When Anushay Hossain gave birth to her first child ten years ago in a DC hospital, she dealt with complications that were so serious, she later realized her life might have been in danger. To get herself through the ordeal, she kept saying, “I am not going to die.” After all, she thought, this was America, not Bangladesh, where she had grown up in the 1980s. Hossain and her child are now fine. But the experience left her pretty rattled, and it got her thinking about how women are often treated by the medical establishment, even in one of the world’s best health-care systems.
Now she’s written a book on the subject. The Pain Gap explores the systemic healthcare problems that affect women in this country, especially women of color. Hossain—a freelance journalist, host of the podcast Spilling Chai, and former policy analyst for the nonprofit Feminist Majority Foundation—originally planned to focus on issues related to pregnancy and childbirth. However, the book ended up looking at women’s health more broadly, from depression to domestic violence to, as the title suggests, pain-tolerance biases. After interviewing patients and experts and sifting through the research, Hossain argues that misogyny is baked into American medicine and that women continue to face all kinds of challenges when seeking care. “We are still staying silent and polite,” she writes, “and it’s literally killing us.
We caught up with Hossain at her Spring Valley home to talk about The Pain Gap, her Covid experience, and what it was like to go head-to-head with Tucker Carlson on his Fox News show.
You originally had a narrower idea for the book but ended up expanding it. How come?
I had written a book proposal in late 2019. Initially, I wanted the whole book to be about America’s maternal-health crisis. At the beginning of 2020, I had a publishing house that was interested. I was this close to signing, and then my agent started getting worried about Covid. My agent was like, “I don’t know if anyone wants to hear about [a different] public-health crisis. I don’t know if I can sell this.” So I kind of had to restart it. I would love to write a book on how hard it is to write a book. I’d call it The Brown Girl’s Guide to Getting Published.
I’m surprised to hear that you were every bit as blindsided by what happened with Covid as the rest of the country, given that you’ve learned how screwed up the American healthcare system can be, through both your research and your own delivery horror story.
Covid was the first time I felt unsafe in America. Once it was here and we were told to lock down, I thought we were going to be locked in until June, and I was like, “Holy crap, I’ve never seen Americans be asked to sacrifice anything.”
I didn’t know how messed up the American healthcare system was. When [a health crisis] happened to me, I thought it was a one-off.
That was the crazy thing about the experience of reading this book for me. I’m reading all these terrifying accounts of these women’s horrible medical experiences, I’m looking at the studies and data that shows that this is a larger trend in healthcare, and yet I have this ingrained knee-jerk reaction of, well, their doctors must have just been bad apples.
The radical thing I propose in the book is to believe women, and believe women of color. Because you could say it’s just a couple of bad apples, but the numbers are insane. I mean, if Black women in America are [two to three times] more likely to die in childbirth than their white counterparts, there has to be something wrong.
One of the most disturbing things that came out of [my research for] the book is that none of this is unsolvable. We know how to intervene and save women’s lives in almost every single issue that I bring up in the book. I think the big problem that I [address] is: “Are women’s lives a priority?” And the answer is no. That’s a big effing problem.
It’s more than just treatment—it’s the research, too. Like, it wasn’t until the ’90s that the NIH was required to have women be a part of clinical trials. Researchers don’t even want to use female mice, because their hormonal cycles mess up trials. Guess who else has hormonal cycles!
Where are all the female mice? [Seventy percent] of people who suffer from chronic pain are women, but [researchers use] majority-male mice.
The mice patriarchy! I’m no expert, but that just seems like bad research to me. When you’re testing out a new drug, why on earth would you ignore hormonal effects?
One doctor I interviewed said it’s because it’s much cheaper. And beyond the gender issue, [research subjects are] mostly white people. There’s no mandate saying you have to diversify, and that’s a really big problem. Women’s health has always been dismissed. Everything was tied to our womb and our uterus, like we can’t have any other health issues.
I’ve always had this feeling that anything related to the female reproductive system is considered somehow outside the norm, even though half the population is having the same monthly experience as me.
It’s just crazy. When I started the initial research for the book and started interviewing women, I actually thought I didn’t have a book anymore. Every woman had a sexist healthcare story, and every woman of color had a sexist and racist story. I was like, “Maybe this is normal, because the stories are everywhere.”
It’s not just about dying in childbirth. It took Padma Lakshmi almost 20 years to get diagnosed for Stage IV endometriosis. She was told she didn’t have a high threshold for pain. People really expect women to live with pain.
I’ve always been confused about why research money doesn’t seem to flow toward treatments for women’s health issues. I mean, even from a purely profit-based standpoint. So many women would fork over so much cash for better endometriosis treatments or contraceptives with minimal side effects that don’t involve a painful insertion.
We just don’t know that much about women’s health. When the Covid vaccine came [and pregnant women weren’t tested in trials] is when I really got it. We were left out in real time. [Many] vaccines don’t harm the fetus, and we now know that Moderna and Pfizer are okay [for pregnant women].
But we know that basically because of studies that looked at pregnant women who elected to take it without knowing what to expect.
Exactly. And what really pissed me off was that we saw the gendered impact of Covid. So much landed on our shoulders when schools closed, when childcare was gone. And then the most anticipated vaccine comes out during this unprecedented pandemic and [pregnant women] are locked out of it. They’re like, “You should decide on your own, talk to your provider.” And if American women don’t get it right, we’re all f—ed. The fates [of women across the globe] are so intertwined.
I think Americans have never understood the power of American foreign policy. I don’t think most Americans can imagine that laws that are formulated and passed in Washington, DC, affect the health and rights of women and children all over the world.
But, you know, America does amazing global-health work. America basically introduced the concept of public health to Bangladesh and helped us slash our maternal mortality by 40 percent. When people overseas think about America, [they] imagine the movies. So I always thought it was the gold standard of care. And in this book, I’m not saying it’s not. We do have amazing healthcare access if you have insurance. I’m just saying you can advocate for yourself. [Journalist] Maya Dusenbery has said that a lot of times women found that if you bring a male with you [to doctor’s appointments], you’ll be believed more.
Like what I do to try not to get scammed at the auto shop.
Your healthcare is a team effort, and you are the most important member of that team. Give as much family history as you can to your doctor. If you don’t feel safe with your doctor, find another provider. Keep a paper trail, especially if you’re a woman of color, because a lot of times you’re not going to be believed.
My parents were really sick over the summer, and I brought them to the States. I followed my own advice in the book. We got such great healthcare, and both of their huge problems were solved. It made me realize that America is such a great country. We have access to the best resources. It’s the question of who gets access to that system.
You got a lot of attention when you went on Tucker Carlson’s Fox News show in 2018 and argued with him about the subject of toxic masculinity. Would you ever want to go on and do that again? I have to say, it looked like a fairly unpleasant experience to me.
I’m still kind of traumatized. I was kind of naive. Even though I’ve had experience in TV world, I still really don’t understand it. But I do know that there’s bullshit going on around what the producers tell you and how they pitch the segment to you, and then what happens when you’re on with the anchor. Basically, they can get you to do whatever they want.
I had gone on [his show] before to talk about climate change, and he just yelled at me. It was so weird. But the second time, it was about toxic masculinity and I was like, Gender is my jam! Is he really going to talk gender with me? It ended up being off the rails. Now I don’t even think I would go near the Fox studio. But I will say they do have a great hair-and-makeup team.
This article appears in the December 2021 issue of Washingtonian.