Sex stereotypes are stereotypical ideas about masculinity or femininity, such as expectations about how people should represent or communicate their gender to others, gendered expectations about roles based on sex, or belefs that gender can only be binary. They fuel pervasive forms of sex discrimination in our health care system. Sex stereotypes can significantly impede equitable access to high-quality, comprehensive, and affordable health care coverage and service delivery for Lesbian, Gay, Bisexual, Trangsgender, Queer, Intersex plus (LGBTQI+) people and other women. This blog post, adapted from our recent Q&A on the U.S. Department of Health and Human Services’ (HHS) 2022 Proposed Rule on Section 1557, explores some of the ways people experience discrimination based on sex stereotypes in health care and provides advocates information on how the Biden Administration’s proposed changes would help ameliorate those inequities.
Sex stereotypes about women and people with uteruses is ancient. For millenia, sex stereotypes drove providers in western societies to discriminatorily misdiagnose women with “hysteria,” an umbrella explanation crafted from a wide range of symptoms that only affected people with uteruses. The American Psychiatric Association recognized hysteria as an official diagnosis until 1980. While the language has changed, women and people assigned female at birth, and particularly people who live at the intersections of multiple identities, such as Black women, continue to experience widespread related discrimination. They are labeled as “chronic complainers” and told their symptoms are “all in their heads.” As a result, women and people assigned female at birth, and especially Black, Indigneous, and other people of color (BIPOC), often experience years- or decades- long delays in accurate diagnosis and treatment for chronic conditions such as endometriosis. Providers are also much more likely to prescribe women in pain sedatives, rather than pain medication, than they do for men in pain. Because providers are half as likely to prescribe Black patients pain medication than their white counterparts, Black women experience compounded discrimination.
In addition, sex stereotypes significantly undermine coverage and care for LGBTQI+ people. This discrimination can understandably discourage LGBTQI+ people from seeking care and can also make it challenging to identify alternative services. For example, a new nationally representative survey found that more than one in five Transgender respondents, and nearly one in three Transgender people of color, were denied reproductive or sexual health services in the last year because of their actual or perceived gender idenity. Twenty-three percent of LGBTQI+ people, thirty-seven percent of Trangender people, and fifty-percent of Intersex people who responded postponed or avoided getting needed health care in the past year due to discrimination or mistreatment by providers.
As the only federal civil rights law with specific protections against discrimination on the basis of sex in health programs and activities, Section 1557 is vital to combating these challenges. In 2016, the Obama Administration finalized regulations implementing Section 1557 and named sex stereotypes in its definition of sex discrimination. In 2020, the Trump Administration published a new Final Rule that removed this definition and gutted many other crucial protections from implementing regulations. The 2022 Proposed Rule includes a revised definition of discrimination on the basis of sex as that whichincludes, but is not limited to, “discrimination on the basis of sex stereotypes; sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; and gender identity.”
The 2022 Proposed Rule also restores provisions that explicitly clarify that covered entities must provide individuals equal access to health programs and activities, health insurance, and health-related coverage without discrimination on the basis of sex. These provisions will help protect individuals from discriminatory denials of or limitations on services, as well as coverage for services, based on sex stereotypes. HHS’ approach shows promise for improving equity in access to health coverage and service delivery for LGBTQI+ people, women, and others subjected to sex stereotypes.
Learn More and Get Involved
HHS is accepting comments on its Proposed Rule through October 3rd. If you are submitting comments on discrimination related to sex stereotypes, you can do so at the National Latina Institute for Reproductive Justice’s comment portal for reproductive health, rights, and justice advocates or National Center for Lesbian Rights’ comment portal for LGBTQI+ advocates. If you are commenting on a range of health issues, you can do so using NHeLP’s comment portal for any health advocates. You can also submit comments at Regulations.gov.
Here are some additional resources that might be useful:
- Questions and Answers on the 2022 Proposed Rule Addressing Nondiscrimination Protections under the ACA’s Section 1557, our overview of the ways Section 1557 impacts various individuals, especially those who live at the intersection of multiple identities.
- Blog: What is Section 1557? An Introduction
- Blog: How the Proposed Changes to Section 1557 Affect Individuals with Limited English proficiency (LEP)
- Blog: How Changes to Section 1557 will Improve Health Care for LGBTQI+ People
- Blog: How Changes to Section 1557 will Impact Health Care for People with Disabilities
- Blog: How the Proposed Section 1557 Rule Addresses Discrimination Based on Sex Stereotypes
- Blog: How Proposed Changes to Section 1557 Strengthen Protections Related to Pregnancy or Related Conditions, Including Abortion.