In my women’s health course, we were asked to write informal and non-academic ‘think’ papers based on our readings and discussions on the subject. Its a great exercise where one gets to rant, vent out and not care about maintaining adcademic decorum. I chose to begin with the basics, and ponder over the question of ‘what is women’s health’. Here’s what I wrote and links to the articles that formed the basis of it:
What is women’s health? A simple, yet profoundly complex question.
Simple, if indicators, statistics, models, approaches, frameworks and methods of looking at this question are already pre-defined, standardized, tested, modified and accepted. Even though these themselves may not be simple enough, yet they simplify the question. Because through them, you can understand the question in only a particular way and thus arrive at only particular answer/s. The boundary is set into which this question is to be confined, and answered. Therefore, simple.
Complex, if we break these boundaries and start to really question the question itself. Who is asking this question? From what standpoint and why? What do they mean by ‘women’? What is their understanding of ‘health’? Even here, there would be some norms, for norms are everywhere, explicit or implicit. But, perhaps the acknowledgement of the complexity of the question, and the potential in the process of questioning the question may help challenge, if not annihilate, the dominant norms of defining what women’s health means. Such an approach may help accommodate the multiplicities, the conflicts, the unease, and indeed, the similarities that answers to this question may encompass. Finally, such an approach would underscore that there is no ‘final truth’ to the answer of this question, for the truth is constantly co-constituted with diverse forces that act upon/through/along with it. Therefore, ‘what is women’s health’ is a complex and discursive question, which more than anything else, should compel one to think, churn, reflect and raise more questions than simply finding ‘valid’ answers.
Inhorn’s paper flags off this process of questioning. She writes as if she is also reflecting on the question, uninhibited and unapologetic. She doesn’t mince words when she critiques the biomedical and public health establishment for having defined women’s health for/on behalf of women, rather than women defining it themselves. Her politics is evident in everything that she writes, and she beautifully blends that politics with rich academic scholarship on the subject, exhibiting a writing style that teaches much more than what the content is expected to convey.
Apart from very important points that she makes about reproductive essentialization of women’s bodies, medicialization of women’s lives, politics of women’s health, women’s local moral worlds etc., one of the key take-aways for me is this: even though many of the authors of the listed ethnographies are clearly influenced by feminist frameworks, they remain reluctant to introduce the polemics of feminism for the fear of losing academic “neutrality” or being critiqued for doing so otherwise. She herself was targeted for her book ‘Infertility and Patriarchy’. One critic attacked her for “packaging her excellent analysis within an envelope of predictable and tedious feminism, full of ‘gendered’ this and ‘patriarchal’ that”. The critic, clearly wanted her to separate her feminism from her academic analysis, as if the analyses, thoughts, ideas or research in general, exist outside ideologies/value positions/belief systems. The fact that the critic didn’t want her to explicitly associate her ideologies with her work was itself a value position, however implicit.
But what is even more important to note here is Inhorn’s response to this: she urges more and more authors and researchers to place patriarchy centrally in their frameworks and writings on women’s health. She asks us to come out with more scholarship on women’s health where discussions on patriarchy are framed around the empirical realities, and to also theorize, not just describe the lived experiences, of patriarchy’s health demoting effects.
That patriarchy is the primary lens of thinking about gender-based oppression is undeniable. It permeates into almost all spaces-personal, political, professional, and beyond. But, no longer can it be thought of only as ‘male domination, oppression and exploitation of women’ (Walby, 1990). While this is useful for initial understanding, it is also narrow in its scope in explaining complexity of notion of patriarchy. Patriarchy is a systemic and structural problem: the state can is patriarchal, Brahminical society is patriarchal, the family is patriarchal and even women are patriarchal themselves when they oppress women in lower positions than themselves or persons of marginalized genders. Central to all this is the question of power, without which we cannot understand patriarchy.
How does one see patriarchy in one’s immediate context, in this case as a new student of public health? It can be seen everywhere: From the texts we read to the shared spaces we call our classrooms, to the health settings we study/observe. A doctor is always a he, and the patient he treats is always a male. “India’s health services system suffers from shortage of MANpower”. “Epidemiology is the study of disease pattern in MAN”.
At such moments, ‘public’ seems like a misnomer. If it was only the matter of problematic/sexist language, then one could still (unwillingly) manage, although as Kriger argues, “language embodies ‘important social and historical processes”. But, its not just a “word here or there” or “slip of the tongue”. It’s a discourse that reflects and is shaped by patriarchy where women’s as well as marginalised genders presence, experience, labour and voices are negated or invisiblized in the name of ‘universal’ pronouns, examples, narratives, references. Furthermore, the marginalisation of non-binary genders, sexual minorities, differently abled persons in the discussions as well as in the reading lists/texts/papers/journals is too glaring to be ignored.
Krieger too talks about this in her paper. She problematizes the fact that till 1970s, the term gender was conspicuously absent from the textbooks of public health. And today, there continues to be a confusion to whether to use sex and gender interchangeably or as distinct constructs. In particular, epidemiological and health research has been challenged by lack of conceptual clarity. Krieger’s solution to this problem is that we are both- a gendered person and a sexed organism, simultaneously. It is this different permutations and combinations of gendered relations and sex-linked biology and their synergies that determine health of an individual.
But there are more things, beyond the gender-relations and sex-linked biology, that determine women’s health, urges Doyal, and for that one needs to step outside of the ‘body’ to understand how women’s lives make them sick. In a classic political economy text, Doyal is able to weave together rich analysis of women’s oppression and role of public health in both its continuation as well as its potential in challenging it. Quoting Rubin, who writes these words as if she is writing poetry: “Female subordination has both endless variety and monotonous similarity”, Doyal argues that not all women are always worse off than all men, but in most societies, women are structurally unequal than men. This where is she rejects crude universalism as well as crude difference theories, and urges us to focus on women’s ‘common difference’.
My another favourite message from Doyal is this: “If biological finality of death can only be explained in a wider social context then the complex realities of women’s sickness and health must be explored in similar ways. In order to do this, traditional epidemiological methods have to be turned on their head.”
Tuning traditional and mainstream epidemiology on its head has been the main theme of the brilliant paper by Inhorn and Whittle where they expose the antifeminist bias in the in contemporary epidemiological research, explore the possibilities within the emerging “new” epidemiologies to incorporate an alternative feminist framework, and finally propose what they call the feminist epidemiology. Such an epidemiology would be a resistance to the marginalization as well as narrow definition of women’s health concerning only reproduction/reproductive pathology. Courageous and unapologetic, the women authors challenge the hegemonic epidemiology establishment in the US and openly name the international and highly regarded journals such as the American Journal of Epidemiology, Journal of Epidemiology and Community Health, Epidemiology, International Journal of Epidemiology, etc., for not correcting, and even perpetuating, antifeminist bias. This is a highly rare instance, hardly ever done by academics who are too conscious of their publications, promotions and prestige to risk it for politics. Writing like this is a radical act in itself, something that speaks truth to the power.
Inhorn and Whittle leave an important trail for us to discover and embark upon when they talk about the contours of a feminist epidemiology they envision. It is as if they are telling the young researchers like us where to pick up the threads from and how to weave our own journeys of research, action, politics and academics while upholding the commitment to feminist politics in intersecting spaces of personal, political, professional and beyond.
Such an epidemiology, they posit, would have no ‘universal category’ of ‘women’ in its framework. Drawing from works of black feminists and third world feminists, as also Dalit feminist stand point, such a postulation would acknowledge that even the biological similarities that are there among women are experienced differently depending upon their locations and identities.
It would have a new episteme, a new theory and a new methodology that empower women to take part in knowledge production, where they themselves talk about their lives or are being emphatically listened to instead of being talked about or on behalf of; that documents their health and diseases in their entirety; that places gender oppression in the centre of analysis of women’s health; that links their local experiences with geo-political forces.
Such a framework would require us, the students, the researchers, the teachers, academics, activists, epidemiologists, policy makers, development workers- to be critical of our privileges and positions in the spaces we are part of. It would require us to see how we and our work are implicated in perpetuating hierarchies and structures of domination, and it would require us to challenge them, break them and/or replace them with new and alternative spaces.
Finally, with the question we began this paper with, such a framework of an emancipatory feminist epidemiology or public health broadly, would necessitate radically questioning and critical rethinking about ‘what is women’s health’.
PS- Apologies for not being to upload Doyal’s book here. I had read the hard copy of it and I am not able to find it online.