Guest Editorial

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Lynne Hunt
Centre for Public Health and Medical Education, Edith Cowan University, Western Australia

Beverley McNamara
Senior Lecturer Anthropology and Sociology, School of Social and Cultural Studies, The University of Western Australia

Article Text

The modern, women's health movement emerged as part of second-wave feminism in the last quarter of the twentieth century. It was born of a desire for woman-friendly health services and the need to address health concerns defined as important by women themselves. Scholars identified an uncritical adoption of patriarchal social values by mainstream health services as a key issue, giving rise to the movement. Dally (1991), for example, showed how, from its very inception, the medical profession confirmed prejudices about women and raised sexist judgments to the status of scientific propositions. In other words, society's dis-ease with women was transformed into disease. So powerful had been the influence of sexist values on the development of medicine that Virchow, recognised as one of the greatest pathologists of the nineteenth century, concluded: 'Woman is a pair of ovaries with a human being attached; whereas man is a human being furnished with a pair of testes' (Dally 1991: 84). A woman was her uterus. In a process that Foucault (1978) described as the 'hysterisation' of women, nineteenth century doctors advanced the notion that the uterus was the controlling organ in women. It was understood to be connected to the nervous system thereby influencing women's physical and mental well-being. As a consequence, the term hysteria was coined to describe mental disturbance occasioned, it was argued, by the uterus.

The hysterisation of women has also inclined medical services to provide, somewhat narrowly, for women in terms of their reproductive health needs. Even today, it is not unusual to see identifiable women and children's clinics and hospitals in modern, Western countries. In contrast, the twentieth century women's health movement sought to re-conceptualise notions of women's health and to broaden the scope of women's health care. Issues such as domestic violence, sexual assault, mental and physical well-being and the health consequences of patriarchy were embraced as serious concerns affecting women's health and well-being. Yet, while these previously neglected issues were brought to light, a danger existed in essentialising women as a homogeneous group. Differences between women, and postmodernist notions of fractured identity, could be obscured by focussing attention too broadly on issues of gender, while ignoring the rich diversity of women's experiences. It is with the express purpose of highlighting the broad social canvas of women's experience that we present a selection of papers in this symposium that focus on diversity in women's health. This exploration of difference reveals, in sharp profile, the need to deconstruct received wisdom and research evidence about the category 'woman' as it is applied to health.

Two of the papers in this symposium arise from the Australian Longitudinal Study on Women's Health (ALSWH), a unique, twenty-year study of the health of 40,000 Australian women. Marilys Guillemin's paper is a study of heart disease and mid-age women in which she explores important gender differences in the diagnosis and treatment of cardiovascular disease which show that women can be disadvantaged when confronted with a health care system that codes cardiovascular disease as male. This kind of gendered health experience is summarised here in the words of one of Guillemin's respondents:

We went to the hospital, where they gave me valium and sent me home...The pain never stopped, it was just there the whole time. On the Saturday morning I said to [my husband] 'I'm going to die, I know I am', so he put me in the car and went to [another local hospital]...They put me straight through to someone who was on duty who came down and met me in the lift. He later told me another two minutes and I wouldn't have made it.

The second ALSWH paper paints a broad canvas of the health and well-being of rural women. Penny Warner-Smith, Lois Bryson and Julie Biles show differences in women's health status and opportunities arising from age and area of residence. Their evidence indicates that 'different' can mean unequal. Younger, rural women, for example, are poorly qualified, have fewer job opportunities and become mothers at comparatively young ages, as one young respondent noted: 'My friends and I went to an all girls Catholic school and out of a graduation of 35 girls in 1993, we have 16 children and I'm only 19. This makes me very sad'.

The theme of age and educational status is addressed again in Ann Evans' paper in which she pursues the relationship between education and decision-making associated with teen pregnancy. She notes that, 'young women who have a stronger attachment to, or liking of, school are more likely to terminate than continue their pregnancies'. Using data from a purpose specific survey in Australia, Evans also indicates that most young women within the sample who chose motherhood were happy with their decision, whereas those who chose abortion were more likely to have mixed feelings. The issue of pregnancy per se is used by Martha Macintyre, but in an entirely different context to Evans. Macintyre explores notions of tradition and modernity thus challenging stereotypical notions concerning the apparent control that indigenous childbirth offers to women. She shows that village women in Papua New Guinea (PNG) have embraced modern obstetrics, particularly where there is continuity between traditional beliefs and modern medical practice. She contextualises the acceptance of the medicalisation of childbirth within broader traditions of 'positive cultural attitudes relating to economic development and the desire to be modern' that have affinity with the cargo cults of the mid-twentieth century. Importantly, Macintyre does what should be done in a review journal: She raises researchable questions about indigenous childbirth, particularly as they pertain to the issue of choice that has informed the feminist women's health movement. Choice, she suggests, may have a different meaning to women in PNG than that which prevails in the West. She notes that, 'under-funding of the government health system and the lack of access to care for many rural women means that women often do not have the choice but to stay in the village'.

The profound importance of choice as it influences the degree of personal control over one's life is evident in Farida Tilbury and Mark Rapley's account of refugee women, who they see as having different needs to migrant women:

Their experience is considerably different from voluntary migration. These women have not had the opportunity to say goodbye to people or place, to take precious things with them, and cannot keep in touch with or return to loved ones. They have experienced loss, life in refugee camps, torture and trauma, often rape and sexual abuse, and battles with bureaucracy.

The structural determinants of mental well-being among refugee women are addressed with Tilbury and Rapley arguing that 'the so-called mental health problems of refugee women are entirely normal, rather than pathological, reactions to traumatic events, filtered through the matrix of disadvantage entailed by being a refugee in Australia'.

Even so, the line between migrant and refugee status is blurred, not the least because, on arrival, both share the pain and excitement of acculturation as they adjust to new value systems and ways of behaving. It is within this context that the migrant experience, as it pertains to drinking patterns, is explored in Barbara Wolska, Sherry Saggers and Lynne Hunt's paper. They illustrate that different social settings give rise to different drinking behaviour, and that, overall, Polish-Australian women drink more in Australia than in their homeland, a factor that may have negative consequences for their physical and mental health:

These times it's okay for women to drink, before [in Poland] it was not accepted, and a woman drinking would get negative comments, it's only men who could get drunk and be happy, the woman had other responsibilities, but now it has changed ... especially here in Australia.

In exploring the intersection between gender and other key variables of social location, the papers in this symposium highlight a rich diversity between women, which contributes to their very different health experiences. Age, area of residence, traditional and Western social background, and refugee status are all explored with a gendered lens. This lens, honed through the rigours of both qualitative and quantitative research, magnifies and clarifies how women manage their unique health challenges, all the while navigating a health care system that still echoes of an entrenched patriarchy. While a broad sociological perspective is brought to the papers, gender per se remains fundamental to the analysis in each paper. As Warner-Smith, Bryson and Biles observe, 'There [remains] an urgent need to integrate a thoroughly gendered approach not only into all analyses of spatial inequality but also the analysis of the distribution of and access to services'. Together, the papers provide qualitative and quantitative evidence that will inform academic debate, policy and health care practice.

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