts to reframe “hysteria,” the term used for thousands of years to dismiss women’s frame, as a powerful collective voice with potential for change, but the political establishment is still largely white and male and that’s a larger problem to solve.

In my view, what we’re talking about here is major systemic overhaul of US institutions at every level, not traditional party politics, and so I found Hossain’s trust in the Biden administration overly optimistic. Perhaps the most intriguing to me was the story of a birth center in Florida that’s virtually training clinicians in its patient-centered model, drastically improving outcomes for Black pregnancy. Community solutions may be the best way forward while books like these continue to raise awareness of a system that is well and truly broken.

Received this through NetGalley, does not effect my review (clearly).
I skimmed most of this after about the 20% mark. At that point, the book changes from mostly anecdotes from women who lived through absolutely horrific medical experiences to nonstop COVID. And a lot of it wasn’t really medical in nature, and most of it didn’t have anything to do with pain, or how it was killing women.

The synopsis was incredibly misleading, as was the title. If I wanted a book about COVID, I would have requested a book about COVID. I have books about COVID on my bookshelf. I wanted a book about medical professionals not taking women seriously, and this book is not that.

A very important topic! This book had me thinking. I’ve also recommended it to a few friends and peers

Thanks NetGalley for proving an electronic ARC. I think that this book couldn't have been more relevant and important. I read "Ask me about my uterus" by Abby Norman and we need more books like this. So glad that Anushay Hossain wrote this.

RATING: 3 STARS
2022; Tiller Press

I love the message of this book, and agree with all that it has to say about racism and sexism in medical spheres, but I just couldn't get into the writing. I understand that Hossain is injecting herself and her story into the book to create some connection with the reader (and maybe to show her own personal examples, and how she came to notice this in the first place). At times, it read like a biography and other times like an article, essays strung together, so I kind of lost focus with it. I am glad I read it as I can now look for more literature and resources out there. I think it is important to get this information out so it can be eradicated.

***I received a complimentary copy of this audiobook from the publisher through NetGalley. Opinions expressed in this review are entirely my own.***

Thanks NetGalley for proving an electronic copy of this book in exchange for an honest review.

I'll keep it short and sweet. As a Black woman I'm fully aware of how the odds are stacked up against women like me in healthcare but I had no idea how bad it was until I read this. Truly eye opening.

I was shocked by the author's negative experience in the American healthcare system. I don't think that the system is perfect by any means, but the severity of the problems was unveiled by this author. When she came to the recommendations for women, they seemed weak and not because she wanted them to be. It makes me furious that women can be in real pain and be ignored. I received a review copy from NetGalley.

I wrote my thesis on bias, harm, and epistemic injustice in the US medical-industrial complex, exactly along the lines of this book, so I was excited to see its recent publication in October 2021! I had found a few books then that I liked enough, but most scholarship on this issue was glaringly from white writers, so this book's perspective combining facts and journalistic stories with personal stories on medical trauma during childbirth as a Bangladeshi immigrant in the US was welcome. And I was especially excited to receive an ARC of this book (thanks to the publisher and NetGalley), so I could move it up my reading list! After reading, I still think it's a good addition to the genre, especially as an introduction to medical sexism and racism, but the analysis and organization was a little lackluster.

Positive aspects: I liked how this book rooted itself in the author's perspectives as an immigrant and woman of color. The pandemic statistics and stories are hugely relevant and necessary updates to pre-pandemic scholarship. I liked how chapters focused not just on physical and maternal health barriers but also on mental health barriers, especially when depression and anxiety are the logical culminations of increased career and caretaking burdens. And I liked that this book ends with some tangible tips for women, especially WOC, to track their medical care and advocate for themselves in an overwhelming system. A lot of these books end relatively hopelessly, and although this acknowledges the need for significant institutional change beyond any individual's capacity, these tips are vital for folks' survival right now.

Negative aspects: This takes on a highly neoliberal and reformist tone about medicine. Prior to reading, I thought a solid, introductory account on medical bias from a WOC was the main book I was missing in this genre. I'm realizing it may instead be a book on this topic through a more radical lens, explicitly critiquing the medical-industrial complex. I say this because even this book takes on an overarching argument that, whatever bias exists against women at large, the issue is worse for WOC. The better and needed alternative might be centering WOC first then extrapolating outward to what exists and may come to exist for larger swathes of the population (or just focusing on WOC). As one example of the analytical shift I mean, there's a section here about how women's under-treatment in procedures that really shouldn’t be outpatient is a sexist vestige and we need more time, in-patient attention, and pain medication and resources for these procedures. But the medical-industrial complex as a whole is trending toward churning patients in and out quickly with no real care for them. The overall trend isn't stagnant or improving, it's actively worsening, and this happens to be how it's manifesting for women as a particularly vulnerable population with a long historical legacy of medical mistreatment. Similarly, the "I have faith in Biden" argument is laughably bad to me, the reverence for the US as a (potential) gold standard of healthcare that can trickle down into other countries ignores ongoing imperialism and much more insightful and useful understandings of political economy, and the 'vaccine hesitancy in Black communities' discourse strikes me as inappropriately framed (because yes, Tuskegee is a real and awful legacy, but we need to look at material barriers to vaccination in Black communities driving low vaccination and high death rates, rather than buying into a narrative that ultimately blames the 'sensitive feelings' of Black folks). And even the sections on mental health stray away from 'hard' examples of psychiatric disabilities beyond depression, including altered states, autism and ADHD, comorbid physical and mental health conditions, and so on.

A video review of this book will be included in my November reading wrap-up (on YouTube here: https://www.youtube.com/channel/UCTSE1txyBkNKCrBbBmJ1AhA), likely released in the first week of December.

When Anushay Hossain got pregnant in the US, she never thought her life would be in danger. However, after almost losing her life and the life of her child, Hossain is confronted with the reality of healthcare in the US. This book confronts the problems that people with uteruses, especially people of color, have when needing healthcare.

I really liked the premise of this book. I think the execution, however, was a little lacking. I was a little bothered by the lack of inclusive language. The discrimination that people with uteruses does not just happen to people who identify as women. I also felt this was a little too statistics-heavy without enough analysis. I felt like I was just getting numbers shoved at me. Overall, this was an interesting read.

It’s rare that a book makes me feel so angry for the whole entire book. This book made me angry and I stayed there. Not AT the book. But at the honest content. I know this book is very centred on American womens struggles. But as Anushay points out at the end, these struggles are all of our struggles. All women. Women adjacent. Trans women. People with uteruses. Women without uteruses. Etc. the issues in this book about how we are not listened to at the detriment of our health and our lives is horrifying. I am a statistic of a health care system that in pregnancy at 19 IGNORED my concerns. I nearly died from a stroke. I am white. I live in Canada. I came from a middle class family. My issues are taken and made even worse for anyone who is “other” BIPOC, queer, or disabled. This is my review. This book is heavy and deals with really tough content. (Traumatic births, abortion, lack of abortion, rape, pregnant children, death in childbirth, death of babies during childbirth) but it was a book I am glad I picked up… and so angry that it’s valid.

THis book is so important. So many women are ignored or not listened to each year in the medical system and it needs to stop. Whether the bias is gendered, racist or anti-fat, doctors need to believe what their patients are telling them.
Thank you to netgalley and the publishers for providing me with an arc for an honest review.

Interesting read but the description is completely misleading.

The Pain Gap by Anushay Hossain covers a wide range of traditional women's rights issues: abortion, childbirth, paid leave, women and pregnant women being excluded during vaccine testing, domestic violence, and unfair child rearing responsibilities.

Pros:
*Contains some interesting stories from women in their medical journey
*Touches on a multitude of hot topics in the realm of women’s rights

Cons:
*The target audience is not clear. The author spent a great deal of time discussing proposed policy issues and introducing a large number of organizations. This information was extremely boring. Women struggling with a health condition need help now, not wait for some policy which may or may not go into effect.
*The author spent considerable time on the issue of mental health and cited how women and WOC have such a high rate of depression. However, these statistics are greatly exaggerated because doctors overprescribe antidepressants. If a woman walks in with a difficult health problem, it is extremely easy to label her as “crazy” and write a script for an antidepressant.
*This book was billed as “The Pain Gap: How Sexism and Racism in Healthcare Kill Women.” However, most of the book did not cover this issue. Instead, it was a feminist manifesto (which I have absolutely no problem with) but it wasn’t as good as the book, White Feminism by Koa Beck.

Being through the health system this last year, I actually have put together my own list of tips that I will include at the very end of this review because the sick and dying can’t wait.

Overall, the author and I share many of the same ideologies; however, the book would have been better if the author had focused more on sharing the stories of women in their healthcare journey instead of a broad issue book covering nearly every women’s issue.

*Thanks, NetGalley, for a free copy of this book in exchange for my fair and honest opinion.

Tips For Your Healthcare Journey:
1) If you can afford it, hire a Private Patient Advocate. These are some of the things that my advocate has done for me:
a. Finds and schedules high quality doctors who are professional, respectful, and won’t stop until they find out what is going on.
b. Moves me up off the waitlists. Who can wait 2 years to see a doctor?
c. Reviews my medical records and prepares me for what to expect for my appointments.
d. She can get on the phone with my doctors and ask medical questions and let them know that they need a better plan and question if they have considered all alternatives.
2) You have to be your own doctor. Read as many health articles as you can. Stand your ground. Many, many doctors simply don’t care about your pain or how difficult your life is. However, if you quote medical articles to them, it is extremely difficult for them to brush you off as crazy.
a. Talk to other people on Reddit (ask questions and find support). Find out who the good doctors are and who to avoid like the plague.
3) If your doctor says that you are depressed or have a “Functional Neurological Disorder”, question that diagnosis.
4) Never give up on yourself. If you aren’t getting answers that make sense or you have a poor quality of life, see someone else (another doctor, nurse, physical therapist, acupuncturist).
5) Really inform yourself about labor if you are expecting because you can’t rely on the doctors being honest or explaining all of your choices. If you go to a large OB practice, there will be no continuity of care because you will see a new doctor at every appointment. Some of these doctors will literally schedule you for a 5-minute appointment. When you go into labor, you might end up with a doctor who you have never met before, and the doctor will only appear once the baby is crowning. At least with a midwife, they will take you through your entire labor, and you can be assigned to one person instead of being passed around like a hot potato to so many different doctors.

😤 If this doesn’t make you furious

I’m not sure what will 😫

💪 It’s time to stand up for what’s right

The Pain Gap solidified I’m not alone, by exploring how sexism & racism in healthcare endanger and kill women, especially women of color, in America.

🙅🏻‍♀️I’m aware of this disparity. Many of us are. I’ve suffered from it tremendously. Friends of mine have too. But after reading this book, and the stories of SO MANY other women, the lack of adequate research and the vast absence of empathy in the American health system I’m not mad, I’m furious. I’m screaming mad. Crying hysterically mad… and if you’re a woman, or love a woman, you should be too.

🙅🏻‍♀️This book has content warnings galore. Racism. Sexism. Death. Maternal mortality. Medical trauma. Misogyny. But how could it not? If a nonfiction book is going to even dip a toe into the healthcare industry it wouldn’t be possible not to. Which is why this book is so important to read. Knowledge is power. We must arm ourselves with knowledge in order to stand up for ourselves and advocate for our health… and the heath of all women.

🙅🏻‍♀️Think I’m over exaggerating? Did you know in 1986 a study was conducted on a group of MEN to explore how obesity impacts breast and uterine cancer? For those in the back, men don’t have a uterus.

Hossain has done a fantastic job compiling a ton of information, both through research and anecdotal to tear down the veil and expose the disparities in our health system. She then discusses how to advocate for ourselves, loved ones, and for a real change in the medical industry itself. I do feel there could be a bit of an edit, some chapters do carry on a bit, and for the average reader a cleaner more precise focus would be more effective… but overall this was still a fantastic read that I recommend everyone to add to their TBR.

The Pain Gap illustrates the gap in medical care women in America, and more so women of color in America, face. It uses statistics and anecdotes from women who have experience poor medical care, particularly maternity care. It's a difficult read that tries to find balance between honestly illustrated the problem, without leaving the reader feeling hopeless. Hossain does a good job of balancing what individual women can do to advocate for themselves, while also acknowledging that systemic problems like the bias in maternal healthcare can't be fixed just by individuals advocating for themselves, but by systemic change.

This book was a punch to the gut as a woman who has been through difficult times with healthcare myself. It’s nothing I haven’t heard before but I believe this could open the eyes of so many to see that women are constantly victims of a shitty healthcare system.