Feminist writers have documented the ways in which inequalities based on gender are reflected and reproduced in health and social care services. Although the majority of workers in care services are women, men are over-represented in management and in positions of authority, and male-dominated professions, such as medicine, tend to exert more power than those, such as nursing, in which women are the majority. For example, whereas women make up 75% of the workforce in the NHS (Doyal, 1999), the bulk of decision-making power resides with the medical profession and senior management where women are vastly under-represented. Women tend to fill most of the lower-paid and lower-status roles in care services and women are the majority of unpaid carers.
What are the implications of these structural inequalities in terms of interpersonal communication? The under-representation of women in management, and in high-status professional groups, can mean women are routinely excluded from discussions in which decisions are made and policies formulated. However, even where women are represented, gendered power may operate in less direct and obvious ways. You may recall the course tester in Activity 13 who mentioned the male manager who excluded women's voices from discussions in meetings. Even where women are well represented in a meeting or workplace, they may think their voices carry less weight or influence than the men's. Men may use their organisational power, either consciously or unwittingly, to silence or bypass women's voices. At an organisational level, certain kinds of discourse – ways of thinking and talking about issues – may be privileged over others. Female staff may have a sense that certain kinds of ‘masculine’ discourse have greater power and influence in the organisation than ways of talking and thinking that are perceived to be more ‘feminine’. This is a difficult subject to broach without making sweeping (and essentialist) generalisations about men's and women's styles of communication. Later in this section we shall address the question of whether men and women actually do tend to communicate in different ways, and how to account for these apparent differences.
The next activity gives you the opportunity to reflect on the ways in which gendered power operates in a workplace familiar to you.