The Vulnerable Empowered Woman

Tasha N. Dubriwny

• Publisher: Rutgers University Press
• Year: 2012
• Print ISBN: 9780813554006
• eBook ISBN: 9780813565811
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

The feminist women’s health movement of the 1960s and 1970s is credited with creating significant changes in the healthcare industry and bringing women’s health issues to public attention. Decades later, women’s health issues are more visible than ever before, but that visibility is made possible by a process of depoliticization

The Vulnerable Empowered Woman  assesses the state of women’s healthcare today by analyzing popular media representations—television, print newspapers, websites, advertisements, blogs, and memoirs—in order to understand the ways in which breast cancer, postpartum depression, and cervical cancer are discussed in American public life. From narratives about prophylactic mastectomies to young girls receiving a vaccine for sexually transmitted disease, the representations of women’s health today form a single restrictive identity: the vulnerable empowered woman. This identity defuses feminist notions of collective empowerment and social change by drawing from both postfeminist and neoliberal ideologies. The woman is vulnerable because of her very femininity and is empowered not to change the world, but to choose from among a limited set of medical treatments.The media’s depiction of the vulnerable empowered woman’s relationship with biomedicine promotes traditional gender roles and affirms women’s unquestioning reliance on medical science for empowerment. The book concludes with a call to repoliticize women’s health through narratives that can help us imagine women—and their relationship to medicine—differently.

Chapter 1

Theorizing Postfeminist Health

Risk and the Postfeminist Subject

One of my primary arguments throughout this book is that contemporary representations of women’s health have been disarticulated from feminism and that this disarticulation has significant ramifications for women. In this chapter, I offer a brief discussion of the women’s health movement and the activist feminist approach to women’s health that developed through the activism, publications, and theorizing of some segments of movement. It is precisely a feminist politics like the activist feminist perspective that is missing from current discussions of women’s health in mainstream public discourse. I also offer a theorization of the current status of women’s health discourse, which I see as drawing from postfeminism rather than from feminism. Postfeminism has usurped the position of feminism, bringing with it a representation of women as highly gendered individuals who are empowered to choose among medical treatments, manage their future and current health by altering their lifestyles, and increase or play up their femininity by taking advantage of ever-expanding opportunities to modify their bodies and lifestyles. I focus on how a postfeminist sensibility governs discourse about women’s health through a larger rhetoric of risk in which women are represented as part of an inherently at-risk group that must engage in a constant monitoring and management of risk.

Feminist Activism, Women’s Health, and Transformations of Medicine

The development of allopathic medicine in the United States can be roughly divided into three stages. The first era, from 1890 to 1945, “centered not only on the professionalization and specialization of medicine and nursing but also on the creation of allied health professions, new medico-scientific, technological, and pharmaceutical interventions, and the elaboration of new social forms.”1 In the decades after World War II, the jurisdiction of medicine expanded dramatically. Adele Clarke and Janet Shim explain: “By conceptually redefining particular phenomena in medical terms, and thereby effacing them as social problems, medicine as an institution became understood as an important new agent of social control.”2 Clarke and colleagues label this second period the “medicalization era” and suggest that it ended around 1985. After that, the dramatic changes brought on by technoscience and biomedicine ushered in our current “biomedicalization era.”3 The work of feminist women’s health activists I describe in this section occurs in the social context of the medicalization era, when patients were largely understood to be passive recipients of medical treatment; medical professionals controlled access to and the creation of specialized knowledge; physicians and other medical experts worked through a paradigm of definition, diagnosis, classification, and treatment; and human bodies were expected to adhere to a standard norm.4

Although medicine “has no essence”—it cannot be reduced to simple social control or the management of social problems—and the process of medicalization has “made us what we are,” the processes that were prevalent during the medicalization era in the United States were not equally distributed among the population.5 Nikolas Rose asserts, “Some people are more medically made up than others—women more than men, the wealthy differently than the poor, children more than adults, and, of course, differently in different countries and regions of the world.”6 For the many women involved in feminist women’s health activism, which includes women in the women’s health movement and the numerous women who participated in feminist groups that responded to, supplemented, or at times resisted the dominance of largely white women’s groups, recognition of women’s specific role in the history of medicalization was an important step in a larger move to understand the many ways that gender and sex bias affected medical practice. Steven Epstein argues that despite the ubiquitous claim that “the field of medicine has long presumed a ‘male norm,’” the history of medicine in the United States points to a more telling, and problematic, attention to difference.7 Western medical theorizing about differences between social groups and individuals “placed European men at the pinnacle” by explicitly studying women, racial minorities, and other underprivileged groups and interpreting differences between these groups and European men as evidence of European men’s superior intellect and physiology.8 Epstein explains that understandings of (and research on) female difference can be traced back to ancient Greece. By the eighteenth and nineteenth centuries, the focus on women’s difference “tended to construe femaleness as almost inherently unhealthy and viewed women as essentially controlled by their reproductive organs.”9 The medicalization of women’s bodies and lives produced specific understandings of women as frail and inferior. These understandings were thoroughly critiqued by women’s health activists.10

Feminist women’s health activists in the late 1960s through the early 1980s can be best understood as positioning themselves as critics of the medical industry. They problematized the medicalization of women’s lives and critiqued the passive role women were often expected to play in relation to more active, expert physicians. Feminist criticism of the medical industry took many forms. Radical feminists, for example, offered a “thoroughgoing critique of patriarchal practices and assumptions,” while liberal feminists included medicine in their larger push for the “mainstreaming of women within all branches of U.S. society.”11 Feminism comes in many shapes and forms, and in this project I use an open-ended definition of feminism that draws upon what these many perspectives have in common. Andrea O’Reilly, writing on “feminist mothers,” offers this understanding of feminism’s common goals: “Feminists are committed to challenging and transforming this gender inequity in all of its manifestations: cultural, economic, political, philosophical, social, ideological, sexual, and so forth. Also, most feminisms (including my own) seek to dismantle other hierarchical binary systems such as race (racism), sexuality (heterosexism), economics (classism), and ability (ableism).”12 Anthropologist Sandra Morgen describes the women’s health movement as a “revolution” that transformed health care.13 This revolution would not have been possible without the many feminist perspectives that informed the women’s health movement. For example, the women’s health movement may be best remembered for its radical self-help activities, including providing abortions and demonstrating how to perform vaginal self-exams with a speculum and a mirror. However, radical feminist health activists were complemented by liberal feminist activists, and both groups were challenged to create more intersectional approaches to women’s health by women of color. The revolution brought about by women’s health movement activists included arguments against the radical mastectomy, questions about the safety of the birth control pill and other methods of contraception, a focus on sterilization abuse in underprivileged populations, attention to problems of access to basic medical services, and theorization about the intersections of poverty, geography, race, and health.14

Chronological narratives of the women’s health movement often begin with the actions of women involved in women’s liberation in the late 1960s. Sandra Morgen begins her account of the movement with the 1969 meeting of women who became the now-well-known Boston Women’s Health Book Collective.15 The foundational stories that make up the movement are, according to Morgen, the story of Our Bodies, Ourselves, the story of self-help gynecology, the story of the development of the “policy wing” of the movement (eventually embodied through the National Women’s Health Network), and finally the story of abortion rights and the Jane organization.16 The role of women of color activists, specifically African American women, is treated in many chronologies as an afterthought with a notation of the creation of the National Black Women’s Health Project (NBWHP) in 1983. Although Morgen’s account does not fall prey to this problem, she covers the health organizing by women of color in a chapter separate from the foundational stories of the women’s health movement. The separation of women of color from the usual chronologies of the women’s health movement overlooks both individual activists and many organizations, such as the National Welfare Rights Organization in Pittsburgh, that took up women’s health issues (often reproductive issues) from a feminist perspective.17

Because of the problems of some chronological narratives regarding the participation of women of color in the women’s health movement and because of my own interest in a perspective that many different groups shared, I focus the remainder of this section on three facets of a feminist perspective on women’s health that together make up what I call an “activist feminist approach” to health: the politics of knowledge, self-determination, and contextualization. The first theme—the politics of knowledge—encompasses a range of beliefs about the production, distribution, and validation of knowledge. Nancy Tuana describes the women’s health movement as an “epistemological movement,” one dedicated not only to providing women with knowledge but also to creating new knowledge.18 Issues having to do with access to medical knowledge spurred the creation of the Boston Women’s Health Book Collective and was also a prime focus for Barbara Seaman’s landmark book The Doctor’s Case Against the Pill.19 Women’s health movement activists wanted medical knowledge in women’s hands, but they also performed extensive critiques of the knowledge about women’s bodies and lives created by the medical industry. As Anne Koedt’s famous essay “The Myth of the Vaginal Orgasm” so eloquently demonstrated, what passed as medical knowledge was always based in culture and reflected dominant values about gender and sexuality.20

In addition to theorizing about the cultural situatedness of knowledge production and critiquing women’s lack of access to medical knowledge, activists offered a significant challenge to standard accounts of objective knowledge by insisting on the validity and importance of their own experiences. Women’s experiences with the Pill, for example, were collected as anecdotes and provided important evidence for Seaman’s argument. The development and practice of an experiential epistemology within the radical wing of the women’s liberation movement extended to the self-help arm of the women’s health movement. Michelle Murphy summarizes, “Experience, as conceived within the women’s self-help movement, provided a kind of evidence that was used to critique science, especially biomedicine, by providing a different knowledge of the world.”21 More broadly, experience provided one foundation for women of color to critique women’s health movement activists that worked from the viewpoint of white, middle-class women. As just one example, African American feminist groups “forged a theoretical framework about ‘simultaneous oppressions’ and reproductive politics in the 1970s.”22 The framework of simultaneous oppressions was based in part on the knowledge women of color formed from their experiences. Loretta Ross, an activist who directed the National Organization for Women’s (NOW) Women of Color Program and was also involved with the NBWHP, remembers her experience of sterilization abuse as a moment that made her ask “what the hell is going on here?”: “It was the fact that for six months, I’d been going to this joker and his misdiagnosis and maltreatment ended in sterilization. That made me mad. But that’s when I began reading more and paying more attention to how many women were sterilized.… I looked at my sister and my mother.… There were very few women who were ovulating in my family by their thirties.”23 Her experience of mistreatment by a physician, coupled with the experiences of her family and her community, produced the knowledge that sterilization was “much more widespread” than she had previously thought. Such individual and familial experiences by women’s health activists thus not only challenged medical understandings of women’s lives and bodies but also shaped the women’s health movement’s production of knowledge and theories about their own bodies and lives.

The second theme of the women’s health movement was often closely tied to women’s ability (or inability) to access knowledge: self-determination. What I understand as “self-determination” is actually two interrelated areas of emphasis regarding agency. First, women’s health activists crafted arguments about their rights over their own bodies. These arguments—often made within the context of reproductive politics—suggested that women’s bodies were women’s property. The Chicago abortion network Jane is an excellent example of women literally taking their health care into their own hands. Second, women’s health activists made arguments about self-determination that emphasized the importance of women’s agency in making choices about their own health care. Toine Largo-Janssen explains: “The perception of wrongful medical interference with the female body formed a central issue. This theme later expanded within health care into the notion of autonomy, authority over one’s life, issues that were also valid and particularly important at times when decisions had to be made about illness and health.”24 In her work on breast cancer, Rose Kushner decried the standard practice known as the “one-step procedure” in which women were sedated, their breasts were biopsied, and, if the biopsy was positive for cancer, they underwent mastectomies without ever being wakened from anesthesia. Kushner’s exposé was instrumental in establishing practices of informed consent regarding breast cancer surgeries. She argued forcefully for a “two-step procedure” that gave women an active role in the choice of breast cancer treatment.25

Where Kushner advocated for women’s right to be active in the medical encounter, self-determination as voiced by other activists expanded beyond the patient-physician relationship and took on relationships that were often far more personal: those between men and women. In her 1969 essay “The Pill: Genocide or Liberation,” Toni Cade, an activist involved in both the women’s liberation and Black Nationalism movements, confronted the difficult question of whether Black women should understand the Pill as an instrument of genocide or use it wisely to control their bodies and destinies. Cade describes her experience at one meeting of Black activists: “Finally, one tall, lean dude went into deep knee bends as he castigated the Sisters to throw away the pill and hop to the mattress and breed revolutionaries and mess up the man’s genocidal programs.”26 Although Cade clearly states that she does not agree with the idea (offered by some women’s rights groups) that the Pill “really liberates women,” she argues convincingly that it—and women’s control over their own reproduction—is essential to the success of both Black Nationalist and women’s liberation movements. She argues that women’s right to bodily self-determination includes access to the Pill, which gives them time to “focus on preparation of the self” instead of abandoning control of their lives to others.27

The final theme of an activist feminist approach to women’s health is contextualization. In her review of the important ramifications of the women’s health movement for medical science, Largo-Janssen suggests that women’s health activists drew attention to the “psychosocial context” of illness. She writes, “The operative concept of illness needed to be redefined as a biomedical concept that acquires meaning within the context of individual lives and social circumstances.”28 By “contextualization of health and disease,” I mean, like Largo-Janssen, to point to the various ways women’s health activists emphasized not just biomedical understandings of health and disease but also the social context in which individuals were understood to be healthy or diseased. Early conversations among the members of the Boston Women’s Health Book Collective point to the importance of social location in determining one’s experience of health and illness. Recognizing its members’ own privileged position, the collective explained that “poor women and non-white women have suffered far more from the kinds of misinformation and mistreatment that we are describing in this book.”29 The Black women’s health movement was pivotal in the process of contextualization, as such activists pointed not only to the inherent racism (often through ignorance) of some women’s health groups but also to the social contexts of race and class as important factors in any discussion of women’s health. The need for such contextualization was clear in the reproductive rights movement, for example. Byllye Avery remembers, “We told them [white women in the abortion rights movement] it was unwise to just talk about abortion. We felt like a lot of [black] children were dying from infant mortality and a lot of other things that were not being talked about. We never [focused on] a single issue at all, but they didn’t listen.”30 Although admittedly an imperfect effort, the women’s health movement did attempt to place women’s health in social and cultural contexts.

The three facets of the activist feminist approach to women’s health—the politics of knowledge, self-determination, and contextualization—undergirded activ...

Table of contents

• The Vulnerable Empowered Woman
• Contents
• Acknowledgments
• Introduction
• Chapter 1
• Chapter 2
• Chapter 3
• Chapter 4
• Chapter 5
• Afterword
• Notes
• Bibliography
• About the Author