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Health as women's work: a pilot study on how women's magazines frame medical news and femininity.

Abstract: Women's magazines have been a valuable source of health information for their readers, highlighting issues that were ignored by the mainstream press. Yet, in addition to teaching women about health, magazines also teach women about femininity--about appropriate roles and values. This manuscript reports findings from a qualitative analysis of more than 40 articles in 10 women's magazines. Magazines depicted women as caretakers of their own health, as well as the health of their loved ones. Articles framed health as women's work, suggesting that women must be vigilant to protect their families' health. Although they provided valuable information on a variety of health concerns, women's magazines reinforced and idealized traditional feminine stereotypes of women as caretakers. Rather than present caretaking as an expected role, magazines might consider why women are responsible for this work and explore how women view their caretaking tasks.

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For more than a century, women's magazines in the United States have provided readers with a wealth of information aimed at helping them develop essential feminine skills and knowledge. Magazines have published articles advising women how to bake the perfect meatloaf, how to maintain the perfect hairstyle, and how to experience the perfect orgasm. Magazines have offered advice about how to save money on back-to-school clothes, how to save time in the kitchen, and how to save a failing marriage. To help women cope with life's imperfections, magazines have provided instructions on how to select fashions that hide figure "flaws," how to cope with male rejection, how to circumvent cranky coworkers or inept bosses, and how to help a child who is failing in school. For about the cost of a fast-food lunch, a single issue of a women's magazine provides at least a dozen articles offering advice to readers on how to make their lives easier, homes safer, and families happier. Women's magazines serve the role of a modern "high priestess" offering step-by-step instructions for "the demanding--but rewarding--state of womanhood" (Ferguson, 1983, p. 131, 185).

Women's magazines have become a how-to guide for daily living, and among the topics included in these instruction manuals is health. Contemporary women's magazines publish informational articles covering a broad spectrum of health topics, and magazines invite readers to learn more about their bodies so they can prevent illness and forestall disease. While these publications have been praised as an important source of health information for women (Consalvo, 1997; Harrison, 1982), magazines also have been criticized for their superficial treatment of health topics (Andsager & Powers, 1999; Gerlach, Marino, Weed, & Hoffman-Goetz, 1997) and their failure to challenge patriarchal and capitalistic ideologies, which dictate that happiness can be achieved through relationships with men and acquisition of products advertised in magazines (Demarest & Garner, 1992; Durham, 1996; Friedan, 1963; Leman, 1980; McCracken, 1993; Merskin, 1999; Steiner, 1995; Weston & Ruggiero, 1985-86; Wolf, 1991).

The purpose of this paper is to analyze health care coverage in a small sample of contemporary women's magazines. This project explores the content of health articles and uses feminist theory and qualitative textual analysis to discover the frames embedded within these health texts. Specifically, the papers seeks to determine:

RQ1: What health issues and topics are covered in women's magazines?

RQ2: How do women's magazines frame health care issues?

RQ3: What do these frames tell us about women's roles in the larger society?

Literature Review

In beginning a discussion of health coverage in women's magazines, it is important to consider the effects of two social phenomenon in the United States: the positioning of health as a consumer product and the second wave of the women's movement. Both are concerned with locus of responsibility for health. The health consumer movement positions good health as an undertaking--a task a person must accomplish--while the women's movement has encouraged women to learn more about health as a means of taking control of their bodies and their lives.

Ancient cultures labeled illness as punishment for immoral behavior, the work of demons, or an inexplicable act of nature; however, discoveries by 19th and 20th century scientists on how diseases spread changed beliefs about the causes of illness and generated discussions on the responsibilities for prevention (Keller, 1995; Kirkwood & Brown, 1995). In this modern context, illness was no longer viewed as external, the result of fate or curses or uncontrollable natural forces. Instead, disease was characterized as internal, caused by personal choices and actions, and this paradigm shift placed the onus of responsibility for illness on the individual (Kirkwood & Brown, 1995). As modern medicine developed cures for disease, individuals did indeed gain more control over their own health, and chronic diseases replaced infectious diseases as the most common causes of death in industrialized countries (Mensah, 2004). With these advances, the focus in public health shifted from disease containment to disease prevention, and individuals were encouraged to be architects of their own good health, rather than passive victims of illness (Kar, Alcalay & Alex, 2001).
   The traditional rationale for health education
   was that disease and illness are largely
   preventable, that human behaviour is strongly
   linked to the aetiology of many diseases and
   conditions and the management of others, that
   therefore, people should be encouraged to adopt
   a healthy "lifestyle"... (Lupton, 1995, p. 44)


This change in health discourse meant "the reconfiguration of the individual, or subject, from a relatively 'docile,' passive recipient of advice and health care to one who possesses the capacity for self-control, responsibility, rationality, and enterprise" (Nettleton, 1997, p. 213). Medical problems and solutions were now formulated at the personal level, and health became a mega-value, encompassing all that was good and worthwhile (Crawford, 1980). In this perspective, good health became a much-sought-after utopia (Chrysanthou, 2002), and this focus on personal responsibility also fostered a culture of self-blame for personal failures. "Bad attitudes, habits, or actions are credited with causing diseases, and to the degree we are responsible for our bad 'life-styles' we are responsible for our diseases" (Kopelman, 1988, p. 52). In this construct, "poor health is a 'distasteful' state," and good health a "harmonious integration of body and mind" (Lupton, 1995, p. 70). While disease historically had been characterized as an outward symptom of inner corruption (Gilman, 1988; Sontag, 1990), the health consumer movement established wellness as evidence of restraint and good judgment.
   Since the mid-1970s in the United States,
   the boundaries of what is popularly considered
   essential health behavior, or minimally
   responsible health behavior, have been
   expanding. The new health consciousness has
   ushered in an era of rising expectations fixed on
   improving and protecting the body. Whether in
   the name of health, fitness, or weight loss--themes
   that become entangled--some
   disciplined activity is usually mandated....
   Discussion about health as a matter requiring
   self-control, discipline, denial, and will power is
   most clearly associated with a concept of health
   as a distinct goal. (Crawford, 1984, p. 66)


While consumer culture debates focused on issues of individual mastery, the relationship between health and power is a topic women's advocates and feminist scholars also have explored. Foucault (1986) posited that the private body is a site of public control, noting that medicine has garnered dominance and influence equal to that of religion. Crawford (1984) later characterized the body as a cultural text--"a powerful medium through which we interpret and give expression to our individual and social experience" (p. 61). Taking into consideration the relationship between the body and power, Lupton (1997) argued that the practice of medicine in the industrialized world is one way in which the ideology of patriarchy has been reinforced, a means of perpetuating the imbalance of power between women and men:
   Feminist critics have viewed the medical
   profession as a largely patriarchal institution that
   used definitions of illness and disease to
   maintain the relative inequality of women by
   drawing attention to their weaknesses and
   susceptibility to illness and by taking control
   over areas of women's lives such as pregnancy
   and childbirth that were previously the domain
   of female lay practitioners and midwives. (p. 97)


As the second wave of feminism began in the United States in the 1960s, health became a topic of intense concern for women's advocates, many of whom argued that if women were to control their bodies, they needed factual information about biology and physiology.
   Feminist activism in health starts from women's
   exclusion from medical knowledge and practice.
   Activists have pointed to ways in which such
   exclusion disempowers women, and have
   therefore sought to promote women's knowledge
   of how their bodies work as an act of
   empowerment. (Birke, 2003, pp. 42, 44)


In this context, women strove to become subjects, not objects, in their own health care discourse.

Mass media can play a role in shaping health knowledge by educating the public about health issues and increasing health professionals' accountability to the public (Rowan, 2000). Feminist scholars long have argued that women's magazines have played a significant role in shaping women's health debates, and, some scholars have suggested, in improving women's health. Many health concerns first came to the public's attention through women's magazines as these publications tried to make health-care information accessible and understandable (Harrsion, 1983). In the early 20th century, Ladies' Home Journal and Good Housekeeping ran negative articles on patent medicines, which had no proven efficacy and were high in alcohol content (Stage, 1979). The Women's Home Companion and the Delineator advocated the Pure Food and Drug Laws, and, in 1908, risking a violation of the Comstock Laws prohibiting the mailing of obscene materials, the Ladies' Home Journal ran articles on venereal disease (Zuckerman, 1998). The Journal also commissioned a series on the causes of maternal death and "convinced readers of the need for medical accountability" (Walker, 1998, p. 15). Good Housekeeping published articles on women's need for sex education, and the Pictorial Review advocated birth control (Zuckerman, 1998). In the 1930s, most women's magazines had an institute or center for testing consumer products, established, in part, to protect readers' health (Zuckerman, 1998).

Modern readers continue to rely on women's magazines as a primary source of health information (Zuckerman, 1998). Articles on childbirth and pregnancy are key topics in women's magazines, while other features focus on disease prevention, the need for medical second opinions, treatment options, and education resources (Zuckerman, 1998). Contemporary magazines also have contributed to health research through education and advocacy. Bunton (1997) observed that the women's magazine typically "reports and comments upon medical findings, extrapolates and interprets these findings for the general reader, and makes judgments about the quality of the knowledge.... Magazine medicine, then, spans and often bridges specialist and non-specialist knowledge systems ..." (p. 232-233). In addition, magazines have sponsored events to promote women's health. For example, Mirabelle held a conference on women's health, Glamour suggested the establishment of a coalition to study eating disorders, and Woman's Day has encouraged women to recognize they have a right to quality care (Media Research Center, 1996).
   Women's magazines can be criticized for many
   things, but they are important sources of
   information about women's health. The type of
   information they give ... which is generally
   geared toward women, is often not available in
   other popular media. (Consalvo, 1997, para. 52)


Criticisms of women's magazines often center on the publications' reinforcement of women's traditional roles as homemakers or their status as second-class citizens in a patriarchal culture.
   Research suggests the media have played a key
   role in raising the consciousness of women
   concerning their health. However, some critics
   question whether the media frame the issues to
   conform to dominant values and representation
   rather than meet the needs of women. (Andsager
   & Powers, 1999, p. 548)


In analyzing magazine coverage of women's health, many scholars have argued that publications provide content that is superfluous. Weston and Ruggiero (1985-86) studied six women's magazines in the 1970s and found that while the publications regularly included articles on dieting and sexual health, they did not focus on health problems or illnesses that were the most frequent causes of death among women. Nor did these articles mention violence against women, specifically rape or domestic abuse. In an analysis of articles appearing in 13 women's magazines from October 1995 through September 1996, the Media Research Center (MRC) found that among 56 health articles, 35 offered only one point of view and framed stories in alarmist language that presented minor risks as major concerns (MRC, 1996). Dr. Elizabeth Whelan, president of the American Council on Science and Health, reviewed 14 magazines published in 1996 and found that they "tended to emphasize nonexistent or trivial health risks, while largely overlooking major causes of disease particularly cigarette smoking" (Whelan, 1996). Gerlach and colleagues (1997) examined seven women's magazines, published from 1987 through 1995, and found that colon cancer, the third leading cause of cancer deaths among women, was seldom mentioned. Finally, a Kaiser Foundation report, noting that sexual health was prominent topic in women's magazines, recommended that the publications expand their coverage to include information about AIDS and sexually transmitted diseases, rather than focus on pregnancy, abortion, and contraception (Broaden sexual, 1998).

Fueling arguments about superfluous content is magazines' focus on women's physical appearance. Some scholars have suggested that while women's magazines seek to promote health, they, in fact, promote only body image and a distorted image at that (Kellaway, Rickard, & Borrayo, 2003). Canandian researchers, analyzing magazines published for adolescent girls from 1970 through 1990, concluded that articles on nutrition and fitness emphasized body shape and weight loss (Guillen & Barr, 1994). One study suggested that magazines often depicted the ideal body as slim and smoking as a means to achieve thinness (Gritz, 1987), while a small study of college-age women found that those who viewed fashion magazines were more likely to feel frustrated with their body image that those who looked at news magazines (Turner, Hamilton, Jacobs, Angood, & Dwyer, 1997). Another study, which examined the visual images used with newspaper and magazine articles on breast cancer in 1990s, found that "patient-blaming images" had declined, yet magazines aimed at younger women emphasized beauty rather than health (Andsager, Hust, & Powers, 2000).

Rowan (2000) has argued that a key factor in effective health communication is building trust, and women's magazines appear to have a level of credibility among their audiences. In spite of criticisms and declining newsstand sales (Fine, 2003), magazines remain an important source of health information (The female persuasion, 2002; Walsh-Childers, 1997). One survey found that, in terms of health information, women say magazines are second only to physicians as sources of health information (Where women, 2000, p. 10).

Methodology: Framing Women's Health

While there have been numerous studies of health care coverage in women's magazines, researchers less often have considered how notions of individual responsibility and bodily perfection interact with feminism's broader goals of self-sufficiency and equality. This study examines how women's magazines frame health messages to determine how messages reinforce or challenge traditional stereotypes of femininity.

Framing is a form of analysis that looks at how the media present and categorize information, and a frame is, in essence, a "super-theme" (Altheide, 1996, p. 31). Scholars suggest framing is a tool the media use, often unconsciously, to categorize and interpret vast amounts of information (Gamson & Modigliani, 1987; Goffman, 1974; Pavlick, 2001; Reese, 2001; Tankard, Henrickson, Silberman, Bliss, & Ghanen, 1991; Tuchman, 1978). Frames offer a structure that helps the media gather and present news, as well as a structure that helps readers interpret news events (Schuefele, 1999). "Ultimately, frames may be viewed as an abstract principle, tool, or 'schemata' of interpretation that works through media texts to structure social meaning," (Reese, 2001, p. 14). Frames tell us what "content is relevant to discussion of a social concern" (Hertog & McLeod, 2001, p. 142).

Framing spotlights and emphasizes, but it also circumscribes. It calls "attention to some aspects of reality while obscuring other elements, which might lead the audience to have different reactions" (Entman, 1993, p. 55). Framing involves selection, choosing and highlighting an issue, and salience, making the issue "noticeable, meaningful or memorable to audiences" (Entman, 1993, pp. 52-53). Gitlin (1980) suggested frames transmit ideologies (p. 2) and explained that "what makes the world beyond direct experience look natural is a media frame" (p. 6). Frames "are the principles of selection, emphasis, and presentation composed of little tacit theories about what exists, what happens, and what matters" (Gitlin, 1980, p. 6), and the media's chief tool for creating and presenting "images of order" (p. 11).

In terms of health messages, frames can be a way to synthesize and simplify complicated scientific information. In health articles, frames personalize. They help readers answer the question: "Why does this matter to me?" Framing is essential to reader understanding, and "the meaning of text resides in the frames" (Fox, 1997, p. 32). Andsager and Powers (1999) have noted that "media framing of complex diseases is important because the way these are presented may affect individuals' choices regarding health" (p. 76). In their analysis of the framing of 127 articles on breast cancer in seven news and women's magazines, the researchers found that both types of magazines focused on prevention and treatment; however, women's magazines presented stories in terms of personal crises, while news magazines framed stories in the context of economics (Andsager & Powers, 1999).

To examine how women's magazines frame health care issues, it is critical to define "health." For this paper, I used the broad definition of health developed by the World Health Organization (WHO): "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity" (WHO, 2000). This expansive concept allowed analysis of articles on physical health, including disease prevention and self-diagnosis; mental health, including stress and depression; public health issues, such as domestic violence and sexual abuse; and health policy issues, such as insurance coverage and funding for research.

To understand how women's magazines framed heath issues, I studied the content of health articles published in 10 women's magazines in early 2001. The sample used in this study was purposeful and selective: My goal in undertaking this project was to present a "snapshot" of health care coverage in women's magazines--to understand what a reader might learn during one trip to a newsstand. The magazines used for this study were purchased at a single newsstand on the same day, although their dates of publication ranged from December 2000 to February 2001. I included only general interest magazines in this analysis and excluded magazines that had a primary focus on health since my goal was to examine how health articles were presented in a broader context of women's interests. In an attempt to capture the diversity of women's interests, I chose magazines targeted to different audiences:

* Cosmopolitan, a magazine for young women that "focuses on personal growth, relationships and careers, with expanded coverage of fashion and beauty, health and fitness;"

* Curve, "the latest in lesbian-related celebrity interviews, news, politics, pop culture, style, travel, social issues and entertainment;"

* Essence, a magazine for "today's educated, affluent, and active African-American woman" with information to help readers "take charge of their emotional and physical well-being;"

* Girls' Life, for girls ages 10 to 15, with a focus on "friendships, self-improvement, fashion/beauty;"

* Jane, "a lifestyle magazine for women 18-34 ... with a unique sense of humor and a keen pop culture sensibility;"

* Ladies' Home Journal, one of the "Seven Sisters," the grouping that includes the oldest women's magazines in the United States. The magazine is targeted to "women homeowners ages 30 to 50 years of age ... active, educated moms who are in the position to make purchasing decisions ...;"

* Latina, a magazine for young Hispanic women;

* Marie-Claire, "a modern woman's one-stop shop for style and substance;"

* Ms., which offers a feminist perspective;

* Redbook, targeted to "30-something young marrieds and young moms" (SRDS, 2004).

In conducting this research, the unit of analysis was the magazine article. I reviewed each magazine's table of contents, then selected only health articles for further study. I analyzed all articles related to physical or emotional health, including special features, regular features, first-person stories, and health "briefs." I examined articles in which the primary focus was health; for example, if a celebrity discussed her life goals and mentioned diet, I excluded that article.

As part of this project, I conducted a simple quantitative content analysis to determine 1) the frequencies of health articles in magazines and 2) the subject areas covered. To ensure inter-coder reliability, a graduate student also reviewed four of the 10 magazines to determine the number of articles that focused on health care; the inter-coder reliability rate was 79 percent, within the acceptable range for communication research (Keyton, 2001). I then developed a coding sheet to examine topics of health articles, listing eight possible subject areas (sexual health, diet/exercise, cardiovascular disease, cancer, diabetes, mental/emotional health, osteoporosis/bone health, and other). Again, a graduate student examined a 35 percent sub-sample of articles, and the inter-coder reliability rate was 87 percent.

Because quantitative methods have limitations--they can tell us the numbers of articles but cannot uncover the deeper meanings of text (Keyton, 2001)--I conducted a qualitative textual analysis to discern story frames. To ensure consistency in the analysis, I developed a matrix, adapted from a protocol by Altheide (1996), to examine articles' context, content, and underlying messages (Attachment 1). I analyzed each article using the matrix to explore carefully how language was used as a tool to construct frames, basing the analysis on five elements of framing used in a previous analysis by Gamson and Modigliani's (1989, pp. 2-3): metaphor (comparisons), exemplars (historical examples from which lessons are drawn), catchphrases (buzzwords or words or phrases commonly used to describe a quality or phenomenon), depictions (characterizations of people or events), and icons. Although Gamson and Modigliani analyzed icons as visual images, I included only text in this analysis. I expanded the term icons to include the dictionary definition of icons as images of the sacred (Webster's, 2001).

There are limitations to this study. First, this is a small sample size, so the results are not generalizable. Second, this study looks only at the presentation of issues. Scheufele (1999) has theorized that framing can be used both to understand how the media present information and how readers interpret meaning, but in this paper I concentrated on the text, not the audience reaction. Finally, qualitative methods are subjective in nature; therefore, the study should be regarded as a single attempt to uncover meanings embedded in women's health articles.

Findings: Health as Women's Work

This analysis suggested that health care continues to be an important issue in women's publications. Of the 337 non-fiction articles appearing in the 10 magazines, 42 or nearly 12 percent concerned health topics, competing for space with articles about travel, the arts, celebrity news, fashion, beauty, and relationships. Authors of health articles included medical writers, magazine editors, columnists, and "survivors"--readers who crafted first-person accounts of health problems (often told to journalists), how the problems changed their lives, and how authors overcame emotional or physical obstacles. The phenomenon of first-person survivor articles frequently placed women in the position of health care experts; while doctors, nutritionists, and consumer health advocates also were depicted as knowledgeable, they played supporting roles, responding to women's questions or offering advice. The length of articles varied from as short as one paragraph to as long as four pages, with most following a similar format--identification of a health problem, background information on the problem, proposed solutions to the problem, and "calls to action"--advice for women on next steps they could take.

Health care topics featured in the magazines were broad and diverse, covering emotional as well as physical health, and situating health in the broader context of women's multiple roles as income-earners, homemakers, mothers, daughters, wives, and lovers (See Table 1).

For women's magazines, old news was a staple of health information. Articles typically did not contain news of medical "breakthroughs;" instead articles repeated old news, recycled information from medical journals and scientific studies, and published tried-and-true health dictates. Latina carried an article on the importance of drinking eight glasses of water per day ("Drink up," 2001)--hardly groundbreaking information. A first-person article about a woman who became blind from complications of diabetes, published in Marie Claire, included a list of disease symptoms (Halliwell, 2001)--again, interesting information, but not new information. Ladies' Home Journal featured a list of 25 "heart-smart" moves to prevent cardiovascular disease (Leader & Sciammacco, 2001), which included exercise and a balanced diet, while Redbook published an article, designed to expose "13 big fat diet lies that keep you from losing" weight, with tips such as eat sensibly and exercise regularly (Kusek, 2001, p. 34). Even articles about recent medical breakthroughs included information readers might have obtained earlier from other sources. For example, a Latina article discussed mifepristone as a controversial abortifacient (Difulco, 2001), although the drug had been available in Europe since 1988 and had been legally available in the United States since September 2000 (Mifepristone, 2004).

In examining the text of magazine articles, the central frame that emerged was that of health as work, mirroring health consumer notions of well-being as an accomplishment that requires commitment and perseverance. Health was a quality women could attain if they were alert, knowledgeable, and proactive, and women's job was to make choices that could improve their own health as well as the health of those they loved. While illness was not presented as a punishment, wellness was presented as a trophy for women's endeavors. Women's magazines emphasized that good health was an achievement born of readers' diligence and acuity. In this sample of articles, health itself became a metaphor for liberty and illness a metaphor for women's failures.

In framing health as work, magazines positioned disease as a tangible threat, and women as the logical guardians of bodies, homes, and families. Articles portrayed illness as a thief that could destroy safety and security. It robbed women of wholeness--of potential for a full life--a life that, by most accounts, included romantic love, sexual pleasure, children, and in some cases, a meaningful job. The author of a Cosmopolitan article on heart disease recounted her personal experiences when she suffered a heart attack: "I felt like I'd lost everything--my health, my job, and most important, my freedom" (Ducker & Shoan, p. 154). A first-person article in Essence written by a 38-year-old woman who experienced early menopause, reported that physiological changes made her feel "out of control" (Lee, 2001, p. 76).

Articles often were couched in terms of warnings, reminding women that they were vulnerable to invisible, silent forces, and language in articles could be alarmist. In a Latina article about a woman who had undergone a kidney transplant, the author warned readers that good health could be "ripped from your grasp in an instant" and wrote that she "went from being a healthy teenager with a bright future to being a young woman struck down by a chronic illness" (Lara, 2001, p. 78). A Ladies' Home Journal article on high blood pressure alerted readers that "this disease could be creeping up on you" and "is particularly threatening to women" (Frishman, 2001, p. 84). The article used the catchphrase "number-one killer," noting that it could "wreak havoc" on the cardiovascular system (Frishman, 2001. p. 82). Redbook listed eight "scary truths" about osteoporosis, noting it "steals more lives than breast cancer" (Colino, 2001, p. 26). "Just because your doctor isn't talking about osteoporosis doesn't' mean it's not happening to you" (Colino, 2001, p. 26). Another Redbook article warned readers that ear infections among children tripled during the past 20 years and told readers that "day care is basically a Petri dish swarming with infectious organisms...." (Galewitz, 2001, pp. 138). Redbook also included a health brief entitled, "Danger: You Can Be Too Clean" (Graham, 2001, p. 23), while a Latina article asked readers, "are you risking on-the-job injury?" (Are you, 2001, p. 56). Marie Claire asked its readers, "Is stress making you fat?" (Dicostanzo, 2001, p. 176).

Given that magazines depicted illness as an enemy, it is not surprising that many articles contained battle metaphors, advising women to develop strategies to protect health. The Redbook article on child earaches described "the arms race" of bacteria versus antibiotics (Galewitz, 2001, p. 136), and a separate article on osteoporosis described how "calcium is mobilized" in bones (Colino, 2001, p. 30). In a Jane article, the writer described her attempts to lose her virginity prior to a hymenotomy as "a full-on campaign" (It happened, 2001, p. 77) Author Linda Richman, who related her own experiences in coping with the death of her child, advised women that sometimes the best way to fight depression is to be overwhelmed by it. "You've got to drop the bomb on yourself," she told readers, and she revealed that she sometimes watched the movie Terms of Endearment to bring on a crying session. "It's the nuclear weapon of dead-children movies" (Richman, 2001, pp. 95, 96).

While magazines depicted illness as a threat, they also assigned responsibility for stopping the threat: Fact-finding research was among the essential tasks in maintaining good health, and comprised a crucial element of women's health work. Ladies' Home Journal told readers that "people who are informed about health care get the best treatment" and advised women to talk with their doctors about heart disease (Leader & Sciammoacco, 2001, p. 80). A Latina article included Web site and telephone contacts of information on mifepristone.

Articles in women's magazines portrayed physicians and researchers in contradictory roles--as women's helpers but also as part of a health-care system that did not always put women's interests first. While magazines did not herald doctors as ultimate authorities, publications did encourage women to work collaboratively with the medical community, seeking advice and treatment. A short article on breast cancer in Ladies' Home Journal suggested women "get a second opinion" and "seek out a breast cancer specialist or go to a breast cancer center" (Roufos, 2001, p. 92). A brief article in Girls' Life advised a young reader with back problems to get a doctor's exam. "No matter what the diagnosis, you do have options--talk to your doctor or chiropractor" (Body Q&A, p. 32). A Cosmopolitan article cautioned women not to rely solely on themselves for diagnosis and treatment of vaginal itching, but instead to seek physician advice. "Praying your private problem will automatically disappear doesn't do the trick.... leave the diagnosis to your gyno" (Howard, 2001, p. 162). An Essence piece encouraged readers to find a "menopause-friendly doctor" (Grant, 2001), and an article in Girls' Life suggested young women talk with physicians about any problems during their early years of menstruation. "Though sharing your irregularities with your doctor might be a bit embarrassing, it's really important" (Clott & Cordi, 2000, p. 88). However, this reliance upon medical experts could be framed as childlike dependence as was the case with a Latina article on weight loss. The author, who sheepishly admitted to eating ice cream while on a diet, reported she was relieved when "my doctor didn't scold me" (Martinez, 2001, p. 58).

Articles warned women that not all doctors and scientists were their allies. Ladies' Home Journal published a short article reporting that 20 percent of women treated for breast cancer from 1989 through 1995 may have received inappropriate treatment, putting women at risk of a reoccurrence (Roufos, 2001, p. 92). A Redbook article on cryosurgery following abnormal Pap smears warned women that doctors might tell them the procedure is "routine, tolerable, and quick," but would fail to tell them it's also painful (Graham, 2001, p. 23). The short article told women what they really could expect. Ms. magazine presented a report on the regulatory process that led to government approval of Tamoxifen, a drug promoted to prevent breast cancer. The article investigated whether the National Cancer Institute (NCI) misled women about the risks of Tamoxifen and concluded that "even before Tamoxifen was approved, the NCI did have risk/benefit data but failed to analyze it until after the drug was on the market" (Pappert, 2000/2001, p. 44).

The medical community, however, was not the only health resource for women. Magazines encouraged readers to rely on other women for information, advice, and support. An Essence column suggested a reader talk with women who had undergone abortions to help cope with the anger she felt toward a partner who had encouraged the procedure (Grant, 2001). A separate article advised women to join a support group to discuss menopause (Lee, 2001, p. 195). Girls' Life encouraged readers with questions about menstruation to seek help from their mothers. "Your morn can answer a ton of questions. She's been there!" (Clott & Cordi, 2001, p. 57). In the Ms. article on Tamoxifen, women's health advocates were depicted as working to protect other women--female health consumers (Pappert, 2000/2001). A Jane article on domestic violence in Nicaragua profiled the National Police Women's and Children's Center, which developed written contracts that "abusive men sign, promising not to beat the shit out of their wives" (Guerra, 2001a, p. 134). Magazines urged women to be cautious, but they also assured women they could trust their own judgment after they synthesized information they had gained from conducting their own research.

To further encourage women to be proactive, articles included instructions--"recipes"--on how women could maintain their health. Frequently, these instructions were presented as bulleted lists, offering advice and next steps for readers. One Latina article listed six "surefire ways to reduce your risk" of repetitive stress syndrome at work (Are you risking, 2001, p. 56), while a Redbook health brief listed four "what to do next" steps for women who experienced bleeding after sex (Graham, 2001, p. 23) and the 11 habits of stressless women (Bacher, 2001). Ladies' Home Journal presented a bulleted list of how to prevent high blood pressure (Frishman, 2001) and "25 heart-smart moves to make right now" (Leader & Sciammoacco, 2001).

Magazines depicted stress, caused by demands of home and work, as a source of health problems and included articles advising women on how to relax. A Ladies' Home Journal article emphasized the healing aspects of home life. "Outside of work, Weiss, a mother of two, relaxes by focusing on her family.... 'You can't obsess about work when you're with your kids'" (Cooper, 2001, p. 64). The same Ladies' Home Journal explained how one woman managed stress:
   Friends and family also help. Her husband, Ron,
   a restaurant manager, tackles the morning routine
   so that she can start the day without rushing. Sue
   says, "There's nothing wrong with asking for
   help.... It's like recruiting your own cheering
   section." (Cooper, 2001, p. 71)


A separate article in Redbook also encouraged women to turn to their families to alleviate winter depression:
   "For me, heading to a cozy bar with my husband
   for a glass of red wine is the best way to
   appreciate the winter."

   "I take the kids out for a walk after dark, when
   the moon is shining on the snow and the ice
   crunches under our boots." (Evans, 2001, p. 84)


If women did fend off threats of ill health, the benefits were substantial. They could claim good health, but they also could have happiness, freedom, low stress levels, and better relationships with men and children. A Ladies' Home Journal article about preventing hypertension promised connections with loved ones. "You'll be thankful for the payoff--more years to spend with your family" (Frishman, 2001, p. 86). A first-person article in Cosmopolitian, in which a 27-year-old woman described her recovery from a heart attack, said that exercise and relaxation meant "I'm living the life I was meant to live" (Shoan & Zucker, 2001, p. 154).

Prominent among the rewards of good health was sexual pleasure, which was presented as both a benefit of and a means to maintain good health. An Essence article told women that "exercise not only keeps you strong and healthy but it also increases your sexual pleasure" (Scruggs, 2001, p. 82). In one article, an author said she would "reduce stress, exercise more and deepen my connection with my husband" in order to improve sex drive (Hicks, 2001, p. 84). An article in Ladies' Home Journal advised women that one way to prevent heart disease was by intensifying sexual activity. "Having sex not only helps you feel more connected to your spouse, but it's also a mini-workout equivalent to running three minutes on a treadmill" (Leader & Sciammacco, 2001, p. 76). Essence published an article about the sexual benefits of sit-ups, noting that exercise "not only gives you greater pleasure but pleases your partner as well" (Scruggs, 2001, p. 82), plus an article with information on herbal aphrodisiacs (Hicks, 2001). A brief article in Girls' Life told readers that "a healthy attitude toward sex reflects healthy sexual behavior" (The "talk," 2001, p. 18), while a Ladies' Home Journal article warned women that sexual dysfunction was an unpleasant side effect of hypertension, noting that women "reported more arousal problems, fewer orgasms, and more pain during intercourse than those with normal blood pressure" (Frishman, 2001, p. 84). Jane's profile of Jenny, a young woman who underwent a hymenotomy, presented sexual satisfaction as a sign of good physical health and sexually activity as a marker of normalcy (It happened, 2001).

In this sample, the pleasures of sex were generally removed from the physical consequences of sexual intimacy. Latina was the only magazine to carry an article on unwanted pregnancy--a health brief on the risks and benefits of mifepristone (Difulco, 2001). Sexually transmitted diseases (STDs) were mentioned in three articles. Ms. ran an article about HIV-testing (Block, 2000/2001); Cosmopolitan carried an article about vaginal itching, advising that some symptoms could indicate an STD (Howard, 2001); and Jane's "Sex, Sex, Sex" column told international scientists to "shake a leg" and develop a new vaccine to prevent herpes (Guerra, 2001b).

Only one article among the 42 analyzed discussed women's health in terms of self-reward rather than improved relationships with others. Curve published an article on domestic violence, suggesting that "women are primed for love and romance, schooled by society and our mothers to desire love and romance from infancy" (Brownsworth, 2001, p. 48). The article cautioned women that violence often is disguised as love and urged women to "let go of the pressure to be coupled" (Brownsworth, 2001, p. 48).

Conclusion: Missed Opportunities

Tulloch and Lupton (2003) observed that our contemporary health culture reflects "an increasing desire to take control over one's life, to rationalize and regulate the self and body" (p. 10). Women's magazines reinforced this notion of regulation, not only positioning health as the product of work but also as the product of women's work, placing women in charge of their own health as well as the health of their loved ones. Magazines typically provided information in prescriptive terms, depicting health as something that could be mapped, planned, and achieved. While magazines incorporated some feminist sensibilities--that women should take control of their bodies, that women had a right to accurate health information, that knowledge about health empowers women, and that women were smart enough to make their own decisions--these publications also reinforced women's traditional role as guardians of the home.

"Women are major consumers of health care services, in many cases negotiating not only their own care, but also that of their family members" (Salganicoff, Beckerman, Wyn, & Ojeda, 2002, p. vii), and it could be argued that magazines' framing of health as women's work accurately reflects women's roles in the larger society. Women are the primary caretakers for children, and assumptions that women are "natural" caregivers abound, due to Western cultural norms that define femininity in terms of connections to others (Chodorow, 1974; Fee, 1993; Miller, 1976). These norms prevail in spite of women's increased participation in the workforce and men's changing roles within the family (McKie, Gregory, & Bowlby, 2002; Misra, 2003). "Most females are socialized to be sensitive to others and to understand that caring is an ongoing expectation of them.... Historically 'women' has been the answer to the question of who cares" (Wood, 1994, pp. 5, 164). Magazines did not challenge the notion that women were caretakers; articles instead offered advice on how they could become better caretakers.

In this analysis, women's caretaking activities were limited to relatively healthy selves, husbands, and children, and caretaking was assumed to be rewarding and fulfilling, albeit stressful. Some researchers suggest women achieve a sense of worth and satisfaction from caretaking (Altschuler, 2001; MacRae, 1995; Martire, Stephens & Franks, 1997), yet some feminist scholars have noted the discrepancies in women and men's caretaking duties (Jecker, 2002; Kittay, 2002). Wood (1994) argued that caretaking can be a good experience when chosen and valued; conversely, it can be damaging and draining when forced and underrated. While women's magazines presented caretaking as a fact of life, one thing missing from articles was women's perspectives on their caretaking roles. There were no stories from women, explaining the satisfactions of caring. Nor did articles focus on some of the negative aspects of caretaking, such as role strain among women who must take on the responsibility of care for dependent relatives; the isolation, loneliness, and depression that comes with round-the-clock caregiving; and the self-doubt and sense of failure that can accompany unrealistic expectations of perfection. Additionally, magazines did not discuss caretaking of elderly, disabled, or chronically ill relatives, tasks largely performed by women (Armstrong & Armstrong, Nd; Eldercare, 1998; Jecker, 2002; Jenkins, 1997; Little, 1995; Moen, Robison, & Fields, 1994; Misra, 2003; National Family, 2004; Pavalko & Artis, 1997; U.S. Department of Health, 2005; Witt, 1994). Meleis and Lindgren (2002) have written that women's caretaking work has typically been devalued in a capitalistic society that defines work as income generation and the production of goods; magazines failed to look at the economics of caretaking, including women's need to pay someone to assume their traditional caretaking responsibilities if they participate in the paid labor force. Women's magazines reinforced women's roles as what Irigaray has called "the nurse of man and society" (1993, p. 83).

Lupton (1995) wrote "the maintenance of good health is the responsibility of the individual, or the idea of one's health as an enterprise" (p. 70), assuming a "'free subject' who has a number of choices of actions" (p. 61). Articles in this sample focused on the individual's role and choices, but magazines ignored the fact that, in a gendered society, women may lack autonomy to prevent illness or preserve health. Magazine articles typically assumed their readers lived in a world of youth, heterosexuality, and economic security, without acknowledging that women may perceive they have little, if any, control over the actions of partners, co-workers, children, physicians, insurance company executives, or employers. Articles also encouraged women to ask questions, without noting that for many women questioning authority, even speaking in public, can be a difficult endeavor. Magazines advised women to become empowered through information, yet did not recognize that women, even if they have accurate health information, may feel powerless to act on what they know.

It's worth noting that magazines presented valuable information on some key health topics--heart disease, the leading cause of death and disability for American women; osteoporosis, a condition that will affect nearly half the women over age 50; and depression, which affects nearly 20 percent of women (Women's Health, Nd). Two articles focused on domestic violence, the cause of approximately one-third of all female homicides (Domestic violence, 2005). Yet, articles also ignored some key health issues. Four articles in this data set acknowledged that smoking can worsen women's health, yet there were no features on lung cancer, the fourth leading cause of death among all women (CDC, 2001). AIDS was mentioned briefly in one Ms. article, although women account for 25 percent of all new AIDS cases in the United States (Women's Health, Nd), and AIDS is the sixth leading cause of death among women ages 25 to 34 and the seventh leading cause of death among women ages 20 to 24 in the United States (CDC, 2001). Granted this was a small sample; future studies might consider the correlation between diseases that most affect women and dominant topics in women's magazines.

Seven articles in this sample included first-person accounts of coping with illness. These accounts rightly positioned women as authorities on their bodies and offered unique perspectives on how illness can affect family life, work abilities, and self-image. However, first-person articles often focused on events that were rare and spectacular--early menopause, a heart attack at age 27, a hymenotomy, surgery to correct blindness. First-person accounts provided tabloid drama; magazines might better serve their readers by providing accurate information on more common medical concerns among their target audiences.

Perhaps one of the most troubling articles in this analysis was the lengthy question-and-answer feature on menstruation in Girls' Life. In working to allay girls' fears about menstruation, the article anticipated and answered dozens of questions young women might have about their periods, admonished young girls to be proud, and told readers to "rejoice that you have become a woman!" Yet, the article included a sidebar on "your most embarrassing period moments," in which young women described how boys made fun of their use of tampons or pads and ridiculed them when there were stains on their clothing (Clott & Cordi, 2000/2001). Rather than give young women advice on how to handle this type of harassment, the magazine offered only pity, implying that girls should accept boys' insensitive behavior.

While little scholarly or journalistic research has been conducted on the content of men's magazines, the analyses that have been done suggest these publications mirror women's magazines, in that they offer information on health topics important to readers (Hoon, 2005); reflect some of the same focus on body images and weight loss as do women's magazines (Frederick, Fessler, & Haselton, 2005; Nemeroff, Stein, Diehl, & Smilack, 1994), and promote consumerism (Featherstone, 1998). However, men's magazines promote self-confidence rather than self-doubt (Levine, 1994), and present women as sex objects rather than product users (Baker, 2005). An examination of men's magazines was beyond the scope of this research project; however, an area of future research would be a comparative study that examines whether men's magazines offer the same triangulation of health, work, and responsibility as do women's publications.

On the surface, magazine messages that women should work hard to keep themselves and their families healthy may seem contrary to traditional feminine stereotypes of passivity; however, health-care articles promoted another feminine stereotype as they encouraged women to be ferocious caretakers--nurturers par excellence. Women's magazines have been criticized because they "reinforce the idea that it's a woman's job to make sure her world--including her husband, children, and work--is running smoothly. By implication, they suggest that if life is not satisfactory, it's her fault" (Doner, 1993, pp. 37-38). By framing health as women's work, magazines characterized health, not as a state of well-being, but as a state of well-meaning, in which women must strive to be healthy, not necessarily for their own sakes, but in order to fulfill their traditional role as nurturers. Editors might ask why the presumption that women are caretakers exists and explore some of the societal norms that underlie this assumption. Editors also might consider whether a focus on caretaking as a lived experience, rather than caretaking as a feminine duty, would better serve readers.

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Barbara Barnett, Ph.D., is an assistant professor in the William Allen White School of Journalism and Mass Communications at the University of Kansas. Her research focuses on media representations of women and femininity. She received her master's degree from Duke University and her doctoral degree from the University of North Carolina-Chapel Hill. You may contact her at: 205-C Stauffer Flint Hall, The University of Kansas, 1435 Jayhawk Blvd., Lawrence, KS, 66045. Her e-mail is: barnettb@ku.edu.
Table 1: Health topics in women's magazines

Topic                            Number of      Percent
                                 articles

Sexual/reproductive health       16             38%
Diet/exercise                    16             38%
Cardiovascular disease           5              12%
Cancer                           2              5%
Diabetes                         1              2%
Mental/emotional health          10             24%
Osteoporosis                     1              2%
Other                            10             24% *

* Because some articles contained more than one topic,
percentages do not add up to 100.
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Date:Sep 22, 2006
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