Abstract
In Arundhati Roy’s The God of Small Things, a mother finds satisfaction in the fact that although she has no job she is able to seek work. The story is set in South India, where women’s empowerment, education, and employment—evidence-based policies to improve health outcomes—have helped the region steer a different path to the rest of India and much of South Asia. Every nation has its story of women’s struggles for rights, yet what have we truly learnt?
The United States is often seen as a leader in the movement for women’s rights. With its financial power and global political influence, the US positioning on women’s rights matters. When countries become dependent on US support they also can become hostage to US ideology becoming an instrument of foreign policy.
When Donald Trump reconstituted the US Supreme Court to create a majority of ideologically aligned judges, one of the concerns was the potential impact on women’s and other rights. Those concerns were well founded, particularly on the polarising issue of abortion. 1 Abortion can’t be eradicated by banning. It is just driven underground and becomes unsafe. People who are disadvantaged are disproportionately affected. More women become ill and more women die.
Doctors have an important role to play in supporting women who are seeking an abortion in a legislature where it is banned–just as they do in advocating to prevent harm in other spheres, such as the dangers of a nuclear war 2 –but may themselves be conflicted by moral or religious beliefs. Conflicts of interests of doctors extend beyond the financial, although financial competing interests are more readily measurable.
The influence of conflicts of interest on clinical decision making is well established but does require greater transparency and coping strategies. An analysis of 31 UK and international organisations reveals a “wide variation in what interests should be revealed, when and how.” 3 Careful study design is an important but unreliable way of eliminating bias in research. 4 The challenge in clinical practice and policy making is harder to find neat solutions for.
One of the reasons the public places such high trust in doctors is that it believes them to be working free of conflicts and in the patient’s best interests. Lawyers believe themselves to be working in the best interests of their clients. When the US Supreme Court, gamed to include a majority of ideologically driven judges, reinforces those ideologies in its law making, in whose best interests is it working? Certainly not women when it comes to the sea change in reproductive rights in the US.
The value of supporting women’s rights is an old lesson, and we should have learnt it by now.