Women and Health

The Politics of Sex in Medicine

Elizabeth Fee

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9781351840606
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In the face of the long domination of medical care by men, Women and Health explores from a variety of perspectives the twin issues of women in health care, and the health care of women. Specific sections address the women's health movement, birth control and childbirth, women in the health labor force, and the influence of women's employment on their health. Already acclaimed by scholars and health policy-makers alike, Women and Health is sure to become a standard sourcebook on an important and neglected subject.

PART I

The Women’s Movement

CHAPTER 1

Women and Health Care: A Comparison of Theories

Elizabeth Fee

What do feminists have to say about the health care system in relation to women? A great deal, and most of what they have to say is highly critical.

Women are recipients of health care, and, increasingly, they have been critical of the form and content of this care. Particularly in those areas of medical care that most directly impinge on women’s lives as women–gynecologic examinations, birth control and abortions, sexuality, childbirth, and psychotherapy-feminists have been articulate critics of the nature and quality of medical treatment.

Women are also dispensers of health care. For millennia, mothers traditionally assumed responsibility for the health of their families. Many of these traditional women’s tasks have now been socialized, professionalized, and organized in giant medical institutions, but the overwhelming majority of the workers are still female. They occupy the lowest rungs of the medical hierarchy, are poorly paid, and have little power or voice in the organizations in which they work. Clearly, women experience their oppression not only as patients but also within the delivery system itself.

Has a systematic analysis of the relationship of women to health care emerged from the feminist writings of the last decade? Specific complaints are widely shared and generally recognized by feminists, and indeed by women in general, but although they may agree as to the existence and symptoms of a diseased state of health care, the diagnosis of the problem takes several distinct forms. Consequently, different groups may be led to prescribe various cures.

All recognize that women’s problems with the organization and delivery of health care cannot be solved within the context of the medical system alone; since this is only one aspect of their social oppression as women, the solutions required must involve more radical social change. One’s diagnosis of what is wrong with medical care must be related to one’s diagnosis of what is wrong with society in general. Here, not all feminists agree. A feminist consciousness grows from the surfacing of anger at being constantly manipulated, harrassed, limited, and repressed into the social role of “woman”; but the answers to the obvious questions of why this thing happens and how to best struggle against it are not self-evident.

There are at least three forms of social criticism which the women’s movement has taken; these may be labeled as liberal feminism, radical feminism, and Marxist-feminism. As these three branches of the feminist movement have differing approaches to the analysis of women’s situation, their prescriptions for the ailing American health care system are also different. This discussion of feminism and medicine will therefore be presented in three parts. Each section will briefly describe the general political framework adopted by one branch of the movement and then proceed to a consideration of that group’s analysis of medical care. This general and perhaps overly schematic approach is intended for purposes of clarification and also to stimulate discussion; it should be noted that it presents as static positions ones which are in fact highly dynamic and in process of development. Also, although the categories used do describe distinct approaches to the analysis of “the woman question,” this is a classification of modes of analysis and not of individuals. Particular women and/or organizations may, and do, adopt elements of each analysis; they may, and do, change their perspective over time, as a result of both external conditions and internal discussion and development. Any attempted description of a dynamic political movement should be out-of-date as soon as it is printed.

LIBERAL FEMINISM

Liberal feminism is the most widely diffused and generally acceptable version of feminism. Even many of those antagonistic to “women’s lib” can accept, at least in principle, the goals of equal pay and equal opportunity for women. The liberal feminist position was crystallized by Betty Friedan’s now classic text, The Feminine Mystique, and given organizational form in the National Organization of Women (NOW); the movement demanded equal opportunity for women to enter the upper reaches of the job market and equal treatment once they got there (1). Liberal feminists do not seriously challenge the hierarchical structure of American society; they simply want access to the same choices as are available to men. NOW fought to “bring women into full participation in the mainstream of American society now, exercising all the privileges and responsibilities thereof in truly equal partnership with men” (2).

One of the tasks of this movement was to prove that women were as capable as men, that their exclusion from all the centers of power had no rational or biologic basis. They therefore attacked the nexus of ideas and attitudes, “male chauvinism,” that held women to be inferior beings. If women were not really inferior, then they were victims of a sexist ideology, supported and reinforced by a system of socialization which trained women to accept and adapt to a limited social role. If the women’s problem was not real but ideological, it could be effectively countered by a program that combined persuasion, reeducation, the provision of “role models,” and the development of pressure groups which would change both people’s ideas of women and the legal and economic discrimination which reflected these ideas.

An underlying assumption was that the chauvinist complex of derogatory feminine stereotypes served no essential social function; chauvinism was either a male psychologic peculiarity or a species of bigotry. It ill served the ideals of equal rights to which democratic societies were supposed to be committed; indeed, it assured the waste of valuable human resources and human talent. It was clearly outmoded, counterproductive, and a vestige of earlier unenlightened eras. The movement would carry on the banners first raised by feminists a hundred years earlier and finally banish the historical hangover of sexual discrimination. The tempo of the sixties favored the belief that equality, or at least the more cautious “equality of opportunity” could be won without the necessity of transforming the economic and social infrastructures of the United States. This considered optimism gained support from a review of their numbers: women were the majority of the population. Unaided if needs be, in alliance with progressive males if they were willing, women could enforce the changes they wanted and needed. In those heady early days few believed that all women did not share the same essential interests or that historical cleavages of class or race might disturb female unanimity. The movement launched a campaign for all the equalities: equal rights in the eyes of the law, equal job opportunity, equal pay, equal access to education, equal promotion and professional advancement, equal credit. Child care and housework–the tangible requirements of the existing order–could be equally shared with men within the family or socially organized in day-care centers and communal living arrangements (3). Future socialization of children into sex-specific roles would be combatted by pressure on the educational system, on publishers of children’s books, and on toy manufacturers.

During the flush economic times of the sixties, the liberal feminist movement made considerable headway. The case for equality gained widespread publicity and seemed compelling to many women and men; concrete legislative victories reinforced the belief that gains toward equality were possible “within the system”; they moved on toward a constitutional amendment that would embody their central demand in the fundamental law of the land as their predecessors had done with the women’s suffrage amendment fifty years before. The resistance to apparently reasonable demands has proved stronger and more stubborn than the theory would seem to predict, particularly on the part of other women, some of whom cling to women’s roles as housewife and mother in preference to the free labor market. Liberals counter with the explanation that women are to have a free choice whether to stay at home or go out to work, but the ideal of free choice seems increasingly implausible in the face of growing unemployment and inflation. Indeed, as the state of the economy has begun to restrict and erode some of the hard won gains of the last decade, many have begun to search for a more penetrating analysis of the roots of their oppression. For many more, however, the direction already marked out seems sufficiently correct and they continue with the struggle to win women’s rights and equality within the established system.

Liberal Feminism and the Health Care System

Liberal feminists see the social subordination of women reflected in the sexual structure of the organization of medicine, i.e. in a field where women are the majority of health workers, the upper reaches of the medical hierarchy constitute a virtual male monopoly. The imbalance of the sexes here is more extreme than in most other areas of employment, a situation which seems particularly ironic since the practice of medicine requires personal characteristics compatible with those traditionally ascribed to women. The case of the Soviet Union, where the majority of physicians are female, has been frequently cited to show that no social or biologic necessity enforces the rule that men become doctors and women, nurses. The demand for sexual equality in education and employment should rather result in approximately equal numbers of men and women in each occupational category.

Another area of criticism concerns the nature of the patient-doctor interaction. Physicians heal (or do not heal) from a position of power; they relate in either a paternal or an authoritarian manner to their patients. They may withhold information about a diagnosis, be deliberately vague and obfuscatory, or be simply incapable of explaining the problem in nontechnical terms; they seem to doubt that patients have a right to an explanation of their illness. Aware that these attitudes are also directed at men, liberal feminists correctly argue that they are exaggerated when the patient is female: well or ill, women are accorded less respect. Many women feel that their symptoms are treated less seriously than those of men because doctors harbor the secret suspicion that most of the medical problems presented are psychosomatic.

The “specialist” is a more accurate term than “doctor” to describe the focus of the liberal feminist critique of medical attitudes. Middle-class women usually do not see a general practitioner, but rather a series of specialists: a gynecologist for birth control and pap smears, a pediatrician for the kids* fevers and a psychiatrist for depression and anxiety. The disaffection with medical care, already directed at the upper strata of the profession, tends to concentrate on two specialties: gynecology and psychiatry (4, 5, 6, 7). These are the medical areas in which contempt for women is most evident; each has a long history of explicating the disadvantages of a female body and a female mind. A survey of gynecologic or psychiatric textbooks reveals the contribution of medical education to the reproduction of these attitudes in new generations of medical students.

The criticism of the sex-typing of health occupations and that of the sexist attitudes of physicians intersect in the call for more women to be admitted to medical schools. Women physicians should be more capable of treating the health problems presented by women patients with respect, if only because the female body would be less alien and the female mind less mysterious. The overwhelmingly male bias of gynecology and psychiatry would be difficult to maintain if even half of their practitioners were female. Medical research might become less male biased if the research teams were composed of equal numbers of each sex. Rigid distinctions between medical skills and “caring” functions would weaken if they were not reinforced by sexual differentiation; the widespread desire for such an integration is attested to by the popularity of the Marcus Welby image, fictional though it be. Then, too, a feminization of the medical profession and a corresponding invasion of nursing by men would erode the artificial income and status distinctions between doctors and nurses; this relation is maintained as a traditional male-dominant, female-subordinate one.

This liberal critique thus approaches the problems of medical care at the point most visible to the middle- and upper-middle-class consumer, the private office of the physician or specialist. From this vantage point, the giant medical institutions, clinics, and hospital emergency rooms tend to fade from view, although it is here that the health needs of most women are met–or, more frequently, not met. In speaking to the attitudes of male doctors, this critique centers on the tip of the medical iceberg and tends not to deal with the majority of health workers–medical technicians, orderlies, household workers, and practical nurses, over 70 per cent of whom are women (8, 9). In emphasizing the need to equalize the upper ranks of the medical profession by sex, it implicitly acquiesces in a hierarchical structure which rests on a base of exploited, largely female labor. The liberal position offers most to those who can afford a view from the top, to women who might have gone to medical school had admissions been equal to both sexes, to women who would be able to pay for feminist therapy if it were available. It offers less to the woman who cleans the floors of the hospital or is sick because medical care is unavailable or too expensive.

RADICAL FEMINISM

Radical feminist goals are not to achieve equality with men under the existing social and economic structures, but to entirely transform existing social institutions. Liberal feminist solutions seem weakly reformist and inadequate to serve the needs of women; radical feminists do not want to perpetuate a society which is perceived as fundamentally inhuman.

Many of the women oriented toward radical feminism had participated in civil rights, student, and anti-war movements. With radical men they shared certain characteristic ideas and attitudes: a profound alienation from American culture, a distaste for formal hierarchical systems, a contempt for traditional political forms, and a commitment to the radical restructuring of both values and institutions.

It became apparent, however, that existing Left organizations, for all their disaffection from the dominant culture, yet shared one important characteristic with it: sexism. The SDS (Students for a Democratic Society) proved male...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• PART 1: The Women’s Movement
• PART 2: Case Studies in Women’s Health
• PART 3: Women in the Health Labor Force
• PART 4: Women’s Work, Women’s Health
• PART 5: The Professional Control of Social Conflict
• PART 6: Biology, Nature, and the Construction of Knowledge
• Contributors to the Volume