Gender Bias and Discrimination in Healthcare as Experienced by Basque Women and Gender Non-normative Individuals in the Basque Country.

The Basque Country is one of Europe's many stateless nations and home to the Basque Indigenous population. As members of an Indigenous and ethnic minority culture, Basque women and gender non-normative individuals risk suboptimal healthcare services and outcomes because of gender bias and discrimination. This study explores their experiences with healthcare services and identifies the ways in which gender bias and discrimination serve as a barrier to cultural safety in the Basque Country. We used critical ethnography and triangulated data from 37 semi-structured interviews, health clinic observations, 4 focus groups, and document analysis. Thematic analysis was used to identify overarching themes from transcripts and field notes. Participants reported numerous instances of discrimination that hinder the implementation of cultural safety. We found that gender bias and discrimination are central to the healthcare experiences of Basque women and gender non-normative individuals. These issues manifest in various ways, including knowledge transmission gap regarding women's health, discrimination based on sexual and/or gender identity, and obstetric and gynecologic violence. Meanwhile, patient autonomy during healthcare encounters is a key facilitator. Training in self-reflection, bias awareness, and gender-affirming can reduce discrimination. Findings also highlight clinical knowledge gaps and the need to integrate cultural safety into nursing education and practice.