Rethinking Sex, Gender & Health
Research on women’s health has been shaped by the constellation of factors that orbit the powerful sex (biology)/gender (social) distinction. At this point it may be useful to sum up the main arguments that have been made in this respect so far. We have seen that in contexts where women’s biological bodies have been negatively defined which marks out most of history – the equation of men and the social, women and the biological has been a fundamental tool for the oppression of women. The sex/gender distinction was a powerful counter-framework and a veritable treasure trove for research on women’s health. But it harboured considerable problems that came to light as research progressed. One of these was a bifurcated agenda, with a tendency to focus on either the social or the biological. Another related problem is the focus on male/female difference. When sociological research on health was developing during the 1960s and 1970s, differences between male and female experience, or the bi-polar social script, were a palpable feature of society. It is not surprising that this prompted a search for the factors that differentiate male/female health status and their experience of health and health care. The current article focuses on the problems that this poses for the analysis of health.
Since ultimately their ‘biological sex’ is the only characteristic that all women can share – even though they do not necessarily do so – it has become an obdurate marker of distinction. In theory, ‘social gender’ is more open than biological sex – sex, it has been argued, is the constant, gender the variable – but in practice, feminists have tended to divide and distinguish men and women on social (gender) grounds as much as they have along (sex) biological lines. This has been apparent in research on the social determinants of health status. At the same time as it is taken as read that men and women are not intrinsically different – since gender, so it goes, is not tied to sex – assumptions typically have been made about which social factors are relevant for male experience and which for female experience, in advance of research. Research gets trapped in the ideological context of what it is trying to analyse (Carrigan et al. 1987) as difference is sought from the outset. Even when the same overall questions are posed about men’s and women’s health (and until quite recently conjoint research has been rare), results are often read through the lens of differences rather than similarities (Annandale 1998). Indeed difference has been so deep-seated that sometimes similarities do not get reported at all (Kandrack et al. 1991; Macintyre et al. 1996). Although she is not referring to health, Linda Nicholson argues that the physiological self is still viewed as ‘the “given” on which characteristics are “superimposed”; it provides the location for establishing where specific social influences are to go’ (1999). She dubs this the ‘coat rack’ view of self-identity: the biological body is viewed as a type of rack upon which different cultural artefacts, especially those of personality and behaviour, are placed. While this is not necessarily determinist, it does imply a biological foundationalism (Nicholson 1994).
The focus on difference is an understandable reaction to medical and social research, which has a long and ingrained history of making women invisible by privileging men (Rapp 2001). Women’s exclusion was justified historically on the grounds of protection. A raft of protectionist policies followed the Nuremberg Code of 1949, which outlined the basic moral, ethical and legal requirements of research with human subjects. A series of tragic incidents such as thalidomide and diethylstilboestrol (DES), alongside the exposure of unethical research practice such as the Tuskegee syphilis and Holmesburg prison experiments (Hornblum 1998; Jones 1981), spurred stringent regulations in the US Department of Health and Human Services (Wizemann and Pardue 2001). Although policy guidelines did not exclude specific populations, they did state that vulnerable subjects must not be exploited. Consequently, researchers became averse to including women in their studies given the risks to those who became pregnant and potentially vulnerable during drug-related research. Protectionist policy pertained until 1990, when a landmark Government Accounting Office (GAO) report to Congress documented the failure of the National Institutes of Health to implement the recommendations of the 1985 US Public Health Task Force on Women’s Health Issues, which stated that ‘biomedical and behavioural research should be expanded to ensure emphasis on conditions and disease unique to, or more prevalent in, women in all age groups’ (GAO, quoted in Eckman 1998). Subsequently the newly created US Office of Research on Women’s Health issued statutory guidelines for the inclusion of women in research. Of course, this is not bound to ensure that they are given equal attention (Plechner 2000). Social epidemiological research, for example, has a marked tendency to obscure women’s (and also men’s) presence either by aggregating data or routinely adjusting for sex (Doyal 2003; Inhorn and Whittle 2001; Kaufert 1999; Wizemann and Pardue 2001). Clinical and social epidemiological researchers alike typically have taken the male body and male experience as the ‘gold standard’ for the population as a whole, assuming – if it is thought about at all – that this is generalizable to women.
This continues to this day, but it was during the 1970s that female researchers first began to open up what has been dubbed the ‘black box’ of medical science, to ‘poke around in its interior, look for women, and ask “who hid them, how and why?”’ (Kaufert 1999). The negative consequences of taking men as the norm are not difficult to discern. In studies of population health, it leads to a neglect of how determinants of health may be different for women and men, and in the delivery of health care, it runs the risk of making assumptions that certain diseases ‘belong’ to men and, consequently, of misdiagnosing signs and symptoms in women. For example, CHD, the single largest cause of death for women in most western countries, was severely under-researched until very recently because it has been defined as a male disease (Bird and Rieker 2008; Emslie 2005; Emslie et al. 2001). Clinical and lay perceptions of the disease continue to be heavily clouded by the later onset in women (typically by seven to ten years and associated with the protective advantage of oestrogen before menopause) and by lingering and inaccurate stereotypes of the ‘coronary candidate’ among the general population that heart disease results from the stresses that middle-class men experience in the workplace (Riska and Heikell 2007). There is now accumulated evidence that physicians are less likely to recognise the clinical signs of CHD in women and less likely to refer them for diagnostic tests, such as angiography and procedures such as arteriography and bypass surgery (see, for example, Arber et al. 2006; Shaw et al. 2004). The male image of CHD clearly reflects the ‘coat rack’ model of the body and identity (Nicholson 1999) referred to earlier: certain traits – such as the drive, impatience and competitiveness of the so-called ‘type A’ personality – are characterised as male and, consequently, it is male bodies that are identified as ‘at risk’. As Elianne Riska discusses, this image is not only ‘gendered’ but also class and time bound, reflecting many of the ‘values and behaviours that were crucial parts of white middle-class masculinity in the 1950s and 1960s’ (2004). The response of feminism to the exclusion or invisible presence of women in clinical and epidemiological research has been to invert the focus on men in favour of a focus on women and, in so doing, to highlight difference. This has involved bringing female-specific health issues such as pregnancy and childbirth to the fore and highlighting the specificity of women’s experience of ‘shared’ health problems such as heart disease, that is, making clear that women’s health is about more than their reproductive organs. While this has the considerable merit of unmasking the suppositions of male-dominated medical research and practice discussed above, it also has downsides. Not the least of these is foreclosing criticism of developments such as gender-specific medicine.
Gender-specific medicine is rapidly growing in influence as observed in publications, international conferences and meetings, research and health care centres. Three of the most well-known centres are the Partnership for Gender-specific Medicine at Columbia University in the US, the Centre for Gender Medicine at the Karolinska Institute in Stockholm, Sweden, and the Centre for Gender in Medicine at Charité Universitätsmedzin in Berlin, Germany. On the face of it, the use of the term gender in ‘gender-specific’ medicine is simply a misnomer, since it would appear that what is really meant is ‘biological sex’. Yet advocates of gender-specific medicine make claims to be continuing the agenda of the women’s health movement and evoke the sex (biology)/gender (social) distinction. Legato’s vision is for a future where ‘all doctors will be gender-specific doctors, who treat men and women more accurately and more effectively, and who above all are more cognizant of the complexity of what it means to be a male or a female’ (Legato 2003). Yet the new discipline of gender-specific medicine is defined in a very limited way as ‘the science of the differences in the normal physiology of men and women and of the way they experience disease’ (Legato 2003). And this is what makes its growth particularly concerning: it provides a ‘strong mandate and agenda for research on sex differences understood strictly in biological terms to proliferate’ (Grace 2007).
So it is not simply that sex is a synonym for gender, but that gender, or the socio-cultural, ceases to matter. This is highlighted by Antje Kampf (2006) who reports that most papers presented at the first worldwide symposium on gender-specific medicine, in Berlin 2006 (the Berlin Symposium), were predicated on the notion that biological influences precede cultural and social influences. Similarly, although the spearhead publication from the US Institute of Medicine, Exploring the Biological Contributions to Human Health. Does Sex Matter? (Wizemann and Pardue 2001), ‘focuses on the effects of biological sex differences on health and the need to evaluate these biological differences in every study, it does not fully examine how these biological factors interact with social and cultural factors’ (Bird and Rieker 2008). In the gender-specific paradigm more generally, where ‘social’ or ‘cultural’ factors are referred to, they are either so vague as to be virtually meaningless or framed in a highly individualised manner (e.g. 011 personal attitudes or the choices that individuals make about their health). The social therefore becomes a residual category that is devoid of meaning and unrelated to the wider social structural factors that impinge on health. Moreover, it is not only that, more often than not, discussion proceeds by reference to biology but that it proceeds by reference to biological difference (Grace 2007; Kampf 2006). Why is this happening? To answer this question we first of all need to1 take note of the heavy emphasis on specific diseases or health conditions. Diseases of particular parts of the body such as the heart (many of the leading proponents of gender-specific medicine are cardiologists), the bones, the breast, the lungs and the colon are the major focus. As Anne Eckman discusses, the lack of attention to heart attacks in women ‘has functioned as a proxy index of medical bias against women’ (1998). But more than this, ‘the lack of biomedical research about women has also functioned to produce a new narrative about the source of women’s inequality – a narrative that foregrounds the need for medicine to embrace a new view of women’s bodies’. The overriding message of this narrative is that we are missing knowledge about bits of their bodies. With this, the ‘whole woman’ disappears from view along with any interest in the social structural sources of inequality that influence women’s health, such as poverty, interpersonal violence and lack of access to resources. Social inequalities are elided through the imagery of women’s bodies as ‘equal and opposite to a man’s’.
To complete the answer to the question of why biological difference is valorised, we need to reflect on medicine as a business. Unsurprisingly, given the focus on particular diseases and parts of the body, much of gender-specific medicine is hospital based (including laboratory-based research on the cellular structure of the body) and high-tech in orientation. Corporate partnerships are not uncommon. The Partnership for Genderspecific Medicine at Columbia University in the US, for example, lists current and past supporters such as pharmaceutical companies Procter & Gamble, Wyeth, Bristol-Myers Squibb, Kos Pharmaceuticals, Pfizer, AstraZeneca, Johnson and Johnson and CVS/pharmacy (see http://partnership. hs.columbia.edu/sponsors.html). This continues a history of heavy investment of the pharmaceutical industry in ‘women’s health’ research, such as menopausal symptoms (Lagro-Janssen 2007). Even though it is not the focus of discussion here, it should be noted that gender-specific medicine concerns men as much as it does women. For example, the Journal of Men’s Health and Gender, which endorses gender-specific medicine, contains a staple diet of articles on the andropause and erectile dysfunction. Sex differences research therefore has big business potential as discoveries of ‘gender-specific’ responses to pathogens open up new markets for ‘genderspecific’ treatments, such as drug therapies and modes of care. Grace (2007) provides an illustration of this from a paper presented at the Berlin Symposium. She recounts the speaker’s interest in ‘gender pharmacogenomics clocks’, which, it was claimed, would lead to the creation of a biotechnology that provides ‘gender time-mapped pharmacogenomics personalised medicine’ (Bendayan quoted in Grace 2007). The promotion of geneticand molecular-level research signals the resurgence of biological and genetic essentialism in the wake of the Human Genome Project (Kampf 2006). Insufficiently documented or spurious claims of sex-related differences in genetic associations in diseases are growing (Patsopoulos et al. 2007) As Peter Conrad remarks, the biotechnology industry ‘promises a genomic, pharmaceutical, and technological future that may revolutionalise healthcare’ (2007). Gender-specific medicine looks set to be a major part of this future. So far I have argued that although ‘social gender’ appears, in both conceptual and empirical terms, to be more variable and flexible than ‘biological sex’, in actuality it is drawn towards opposition. Recent developments, such as gender-specific medicine, only serve to reinforce this. This is part of what Anne Fausto-Sterling calls the ‘spreading oil-spill of sex’ (2005) and a stark warning sign that biology needs to be brought back into the feminist fold. The question is, how?
The Sex/Gender ‘Looping Process’
Most research has tended either to positively revalue women’s (given) biological difference from men or to turn biology aside. In both cases, it remains a given. When left as a natural and fixed dichotomy, sex/biology is highly likely to inform the experience of social gender; that is, gender is still read through sex (Moi 1999). Raia Prokhovnik explains that ‘as long as gender only trades on a foundational “natural” sex difference (which undermines an effective difference between the two terms), then all the elements of the sex/gender distinction are determined, either biologically or socially or both’ (1999). Instead of liberating women, their oppression can be perpetuated and sometimes even intensified. Gender built on sex becomes binary difference, too, as ‘differences among women are silenced and difference between men and women privileged; the sameness among women is presumed and the similarity between men and women denied’ (Eisenstein 1988). As fundamental and linked oppositions, sex and gender underwrite further dichotomies such as nature/culture, mind/body and reason/emotion. The clusters that arise are well documented: men are rational, women are irrational; women are associated with nature/ body, men with culture/mind, and so on. These oppositions are interdependent since each term derives its meaning from an established contrast, rather than from some intrinsic or pure antithesis. Moreover, as many have pointed out, they are inherently patriarchal given that their ‘very structure is privileged by the male/non-male distinction’ (Grosz 1990), where the leading term is accorded a primacy that is passed off as ‘natural-eternal’ (Cixous and Clément 1986) and its opposite is given a subordinate or secondary status. Woman is ‘positioned as man’s attenuated inversion, as a mere specular reflection through which his identity is grounded’ (Kirby 1997). Heterosexist bias is also evident, since everything outside the binary is defined as an anomaly or perversion (de Lauretis 1987; Fuss 1991; Jackson 1999; Mathieu 1996). Although it is unusual within feminism to apply these general points to health, it is apparent when we do that health and illness are drawn towards opposition, as the biological difference that girds our thinking spills over into the social as a series of new dichotomies are layered one on top of the other. The unfortunate consequence of this binary logic is that positively associated health becomes attached to men, and negatively valued illness to women. It then becomes difficult to see men as ill and women as well. The ironic consequence is that feminism can end up entrenching women’s ill health, unintentionally colluding with patriarchy by not letting them be well, that is, pathologising their health. And, of course, as a corollary, construed as well by comparison, it is difficult for men to be ill (Annandale and Clark 1996). In these terms, it is fairly easy to see why men – viewed as strong, resilient, robust and, above all, healthy – are selected into privileged positions and why women are not. Any attempt to undermine patriarchy through social and/or biological difference can be wrong-footed since it gets trapped within the problematic that it is trying to challenge.
This discussion suggests that attempts to challenge patriarchy by distinguishing (biological) sex from (social) gender are problematic. This is because they leave biological sex as difference precisely in order to construe gender as more fluid. Left unchallenged, biological sex remains a binary either/or difference between male and female bodies. Gender ultimately lapses back onto this dichotomy rather than flowing free from it, and hence sex difference continues to be the basis of gendered experience. This means that, although on the surface a lot of feminist research on health has cast biology aside in favour of a focus on social variations between men and women – and this is a problematic move in itself – it makes a spectral return. An unspoken biological difference is embedded within its framework: social gender is still wedded to biological sex, and both tend to operate in a dichotomous manner. Since sex has been identified as the culprit in the failure of gender to free women from patriarchal control, it makes sense to challenge the way that it is conceived. It is fairly common now to see the argument that sex is neither natural nor fixed. Erving Goffman (1979) and others made it clear that ‘gender attribution’ and ‘gender display’ are ongoing practical accomplishments of everyday life; that is, it has been appreciated for some time that the body is bounded and marked as sexed because we view it through the various social lenses of gender. Christine Delphy puts this well: ‘when we connect gender and sex, are we comparing something social with something natural, or are we comparing something social with something which is also social (in this case, the way a given society represents “biology” to itself)?’ (1993). In these terms, sex is the retrospective projection of gender; gender comes before sex, rather than the other way round (Butler 1990, 2004; Elam 1994). This is not to suggest that the material body is a fiction, but rather that sex is the embodiment of gender, although for some feminists, such as Drucilla Cornell (1991), what we perceive as reality (here a sexed body) is quite literally a reality effect, produced by the language of gender. Crucially, then, a feedback loop is in operation whereby our ideas about (social) gender are constrained by our limited ability to envisage sex (biology) in anything but dichotomous ways, and the possibility of breaking away from dichotomous perceptions of sex (biology) is restricted by the firm grip that our ideas about social gender as dichotomy have on the biological imagination. This ‘looping process’ also makes clear that the social need be no more (or less) malleable than the biological. Feminist biologists and others have pointed out that ‘gendered dichotomies are etched deep into the narratives of biology’ (Birke 1999: 41; see also Epstein 1990). Perforce nature has been read in highly gendered ways. This is evident in the surge of interest in gender-specific medicine, discussed earlier, which ‘endorses the dichotomising and this essentialising of biological sex . . . and disavows attempts to re-theorise biology in non-dualistic terms’ (Grace 2007). In gender-specific medicine and more widely, two fixed and dichotomous groups – men and women – are constructed (through the language of sex difference) out of a series of biological and social markers such as hormones and percentage body fat that, in actuality, are best viewed as continua rather than distinctions. As Lynda Birke discusses: it does not really matter that scientists themselves would not claim one hormone or other as belonging only to one sex. By labelling them as such, a binary narrative is created, which in turn gains currency in the wider culture precisely because it fits so neatly with cultural stereotypes.
Barbara Hanson (2000) likens the tendency to create a dichotomy out of physical characteristics that exist on a continuum to the process of dividing mercury with a ruler. Since the dichotomisation is empirically false – the phenomena reconstitute themselves when the ruler is removed – research findings are distorted. We then take it as read that the constructed male/female difference on the physical attribute in question is important for the aspect of health under consideration, when it may not be. Dichotomous thinking that took hold during the 1800s (Laqueur 1990) therefore has shown an amazing resilience, retaining its grip on biomedical thinking in the face of mounting evidence that the ‘defining features’ of sex difference, such as the chromosomal ‘gold standard’, may not be relevant. Hormone levels, for example, can be manipulated with drugs to promote the development of more marked sex attributes and even ‘opposite’ sex attributes. Yet the will to mark difference persists. Thus the commitment to sexual dimorphism leads to the quite literal carving of difference onto the body in the case of surgical management of intersex (Butler 2004; Kessler 1990, 1998). Functional reproductive capacity is often taken as the divide between men and women. But this in itself is a normative ideal, since at any one point in time, and for the majority of their lives, most females are incapable of reproduction – being, for instance, too old, too young, too malnourished, at the wrong point in their menstrual cycle and so on to ‘reproduce’ (Cealey Harrison and Hood-Williams 2002). The fusion of sex and gender therefore is tighter than feminists initially appreciated. The ‘looping process’ is so entrenched that the grip of patriarchy on women’s experience cannot be broken by prising the two apart and stressing the social nature of gender. By implication, then, gender can only fulfil its initial feminist promise and be truly variable – that is, no longer annexed in specific ways with either men or women – when it is no longer tightly bound to sex (biology) as a fixed dichotomy. The logical corollary is a two-headed offence that recasts both sex and gender as malleable and multiple. This calls for a more porous model of sex/gender, such as that advanced by feminist philosopher Tina Chanter, who is of the opinion that we should be developing a theoretical position whereby ‘neither category is evacuated of meaning but both are constituted, in relation to one another, as permeable and instable’ (2000). This evokes Jacques Derrida’s (1982) insistence that dualisms such as male/female and health/illness be re-conceptualised as a cohabitation of terms rather than an oppositional either/or. Here, the object is to resist closure (Linstead 1993) not just by elevating the suppressed term but by subverting or destabilising the hierarchical division itself, so that when thinking of women and men, commonalties become as important as differences and men can no longer be associated with all that is valued and women with all that is devalued (Barrett and Phillips 1992). Arguably it is more difficult to associate men with positive health and women with negative health when sex and gender are both conceived as more fluid. This does not mean that difference is of necessity obliterated (in thought or in practice). At the very least, some minimal point of commonality and continuity of debate necessitates the linguistic retention of the familiar terms, ‘man’ and ‘woman’ (Fuss 1989). But, more importantly, however much we may fear ‘being discovered unwittingly behind enemy lines; caught in the suffocating menace of that carnal envelope’ (Kirby 1997), keeping difference in play may have strategic or interventionary value. It is the artefact against which more fluid and shifting differences of sex/gender are counter posed.
In these terms, it is questionable whether it is possible to open up the space for suppressed heterogeneity without evoking the (appearance of) unity (Flax 1990). From this perspective there is no way of going back to the (mythical) artless biology of patriarchy. It has not simply been uncovered as sexist; it has been undone. The emphasis on fluidity and flow shares the desire of feminist biologists and social science commentators on biology to ‘think about the body as process(es) rather than fixed’ (Birke 2003). Emphasis is placed on the development of the organism in interaction with the world (rather from some blueprint in the DNA). As Toine Lagro-Janssen puts it, ‘a biological organism such as the human body is an open system that is influenced by environmental and evolutionary factors. Genes and sex hormones can never be the only explanations for differences between the sexes’ (2007; see also Grosz 1994). Genetic activity is not pre-programmed; it ‘guides development by responding to external signals reaching specific cells at specific times’ (Fausto-Sterling 2003). Bodies have agency in relation to their environment as they constantly respond to change, both inside and out. Although it is something of a sociological commonplace nowadays to assert that the biological body is socially inscribed, in concrete terms our understanding of this process is very much in its infancy (Birke 1999). Anne Fausto-Sterling marshals her thoughts under the rubric of ‘development systems theory’ (DST). As she puts it, from the point of view of DST, ‘neither naked sex nor naked gender exist. Findings of so-called biological difference do not imply a claim of immutability or inevitability’ (Fausto-Sterling 2003). She gives the example of the alleged sex differences in verbal and spatial differences in the part of the brain called the corpus callosum. As she puts it, the assertion of difference is just a starting point; the interesting question is how any differences developed in the first place. Thus, ‘what childhood experiences and behaviours contribute to the developing anatomy of the brain? . . . How do nerve cells translate externally generated information into specific growth patterns and neural circuits?’. In other words, sex and gender are mutually constructed; ‘we acquire a body rather than a passive unfolding of some preformed blueprint’.
Disrupting the Sex/gender Straightjacket
Although postmodern and cultural feminist approaches have rarely been brought together with health (Clarke and Olesen 1999; Shildrick and Price 1998), they seem to hold out the potential to disrupt the certainty, or decidability, of the more modernist epistemologies where differences are produced between relatively stable categories (genders, sexes, types of bodies, and so on). Framing both sex and gender as permeable and instable chimes with new approaches to biology, discussed above. As Teresa Ebert puts it in her critical reflection, in postmodern approaches difference is conceived as ‘self-divided, as always split by its other’ (1996). The intention is to disrupt ‘the clarity and certainty of meaning’, thereby dehierarchising binary oppositions and celebrating undecideability or, as Diane Elam puts it, keeping the complex interplay of sex and gender ‘open as the space of a radical uncertainty’ (1994; see also de Lauretis 1987). Postmodern feminism seems well placed to comprehend the implications for health of the wide-scale social changes that have been taking place since the last quarter of the twentieth century, which many have argued have rendered traditional stereotypical ‘gender roles’ built on sex all but obsolete. It is also important to appreciate that breaking binary thinking is not simply the province of postmodernism. Thus Judith Lorber (2005) maintains that gender needs to be ‘undone’. She argues that the increased complexities and multiplicities or intersecting identities of contemporary social life are themselves a way of degendering or undercutting the solidarity of binary gender to structure men’s and women’s lives. Postmodern thinking and the stress on multiplicity that has filtered into wider theory seems to have the potential to illuminate successfully the contemporary landscape of gender and health.
Simply put, if sex and gender are becoming more fluid, it makes intuitive sense that health differences between men and women follow suit, since men can no longer be so readily identified with positive health and women with negative health. To put it in overly simple terms, ‘good’ or ‘bad’ health is no longer attached a priori to men or to women as ‘biological’ (sex) or ‘social’ (gender) ‘groups’. The experience of health and illness can more appropriately be seen to cross-cut gender in complex ways (Annandale and Clark 1996), opening up to further inspection the complex interplays of sex/gender, age, ethnicity, social class and so on in relation to health, which many have argued were effaced by middle-class centrism in second wave feminism. However, the dangers of this position are now well rehearsed, if not specifically in terms of health, then at least in relation to the wider politics of gender. As Wendy Brown puts it, ‘the deconstruction of the subject incites palpable feminist panic’ (1995). It is pointed out that doing away with sex and gender as binary difference sweeps away not only the patriarchal powers that constructed difference in the first place but also the possibility of women’s collective resistance and opposition to oppression (Barrett 1991). The argument is that shared experience, the well-spring of collective action for positive social change, is fractured when women come to share more in common with men – for example, ethnic and class-related identities – than with other women (Barrett and Phillips 1992; Zalewski 2000). There is a risk of falling into what Barbara Marshall (1994) terms an unchecked pluralism where all experiences are equal yet where egalitarianism has no place. Strong objections have been voiced in these terms. Stevi Jackson (1992), for example, argues that the logical outcome of postmodernism is post feminism, a world where sex and gender difference are no longer seen as relevant to experience.
This raises the question of just how far off this is from the flourishing academic and popular new wave feminist literature that claims that feminism’s very success means that it is no longer needed. Rosalind Coward (2000) responds to the question ‘Is feminism relevant to the new millennium?’ with a resounding ‘No’. In her opinion, the balance of power ‘between the sexes’ has altered dramatically, so much so that we can no longer talk of patterns of male advantage and female disadvantage. We live, she claims, in a society where feminism’s ‘old descriptions’ no longer work. Society no longer has ‘simple gender lines’. ‘It has many different occasions, practices, lifestyles and styles in which gender is a significant division but not one which consistently ascribes discrimination to one side of that division’ (Coward 2000). The male empire is crumbling, argues Naomi Wolf (1994), yet many feminists continue to portray women as victims, stressing ‘helplessness, silence, pain and defeat’ instead of realising that they now have the power to bring about the conditions to secure equality. Katie Roiphe (1993) maintains that by the 1980s, feminism had become a rigid orthodoxy. Focusing on US campus feminism (and drawing on her experiences at Harvard and Princeton), she maintains that activism around sexual violence threatens to propel women backward to the stereotypes of the 1950s. As activists ‘describe every fear, every possible horror suffered at the hands of men, the image they project is one of helplessness and passivity’. The message they put across, she claims, is not only one of stifling ever present danger but one of women as fragile and innocent, their bodies chaste objects ever vulnerable to male corruption. Roiphe warns that denial of sexual agency in contemporary feminism backs women into old corners, since it leaves them chasing the very same stereotypes that earlier feminists spent so much time running away from. It is arguably a short step from questioning feminism’s contemporary relevance in this way to the view that feminism itself is guilty not only of holding women back, as Wolf and Roiphe contend, but for all kinds of problems faced by women today. It is also inherently conservative (Archer Mann and Huffman 2005; Heywood and Drake 1997). For Ann Oakley (1998; see also Oakley 2002), these writings are themselves part of the wider backlash against feminism. The backlash that emerged in the 1980s and continues apace today trades on the premise that women may very well be (more) equal, but look where it has got them – they may have greater access to financially and personally rewarding jobs, but is it really worth the mental distress that it causes as they attempt to balance home and working life in an attempt to ‘have it all’? (Faludi 1991). Lest it should be concluded that this line of argument is promoted only by younger women, Alison Wolf (2006), a professor at Kings College London, cautions that the emergence of a cadre of ‘elite’ (well educated, ‘high flying’) women in professional jobs is extremely damaging for society. Returning us to essentialist notions, she bemoans the decline of what she calls ‘female altruism’, which has deflected women’s attentions from female concerns, such as caring for the family and the sick, which they all once shared.
It is arguably a short step from questioning feminism’s contemporary relevance in this way to the view that feminism itself is guilty not only of holding women back, as Wolf and Roiphe contend, but for all kinds of problems faced by women today. It is also inherently conservative (Archer Mann and Huffman 2005; Heywood and Drake 1997). For Ann Oakley (1998; see also Oakley 2002), these writings are themselves part of the wider backlash against feminism. The backlash that emerged in the 1980s and continues apace today trades on the premise that women may very well be (more) equal, but look where it has got them – they may have greater access to financially and personally rewarding jobs, but is it really worth the mental distress that it causes as they attempt to balance home and working life in an attempt to ‘have it all’? (Faludi 1991). Lest it should be concluded that this line of argument is promoted only by younger women, Alison Wolf (2006), a professor at Kings College London, cautions that the emergence of a cadre of ‘elite’ (well educated, ‘high flying’) women in professional jobs is extremely damaging for society. Returning us to essentialist notions, she bemoans the decline of what she calls ‘female altruism’, which has deflected women’s attentions from female concerns, such as caring for the family and the sick, which they all once shared. The body ‘is always superficially transformable’. Moreover the ‘postmodern turn’ seems to offer a markedly individualistic kind of radicalism, The lure of individual freedom, choice and opportunity that, on the face of it, appears liberatory might well involve opting into a putatively ‘male’ world of competition and self-interest that will not benefit women, or men for that matter.