A Brief History of Gender Inclusive Policy in Healthcare
The Minerva Project • June 20, 2025
The Classical Period
During this period, human anatomical and physiological research was based on dissections of animal carcasses; understanding of human physiological issues were centered in animal bodies. Research slowly moved to human dissections, but was mainly conducted on a male subject base. Women were thought to be physiologically identical to men, barring the reproductive system, and were thus not included in this research.
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The Middle Ages
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Though women were still rarely included from clinical research and formal medical education, a few were able to pave their way in the field—most notably Hildegard of Bingen, who wrote about natural medicine, and Trotula of Salerno, a female physician who wrote a book about obstetrics and gynecology which would be used for the following hundreds of years. Most women were confined to domestic spaces to practice healing, especially in roles like midwives. However, as medicine became professionalized, female healers and midwives became increasingly marginalized, often accused of witchcraft or sorcery and persecuted during the witch hunts.
19th and Early 20th Century
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Pioneers in the 19th century worked to regain female standing in the medical field, and medical schools increasingly began to admit women into their classes. Supporters made large donations to women-open schools, aiding the financial burden for many women. At the end of the 19th century, more than 7000 women were practicing medicine, and 1200 more were enrolled in medical school.
However, after the publication of the Flexner Report (1910), a book examining medical education and suggesting reform in standards, the number of medical schools open to women quickly decreased as they were reported to have inadequate instruction. The number of women receiving formal education in medicine greatly declined. Some schools even began stating their preference for male students, or installed quota systems for the amount of women they admitted.
Modern Day
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The 1970s saw a wave of activism. Movements pushed for inclusion of women in clinical trials, especially HIV drug trials, leading the National Institutes of Health (NIH) to establish a policy in 1985 that encouraged researchers to include women in their studies. However, the implementation of this policy was poorly applied and regulated. In 1993, the U.S. Congress finally wrote this policy into federal law, with clearer guidelines and requirements. This law is now monitored and regulated by the Office of Research on Women's Health.
The NIH also launched the Women's Health Initiative in 1991, a set of clinical trials that investigated postmenopausal hormone therapy, diet modification, and calcium and vitamin D supplements on heart disease, fractures, and breast and colorectal cancer.
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While much progress has been made, the path towards a fully gender-inclusive system of healthcare is long—systemic bias, like racism and transphobia, and inequity in access and research continue to inhibit progress. Our understanding of biology, gender, and identity is consistently evolving, and so too must the policies of the systems meant to serve all people equitably.
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