Conference

Women’s Rights Perspective in Health – dangerous?

At a training program in Delhi, organized by the VV Giri National Labour Institute, I spoke on birth, breastfeeding and health from a women’s rights perspective.  I gave the presentation to two groups – one comprised 36 PhD students from universities and institutes in various parts of India and the other comprised a similar number of health officials and physicians from developing countries outside India.

We sometimes talk about the inadequacies of the biomedical model of health and birth, insofar as it excludes social, psychological, environmental and spiritual factors.   What we notice less often is the possibility that the biomedical model may itself depend on metaphors that are influenced by cultural stereotypes.

In the first part of my talk, I discussed gender stereotypes in the medical descriptions of women’s bodies and of reproduction.  For this I relied on Emily Martin’s work The Woman in the Body and in particular “The Egg and the Sperm: How Science Has Constructed a Romance Based on Stereotypical Male-Female Roles.”  (Signs, Vol. 16, No. 3 (Spring, 1991), pp. 485-501.

Drawing from several standard medical textbooks, Emily Martin shows that descriptions of women’s bodies reflect the values of industrial capitalism as well as gender bias and stereotype.  Take away these values and substitute gender equality and women’s rights, and you would describe these processes quite differently.

I presented some of her examples  and quoted from her article to explain each one. In summary these are:

Biological process

Standard Medical Textbooks

Why not

conception

journey of the sperm

interaction of egg and sperm

ovum

passive, fragile, dependent, waiting

connecting with sperm

sperm

active, strong, heroic, autonomous

connecting with egg

ovulation

overstock inventory

just-in-time maturation

spermatogenesis

amazing feat

excess

menstruation

failed production

indicator of fertility

menopause

factory shutdown

golden years

I continued to talk about how we had the choice to look at these processes in a way that grants women autonomy over their bodies and reproductive health, and this could help us to take a rights-based approach to women’s health.  Just as I was about to move along to a discussion of women’s rights in birth, several hands flew up.

“The processes are described this way because that is the function of the reproductive organs,” one doctor said.  I replied that we could look at the process differently if we did not assume that the objective of every woman and every menstrual cycle was to have children.

Why are you calling menopause “Golden years?”  several men asked.

I answered that it signals a transition in life and that each phase of life could be appreciated on its own terms rather than regarding the woman’s body only through its child-bearing function.  It is not to imply that earlier phases of life are less “golden” but simply to use a positive and respectful term.

“These ideas would be all right coming from a Western Perspective,” commented a physician from Sri Lanka.  “But you being from our culture, should not be spreading these ideas.  This kind of thought, if it spreads would be very dangerous,” he said.  “It would cause a disruption in our society.”   A physician from Afghanistan agreed with him and added,  “In our culture motherhood is not a burden, it is a privilege.”    One more health official from an African country added that menopause should not be called golden years and went on to explain that men could continue to reproduce for the whole of their lives.

I asked, “Can we hear from any of the women in the room?”

No one spoke up.  The physician from Sri Lanka said, “I am speaking on behalf of the women.”

I was stunned that no one objected to such a statement.   Nevertheless, I stayed on message and reiterated that a woman has the right to decide whether to have children and that having children was not the only, primary, or necessary purpose of a woman’s life and by extension, women’s health.  To address women’s health from a women’s rights perspective, one must recognize the value of the body without limiting it to its capacity for childbearing.   One must also respect women’s rights when addressing women’s reproductive and maternal health needs, including during pregnancy, labour, birth and beyond.

During the break several women approached me and said, “Your lecture is very interesting.  Some of our colleagues are from very patriarchal backgrounds.”  I said that they should speak up during the discussion.   Later in the evening, I thought of I should have replied to those who cautioned against the social disruption that feminist ideas may cause.  In order to make progress on women’s health issues, we must change our ideas and practices, and be prepared for the disruption that such change would cause.

In the remainder of the seminar, I presented on three themes:

Birth Models that Work.

Breastfeeding Models that Work.

Food Models that Work.

(to be continued …)

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Letter to Editor

Partnership or Sell-out?

Partnership or Sell-out?
21st February 2013

 Interview with JP Mishra, Chief of State Health Resource Center ,

The Hindu, February 22, 2013

Letter to Editor: 
Chief of State Health Resource Center has no answer to questions of monitoring quality, timeliness, or access to care for remote areas, and yet he has already accepted bids for private diagnostic centers to “set up shop” on government premises.  If they set up shop in a location where government services don’t exist, then this would result in additional services available for the public.  Strangely, that does not seem to be a condition of this “invitation.”  Apparently we have to wait and see “whether they are interested in setting shops in Bastar, Sarguja etc.”  And if they are interested in setting “shops” as he chooses to call these private health services, in locations where government diagnostic labs exist, apparently the public service has to relocate, and its staff must be redeployed elsewhere.  Why?

Who has decided that “You cannot run a parallel lab if you have given it to a private player.”  Why must the private player be given a monopoly?  To whom will they be accountable?

Why does the private player get the first choice of where to operate and the public health staff left to be “redeployed” to locations the private players leave unserved?

How can this be called a “partnership?”

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Moments

Krimson 35

Krimson 35

18th January 2013

Appalagraharam, January 8

“The doctor gave me this,” she said, putting a strip of medicine in my hand.

“For what?” I asked.

“To have regular periods.”

“Have you been having irregular periods?”

“Recently I had one 15 days late.”

How about before that?

No, only that one time.

Oh honey, I thought. But I did not say what I thought.

“So you had only one late period and you told the doctor you were not having periods regularly?”

“I told the doctor I wanted to have children and she said this would make my periods come regularly.”

“What prompted you to go and see this doctor?”

“Well a few of us ladies were talking in the village about how we wanted to have kids and one of them was going to see this doctor so I thought I would go along with her. The doctor gave all of us this medicine.”

The medicine was Krimson 35.

If you type Krimson 35 into the google search window, your results will come from sites coming under the category of “Pharmaceutical blogs” like:

http://www.prescriptiondrug-info.com/topics/krimson-35/
http://www.indusladies.com/forums/
http://www.indusladies.com/forums/fertility-and-trying-to-conceive/78870-what-polycystic-ovary-krimson-35-a.html
http://www.pharmainfo.net/supriya-vavilapalli/krimson-35-drug-mostly-used-treat-pcod
answers.yahoo.com

These sites allow visitors to post questions and also answer questions posted by others. They also allow advertisers to reach out to those posting questions and answers. There is nothing to prevent advertisers from posting and answering questions on the site as well.

and on down to
http://www.healthcaremagic.com
where you have the option, apart from browsing or posting on the forum for free, to seek an answer from an online doctor, for a fee.

I was surprised that I did not get results from a single university, hospital or government site. Not even Wikipedia. Still from what I read I could gather that this medicine was prescribed for PCOS and it did not seem that the doctor had gathered enough information to determine that my friend had PCOS. I asked her when the doctor asked her to start the medicine. “She said to start it.” she replied.
“Did she ask you to start now or on a particular date?” I asked.

“She just said to start it.”

Hard to tell whether the doctor said to start now or later. The websites I had checked said that one should start taking the tablets on the first day of the menstrual cycle. I do not know whether this is correct either, but it does not seem to be what the doctor communicated to my friend. Moreover, this appears to be a contraceptive.

I felt like going and asking who else was taking this medicine. But I was not sure how to go about it. I asked a friend who is a doctor in Mumbai about it and he said, “About Krimson 35, there is a fair amount of misuse. However, it is a response to the demand from families and the pressure to bear children – fertility, as you know, being a central point in the Indian context.”

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