Publications

Beatrice Credi (Head of Office), European Liver Patients’ Association – ELPA

International Women’s Day is a time to celebrate women’s achievements while acknowledging the challenges they continue to face — especially in healthcare. Liver disease, a condition deeply intertwined with social and economic factors, disproportionately affects women in ways that often go unnoticed. Gender bias in healthcare, social stigma, and economic disparities continue to lead women to self-stigma, downplay symptoms, skip testing, or drop out of care – ultimately delaying diagnosis and worsening outcomes. 

Gender Bias and Social Stigma in Liver Disease 

The stigma surrounding liver disease has historically been tied to “poor lifestyle choices” – heavy drinking or drug use – which carries a particular burden for women. Social attitudes often impose harsher judgment on women with conditions like cirrhosis or hepatitis, viewing them as having violated gender norms (e.g. the taboo of women drinking alcohol)​.  

In hepatocellular carcinoma (liver cancer), women remain underrepresented in clinical trials and research, even as the incidence in women has been rising. Among people who inject drugs and are infected with Hepatitis C, women are significantly less likely than men to receive direct-acting antivirals—treatment that could cure them. Similarly, the medical scoring system used to assess liver disease severity underestimates women’s condition, leading to lower chances of receiving life-saving liver transplants. Mothers-to-be with Hepatitis B and C face moral judgment and anxiety about transmitting the virus​. Women with obesity—a known risk factor for liver disease—report higher levels of discrimination than men.  

Intersectionality: Compounding Factors and Stigma 

Liver disease in women brings out intersectional stigma also because of the connection with social and commercial determinants of health. For instance, in Europe, obesity rates vary widely based on gender, socioeconomic status, and education levels. Women with lower education levels and financial insecurity are at a much higher risk of developing liver disease due to diet-related factors. Food insecurity and the affordability of high-fat, high-sugar, ultra-processed foods contribute to higher rates of Fatty Liver (MASLD and MASH), a liver cancer risk factor, reinforcing the cycle of poor health outcomes in disadvantaged communities. 

Moving Forward: Ensuring Health Equality for Women with Liver Disease 

• Intersectional approaches. Recognising that stigma can be layered (gender intersecting with poverty, addiction, etc.) Is crucial. Interventions should be designed to reduce stigma on multiple fronts. 
• Empowering patient associations and support groups. Safe spaces for women with liver disease reduce isolation, while peer-led education empowers patients who can advocate for change and influence policy. 
• Gender-sensitive healthcare approaches. Tailoring healthcare services to address women’s concerns can improve their engagement in treatment and overall outcomes. 
• Anti-stigma training for healthcare professionals. Implementing training programs where medical staff interact with community members. 
• Introducing specific criteria in clinical tools and mandatory reporting on gender metrics (like transplant listing rates and waitlist drop-out) can hold institutions accountable for equity. 
• Broaden inclusion in research and guidelines. Regulatory agencies and funding bodies should require adequate representation of women in liver research. 
• Education and awareness campaigns. Public education can dispel myths, highlight diverse liver disease causes, and reduce patient blame. 

Every stakeholder has a role in moving toward more equitable liver care. When a woman with cirrhosis walks into a hospital, she should be met with neither suspicion nor dismissal but with prompt, high-quality care tailored to her needs. Health equality is a fundamental right. However, reducing stigma and bias is not just a matter of justice; it will tangibly save lives by catching disease earlier and improving treatment adherence. With concerted efforts, we can safeguard women’s liver health by establishing a system recognising their equal health rights. 

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