How Feminism Affects Women’s Health
Early feminists were able to use the embodied experience of health and illness as a vehicle to trouble the dualisms that sustained patriarchal power. This placed mind and body in contiguity and held out the potential for an embodied health activism. The current article picks up these concerns as they were developed by feminists and others from around the mid-twentieth century through to the late 1970s and early 1980s. The Second World War popularly is thought to have brought new opportunities for women with respect to employment and personal independence, including sexual freedom and greater bodily autonomy, although in effect this was only for a minority and was in any case short-lived (Caine 1997). Ideas of ‘natural femininity’ were to reassert themselves with a vengeance in the post-war period. The natural/social distinction that early feminists rallied against reached its twentieth-century height around this time. The marked tendency for the expanding discipline of sociology to absorb, rather than to challenge, this bi-polar social script motivated feminist sociologists and fellow travellers to craft a distinction between biological sex and social gender. A productive tension arose as sociological explanations for women’s health were drawn towards the social and the wider body politic, while those of feminist health activists were equally, if not more, concerned with the individual experience of the reproductive or biological body.
The Bi-Polar Social Script
‘Industrial capitalism’ relied upon a relatively fixed and seemingly natural binary difference between man (employment-oriented, producer) and woman (home-based, consumer) (Bradley 2007; Fuat Firat 1994; Hennessy 2000). As Donald Lowe puts it, ‘only in such a context does it make sense to see gender as a social script built upon bi-polar difference’ (1995: 139). The gender ideologies of any period are always ‘in the making’ and, consequently, they are fissured, contested and open to oppositional formulations (Jordanova 1999; Poovey 1988), not least because of local variability. The early decades of twentieth-century America, for example, saw not only the emergence of the ‘professional housewife’ but also the liberated flapper who so concerned Charlotte Perkins Gilmanton. It therefore would be wrong to portray the bipolar social script as hegemonic in form. This said, reflecting on her own experience of growing up in 1940s and 1950s England, Harriet Bradley remarks on how ‘completely unchallenged and taken for granted [the] bi-polar world of the sexes seemed’ (2007: 16–17). And, as Elizabeth Roberts discusses generally for the family lives of working-class women in the north of England between the 1940s and the 1970s, ‘however much attitudes changed, changes in an institution as fundamental as the family were slow-moving’ (1995: 18). Thus as Roberts remarks, it is one of the ironies of history that domestic ideology reached full flowering just at the time when women’s employment was being widely campaigned for. Evidently transformations in wider social attitudes often run ahead of changes in the actual lives of the majority and the influence of established ideologies remains strong. Women’s magazines, for example, continued to endorse the over-riding importance of marriage and the family during this period despite women’s growing labour force participation (Ferguson 1983). The trend towards almost universal marriage that began in the 1920s lasted well into the 1970s. Post-war Britons, for instance, broke all records as marriage rates doubled for men and almost trebled for women aged in their twenties between the 1940s and 1970s (Coleman 2000). Thus the male bread-winner model remained culturally strong well into the 1970s (Davidoff 1995; Tong 2007; Zweiniger-Bargielowska 2001a). Consumerism was a vital instrument of women’s domestication as the production of mass commodities transformed the ‘home-maker from a home producer of goods to a purchaser of commodities’ (Bradley 2007; Matthaei 1982: 164; Pumphrey 1987). Even though they were presumed to be natural experts when it came to consuming for the domestic realm and for themselves, women’s instinctive desire was not left alone; it still needed to be directed towards the assortment of new goods on offer, which ranged over the decades from electric irons, washing machines and cleaning products, to ‘as seen on TV’ gadgets (Clarke 2000; Roberts 1995).
For example, the British Ideal Home Exhibitions did not simply showcase goods; they educated women in homemaking with demonstrations and advice in the new science and vocation of the domestic (Ryan 2000). The exhibitions, the first in 1908 (and, interestingly, subject to suffragette protest), ‘presented a vision of stable femininity and peaceful domesticity’ (ibid.: 10). For example, an advertisement in the Daily Mail newspaper (which sponsors the exhibitions to this day) implied that the vision of the ideal wife–ideal home life set before young men was so dazzling that they could be moved to propose to their girlfriends (ibid.). The implication no doubt was that an ideal home and a husband in one fell swoop was just too much for most women to resist. It was within this context that feminist research on health began to take shape. Its resulting form grew out of the tensions and breakthroughs in its relationship with mainstream sociology and with activist feminism. As recently as the late 1960s, ‘neither the topic of women, nor the existence of women as sociologists were apparent’ (Delamont 2003: 16). Barbara Laslett and Barrie Thorne (1997) draw on Dorothy Smith’s (1974) notion of a ‘bifurcated consciousness’ to depict the experiences of women who entered sociology in the late 1960s and early 1970s: on the one hand, they were committed to their discipline; on the other, they were patently aware that there was a yawning gap between their experiences as women and the frameworks that sociology provided to explain them. Change, of course, did not come at all easy (see, for example, Banks 1999; Deem 1996; Evans 2003; Oakley 1974a). One of the most pressing problems was the uncritical reproduction of the bi-polar social script within the discipline. The legacy of Comte, Durkheim and others was taken forward into empirical sociology during the 1960s and 1970s and beyond, most notably in research on the family, the very domain that was high in the consciousness of the new generation of women sociologists. For example, in his exegesis, William Goode was aware that very little of the ‘sexual division of labour’ is required by ‘the biological peculiarities of the two sexes’ and that, more often than not, it is at heart unequal, given that male tasks, whatever they may be, are ‘defined as more honorific’ (1964: 70). But it seemed that there was little that could be done about this, since it was what society in general, and the family in particular, demanded. It was in response to this ascription that Ann Oakley and others declared the division of labour by sex to be a myth, imported into sociology from without. Oakley observed that, if the function of myth generally is to maintain the status quo, then ‘the sociologist overtly declares this to be part of “his” theoretical enterprise’ (Oakley 1974b: 178). Ostensibly value-free, ‘the sociological argument translates as, the oppression of women is convenient, whilst their liberation would be inconvenient: a disruptive and destructive force’ (ibid.: 182–3). Thus sociology ends up confirming that women’s unpaid labour as child-bearers, housewives and the servants of men is essential to the smooth running of society.
As Betty Freidan put it, ‘at a time of great change for women, at a time when education, science and social science should have helped women bridge the change, functionalism transformed “what is”, or “what was”, to “what should be”’ (1963: 120). The host of responsibilities heaped upon women included liability for how children turn out. Mothering became increasingly exacting work at this time as influential theories such as that of John Bowlby (1951) drew attention to the perceived ill-effects of ‘maternal deprivation’ in early childhood (Thane 1994). Goode (1964) not only placed the socialisation of children but also their achievements in life squarely on their mother’s shoulders, debating, for example, on the effect of women ‘going out to work’. The replication of wider gender ideology in terms of the pecking order in the family is more than apparent in his use of language: marriage is defined in terms of the husband and his wife (not husband and wife, and certainly not the wife and her husband). The strong fit between the structural functionalist orthodoxy and male domination of the sociological agenda not only kept critical reflection on ‘gender divisions’ out of the frame, but also related topics of interest to women. Thus, Oakley (1974a) struggled to get her research on housework taken seriously. Stevi Jackson recounts that, when as a postgraduate she expressed an interest in the study of sexuality, ‘most established academics responded either with incomprehension or with ribald and sexist innuendo’ (1999: 8).1 The reasons why health and illness were not on the sociological agenda are easy to discern. Parsons and others had simply carried forward what had gone before. The neglect of health and the body did not simply flow from philosophical dualism but from the related flight from all that was female-defined. Since women were equated with an unruly and defective body – that is, with illness – to have drawn health and illness into the sociological fold would have risked casting it in decidedly feminine or female terms. To put it simplistically, if men could transcend biology – something that was very important to the sociology of the time – women could not. As Olive Banks reflected, the reproductive or biological determinism in the theories of Parsons and others ‘ruled out any possibility of change favourable to women’ (1999: 406). It therefore made perfect sense for feminists to counter with two claims: first, that women are no more (or less) determined by their biology than are men; and, second, that the image of women’s biology that patriarchy presents to the world is grossly misconstrued. From these two claims it was possible to deduce that women’s oppression is socially caused, rather than biologically given. The basis for this argument was the powerful distinction between sex (biology) and gender (social).
Sex and Gender
Although the potential of the sex/gender distinction to illuminate the harms to women’s bodies and their health shines out when looking back, it was far from easy for the new generation of female sociologists to bring it to light at the time. The women’s movement was drawing increasingly vocal attention to women’s health-related oppression, but this filtered relatively slowly into academia. Health lagged behind other topics of greater interest to the new generation of feminist sociologists such as work and industry, social stratification, and the family (although some of this did have health implications). The newly developing area of medical sociology, in its turn, was slow to take an interest in gender and, when it did, was often more concerned with using women’s experience of ill health or of health care as a resource to explore broader sociological issues and with re-working existing frameworks to accommodate women than with developing new frameworks that would speak for them.
The Women’s Health Movement
The distinction between feminist activists and feminist academics is somewhat artificial since, from the start, activists published in academic collections and many academic feminists were either personally engaged in the women’s movement or they envisaged that their research would have a direct influence upon it. Nonetheless, in its early development, the women’s movement ‘remained fundamentally political and insulated from scholarly focus’ (Olesen and Lewin 1985: 9). Writing about her first encounter with feminism through political resistance to the Vietnam War and the founding of ‘Bread and Roses’ (a socialist-feminist women’s group on the US East Coast), Barrie Thorne (1997) explains that those who entered the field of sociology and the women’s liberation movement more or less in tandem found that, while the two worlds sometimes met with thrilling resonance, they also collided. Although women’s testimonies bear witness to unprecedented and exhilarating change for the better in many women’s lives, the women’s movement defies easy description, particularly with respect to its origins. In the thick of it, Germaine Greer (1971) wrote that we can only speculate as to its causes. It is clear in retrospect that the term ‘women’s movement’ gives deceptive coherence to a movement that was diverse and changing. It was collective, in the sense that all women to varying degrees bore witness to at least the promise of sweeping social and political change, but it was also highly piecemeal, existing in the scores of local activist groups and networks that sprang up in response to a jigsaw of specific concerns, such as women’s health. This amoebic quality and the ‘infinite variety of groups, strategies and organisations’ involved (Freeman 1973: 795) posed difficulties for feminist sociologists of the time as they sought to understand its likely future. Thus, writing in the American Journal of Sociology, Jo Freeman (1973) referred to the lack of regard for wider institutional change in the thousands of virtually independent ‘sister chapters’ around the US – many based around friendship groups and fairly homogenous in terms of social class, age, and ethnicity – which were mainly concerned with personal change using instruments such as the consciousness-raising group. Broadly speaking, the women’s movement was influenced by the radical politics of the US civil rights movement and Left politics (in Britain and elsewhere in Europe) (Carden 1974; Freeman 1973; Rowbotham 1972, 2000).
The civil rights movement sent the clear message that ‘if collective action could destroy racial segregation, which was based on the belief in white superiority, why couldn’t women challenge ideas about female inferiority?’ (Rosen 2000: 59). In Britain, equal pay strikes of the 1960s and the ‘wages for housework’ campaign highlighted class issues and the relationship between the women’s movement and the political left. The idea of wages for housework, which was highly debated within the women’s movement, threw the link between socialism and feminism into particular relief. The argument went that, if housework is economically important insofar as it involves the production and reproduction of commodities for capitalism; that is, the maintenance of husbands and children, as well as the woman herself for the workforce, then it generates surplus value and women deserve a wage (see Dalla Costa and James 1995 ; Gardiner 1976; Malos 1995). However, for most women, the new world that beckoned, such as the unprecedented new freedoms in employment and in the control of fertility, stopped resolutely at their kitchen or bedroom door. Betty Freidan’s The Feminist Mystique (1963) in the US and Hannah Gavron’s The Captive Wife (1966) in Britain awakened feminist concerns about women’s homemaker roles that had been slumbering since at least the 1940s. As noted earlier, there was a large gap between the fetishised femininity of post-war domesticity (Coote and Campbell 1987) and its hidden exploitation, which was alive and well in most women’s own homes, and the wider cultural and political discontent that Greer (1971) and others exhorted women to prize. It was this gap that was to provoke the eponymous slogan: ‘the personal is political’.As Sandra Morgen makes clear in her history of the women’s health movement in the US, even though it was ‘always hewed to its local beginnings’, personal involvement and the knowledge that there were others who were equally engaged, generated the strong feeling that the movement was palpable, embodied, real (Morgen 2002: 11). ‘Members of women’s health organisations believed that they were responding to, as well as nourishing, an inexorable force’ (ibid.: 40). To give some sense of the scope and reach of the movement, it is estimated that, by the early 1970s, there were at least 1,000 organisations engaged in some form of women’s health activism and over 150 free clinics providing a range of services, such as pregnancy testing, abortion (or abortion referrals), gynaecological services and contraception in the US (Morgen 2002; Ruzek 1978). The wealth of experiential data that poured forth highlighted two crucial things: the negative consequences of male medical control of the female body and the ability of women to seize this control in their own interests. Forty or so years on, it can be difficult to appreciate the radical nature of this realisation. Yet even a cursory glance at the literature of the time makes it abundantly clear. The archives of the influential Boston Women’s Health Book Collective, for example, provide compelling evidence of the ‘life changing effect’ for women of finding out about their bodies and their needs.
Formed in 1969 in Massachusetts, the Collective grew out of a Boston workshop on ‘women and their bodies’. As they shared their experiences, many for the very first time, the women began to appreciate that their anger and frustration towards specific doctors and towards the ‘medical maze’ in general, was shared. These ‘doctor stories’ were the springboard for a series of local courses on women’s health. The recognition that ‘body education’ was liberation prompted the founders to write Our Bodies, Ourselves (1978), which went on to become a worldwide best selling book, translated and adapted into twenty languages (Davis 2002a). First published commercially in 1973 and currently in its eleventh edition, the book is widely credited with ‘changing the landscape of women’s healthcare in the United States and around the world’ (Morgen 2002: 5; see also Davis 2002a; 2007b). Towards the end of the 1970s, Claudia Dreifus explicitly used the term ‘health feminism’, which she defined as a movement of women ‘including housewives, mothers, students, lesbians, socialists, herbalists’, all united in ‘their common femaleness, their distrust of organised medicine’ (1978: xxv). The angry responses that practices such as showing women how to use a speculum for vaginal self-examination provoked from established medicine were witnessed in doctors’ surgeries across the US, as well as publicly. In 1972, activist Carol Downer was arrested, went to trial, and was later acquitted, for practising medicine without a licence. The catalyst was the observation by an undercover policewoman of her use of yoghurt to treat a woman’s vaginal yeast infection at an evening meeting of the Los Angeles Feminist Health Centre. Columnist Barbara Seaman’s (1995 ) exposé of the health risks posed by the oral contraceptive pill shook the US medical establishment and led, in 1970, to the Senate hearings that eventually mandated the inclusion of health warnings on all prescription drugs, and helped to establish the principle of informed consent. In Britain, access free of charge and the iconic status of the National Health Service, ‘which symbolised the vision of a collectivist society’, meant that most feminists took it for granted that they should seek to transform the system from within (Doyal 2006: 151; Pringle 1998). A network of community well woman clinics were set up during the late 1970s and early 1980s and the Workers’ Educational Association played (and continues to play) a key role in promoting women’s health education (Black and Ong 1986). The wider link between the women’s movement and health activism in Britain is evident in a range of publications from the 1970s. For example, Spare Rib. A Women’s Liberation Magazine, carried a range of articles that, like the Boston Women’s Health Book Collective, showed women how to ‘bring knowledge of their bodies back to themselves’. Two collections of articles: The Spare Rib Reader (Rowe 1982), covering the period 1972–78, and Women’s Health. A Spare Rib Reader (O’Sullivan 1987), covering 1970 to around the mid-1980s, address topics as wide ranging as menstruation, abortion, breast cancer, radical midwifery, toxic shock syndrome, 111 mental ill health and health hazards at work.
The body/body politic problem
Grass roots health activism provided the essential evidence for what feminists had been arguing for centuries; that women’s malaise was socially produced rather than rooted in their inferior biology. It is instructive to note that in the US, Carol Downer’s first public cervical self-examination is generally seen as the event that, more than any other, transformed health and body issues into a separate movement (Morgen 2002; Ruzek 1978). This is highly symbolic of the wider focus of the movement on the reproductive body or, more accurately, aspects of the reproductive body. And herein lay some dangers. As Lynda Birke puts it, ‘women have long been subject to medical ideologies that construct us as little more than wombs on legs, which a feminist focus on reproduction does not always challenge’ (1999: 12). Susan Reverby remarks that, even at the time, ‘I never thought looking through a plastic speculum was a way to see power’ (Bell and Reverby 2005: 436). She worried that, no matter how much she spoke about the bigger picture, women ‘seemed only to focus on their own bodies’ (ibid.: 436). Equally, Ellen Frankfort (1972) pointed out that, important though they were, doctors, hospitals and drug companies were not going to be affected by having small groups of women learning how to examine their cervixes or how to extract their menstrual periods. She wanted women to organise around the institutions where the power lay. Susan Bell and Susan Reverby encapsulate this as the body/body politic problem: how to connect individual body concerns with the wider structures of oppression. They draw parallels with today’s Vagina Monologues (Ensler 2001). While recognising the individual transformative potential of the play, they worry whether it ‘re-instates women’s problems in our bodies, indeed in our vaginas alone’ (Bell and Reverby 2005: 438). In the 1970s, as now, the focus on individual experience or ‘self-help’ in relation to the ‘sexual organs’ has a troubling resemblance to the medical focus on women’s distinctive ‘body parts’. As Susan Bell discusses with respect to her contribution to the 1984 revision of Our Bodies, Ourselves, by repeating the ‘standard logic and terms presented in leading medical texts’ about matters such as menstruation, the book tended unwittingly to conform to medical images of women’s bodies at the same time as it tried to challenge them (Bell 1994: 12). As well as fixing fragmented medical imagery in women’s imagination in the manner later described by Emily Martin (1987), rather ironically, this ‘looking inside’ part paved the way for women’s general acceptance of the technologisation of birth, such as ultrasound imaging (Kuhlmann forthcoming). Let’s say ‘ironically’ because, the medicalisation of birth became an abiding concern. To sum up the argument so far, the women’s health movement was one part in a constellation of factors – although possibly the guiding star – that shaped how the sex/gender distinction came to be used in the study of women’s health. As we have seen, the body/body politic problem (Bell and Reverby 2005) encapsulated the tensions between activism, which stressed the personal (as political), and the sociological will to analyse wider social oppression or the body politic. The sex/gender distinction as articulated by Oakley (1972) and others had drawn academic feminism towards the social and pulled it away from the biological. Yet, with its focus on the distinctive female reproductive body, it seemed to be the biological that mattered to much of the women’s health movement, albeit with a vital twist since women’s liberation lay in a positive revaluing of women’s biological bodies. This focus was also at variance with the dominant academic agenda where, in the early development of the sociology of gender and medical sociology, it was the social (not the biological) that mattered most.
Gender, the Social and Medical Sociology
Medical sociologists shared a common disciplinary project with feminists generally, which was to distinguish the biological from the social, which dovetailed – at least in theory – with the sex/gender problematic. From the vantage of medical sociology, this involved differentiating its own ‘social’ approach to health and illness from the medical profession’s focus on the biological body. For example, in his landmark publication Profession of Medicine, Eliot Freidson (1970) proposed that illness could be thought of as a biological or physical state that exists independently of human knowledge and evaluation and also as a social state that is shaped by these self-same factors. Illness as a physical state, he argued, is the province of medicine, while health as a social state is the topic of the new discipline of medical sociology. By taking on this distinction, sociologists were carving out an intellectual domain all of their own (Strong 1979). The social imperialism and consequent disembodied approach that was to characterise medical sociology for some time was a legacy of the strong belief of the nineteenth-century ‘founding fathers’ that social interaction – the principal object of enquiry – could never be reduced to biology or physiology. The strong conceptual affinity between the new wave of post-Second World-War feminism and early medical sociology was coupled with a shared experience of exclusion. Much in the manner that feminism was rebuffed by ‘male stream’ academia, the sociology of health and illness traditionally has been undervalued by wider sociology. The lukewarm reception in sociology departments was related to the higher regard given to labour markets, social divisions and religion than to health and illness, which customarily was seen as applied (many of its practitioners worked in settings concerned with the training of health care providers, which remains the case today) and therefore of low status. No doubt its purportedly feminine or female subject matter – namely, the body and caring work – only added to this. But the experience of common problems is not bound to result in unity of purpose. Sara Delamont (2003) is right to note that the sociology of health and illness has been transformed by feminism, but the two academic fields are more appropriately described – historically and today – as parallel rather than integrated projects.
If we go back to the early days of medical sociology in the 1960s and 1970s, it is clear that, even though ‘women’s issues’ were gaining a foot-hold, the male stream agenda that dominated wider sociology had a firm grip. Oftentimes it was not women qua women than mattered to researchers; they were simply convenient respondents. For example, George Brown and his female collaborator Tirril Harris appear initially to have chosen to research women in their influential study, the Social Origins of Depression, more for practical reasons than for any commitment to the social oppression that provoked women’s much higher rates of mental ill health. They relate that since large-scale research can be financially prohibitive, ‘one way to reduce its costs was to study women only, as they probably suffer from depression more often than men’ (Brown and Harris 1978: 22). Moreover, women were ready subjects at the behest of these researchers. Thus, ‘we would need to approach only half as many women as men to obtain the same number with depressive disorders’ (ibid.: 22). ‘It also seemed likely’, they continue, ‘that women, who are more often at home during the day, would be more willing to agree to see us for several hours, the time we needed to collect our material’ (ibid.: 22). First, was the inclination to treat women’s experience as a topic to be ‘added in’ to the existing canon, that is, to fashion a ‘gender awareness’ rather than to overhaul existing theory to account fully for women’s health-related experience. Second, was the tendency to use women’s experience of health care primarily as a resource to explore broader sociological concerns. Third, was the propensity to use male experience as the benchmark or ‘gold standard’ for interpreting the experience of women. There were indications that sociology generally was becoming more ‘gender aware’ during the 1970s and early 1980s. This was evident in criticisms of existing approaches, such as the annotated bibliography of the British Sociological Association (BSA), Sociology Without Sexism (1977), as well as in the deliberations on the ‘state of the field’ and the discipline’s future. For example, in their introduction to a collection marking the thirtieth anniversary of the BSA, Philip Abrams and colleagues wrote that ‘the feminist intervention in sociology has been a particularly important one because it has been able to show how one-sided the theories and researches of many sociologists – both male and female – have been hitherto’ (1981: 3). Although positive in tone, the editors’ support is nonetheless circumscribed, since their agenda appears to extend only to making women ‘sociologically visible’ and to the ‘capacity of sociology informed by feminist thought to broaden the range of sociological concerns’ (ibid.: 9). Clearly this is not a sociology for women but a sociology informed by ‘women’s issues’.
Similarly, in Recent British Sociology, John Eldridge (1980) drew readers’ attention to the neglect of ‘gender differences’ in areas such as community studies and industrial sociology. He remarked that the discipline was at risk of becoming a ‘sociology of this and that’ – the sociology of industry, the sociology of sex and gender, and so on; that is, a sociology of sub-divisions. Despite this, Eldridge was optimistic that the ‘sociological imagination’, a term coined by C. Wright Mills (1975 ), offered a way forward.5 Yet, despite including an indicative bibliography on ‘sex, gender and generation’, Eldridge failed to extend his remarks about the lack of attention to women and gender to any sustained analysis of the state of the field. Rather his discussion was limited to pre-existing areas such as economic life, criminology, education and religion. Although North American and British medical sociology texts, collections and research articles from the 1970s contain a smattering of references to women and several reports of research on women’s health or health care, almost without exception here, too, it is women as a topic that interests authors, rather than a feminist interpretation of women’s experience. As might be expected, the tendency to use women’s experience of ill health or of health care as a resource to explore broader sociological concerns is most apparent in texts, chapters in edited collections and articles by male authors. For example, William Rosengren and Spencer DeVault were interested in how time and space ‘define, legitimate, sanction and handle expressions of pain’ in the obstetric hospital (1978: 202). They were squarely focused on how organisations structure social action and pay little or no attention to the hospital as a hierarchical organisation that attributes power to men, or to the problems that this might pose for women in childbirth. However, female authors were not immune to these problems either.