Gender, Health, and Medical Treatment - Term Paper Example

Gender, Health and Medical Treatment 2009 According to the philosopher, Michel Foucault (1978), power in modern societies stems not only from the oppressive forces of law that stemmed from the “jurido-discursive” attitude of pre-modern societies but through a framework of bio-power that controls the entire life process. From the 17th century onwards, the state has endeavored to control society through various social institutions like the clinic, prison, school rather than through disciplinary power and so on so that there is bio-power over human lifecycle comprising of birth, death, sickness, health and sexual relations. Therefore, control over the body and gender has become crucial aspects of social power in modern societies. Foucault argues that in modern societies, the conduct of individuals and groups is insidiously regulated through scales of regularity by various diagnostic, predictive and conventional knowledge like criminology, medicine, psychology and psychotherapy. In such a scenario, the history of treatment and medicine has been an element of control of social groups. In the post-structuralist school of thought as Foucault’s, which discards the binary categories of man/ woman, tradition/ progress and so on, society considers women as embodiment of social objects that are subject to the ‘male gaze’ that is an instrument for subordination by creating binary attitudes of good and bad in order to wield power (Foucault, 2003, originally published in 1977). The modernist faith in science is ingrained in the masculine characteristics of rationalism and reasoning. In patriarchy that has evolved simultaneously, the history of medicine therefore essentially entails a subordination of women. In the Foucaultian scheme, the doctor replaced superstition and witchcraft as the all-knowing physician. Men were considered as those in power, based on knowledge, to control, order and regulate diseases. Through the clinical gaze of the doctor, essentially male in the 18th century when the clinic was born, the body became the object of analysis and treatment. Pregnancy and childbirth shifted from the domain of the midwife to the clinic with continuous observation and intervention by the doctor. Even in the modern times, disparities in health and the requirement of medical treatment between men and women stem from biological and physiological differences that in turn depend on different life courses and social status (Thomas, 2003). Typically, men hold positions of power even in democracies. Only 14 percent of the countries have achieved 30 percent representation of women in the parliament, as set out in the Beijing Declaration on Women in 1995. Women have less access to and control of economic powers, rewarded for less remuneration than men for the same work, treated differently in global trade. Women receive less education than men; have to walk long distances to collect drinking water in poorer countries, thereby falling vulnerable to violence; sexual and reproductive health problems result in illness and disability to women; more number of women being victims of HIV/AIDS because of restrictions on women being able to practice safe sex and having access to HIV testing and care services; women become victims of gender-based violence and cultural taboos. On the whole, the mainstreaming of gender has generally failed because the approach towards ‘integrating’ women in the society does not challenge existing power equations. Women have continued to be offered stereotyped jobs, not receiving equal training and education and insufficient resources for women’s mainstreaming (Dhawan, n.d). Worldwide, women are facing the brunt of longer working hours, impoverishment, economic insecurity and forced migration and urbanization. According to the conflict theory of sociology, differences in health among groups of population can be explained through the socio-economic differences, that is differences in income, social stratification, access to social capital, social connectedness, gender and other such social parameters (Philips, 2005). Income inequalities between different groups of people, including women, are found to result in differences in life expectancy and mortality rates (Fiscella & Franks, 1997). The relationship between income inequality and mortality rate is found in differences in investment of social capital, that is, investments in social trusts and membership of voluntary groups for health matters (Kawachi et al, 1997). As a corollary, interventions strategies to improve community health needs to be targeted towards the social parameters. Treatment approaches then focus towards building the “social capital” rather than “individual treatment”. Hence, the political environment that ‘sensitises” the social divide and income inequalities are more important than individual causal model (Lomas, 1999). In all these theories, therefore, there is an emphasis of public health policies towards the marginalized sections of the society. After the World War II, the United Nations recognized women’s health as an important issue for economic development and the Commission of the Status on Women was established in 1946. Through the 1970s and 1980s, after the declaration of 1975 as the year of the woman, greater focus was made towards women’s reproductive health targeting safe motherhood, family planning, child survival and nutrition programs (Pradhan, 2003). However, the concern for women’s health was limited to only reproductive health and very little attention was paid towards non-child bearing women, indicating that the woman remained subordinated to men except with respect to their role in procreation. Only in 1985 was it recognized that “women are not homogeneous” and the problems of women were to be looked at in the wider aspect of gender relations. Yet, even in the Beijing Declaration on gender relations in 1995 found that women’s health issues had not been addressed adequately. In the current thought on gender relations, women’s health is a broader aspect with the motherhood role as only one of the roles for women. In many countries, particularly in the Asia Pacific and south Asia, it has been realized that women’s health is related to the socioeconomic conditions and cannot be improved unless that latter transforms to a more equitable ratio. Since a woman requires to be recognized as a complete human being, and not simply with a role in reproduction, women’s physical, mental and social health needs to be looked at from the women’s perspective rather than that of men. With globalization, the traditional economic relationships, including gender relationships, are crumbling down, resulting in severe strain on women’s health. The classical patriarchy, dependent on the male property ownership and family headship notion, had given rise to the urban “fordist gender regime” – male bread earner/ female house maker - in the western world in the 1950s and 1960s, are being duplicated in some parts of the developing world. Economic development and increased competition has meant that the male salary earnings are not sufficient for the increasing consumption patterns. Brenner (2003) notes that incorporation of women in the workforce and their increased access to education and literacy has brought feminism in the forefront of organized politics (cited in Dhawan, p2). At the same time, marginalized women are becoming even more vulnerable to global capital reorganization. Worldwide, women are facing the brunt of longer working hours, impoverishment, economic insecurity and forced migration and urbanization. Working class women find themselves in the crossroad of development and reactionary policy and continue to remain, if not become increasingly so, victims of fundamentalism, economic insecurity and a complex web of power relations that have disastrous effects on their health (Kaplan, 1999, cited in Dhawan, p3). The emerging capitalist structures of many of these societies have eroded the protection that women used to have earlier. Women in the Third World are at the crosshead of two powerful forces: one, the nationalist agenda that is inherently masculine in which women are expected to follow traditional roles while the men are free to participate in the political arena, and two, global capital, which forces women to participate in the economic field, overpowering the nationalist agenda (Mohanty, 1999, cited in Dhawan, p4). Gender bias in health is evident though higher mortality rates among women in many countries in North Africa and Asia despite the increasing number of women in the workforce in these countries. Sex selection abortions have become common particularly in Asia where natality inequality for the girl child is excessively high. There have been studies that show that girls and women are more malnourished compared to boys and men leading to higher mortality in the former group. Women in developing and underdeveloped countries are also characterized by high incidence of maternal undernourishment, low birthweight and child undernourishment, particularly of girl children (Sen, 2001). In all countries, there are differences in the health of groups of population, especially in the urban areas. Not only does absolute poverty result in various public health problems, income inequalities and relative poverty aggravate many diseases, relative poverty, that is the perception of lower living standards vis-à-vis other social groups, which in turn affects physical health further (Ellaway, et al, 2004). Malnutrition, overcrowding, lack of hygienic sanitation and living near industrial premises have severe effects on the health of the urban poor. Women are particularly prone to work-related diseases and environmental hazards. Not only does lack of income and inhibit their access to proper medication, the subsistence income and casual nature of jobs do not allow them to take leave from work even when they are ill (World Bank). In the medical profession, treatment of women has been seen through the masculine eyes. While the male body and male diseases are seen as the normative, women’s bodies are seen as a special realm that requires specialist knowledge with particular emphasis on the women’s reproductive tracts as something “other” in the medical profession. At the same time, many physicians consider female caregivers as subordinate to the rest of the profession. In the earlier days, even common diseases like epilepsy, nervous and physiological problems of women were treated y gynaecologists. Even though medical treatment has progresses much since then, there is a great divide between medical treatment available to men and women. There is a larger proportion of women who go without screening, detection and diagnosis of many diseases. Treatment programs for alcoholics are generally geared towards the male patients while the men often get the therapy of choice in case of AIDS treatment (Thomas, 2003). Treatment of mental health of women has historically been even more misogynist than physical health treatment. In the early 20th century, most psychiatrists were men who typically thought women to be mentally fragile and typically suffering from hysteria, vapours or excessively subordinated sexually by their husbands. According to some feminists, the misogynist psychiatrist attitude persists even today. In addition, the masculine characteristics of rationality, competitiveness and creativity are taken to be the normative for mental health while female characteristics comprise of passivity, conformity and lower motivation for achievement (Scambler, 2003). Another key factor that is assumed to determine women’s health is the emphasis on the body from childhood that leads to several types of illnesses in adult life, like eating disorders. Women’s control over the bodies regarding childbirth has been a much debated issue. This has further aggravated with the transformation of childbirth as a natural part of lifecycle to some sort of an event with medical control and surveillance at the hospital and so on. As the woman conceives and becomes a ‘patient’ of the GP, the entire process thereafter is a technological event with tests, scans and various other medical interventions (Scambler, 2003). The entire capitalist system of healthcare has developed as a patriarchal system. The obstetrician and gynecologist see the woman’s body as something that can be profited from. Capitalist healthcare therefore is based on the exploitation of the woman’s body. Most research on women carers and recipients of treatment have found that the forces of capitalism and patriarchy work together to insubordinate women. Medicine supports capitalism by offering the body as a means of profit while patriarchy defines women’s health as a reproductive and women’s chores tool. Taken together, these two forces undermine the woman’s body. As the social positioning of the woman is defined in terms of family roles, sexuality, childbearing and so on, women’s bodies are offered up for intervention in terms of high-technology high-profit procedures. Thus, from the 17th century onwards, that is from the modernist to the post-modern world of today, women’s health and treatment has been viewed from the eyes of patriarchy and insubordination. In the developed world, the woman’s body is looked at as an object of profit, whether in terms of reproductive health, childbirth, eating disorders or attitude towards beauty, which offers the capitalist healthcare system an avenue for reaping profits. In the developing world, women’s health and healthcare is linked with the social inequalities that result in malnutrition, job and stress related diseases and inadequate access to medical care. Works Cited Foucault, Michel, Birth of the Clinic, Routeldge, 2003 Foucault, Michel, The History of Sexuality, translated by R. Hurley, Penguin Books, 1978 Dhawan, Nikita, “Transnational Feminist Alliances and Gender Justice”, Second Critical Studies Conference, “Sphere of Justice”: Feminist Perspectives on Justice, http://www.mcrg.ac.in/Spheres/Nikita.pdf Fiscella, K and P Franks, British Medical Journal, 1997, Jun 14;314(7096):1724-7 Kawachi, I et al., Social capital, income inequality and mortality American Journal of Public Health, 1997 Sep; 87(9):1491-8 Lomas, Jonathan, Social capital and health: Implications for public health and epidemiology, Social Science and Medicine, Volume 47 Issue 9, November 1998 Sen, Amartya, Many Faces of Gender Inequality, Frontline, Vol 18, Issue 22, Oct 27- Nov 9, 2001, http://www.hinduonnet.com/fline/fl1822/18220040.htm Pradhan, A, Women, Health Policy and Development, Kathmandu University Medical Journal, 2003, Vol 1, No 4, http://kumj.com.np/ftp/issue/4/294.pdf World Bank, Urban Poverty: What are the Policy Issues? Social Protection and Social Services, http://www.worldbank.org/html/fpd/urban/poverty/social.html Kaplan, Caren, et al, ed. (1999). Between Women and Nation: Nationalism, Transnational Feminism, and the State, Durham, NC, Duke University Press Thomas, Richard K, Society and Health: Sociology for Health Professionals, Springer, 2003 Scambler, Graham, Sociology as Applied to Medicine, Elsevier Health Services, 2003 Annadele, Ellen, The Sociology of Health and Medicine: A Critical Introduction, Wiley.com, 2003 Read More