Taking back our bodies: a brief history of women's health.
Where It All Began ...
If we could step back in time some 20,000 years and, as voyeurs of history, could watch the tribes of our ancestors, we would observe how these groups of 20 or 30 people lived as hunter-gatherers. As they hunted, they had to develop a range of collective abilities. For example, so that they could feed themselves and survive, they discovered that it was best to let their prey die by bleeding out. But in this slow and painstaking learning process, they made a curious observation: the females would bleed and not die. They discovered that this bleeding was a cycle that followed the moon or the stars. Sometimes they would stop bleeding, and they would swell up like the full moon; and nine moons later they would pour forth blood and a new creature. Then they would stop bleeding and still live! And one female could do this many times!
Theorists Rianne Eisler and Humberto Maturana both agree that, spurred on by survival needs, females developed two abilities that were transferable to the larger group. One of these gifts to humanity was the ability to walk upright: females needed to free their upper limbs to hold onto their offspring while gathering seeds, fleeing predators, or simply migrating. In addition, they invented rudimentary carriers to hold their children or foodstuffs.
The other ability, Maturana writes, was born of the mothers' observations of their children during long periods of breastfeeding. The nursing mothers noticed that babies trembled when cold, or squirmed when hot or tired, and cried when they were in pain. And these grandmothers of ours, concerned and curious, began to experiment with a language that would allow them to understand their offsprings' expressions and meet their needs. A gesture, like a stuck-out tongue, a grunt or a coo, would be repeated by the child and encourage some predetermined conduct. From this mother-child relationship emerged one of the most important forms of communications, a subtle network of interwoven emotions and expressions.
After two or three births our prehistoric grandmothers learned their first lessons of anatomy and physiology and were able to help other women give birth. Knowledge was slowly accumulated and transferred to the following generations until the Inquisition finally condemned this "devilish" wisdom linked to the stars and the planets and incorporating dances and massage.
In the earliest days of the human tribes there seemed to be no boundaries between the individual and the collective and between humanity and nature or the cosmos. However, as recent archeological investigations suggest, there was a sort of cult to the female body. We find vulva-like cowrie shells, the pre-historic Venus figures, seeds, the earth, symbols of vessels from which new life emerges.
How these first humans, especially women, developed a living medicine based above all upon self-care and on learning the use of plants is a very interesting topic of study. In her book, The Chalice and the Blade, Dr. Eisler used the term "gylany" to describe these societies which, until a few centuries before our era, were characterized by the social, economic, cultural and political equity of women and men in which the differences between the sexes were recognized and exploited for the mutual benefit and enjoyment of both, without the oppression of either. Traces of such civilizations have been found in the areas around Mediterranean and the Aegean Seas--signs of the collective efforts of peoples whose energies seem focused on making life more pleasant. The artistic heritage of these peoples are found in the ceramics of the Minoans which display a unique and carefree attitude towards the human body, be it woman or man: upright torsos, direct gaze and relaxed expressions, so very different from the rigid, austere portraits of the Middle Ages.
These "primitive" women and men, so self-assured in their own bodies, gave humanity the first measures of the universe: feet to measure distance, hands to measure height. The body was also the metaphor for describing other aspects of the natural and human-crafted world. In some cultures the word for "sap" is the same as the word for "blood"; the word for "mouth" may also be used to describe the door of the house.
Long ago there were no boundaries between art, religion, science and culture. As a result, humanity's experience of the body--and especially women's relationship with their bodies--had a certain spiritual, political and ethical coherence which was beneficial for life in all of its manifestations.
How We "Lost" Our Bodies
Today we know that the Nordic peoples, hungry and displaced, forced to migrate by the movements of glaciers, violently imposed their forceful male gods on these "gylanies." With these masculine entities came the symbols of death: the thunderbolt, the trident and the sword. And the secular imposition of these masculine cultures began with the physical possession of those who symbolized the mysterious source of life: women. The patriarchy took over.
As women lost control over their own bodies, they also lost all other rights. And men lost as well: moving from partners to "dominators" who possessed something both desired and feared. All humanity lost.
When the priests began to copy down the history of western civilization as we know it, they carefully erased the names of women whose lives and work contradicted this new order. For example, Themistoclea, who taught Pythagoras; Diotima, Socrates' teacher; and Pericles' companion Aspasia, a brilliant scholar and stateswomen, author of the leading civic instruction of the era, are all missing. Aretha of Cirence, who led the most important school of natural science of her age, which called for "a world without masters or slaves" was forgotten, as was Jesus' disciple Tabitha, whose name is also translated as Dorcas.
Women's knowledge was slowly leeched away. Socrates was sentenced to death for corrupting youth with ideas that challenged the power of reason and proposed, among other things, "equal education for women and men."
Our female ancestors were slowly reduced to the kitchen, the harem, and centuries later, the convents. But the most crucial aspect of this subordination was the condemnation of women's bodies.
Under the influences of slavery and the philosophies of the Middle Ages, women's bodies became objects. The idea of women as "imperfect men" or "walking wombs" gained popularity. Women were no longer citizens. They could not own property, and there was no reason to educate them. It was even debated whether women had immortal souls. Descartes appeared on the scene with his clockwork universe, proposing that everything could be broken down into parts and comparing women to Nature. The idea resonated with western thinkers keen on separating the soul (immortal and judicious thought) from the body (pure, dissectible nature), which like women could and should be conquered, by force if necessary, for the benefit of civilization.
Impact and Resistance
Numerous authors have studied how this process affects women's self-image, our perceptions and attitudes towards our bodies, and the impact of these perceptions on the physical and mental health of all humankind, since women comprise half of humanity. The human body, especially the bodies of women, were transformed from venerable objects of pleasure to the source of torment.
It was believed that women could entrap men with their devilish wiles. In a guide for the confession of women, one Spanish priest wrote that "if they had sexual intercourse with a man, [women should be asked] if they had caused him some harm or placed on him some curse that could cause illness or death." In medieval Europe people--especially women--used heavy layers of clothes that confined their bodies, and bathing was generally prohibited.
If my body is considered a sinful object, if I must hide an ancestral knowledge of my body, knowledge that only men are allowed to have, then two things will certainly occur: on one hand, women will develop forms of resistance--for example, in China, women developed a jealously-guarded secret language to pass information on from mother to daughter--and on the other hand, women may resign themselves and accept that they are almost nothing, their worthlessness.
An estimated six million women were accused of witchcraft and sacrificed to the Inquisition. In reality, they were herbalists, healers, alchemists and midwives, who before being killed were cruelly tortured, almost always by being vaginally penetrated by some sort of instrument to supposedly rip out the devil's seed. In the face of this onslaught of patriarchal cruelty by the Church and the State, women accepted that it was better to not know or to pretend to not know. Many women chose to become nuns in order to be able to learn to read and write even though this meant the occasional self-flagellation. They also chose to cloister themselves to avoid forced marriages or were locked up against their will as a punishment for refusing to accept the husband that was chosen for them.
Century after century of women's subordination has implied the denial of our bodies, the denial of our sexuality, the denial of our realities as individuals and our objectification in every sense of the word. This subjugation has taken the form of social, economic and political inequity, exercised by all the powers that be: family, Church, State ... Physical violence has been reinforced by the violence of silence: women are violated by not being named, by not being explicitly endowed with any rights. Not that women are just victims: in truth, just like African-descendant and indigenous peoples, women have constructed forms of resistance, other structures of "micro-power," and we have taken part in the business of humanity, making a contribution that may be unrecognized by conservative ideologies but which nonetheless is significant.
Stripping us of our bodies was the goal and norm of the established order. First, we were dis-empowered symbolically: women are not goddesses, but mortals, and only some may be mothers of certain gods. Next, we were robbed materially: we cannot own anything, we can only be owned. Next, the legal realm: women as chattel, not citizens. And finally, in the fields of "science," such as medicine, women's fundamental role was identified as reproductive.
Inequity: Bad for Public Health, Worse for Development
Health has always been a powerful indicator of a peoples' development, and even though the negative affects of the influence of positivist thinking are often acknowledged, the impact of the dichotomization of the body and the soul is rarely examined from a public health perspective. The detrimental affects of such a philosophy are even worse when the body is identified as a mere object. Not only is our physical health affected, but our mental and social health as well.
The shift, over the course of nearly three millennium, from social and creative autonomy, from veneration in an equitable society, to the reduced realm of the private sphere, to being unnamed, unrecognized and worthless, had terrible consequences for women, but for men as well. All of humanity was affected.
Concentrating women in the domestic realm stripped us of social and political creativity and recreation and turned us into consumers. On the other hand, men were freed to dedicate themselves to leading, participating, producing and providing, but at the same time, they were robbed of their part in the amazing human task of emotional participation and caregiving.
Women were taught to serve others, postponing the fulfillment of our own desires, even including self-care. Women's health and sexuality were regulated by the highest authorities of the patriarchy: the State and the Church, and the direct control of women was in the hands of citizens closest to us: fathers, brothers, husbands, priests. Women were diagnosed as suffering from capricious feelings, hysteria and penis envy--as if humanity could be reduced to a single organ.
This rigid game of gender roles has deprived some of us of participation and others of tenderness. It has excluded some of us from public knowledge and others from private wisdom. Thus, we women have undoubtedly become tyrants/victims of the domestic realm, and men have become the dictators of the public sphere. And because of this--and the disillusionment with life, the radical separation between art and science, the exclusion of spirituality from development, humanity from technology--we are all ailing from too little love, a lack of solidarity, intolerance and the dominant models of development: we have all lost out.
But we are not the only ones who have been made ill by these changes. We have also infected Gaia for, as Aretha of Cirence wrote nearly three thousand years ago: "We are one single substance with our Mother Earth." Going against our mother, the quintessential unnatural act, has become "natural" and desirable. Androcentrism is really the heritage of the patriarchy. We have reproduced not only the symbolic contexts but also the relationships of domination over women's bodies, over those who are different, over nature ...
All the agents of socialization--family, school, communications media--solemnly swear to promote equality, but they actually reproduce asymmetrical relations.
One well-know brand of Colombia beer--whose propaganda was soundly criticized by the women of our country--attempted to demonstrate the superiority of its product with the following messages: "It doesn't get jealous if you have another one," and, "You know you are the first to open it." In some people's minds similar arguments justify domestic violence: "Like animals, women need to be broken in." We even hear such comments in medical clinics.
There is clearly a relationship between this sort of rationale and the recurrent instances of invading troops' rape of girls and women who often have also suffered abuse by their own fathers, as statistics from around the world show. It seems that the feudal custom of "first night" still exists.
Similar rationales justify the fact that women of all ages are still less well-nourished than their male relatives. As Chilean sociologist Teresa Valdes puts it, for the past two thousand years we have indeed been born in original sin, the sin of being born without the basic rights of equality and opportunity.
In semiotic terms, women are above all bodies to be possessed. Women's bodies are eroticized, the source of love, emotional support, pleasure and passion, which can all be regulated or manipulated: "One must fulfill one's marital obligations." Emotional support is not mentioned in legal texts nor medical reports, but therein lies the mis-named "power of women," which is also used to justify other violences, social invisibility and stereotypes.
Every day women continue to silently resist poverty, dictatorships, war, environmental and cultural demolition. Thus, without firing a single shot, we are warriors in a silent revolution to take back our rights.
Women, Health and Development in Figures
I would like to mention a few facts that will bring us to focus on the present and further our understanding of the relationship between women, health and development.
Mortality rates have dropped worldwide among children under five. However, in 11 out of 19 countries of Latin America and the Caribbean more girls die than boys. The leading causes of death among this age group are linked to malnutrition and lack of immunization and timely care.
Girls' needs are still viewed as less important. Often malnourished from infancy, as they grow into adolescence, women need even more iron when they begin to menstruate, and these needs increase with pregnancy and breastfeeding.
In adolescence more young men die due to violence than young women. However, in Colombia and Brazil suicide rates among adolescent women are much higher than among boys of their age, and throughout the region suicide rates among girls are higher than those of boys. Girls' suicides are linked to abuse, repeated rape, unwanted pregnancies and lack of emotional support.
Among the population aged 15-45, rates of mortality and morbidity also are related to reproduction. For women, reproduction often implies a risk. Pregnancies at either extreme of the age continuum, little spacing between pregnancies and malnutrition during pregnancy (insufficient iron, protein, etc.) generate greater vulnerability. Complications from unsafe abortion are a primary cause of maternal mortality, in addition to toxemia, hemorrhages and post-partum complications. In addition, cervical cancer is associated with viral infections and other sexually transmitted infections which frequently go undetected in women.
Women of reproductive age must also contend with the loss of energy from the overload of synthetic hormones, the empirical practices of fertility control and other abuses related to the control of their reproductive capacity.
As women grow older, they may suffer from osteoporosis, cardiovascular illnesses and reproductive/urinary tract complaints. Nonetheless, research, prevention, diagnosis and treatment of these last two pathologies focuses overwhelmingly on men. However, it is more common for women to suffer from strokes than men. These cerebral-vascular events are linked to hypertension, obesity, hormonal factors and the prolonged use of oral contraceptives, a phenomenon which has not been studied sufficiently.
Despite being so overlooked, women make a tremendous contribution to society. In the developing world, women produce more than half of all food crops. Primary health care is provide primarily by women, mostly by mothers. On a global level this informal health care is estimated to be worth four times what is formally invested in health care.
On average, women around the world work approximately 16 hours a day in double and triple shifts. In addition to the responsibility of paid labor outside the home, the omnipresent tasks of the domestic sphere are eternal, nontransferable and multiple. In other words, women must resolve a wide range of problems which they cannot simply delegate or drop. This relentless reality leads to extreme exhaustion and non-specific symptoms of stress, which doctors often catalogue as diverse forms of "hysteria."
According to the UN, in at least one out of every five households, a woman is the sole breadwinner. This clearly results in a progressive decrease in women's leisure time. When we do get a chance to take a break, most women who are married or living with a partner, and have children to care for, spend it watching television--again, trapped in the house.
At the same time, most of the world's poor are women. Women also make up half of the migrants in the world and 70% of all those who are displaced by different forms of violence.
The female body has also been--and continues to be--the stage for medical experimentation on fertility regulation, often with disastrous effects on our health. Those responsible for the iatrogenic illnesses that plague women who have been the victims of such experimentation are rarely held legally and/ or socially accountable. In truth, the cultural impact of medical violence on women's bodies remains to be investigated. Examples of this abuse can be found in the comments to which pregnant women are subjected when they are undressing for an examination: "Hurry up, or do you want me to pull your pants off?" or during childbirth: "I bet you didn't scream so much when you were getting knocked up!"
It is estimated that the voyeurism of unnecessary examinations and surgical procedures could have been avoided in 90% of all mastectomies and 70% of all cesareans.
And finally, the refusal to accept women physicians as candidates for surgical specialties and, above all, the failure to listen to or to understand women's medical/life histories and the lack of a gender perspective in medicine is the result of an historic and cultural construction, rather than solely rooted in biology.
Gender Equity: A Paradigm for Health and Development
Gender perspective provides a political category of analysis proposed by various schools of thought within the women's social movement. This focus implies the need to take into account the social construction of gender roles and their impact on human development through the promotion of asymmetrical power relations in which women are subordinated.
We propose the development of a gender perspective in health and in the clinical practice of medicine. Without a gender perspective, a holistic approach to medicine is impossible.
All humanity--women and men, regardless of their sexual orientation--are part of fundamental human relations. If we accept that we are open systems interrelated with Gala and the universe, we must see that there is an essential relationship between women and men that is based on subordination which is harmful to our collective health. Public health and social medicine cannot continue to ignore this inequity.
A new paradigm must be forged, and those of us who search for alternatives must not ignore the need to reformulate this basic relationship with half of humanity. Otherwise, the entire planet's sustainability is in jeopardy.
Underlying the reconstruction of equitable relations between women and men is the realization of equity among all differences: of ideology, color, language, nationality, sexual orientation, etc.
From "Women, Health and Development" to "Gender, Health and Development"
At the International Conference on Population and Development in Cairo and the Fourth World Conference on Women in Beijing women from around the world came together to promote a paradigm shift, from traditional policies that focused solely on our reproductive role towards the adoption of a gender perspective to create a new type of relationship between women and men based on comprehensive health.
In this sense, we must advance from the triad of "women, health and development" to a broader and more inclusive category of "gender, health and development," bearing in mind the following elements: focus, objective, problem, goal, solution and strategies (PAHO, 1993).
The first focus--women, health and development--emphasizes women as socializers and caretakers of the health of their children, other family members and the community. The second focus--which replaces "women" with "gender"--perceives health as the comprehensive satisfaction of human needs, revealing the relations of power and subordination that underlie the sexual division of labor and cause asymmetry in the exercise of the right to health.
In the first case, the objective is to target women with specific programs and services, especially in the area of maternal health and reproductive care. In the second, the analysis focuses on the asymmetries in accessing services, resources and information, as well as on the way in which women and men demand the promotion, protection and maintenance of health.
In the first case, the problem is seen as insufficient coverage and women's lack of advanced knowledge to care for and treat medical problems. A gender perspective reveals the power relations, the subordination of women and sexist stereotypes that prevent women from exercising power over our own health.
Under the first conceptualization, the goals focus on improving women's health as an investment, thus guaranteeing the health of her offspring; facilitating her insertion in the labor market; and increasing her efficiency in productive and reproductive functions. The goal of the second conceptualization is reducing the power imbalance in access to and use of resources and benefits of care, developing women's capacity for autonomous action, our ability to make decisions over our own sexualities, bodies and lives.
The solution proposed by the first policy is to integrate women into the programs currently being implemented. From a gender perspective, the solution is in developing women as citizens, as rights-bearers with knowledge, information and resources, who have self-esteem and who are recognized socially, economically and politically.
Finally in regard to strategies, in the first instance, coverage is extended, and the quality of women's education as mothers and wives is improved. In the second case, the strategy is to encourage women's health promotion, protection and self-care and facilitate the adoption of mechanisms of participation and the empowerment of negotiation between women's organizations and State institutions.
Finally, it may be necessary to deal with a controversial subject and talk about women's sexual and reproductive rights as essential rights that should be exercised in autonomy, guaranteeing women's sovereign control over our own bodies. These rights include the right to freely develop one's own personality, the right to voluntary motherhood, and the right to enjoy pleasurable sexual relations in conditions of health and free from coercion.
We talk about political will to promote the sustainability of life on this planet, but we must first talk about ourselves as agents of equity and change. We must recognize that the most immediate limitations on our ability to take action as health care workers is the planet itself and that women and men are here to complement each other with our differences.
Agenda Salud (Santiago, Chile: Isis Internacional) no. 1, March 1995.
Capra, Fritjot (1985). El punto crucial. Editorial Integral.
Eisler, Rianne (1990). El caliz y la espada. Santiago, Chile: Editorial Cuatro Vientos.
Pan American Health Organization (1993). "Genero, Mujer y Salud en las Americas." Publicacion Cientifica 541, Washington, D. C.: PAHO.
Revista Mujer Salud (Santiago, Chile: Isis Internacional/LACWHN) no. 3/4, 1995.
Valdes, Teresa (1988). "Afectos y Derechos Humanos, la reivindicacion de las mujeres," in La fuerza del Arco Iris, Jorge Osorio and Luis Weinstein, eds. Santiago, Chile.
The author, a Colombian physician specializing in alternative medicine, is the General Coordinator of the Latin American and Caribbean Women's Health Network, LACWHN. This article was originally presented at the 9th Congress of Anthropology at the Universidad del Cauca, Popayan Colombia, August 17-22, 2000.
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|Title Annotation:||My Body, My Health!|
|Author:||Villaquiran, Esperanza Ceron|
|Publication:||Women's Health Journal|
|Date:||Jan 1, 2003|
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