Gender Studies

The Effect of the COVID-19 Pandemic on Unemployment Rate: Implications for the Gender Gap

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by Farah Hasan, September 27, 2022

Abstract

The recent COVID-19 pandemic has brought on unprecedented disruptions to global economies resulting in income loss and high unemployment rates that have disproportionately affected women. Existing research on COVID-19 and the economic effects of a pandemic on gender-based employment are limited, though rapidly growing, and a literature review providing a holistic overview is needed to advise and inform policymakers on important factors to consider when working towards reparations and economic recovery. Prior empirical work, particularly case studies, will be used for a primarily qualitative analysis, along with the presentation of some important statistics in regards to unemployment. Unemployment rates are exceedingly high for women compared to those for men in both developed and developing countries, with several female-dominated occupations (such as beauticians and cabin crew) being most severely affected by the pandemic due to closures and discontinuation of service. Policymakers should take several factors into account when working towards economic restoration such as a country’s status as developed or developing, type of occupation, and type of unemployment. Additionally, more focus should be given to implementing certain standard practices in promoting gender equality in work outcomes. Such policies will aim to revive employment while improving occupational gender equality in the long run.  

Keywords: COVID-19; pandemic; unemployment; gender gap; developed/developing countries

1. Introduction

This paper seeks to discuss general trends in global unemployment rates after the COVID-19 pandemic took hold, to highlight patterns in the types of occupations most severely affected, and to evaluate potential changes in labor outcomes in regards to gender. As a novel occurrence, the COVID-19 pandemic has impacted individuals and nations from a variety of different angles (such as healthcare, political standpoints, research and development, growing reliance on virtual settings, etc.) and has thus given rise to an immense amount of unknown territory for research. While extensive research is available on economic recessions, not as much is known about the unique impacts of a pandemic, especially as it relates to gender gaps. Most existing literature consists of case studies looking at unemployment rates and demographics within specific countries. It has been observed that the unprecedented disruptions to the global economies brought about by the pandemic in which diversified economies were providing job opportunities for women in different sectors has led to income loss and high unemployment rates. A literature review providing a holistic view of general trends in unemployment and relations to gender on a global scale (synthesizing the information from case studies on various countries) is needed to have a more comprehensive understanding of the true extent of the impact of the COVID-19 pandemic on unemployment and gender gaps. Understanding how the pandemic affected labor markets in both the developed and the developing worlds is crucial as governments continue to develop responses. 

Most evidence used will consist of prior empirical work, such as case studies. The analysis will be mostly qualitative, but will provide valuable statistics and graphical data to highlight comparisons of unemployment rates in different countries and percentage breakdown of labor outcomes by gender. Current literature suggests that the pandemic has widened gender inequality in the labor market. Changes in the gap must be investigated in order to address the potentially growing inequality by enacting and strengthening policies to support women and prevent a possible increase in female unemployment and worsening of gender inequality. The purpose of the present literature review is to highlight various determinants of occupational segregation in regards to COVID-19, such that policymakers will have a clear understanding of factors to consider when formulating policy responses to alleviate the impact of the pandemic and take preventative measures against similar future crises. This will be achieved by discussing general trends in global unemployment rates after the COVID-19 pandemic took hold, highlighting which types of occupations and industries were most often and most severely affected by the pandemic, and evaluating the gender demographics of workers affected in both developed and developing countries across the globe. Failure to investigate this would leave governments and economists in the dark regarding any potentially exacerbated gender gaps due to the pandemic, obscuring the urgency of mitigating any harmful changes. 

In the next section, I will present background on gender inequality and its connection to the pandemic. Section 3 is a literature review on COVID-19 and unemployment rates, types of jobs affected, and demographics of the worker population most severely affected. Section 4 synthesizes findings from the literature review and highlights salient determinants of occupational gender equality in regards to the pandemic, such as the status of a country (developed or developing) and type of occupation, that policymakers must pay heed to. Section 5 summarizes findings and discusses implications for COVID-19-related employment policies, limitations regarding scope of analysis, and recommendations for future research. 

2. Background

Gender inequality is an issue in both developed and developing countries, with 18% of women having experienced physical and/or sexual violence in the previous 12 months (United Nations (UN), 2019). This percentage is even higher in developing countries. A greatly embraced solution to this issue is empowering women financially in finding productive employment opportunities (Dang & Nguyen, 2020). Despite these efforts, the gender gap in employment still exists to significant extents in countries around the world, both developed and developing. This occupational segregation also sheds light on the differences in types of occupations that women and men choose, differences in employment status, and differences in hourly wage. The gender gap is especially important to address, as this impacts lifetime earnings, retirement pension payments, and potentially the educational level and earnings of their children (Bächmann et al., 2022). 

While there is extensive research on the impact of recessions on gender-based employment, knowledge on the impact of pandemics in particular on the gender gap is limited. Studies conducted after the Great Recession in the United States suggest that historically, women have suffered higher unemployment rates than men and that their employment tends to be less cyclical than that of men (Hoynes et al., 2012; Doepke & Tertilt, 2016). It is especially important to focus on gender inequality as a pandemic may differ from a typical recession; it more strongly affects sectors with high female employment shares and necessitates increased need of childcare for mothers due to school closures (Alon et al., 2020). Indeed, the pattern observed after the Great Recession is thus compounded by the effects of the pandemic, as some studies suggest that the negative effects of COVID-19 may have wiped out the global progress in gender equality and poverty reduction from the past 30 years (Sumner et al., 2020). The research that is available on gender-related impacts of a pandemic focuses mostly on developed countries, but even less is known about such impacts in developing countries, where gender discrimination is more prevalent and women are typically already worse-off than men in labor participation, job security, income, etc. (Hossain & Hossain, 2021).

3. Literature Review

In the following section, various notable statistics on unemployment rates due to COVID-19 in both developed and developing countries will be presented. Then, a closer look at the types of jobs most severely affected will be provided, followed by a breakdown of the demographics of individuals who work these types of jobs and were most affected by the pandemic and related governmental response policies. This section can be segmented into three major questions, which will be answered in the following literature review.  

3.1 How has COVID-19 impacted unemployment rates?

Compared to the unemployment effects of recessions, the effects of the pandemic are staggeringly large in comparison. It is important to note the similarities between developed and developing countries in these skyrocketing unemployment rates, indicating that both types of countries were significantly affected and that a deeper look into the demographics of the workers affected is warranted. 

According to Figure 4, in the United States alone, the unemployment rate rose from 19.3% in February 2020 (the start of the COVID-19 recession) to 41.5% in February 2021 about 12 months later. Looking at unemployment rates during the US Great Recession, the unemployment rate began at 17.4% in December 2007 and climbed to about 23% within the same time span of 12 months (ultimately ending at 40.4% after 24 months) (Figure 4). 

[Figure 4 here]

Thus, the spike in unemployment due to COVID-19 rather than the recession was significantly sharper and more profound within the same time span of 12 months, suggesting that the unemployment effects of a pandemic warrant urgent investigation (Bennett, 2021).

Different countries experienced these increasing unemployment rates in different patterns. Burns & John (2020) highlight unemployment rates from a more global perspective. While some countries experienced relatively constant unemployment rates throughout the pandemic (namely Japan, Germany, and the United Kingdom), other countries experienced large and sudden spikes in unemployment similar to that in the United States (namely Canada, while Spain, Italy, and France experienced smaller spikes in unemployment) (Figure 5) (Burns & John, 2020). 

[Figure 5 here]

Sweden, a country that will be discussed in depth later in this paper, experienced an overall increase in unemployment by 2.5 percentage points from February 2020 (one month prior to the onset of the pandemic) to July 2020 (5 months after) (Campa et al., 2021). 

It is important to note that all of the countries discussed so far are developed countries, but the COVID-19 pandemic also had profound, if not even more significant, impacts on unemployment rates in developing countries as well. Prior to the COVID-19 breakout in Nigeria, Hossain & Hossain (2021) found that overall employment rates for women were lower than overall employment rates for men. It was noted that 80% of the sample Hossain & Hossain (2021) studied from Nigeria were employed before the pandemic. From March 2020 to May 2020, the early period of the pandemic, the employment rate dropped to 43%. Even after the pandemic broke out, the employment rate for women continued to be lower than that for men. Additionally, the overall likelihood of being employed dropped by 13% in Nigeria (Hossain & Hossain, 2021). Furthermore, as a result of the pandemic, a significant restructuring of the distribution of employees by gender in farming and business spheres occurred. The employment rate for women in business declined compared to male employment in business during the COVID-19 period (Figure 3c) (Hossain & Hossain, 2021). However, it is interesting to note that the employment rate for women in farming surpassed male employment in farming during the COVID-19 period (Figure 3b) (Hossain & Hossain, 2021). These findings will be expounded upon in the following sections. 

[Figure 3 here]

3.2 What types of jobs were most significantly affected? 

Several job spheres were impacted by the COVID-19 pandemic in both developed and developing countries, from aircraft operation to agriculture. By studying the types of jobs affected by the pandemic, valuable information about the nature of the jobs, worker skill sets/interests, and demographics can be determined. 

In Sweden, some of the occupations that were most heavily impacted by unemployment were aircraft pilots, masseurs and massage therapists, cabin crew, and beauticians (Campa et al., 2021). Of these, the unemployment impacts range from 30.8% for aircraft pilots and related associate professionals (which was the highest) to 15.2% for beauticians and related workers (which was the lowest) (Table 1) (Campa et al., 2021). 

[Table 1 here]

It is important to note that most of these occupations are service-based and typically require physical proximity, consistent with the expectation that they would be affected by social distancing measures necessary in reducing the spread of COVID-19.   

In Nigeria, the agriculture sector typically hosts a large fraction of women and works as a buffer during economic shocks. Thus in the context of COVID-19, women engaged in agricultural work were more likely to keep their job, and the agricultural sector became an alternative employment option for women who were not already involved in it (Hossian & Hossain, 2021). This is consistent with the above finding that the employment rate for women in farming surpassed male employment in farming during the COVID-19 period (Figure 3b) (Hossain & Hossain, 2021).

3.3 What were the demographics of the employees affected?

After broadly considering general trends in unemployment rate due to COVID-19 and associated affected jobs, information on gender breakdown in these spheres sheds light on the disproportionately large impact of the pandemic on women compared to men. In doing so, it is important to consider the developed or developing status of a country as well as their response to COVID-19, as these also have implications on gender-based labor outcomes. 

An overwhelming amount of evidence suggests that the COVID-19 pandemic has worsened labor market outcomes for both men and women, but especially for women. Women are 24% more likely to lose jobs permanently than men due to the pandemic in China, South Korea, Japan, Italy, the United Kingdom, and the United States (Adams-Prassl et al., 2020; Dang & Nguyen, 2020). Table 2 shows that 5.8% of women and 4.8% of men reported losing their job permanently, while roughly equal percentages of women and men (25%) reported losing their job temporarily (Dang & Nguyen, 2020). 

[Table 2 here]

Broken down by country, the impact of gender on job loss due to the pandemic are larger in China, Italy, and the United States compared to Japan, South Korea, and the United Kingdom. In regards to losing a job temporarily versus permanently, there appears to be no significant effects of gender on the probability of temporarily losing a job in most countries. However, only in the United States and the United Kingdom are women more likely to lose a job temporarily than men (Dang & Nguyen, 2020). 

In Nigeria, women remained unemployed for a longer period of time (about 3.67 months) compared to men (about 2.61 months) after the initial COVID-19 breakout (Hossain & Hossain, 2021). This specifically hurts women because the longer women stay unemployed, the longer it takes and the harder it is for them to reintegrate into the labor force, lowering future prospects of finding work (Hossain & Hossain, 2021). Overall, the employment of women decreased by 8% more than the employment of men during the pandemic (Hossain & Hossain, 2021). In regards to the interesting phenomenon of farming and business, women were 44% less likely than men to engage in business activities during the pandemic, but 52% more likely than men to engage in farming (Hossain & Hossain, 2021). Thus, not only did women experience a significantly greater reduction in employment during COVID-19, but also a large shift from business to agricultural work. This suggests that women in developing countries have lower job security than men. This also hurts the overall level of productivity of women, as women-managed land is typically less productive than land managed by men, indicating lower labor market returns of farming for women in comparison to men, and more generally of farming in comparison to business (Hossain & Hossain, 2021). 

Revisiting the case of Sweden, this country exhibited interesting – and seemingly contradictory – evidence regarding the extent of gender-based job-related impact. Figure 1 shows that unemployment risk exists for all wage levels, but lower-paying jobs (signified by lower wage deciles) were at higher unemployment risk (Campa et al., 2021). 

[Figure 1 here]

Although Sweden has relatively low gender-based wage inequality, women still tend to be concentrated in lower-paying jobs, suggesting a contributing factor to unemployment of women (Figure 2) (Campa et al., 2021). 

[Figure 2 here]

Additionally, most of the heavily impacted occupations in Sweden were female-dominated. According to Table 1, beauticians are 96.7% female, masseurs and massage therapists are 81.2% female, and cabin crew is 78.5% female (Campa et al., 2021). However, it is important to note that although some highly feminized occupations were significantly impacted by unemployment, these occupational fields are relatively small in size in Sweden (Campa et al., 2021). On the other hand, the unemployment risk actually decreased for some occupations, a few of which are female-dominated as well. Some of the notable occupations are clinical and operations managers in healthcare, department managers in elderly care, pediatric nurses (97% women), and anesthesia nurses (74% women) (Campa et al., 2021). Thus, although some female-dominated fields were adversely affected by unemployment, these fields are relatively small, and some larger sectors that are also dominated by women have experienced an increase in the demand for workers (Campa et al., 2021). Thus, Campa et al. (2021) found that women did not suffer higher unemployment rates than men in Sweden and may actually have had a just barely statistically significant lower unemployment risk than men did. From March 2020 to July 2020, the unemployment risk for men was 2.5 percentage points higher, whereas the unemployment risk for women was 0.5 percentage points, or 20% less than the risk for men (Campa et al., 2021). 

However, it is important to note that the findings from Sweden may not be representative of the unemployment impacts of women elsewhere in the world, as Sweden took a unique approach in responding to COVID-19. Sweden never enforced a lockdown where people had to stay home from work and school. Since daycare and childcare centers remained open, Swedish families did not have to make significant adjustments to the time they dedicate to childcare, a responsibility that often falls on women (Campa et al., 2021). Additionally, Sweden generally has a high labor force participation rate for women to begin with and works to provide feasible opportunities of combining work and family life. Thus, at least in the case of Sweden, gender did not have a significant impact on unemployment (Campa et al., 2021). Like Sweden, there is also no evidence of unequal impacts of the pandemic on women and men in Germany (Adams-Prassl et al., 2020) or in Italy (Casarico & Lattanzio, 2020). 

These findings suggest that the type and/or extent of governmental response to COVID-19 may have influenced the extent to which gender-based employment was affected. Sweden took a relatively minimalist approach in addressing COVID-19 and thus did not have to greatly deviate from its “normal” way of life. Sweden also experienced relatively equal impacts of COVID-19 on the unemployment of both women and men. On the other hand, countries such as the United States, China, and Nigeria more strictly enforced COVID-19 protective measures such as mandatory facemask use, social distancing, travel restrictions, and lockdowns (Dang & Nguyen, 2020; Hossain & Hossain, 2021). These countries also experienced a greater extent of gender inequality in terms of unemployment due to the pandemic. The status of the country as developed or developing may also contribute to these findings, as these countries have different labor participation rates, infection rates, and shares of women in the labor force (Dang & Nguyen, 2020). 

4. Results

The findings suggest a general global trend in increasing unemployment rates as a result of the COVID-19 pandemic, with women being particularly hard-hit. Based on the literature review, the following section suggests several factors that policymakers should take into account when working towards economic recovery, such as a country’s status as developed or developing, type of occupation, and type of unemployment, which will be discussed in the following section. Policymakers should also consider implementing certain standard practices in promoting gender equality on a regular basis, as these types of practices appear to be protective factors against worsening gender inequality during economic downturns. 

A comparison of the unemployment rates and types of jobs affected between men and women in developed versus developing countries suggests that the classification of a country as developing has important implications on gender-based employment. As Hossain & Hossain (2021) emphasized, developing countries such as Nigeria are in an especially precarious spot given the lower labor participation rates, inferior and more temporary job types, lack of access to savings and credit, and significant earning gap between men and women that existed even before the pandemic. Thus, when the pandemic took hold, lack of protection against the virus and slow economic recovery rate enhanced the long-term negative outcomes of COVID-19 compared to in developed countries. When working towards economic recovery in developing countries, policymakers must target the root of the turmoil– the preexisting gender inequality– and work toward giving women protected property rights, promote labor reintegration after job loss for women (particularly into the field they were previously working in, as opposed to having to switch to agriculture), and support women’s entry into typically men-dominated fields (such as business). 

Developed countries were undoubtedly significantly affected by the pandemic, but in different ways from Nigeria, as they did not necessarily experience gender-based restructuring of the distribution of employees and related effects. Campa et al. (2021) shows that Sweden was able to maintain a state of “normalcy” during the pandemic, did not witness drastically disruptive changes in lifestyle patterns that affected jobs, and experienced a relatively even distribution of negative effects on employment outcomes between men and women. While Sweden’s minimalist approach to COVID-19 may have played a major role in preventing drastic lifestyle changes, this approach was certainly not ideal for every country. It is important to consider Sweden’s preexisting high labor force participation rate for women and the availability of feasible opportunities of combining work and family life. Using Sweden as an example, policymakers in other countries should aim to establish family-friendly measures that allow families to balance work and home life (especially working women, as the shared responsibilities typically fall on them more than men). Implementing such policies would promote gender equality as a part of a country’s regular work culture and may prevent the exacerbation of gender inequalities during economic downturns. 

Other important factors to consider for policy making include type of occupation and type of unemployment. As evidenced by the specific job types that were impacted by the pandemic, such as masseurs, cabin crew, beauticians, healthcare workers, and agriculture, policymakers should aim to help women reintegrate into these industries and establish greater job security in the future in the event of another major economic downturn (Campa et al., 2021; Hossain & Hossain, 2021). Since many of these jobs tend to be service-based and require physical proximity, special sanitary precautions may be taken to reduce the risk of laying off such workers if another future public health crisis occurs. In regards to type of unemployment, policies aiming to help women who lost jobs permanently may be more urgent as there are higher rates of women losing jobs permanently compared to men than losing jobs temporarily (Adams-Prassl et al., 2020; Dang & Nguyen, 2020). Policies facilitating access to education and job training, urging communities to hold networking opportunities and job fairs, and promoting job advertisement on social media may help women diversify their skills and facilitate job match.

5. Conclusions

5.1 Summary and Implications

The purpose of this literature review is to highlight some of the major determinants of occupational segregation during COVID-19 for policymakers, giving them a clear understanding of what factors to consider when formulating policy responses to alleviate the impact of pandemic and take preventative measures against similar future crises. This literature review highlights the increasing unemployment rates that arose as a result of the pandemic, both in developed and developing countries. In both cases, women were disproportionately affected and experienced higher rates of unemployment and difficulty reintegrating into their former jobs, especially since several female-dominated, service-based industries were adversely affected. This is largely attributable to the inability to continue several service-based jobs during the pandemic and the closure of daycare and childcare centers, causing much of the responsibility of childcare to often fall on mothers, who as a result, were more likely to leave their jobs.   

To combat this growing gender inequality, economic policymakers must consider a country’s status as developed or developing, type of occupation, and type of unemployment in crafting the appropriate policies to facilitate economic recovery and gender equality. Potential policies worth pursuing include those regarding job security, training, and family-friendly policies that enable a realistic work-home balance. Although this is a holistic overview of global unemployment rates, Sweden and Nigeria provide particular guiding examples that policymakers can look to in regards to developed and developing countries, respectively. Each country responded to COVID-19 differently based on their unique circumstances and faced varying effects as a result. 

5.2 Limitations 

While this literature review is one of the first in providing a broad overview of the pandemic’s impacts on unemployment, there are a few limitations that must be considered. Firstly, unemployment was measured in different ways in different studies. These numbers were not adjusted before including them in this paper as one purpose of this literature review was to simply outline general trends in unemployment rate globally due to COVID-19. Additionally, although several countries were mentioned in this overview, particular attention was given to Sweden and Nigeria to highlight notable differences between developed and developing countries. However, it is unrealistic to assume that Sweden is representative of all developed countries’ methods of handling gender inequality and COVID-19, and likewise, that Nigeria is representative of all developing countries in this regard. Lastly, this literature review does not advise on specific policies that should be pursued, but rather, simply guiding factors that policymakers should consider. 

5.3 Future Directions

For future direction, reports on unemployment rates (particularly meta-analyses conducted with more gathered data) should be standardized such that rates are measured using the same metrics and calculation methods. More developed and developing countries should also be highlighted to compare and contrast gender-based job outcomes, COVID-19 responses, and policy efficacy. Additionally, unemployment in regards to disparities in race, education level, and location (urban, suburban, or rural) may be studied. Lastly, an analysis of changes in the gender wage gap due to COVID-19 may be included, as these have important implications on earnings and retirement pensions. 

References

Adams-Prassl, A., Boneva, T., Golin, M., & Rauh C. (2020). Inequality in the impact of the coronavirus shock: Evidence from real time surveys. Journal of Public Economics, 189, 104245.

Alon, T. M., Doepke, M., Olmstead-Rumsey, J., & Tertilt, M. (2020). The impact of COVID-19 on gender equality. National Bureau of Economic Research Working Paper No. 26947.

Bächmann, A., Gatermann, D., Kleinert, C., & Leuze, K. (2022). Why do some occupations offer more part-time work than others? Reciprocal dynamics in occupational gender segregation and occupational part-time work in West Germany, 1976–2010. Social Science Research, 104, 102685–102685. https://doi.org/10.1016/j.ssresearch.2021.102685 

Bennett, J. (2021, March 22). Long-term unemployment has risen sharply in U.S. amid the pandemic, especially among Asian Americans. Retrieved March 23, 2022, from https://www.pewresearch.org/fact-tank/2021/03/11/long-term-unemployment-has-risen-sharply-in-u-s-amid-the-pandemic-especially-among-asian-americans/ 

Burns, D., & John, M. (2020, December 31). Covid-19 shook, rattled and rolled the global economy in 2020. Reuters. Retrieved March 23, 2022, from https://www.reuters.com/article/us-global-economy-yearend-graphic-idUSKBN2950GH 

Campa, P., Roine, J., & Stromberg S. (2021). Unemployment inequality in the pandemic: Evidence from Sweden. Covid Economics, 83(2), 1-24. 

Casarico, A. & Lattanzio, S. (2020). The heterogeneous effects of COVID-19 on labor market flows: Evidence from administrative data. Covid Economics, 52, 152–174.

Dang, H. & Nguyen, C. (2020) Gender inequality during the COVID-19 pandemic: Income, expenditure, savings, and job loss. World Development, 140, 105296.

Doepke, M., & Tertilt, M. (2016). Families in macroeconomics. Handbook of Macroeconomics, (2). 

Hossain, M. & Hossain, M. A. (2021). COVID-19, employment, and gender: Evidence from Nigeria. Covid Economics, 82(23), 70-98.

Hoynes, H., Miller, D., & Schalle, J. (2012). Who suffers during recessions? Journal of Economic Perspectives, 26(3), 27–48.

Sumner, A., Hoy, C., & Ortiz-Juarez, E. (2020). Estimates of the impact of COVID-19 on global poverty. WIDER Working Paper, 43. 

United Nations (UN). (2019). Report of the Secretary-General. Special edition: Progress towards the sustainable development goals. https://undocs.org/E/2019/68 

Appendix

Figure 1: Unemployment impact by wage decile in Sweden, (2021). 

Table 1: Occupations with the highest unemployment impacts in Sweden (2021). 

Figure 2: Share of female workers by wage decile (2021).

Figure 3: Job participation rates of males and females in Nigeria in various occupations (2021). 

Table 2: Gender differences in job loss, expected income reduction, weekly expenses, and savings (2020). 

Figure 4: Percent of US unemployed out of work for more than 6 months. US workers are 16 years or older, seasonally adjusted. The Great Recession was from December 2007 to June 2009. The COVID-19 recession began in February 2020 (2021). 

Figure 5: Global view of unemployment rate during the COVID-19 pandemic (2020). 

The Impact of Audre Lorde

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by Zarya Shaikh, May 8, 2022

My central guiding question is “how can the impact of Audre Lorde as a catalyst for women’s liberation be itemized?” This question can be answered by examining Poet Audre Lorde’s work in the Women’s Liberation Movement during the late 1960s going into 1980. Audre Lorde (1934-1992) championed equality through her work as a Black lesbian cancer survivor and mother (Brandman, n.d.). She was a daughter of immigrants and was cognizant of issues in systems of oppression including racism, sexism, classism, and homophobia (Poetry Foundation, 2020). Lorde’s early works, including those discussed in the accompanying presentation, were the roots of her cumulative contributions to feminist theory, critical race studies, and commitment to inclusivity. Her words existed as a response to the second wave of the feminist movement during the 1960s and 1970s. This second wave was intended to help women pivot into roles beyond the private sphere and into the public sphere (Kang et al., 2017). This included motions for women to join more predominantly male workspaces and positions. Birth control and reproductive justice were also significant aspects of the second wave. 

Lorde, seeing that the challenges affecting BIPOC women were not at the forefront of (or even close to) the movement’s agenda, decided to empower women of underrepresented and marginalized communities. The women she hoped to help were the same ones who were taught that their needs were not as important as the needs of the white middle-to-upper class women that the second wave embraced (Aviles, 2019). Lorde outright criticized the flagrant discrimination against BIPOC individuals in systems of injustice (Veaux, 2006). Audre Lorde was similar to other Black feminists in that she not only advocated for women’s rights but also fought for equality within the Black liberation movement. She enabled others to change their own futures on a national scale. Lorde is unique in that her vessel of change was her poetry and she focused on her battle with breast cancer as opposed to reproductive health. With respect to her LGBTQ+ advocacy, she was unapologetic for defying heteronormative standards in addition to beauty standards for what was considered feminine. 

References

Aviles, G. (2019, June 3). Pride #50: Audre Lorde – activist and author. NBC News. https://www.nbcnews.com/feature/nbc-out/pride-50-audre-lorde-activist-author-n1007551

Brandman, M. (n.d.). Audre Lorde. National Women’s History Museum. https://www.womenshistory.org/education-resources/biographies/audre-lorde. 

Kang, M., Lessard, D., Heston, L., & Nordmarken, S. (2017). Introduction to 

Women, Gender, Sexuality Studies. Amherst, Massachusetts: University of Massachusetts Amherst Libraries.

Poetry Foundation. (2020). Audre Lorde. https://www.poetryfoundation.org/poets/audre-lordeVeaux, D. A. (2006). Warrior poet: A biography of Audre Lorde. W. W. Norton. 

Interview With a Female Fibroids Patient: How One Woman’s Story Speaks Volumes About the US Healthcare System

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by Vineeta Abraham, May 6, 2022

Disclaimer: This paper was written for Dr. Marci Lobel’s Psychology of Women’s Health class in Spring 2022. This paper is intended to analyze the real experiences of a woman suffering from health issues. It should be noted that the use of the word “female” in this paper refers to the sex assigned at birth rather than the gender of “women” in general. Name of the interviewee has been changed for confidentiality.

In discussions of menstrual health, we often neglect to pay enough attention to the less apparent changes occurring in our reproductive organs. While one may focus their knowledge of reproductive processes in the female body on the phenomena of menstruation, reproduction, and menopause, there are other symptoms and diagnoses that can impact a female’s menstrual health. 

I was fortunate to have been able to interview Sarah [pseudonym], a 53-year-old registered nurse living on Long Island, about her recent experiences with uterine fibroids, which she identified as noncancerous growths in the uterus. Sarah has been married for 25 years and has three children ages 21, 18, and 16. She is originally from India and moved to the United States in 2003 after receiving her bachelor’s degree in nursing. She follows a Protestant-Christian religious practice and works overnight shifts at Queens Hospital Center. 

Sarah reported finding out about her uterine fibroids at the age of 51, about two years before this interview was conducted. She was lucky enough to have received the diagnosis before experiencing any serious side effects or symptoms. She claimed, “I went in for a regular check-up at my doctor’s office. We had been discussing my anemia for a few visits, so she recommended that I consult with my gynecologist to rule out fibroids.” Unfortunately, the opportunity for a “rule-out” never came. I asked Sarah whether she looked into treatment options upon hearing of her diagnosis of fibroids. She responded grimly, “Yes. The only treatment option is surgery to remove [the fibroids]. That or ablation, which is to block blood supply to the fibroids to shrink them.” Unsurprisingly, Sarah was not eager to undertake such invasive treatment, so after a few weeks of contemplation, she carefully declined. “Temporarily,” she clarified in our discussion. “I won’t be getting any further treatment unless serious complications arise.” She described how having uterine fibroids was not impacting her day-to-day activities any more than other related health concerns that previously existed before this diagnosis. For example, Sarah described how, although 53, she has not yet reached menopause, which is a great cause of concern for her. She also suffers from menorrhagia, which she described as having “severe anemia.” In an afterthought, she added that the fibroids may be adding to this.    

I then asked Sarah about any support or lack thereof she had received from friends and family regarding her diagnosis. She explained that the least support seems to come from her husband: “I asked him to ask around or look into other solutions, if he knows any other doctors, to ask if there are options other than surgery.” He did not follow through with the task, but Sarah did not comment any further on this. On the other hand, she claims better support came from other women, friends or co-workers who had either experienced similar problems or knew of others who had. Sarah described often talking with these women about gynecologist recommendations or side effects in her hunt for more information. When asked if she had felt any financial boundaries inhibiting her from receiving treatment, she said she did not think so, and does not think it would be an issue if she decides to get treatment in the future. 

I also made sure to ask Sarah about how living with this physiological health concern has impacted her mental or psychological health. Fortunately, Sarah replied that she did not experience any psychological differences as a result of her diagnosis. She explained that she is not particularly stressed about having fibroids, as it “doesn’t run in the family, doesn’t give [her] any side effects, and there are no hormonal changes.” She claimed that her lack of distress is one of the reasons she is okay with waiting before jumping into treatment. 

Much of what Sarah discussed with me in our conversation relates to topics discussed in Dr. Marci Lobel’s Psychology of Women’s Health course. For example, Sarah was clear in her explanation of limited options presented to her in terms of treatment for her uterine fibroids. The option of invasive surgery – and not much alternative – seems drastic and frightening for patients like Sarah. This reminded me of a concept discussed in the “Introduction and Overview” reading excerpted from the Physical Health, Illness, and Healing textbook, in which the authors explained how doctors show “more interest in restricting [women’s] reproductive potential than in treating their illnesses.” Although Sarah has decided she will not be having any more children, she described that she is not comfortable with getting rid of all her reproductive organs, an option presented to her through the discussion of surgery. She mentioned that although she may not want to have kids, she needs those organs to produce hormones for the rest of her life (she also demonstrated a distaste for taking external hormone supplements). The thought of invasive surgery comes with many risks and potential side effects, and is therefore understandably less appealing to women who are caretakers or full-time employees – or, like Sarah, both. 

Perhaps this is one of the many reasons Sarah has decided to wait on the decision to treat her fibroids. As she mentioned multiple times in our conversation, Sarah’s fibroids are not an obvious hindrance to her day-to-day routine. In the midst of her hectic work schedule and household responsibilities such as childcare, home maintenance, or cooking, her fibroids are therefore being metaphorically “pushed to the backburner.” This information came as no surprise to me after hearing Dr. Lobel’s lecture on women’s cardiovascular health on February 1, 2022 during which she described how there is often a delay in women seeking healthcare services. Dr. Lobel attributed this delay to factors such as having various other responsibilities or a general lack of knowledge. Sarah’s own testimony relates closely with this concept, as she claimed that her hesitancy to receive treatment came from her desire to learn more information instead of jumping hastily into a decision. This idea of not receiving adequate information was also discussed in the “Introduction and Overview” article, in which the authors described how female patients sometimes receive less information than male patients or report feeling dissatisfied with the communication they had with their healthcare providers. This could come from providers being biased and assuming that male patients are better able to understand their diagnoses or treatment options compared to their female counterparts. However, this lack of strong communication can cause women to feel disrespected or underserved, further discouraging them from seeking healthcare services in the future. True to this idea, when I asked Sarah when the last time was that she went to her provider to check on the status of her fibroids, she responded, “about a year [ago].” Sarah admitted to understanding that the fibroids could grow exponentially in that time frame, and claimed that she will go in for a checkup soon, although she did not clarify when that would be. 

In Sarah’s defense, she has made attempts to remedy her lack of knowledge regarding her diagnosis and treatment options. Sarah described going to her husband primarily to help with the situation. “I asked him to ask doctors that he associates with about other options or if they knew of good places to go for the surgery or ablation.” Sarah’s husband also works in a hospital, and she wished to take advantage of his access to multiple healthcare providers and professional opinions. However, she was disappointed to find that he soon forgot about her situation and never followed through with an inquiry. The lack of support Sarah received from her husband was a theme discussed in Dr. Lobel’s lecture on autoimmune disorders, where she discussed how social support from family and friends can play a large role in the recovery process for female patients. In Sarah’s situation, lack of support from the husband has been a contributor for the delay in her treatment, which may lead to more serious consequences if her fibroids grow.

On the bright side, Sarah claims that she has received better support from her friends and co-workers. Dr. Lobel’s lecture mentioned the benefits of having a support group for patients to connect with individuals who have similar diagnoses or experiences. While Sarah did not attend a formal support group for her diagnosis, she was able to discuss her diagnosis with female friends and co-workers who have experienced reproductive complications. These discussions resulted in sympathy and advice in the form of treatment alternatives or gynecologist recommendations that helped Sarah to feel less alone in her journey. While Sarah, unlike many of the women we learned about in lecture, did not report having serious psychological effects as a result of her diagnosis, she was grateful for the support she received from her friends. This type of support, as we’ve learned, can help women feel less alone in their journey of recovery. 

As seen in our lectures and readings, many of the factors impacting Sarah’s experiences are not unique to her. Female patients are often put in difficult circumstances in which their reproductive organs and menstrual health are endangered, often being placed in situations that male patients and physicians cannot personally relate to. Because of this, it is easy for women to feel isolated or unsure about their treatment options. Women are also disproportionately placed in social frameworks that label them as caretakers or being tasked with other social responsibilities, which adds to the delay in proper treatment. This delay can put them in riskier situations as their conditions may either worsen or become more complicated without proper resources. As in Sarah’s case, there may also be circumstances in which treatment options are available but not ideal, which can also lead to delays and uncertainty in patients. Healthcare services should therefore strive to improve their communication and flexibility in treatment options for females with menstrual and other health related complications. Female patients should feel well supported by both their providers and their social structures throughout their healthcare journeys. 

The Origins of Ancient Rome Reveal Incredibly Sexist Social Structures

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by Namal Fiaz, March 29, 2022

The birth of the Roman Republic, which would soon transform into a vast empire with a monumental legacy, has brutal origins all beginning with a rape victim. It’s no secret the Romans were excellent storytellers; the proof is longevity. Roman myths, passed down for generations, outlived their society and continue to echo off the tongues of modern storytellers. 

The story of Lucretia is a mythological and historical tale that has survived since the early origins of Roman history, over two thousand years since its believed origins in 509 BCE. It was narrated and criticized in several different versions of works by prolific Roman writers such as Livy, Ovid, and Dionysius. Gaining popularity immediately after her death, Lucretia became a legendary symbol of beauty, virtue, and chastity. Subsequently, Roman society encouraged women, and especially young girls, to view her as a matron for model behavior. 

As the victim of the story, the glorification of Lucretia’s story after her death reveals deeper insight into the sexist roles women were expected to conform to in ancient Rome.

In Book 1 of Ab Urbe Condita, “From the Founding of the City,” Titus Livius, or Livy, a Roman historian whose works are largely viewed as reliable historical sources, recounts Lucretia’s story. Livy narrates the events leading up to the climax of her rape, as well as the aftermath and her impact on the founding of the republic. The story begins with Lucius Tarquinius Collatinus, Lucretia’s husband, and his companions drinking at the house of Sextus Tarquinius, son of the king Tarquinius Superbus, one night. The men drunkenly argue on the subject of wives, each man praising his own, and Collatinus decides that the mere sight of his wife at such late hours would put an end to the debate altogether. They mount their horses and head to Collatia, a Roman town governed by Collatinus, and into the quarters where Lucretia resides. Upon entering, Lucretia is seen weaving wool by herself by the lamplight with only the company of slave girls, unlike the other wives who had spent their night mingling and drinking with each other. This alone is meant to portray her legacy as a woman of the utmost chastity and virtue. Lucretia wins “the prize of this contest in womanly virtues”1 for her devotion to her husband and home. Sextus, intrigued by her beauty, is “seized by wicked desire”2 to conquer her modesty. 

A few days later, he returns to Collatia again, this time without Collatinus. His motives unsuspected, Sextus is welcomed to dinner in their home and is provided guest chambers for his seemingly innocuous visit. Late into the night, he enters Lucretia’s room while she is asleep. A knife in one hand, Sextus holds her down while clasping onto her breast with the other, and threatens her to comply with his wishes, otherwise he would lay the dead naked body of a male slave next to her corpse and frame her for adulterous acts. Sextus then rapes her. 

Afterwards, Lucretia, frightened and upset, sends a message to her father and Collatinus to return home with trusted companions so that she can recount all of this. All of the men are enraged by Sextus’ actions. They reassure her that “it is the mind that sins, not the body.”3 This part of the story is particularly interesting as it challenges the norms in Roman society by unexpectedly diverting blame onto the perpetrator rather than the victim who was raped. In the end though, Lucretia deeply fears that her virtue has been “ruined” by Sextus and does not wish to be an “impure” example to Roman wives. She admits that although her heart does not hold any guilt, and that she absolves herself of blame from the rape, she still cannot free herself from punishment. Lucretia reveals a knife she hid under her dress and thrusts it into her chest out of shame as Collatinus, her father, and their companion named Junius Brutus bear witness. Just before committing suicide, she urged the men to decide Sextus’ fate. It is evident she herself prefers to die before being seen as a role model to unchaste women. 

Lucretia’s rape was also the impetus of political revolution in Rome. Collatinus and Brutus led the overthrow of Sextus’s father and exiled the Tarquins from Rome. A new form of government was established in 509 BCE, with Collatinus and Brutus serving as the first pair of consuls of the Roman Republic.

Lucretia’s suicide was socially viewed as honorable by Romans, and she was subsequently immortalized as a heroine. Given that her story serves as thematic for proper behavior for women in Rome, it further reveals incredibly sexist ideals present in Roman society. Lucretia’s position as the embodiment of pudicitia, a term used to describe virtuous women, would only grow after she died. Sexual ethics were deeply conceptualized in ancient Rome; there were several intricate terms to describe one’s social as well as physical position regarding male and female sexuality. Pudicitia was a distinctly feminine descriptor of one’s character, predominantly in relation to morality and sexual fidelity. 

It is important to recognize that the male equivalent of this quality did exist in the form of virtus, meaning virtue, although not nearly to the same extent women were judged. Pudicitia was not praised as a positive ideal in men, rather, it was viewed as a neutral trait for males, and could sometimes be simply reduced to whether they acted in the dominant role in sexual relations with other men.4 Much of the explanation as to why a woman’s chastity held so much value in ancient Rome was due to the fact that it ensured they were kept “pure” for men until marriage. Lucretia’s virtue and sexual modesty was promoted as a feminine ideal through “deeply conservative and patriarchal impulse.”5  It is important to address the emphasis on virginity as men were certainly not scrutinized to the same standards. Roman girls were purposefully married young, the legal age twelve, to “ensure an undefiled body and mind.”6 This view alone amplifies the misogynistic logic used by the ancient Romans to control female sexuality and restrict freewill. 

As expected, Roman societal structures continued to subjugate women throughout the longevity of the republic and empire. The specific reasons for this perceived inferiority of women thrived on their generalization as “fragile and fickle, therefore in need of protection.”7 A plausible explanation for these rigid social structures is the historical dichotomy of men as “protectors” and women as “childbearers.” Additionally, it was a widespread belief that women were “emotional, irrational, and intellectually less capable than men”8 to the point where objections to such beliefs were controversial. In a speech written by Livy, capturing the thoughts of Cato says: “Our ancestors decided that women should not handle anything…they should always be in power of fathers, brothers, husbands. If once they get equality, they’ll be on top.”9 In contrast, Musonius, a Stoic philosopher, argued that women possessed reason and logic, were inclined towards good virtue just like men, and that “men should have as high a standard of sexual virtue as women.”10

Marriage was beyond a sufficient reason society deemed it unworthy for girls to continue their education, instead prioritizing domestic tasks and tending to the wishes of their husbands. It is also dire to address the fact that the majority of the available information about the daily lives of Roman women is provided through the lens of men, often incidental in orations or letters or poems.11 It is clear the ancient Romans did not prioritize women’s education nor urge them to contribute to literature or philosophy. The already lacking information about the daily lives of women is focused on upper class women, with scarce information about common women. In the study of classics, a field that has traditionally been dominated by men, studying the lives of ancient women was an academic priority until recent feminist perspectives concerning historical analysis emerged.

It is known that Roman women were established as subservient to men in all aspects of life; their names were technically not even their own. A Roman woman’s name was the feminine form of her father’s gentilicium during the early republic, which was passed down to all of the sisters, and also shared with aunts and cousins on her paternal side.12 Marriage was largely an social and economic proposition for both parties since the Romans rarely married for happiness and romantic love; the latter was usually reserved for extramarital affairs.

 Additionally, women had limited citizenship status, meaning they could not vote or run for public office, and in many cases their properties were under control of their father and eventually husband. Specific terms evolved for circumstances of marriage: cum manu, “with the hand,” and sine manu, “without the hand.” A woman who was married cum manu was no longer under her father’s authority, but under the legal control of her husband.13 This meant that she was under potestas, “power,” of her husband rather than her father. If she was married cum sine, which was common in the late republic, she remained under her father’s control. She needed his approval to make important financial transactions, and “might have her marriage ended by him even against her wish.”14 In a divorce, which women were allowed to bring forth under legally valid conditions, children were no longer left to her, but rather to her husband’s family. 

A woman’s influence was not acknowledged in the public sphere; they were restricted to domestic matters concerned with running the home. Such partially demonstrates why Lucretia was glorified above the other wives from the moment Collatinus and his companions found her tending to her weaving, historically one of the most domestic chores, instead of away socializing with other women. A “virtuous” Roman wife influenced by the precedent of Lucretia behaved modestly, felt great devotion to her husband and tended to his needs, and most importantly valued her chastity, and in this legendary case, above her own life.

The widespread idealization of Lucretia in ancient Rome provides insight into the way Romans viewed the social structures of gender, family life, law, and marriage. Often portrayed as a docile victim, it is clear Lucretia embodies the submissive traits women were expected to display in order to fit the status quo. Although in modern times her story is often regarded as a mere puzzle piece in the larger image of ancient Rome, it continues to raise questions regarding the position of women in a society where they were severely oppressed.

References

  1. “Titus Livius (Livy), the History of Rome, Book 1 Benjamin Oliver Foster, Ph.d., Ed.” Titus Livius (Livy), The History of Rome, Book 1, chapter 57. Accessed December 8, 2021. http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.02.0151%3Abook%3D1%3Achapter%3D57
  2. Livy, Chapter 57.
  3. Ibid, Chapter 58.
  4. Noreña, Carlos F. “Hadrian’s Chastity.” Phoenix 61, no. 3/4 (2007): 296–317.
  5. Noreña, 301.
  6. Clark, Gillian. “Roman Women.” Greece and Rome 28, no. 2 (October 1981): 193–212. https://doi.org/10.1017/s0017383500033313.
  7. Ibid, 207.
  8. Ibid, 208.
  9. Ibid, 207.
  10. Ibid, 208.
  11. Ibid, 194.
  12. Ibid, 202.
  13. Ibid, 203.
  14. Ibid, 204.

From Criminals to Celebrities: How Women’s Fascination with Serial Killers Reflects Their Perception of Romance

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by Ayesha Azeem, March 25, 2022

People have always been interested in learning about influential people’s lives — through both gossip and the media. Whether we’re learning about Jennifer Aniston’s new fling, Kim Kardashian’s pregnancy, or Harry Styles’s secret vacation, we often interest ourselves with other people’s lifestyles, namely celebrities, because we feel as if we personally know them through our powerful admiration and devotion. We see celebrities as heroes; people we aspire to be like. But why are we so drawn to the lives of villains as well?

Recently, women have developed a strong obsession with true crime, a literary and film genre in which the author examines an actual crime and exposes the actions committed by real people; specifically, there has been a sudden fascination with serial killer crimes. This infatuation with evil reveals our desire to uncover the secrets and truth behind those who commit the horrific acts we abhor. Perhaps it fascinates us that these famous perpetrators hold such obvious disregard for morality and societal values; we feel obligated to witness the dramatic scenes unfold as a means of “preparation” for any real-life danger. 

From Ted Bundy to Charles Manson, women often find themselves deluded into romanticizing famous serial killers. We find it hard to accept that attractive people are just as capable of committing grotesque crimes as ordinary people. Recently, the Joker movie played by Joaquin Phoenix, though fictional, has captured the attention of young girls infatuated with his depressing life story and motivation to commit heinous crimes that are similar to real killers. Though women are more likely to be victims of a major crime, for some reason they feel increasingly attracted to the vile and twisted side of history, intrigued to learn about the ways in which they can face danger.

Psychologists conducted a 2010 study at the University of Illinois to investigate the relationship between gender and the true-crime audience. Psychologist R. Chris Fraley and their team discovered that women wrote 70% of the true-crime book reviews on Amazon, while men felt a greater connection to war books, writing  82% of reviews (Yates). The researchers hypothesized why women may feel an increased inclination to read more true crime and suggested that such stories can provide useful information that may help readers avoid or escape potential attacks such as murder or rape. To investigate this claim, the psychologists reviewed the summaries of the books most often reviewed by women. Further study revealed that women were more likely to read a true crime book if the victim used a clever ‘psychological trick’ to deceive and escape from their perpetrator. Unsurprisingly, women also felt attracted to true crime books with female victims. Thus, evidence strongly suggests that women tend to read more true crime books with clever female survivors because they provide a ‘guide’ of instructions as to how to avoid deadly encounters in real life. If women consume as much violence as they can in art, maybe they can escape the true violence that unfortunately lingers in our reality. 

Recently, the producers of All Killa No Filla, a British podcast dedicated to exploring the lives of serial killers, found that roughly 85% of listeners are female (Woman’s Hour). BBC Radio 4’s Woman’s Hour considered why their listeners consisted mostly of women, and invited Dr. Gemma Flynn, a criminologist at Edinburgh University, and Rachel Fairburn, co-host of the famous podcast, to explain their theories. Dr. Flynn believes that a major explanation for female true crime listeners includes women retaining an extensive fear of crime. According to Fairburn, “women love true crime because pretty much from the time that we’re very small, we’re told to be careful, look after ourselves, watch out for bad people, make sure we get home safely” (Woman’s Hour). The host suggests that society constantly attempts to protect women from danger, instilling in their minds that as long as they’re alone, they can be attacked. Thus, women tend to leave their house with a constant target on their back and safety on their minds, attracting them to true crime out of self-preservation. With the stereotype and widely held belief that women cannot walk alone at night because of possible attacks, women feel the need to protect themselves as much as possible, consuming true crime stories at the top of their list. 

The constant fear society holds regarding women as potential victims of brutal crimes stems from the media’s infatuation with blood and murder. According to a 1992 study conducted at SUNY Oswego, mass media “serves as the primary source of information about crime for up to 95% of the general public,” with approximately 50% of news coverage devoted exclusively to crime stories (Mann). With this extensive reporting on crime and violence, Americans fall victim to their availability heuristic, a mental shortcut that relies on immediate examples that come to a person’s mind when thinking of an idea or event. Because of the increased attention presented towards crime on-air, Americans may not believe that the crime rate has actually decreased over the years since all they hear about is murder, rape, and violence when they turn on their televisions. While murder rates decreased by 20% from 1993 to 1996, reporting on murder on television rose by 721%. (Mann). This affects women especially as the constant fear perpetrated by the media regarding crime and murder may be a key reason in females’ attraction towards true crime media. 

Now that we understand why women tend to reach for books labeled with the true crime genre, the compelling question needed to be answered is why women romanticize these vile human beings. After the release of Extreme Wicked, Shockingly Evil and Vile, a film on the life of Ted Bundy based on the perspective of his girlfriend, viewers went to Twitter to express their newfound admiration for the ‘misunderstood’ villain. Ted Bundy was portrayed by attractive and talented Zac Efron, only attracting more fans to the Ted Bundy “fandom,” a group of teenage girls infatuated with the killer (Donaldson). Some tweets include: “Love that conservative masculinity #TedBundy,” and “Ted Bundy is so hot… wish he killed me” (via Twitter). The women who romanticize serial killers like Ted Bundy and Charles Manson can be described as having hybristophilia, or sexual arousal “over someone committing an offensive or violent act,” as described by Dr. Katherine Ramsland, a forensic psychology professor at DeSales University. These women admire the idea of being the ‘exception’ for a damaged person; they feel the need to ‘nurture’ and ‘protect’ their powerful and evil lovers. These women fantasize about “changing” the broken part of serial killers; they want to “fix” them; usually, women who admire such behaviors have trouble with conventional relationships due to insecurities. If she dates a serial killer in jail, at least she’ll know where he is all the time (Psychology Today). Additional research indicates that women feel attracted to masculinity and may interpret serial killers’ unchecked aggression as ‘protective’ or ‘manly.’ Women may feel that these attributes will keep them safe and secure, and thus may prefer more violent mates (Perrett).

Whatever may be the reason behind women’s fascination with serial killers, this infatuation proves fatal. When Charles Manson and Ted Bundy awaited death, thousands of female fans lined up, expecting to marry these vicious men, refusing to believe their crimes simply because of their attractiveness (Sutton). The never-ending fame of attractive serial killers depicts the true danger: our inclination as human beings to automatically trust and like attractive people, simply because of their looks. Many women fell prey to Bundy and Manson’s traps simply because they might’ve misjudged them for being kind, respectable people because of their beautiful smiles or bright eyes. Though Netflix and other entertainment providers may attempt to raise awareness of real tragedies, it is important to also consider the danger of awareness. Today’s generation may be too infatuated with Zac Efron’s looks and appearance in Extreme Wicked, Shockingly Evil and Vile to realize that his charm was what allowed many to overlook his apparent misogyny and objectification of women: “Women are possessions… Beings which are subservient, more often than not, to males. Women are merchandise” (Wyman). The tales of these serial killers should serve as a warning to many women, rather than favorable romantic heroes; we really don’t know what people are like behind closed doors. We need to remind ourselves who these serial killers actually are: vile, immoral men disguised as educated, charismatic professionals; they are not compassionate or need protection – they do not feel. We must not grieve or sympathize with men that never existed.

Works Cited

Donaldson, Kayleigh. “The Sexy Killer Fandom Wars: No, Fancying Ted Bundy Is Not the Same Thing as Fancying Venom.” SYFY WIRE, 11 Feb. 2019, www.syfy.com/syfywire/the-sexy-killer-fandom-wars-no-fancying-ted-bundy-is-not-the-same-thing-as-fancying-venom.

Mann, Stephen, et al. “Crime and the Media in America.” OUPblog, 3 Apr. 2018, blog.oup.com/2018/04/crime-news-media-america/.

Perrett, David I., et al. “Effects of Sexual Dimorphism on Facial Attractiveness.” Nature, vol. 394, no. 6696, 1998, pp. 884–887. doi:10.1038/29772.

Ramsland, Katherine M. Confession of a Serial Killer: the Untold Story of Dennis Rader, the BTK Killer. ForeEdge, 2016. 

Schildkraut, Jaclyn. “Crime News in Newspapers – Oxford Research Encyclopedia of Criminology.” Oxford Research Encyclopedias, 18 Apr. 2018, oxfordre.com/criminology/view/10.1093/acrefore/9780190264079.001.0001/acrefore-9780190264079-e-32#acrefore-9780190264079-e-32-div1-1. 

Sutton, Candace. “Inside Serial Killer Charles Manson’s Deluded Fan Club.” NewsComAu, News.com.au, 9 Jan. 2017, http://www.news.com.au/world/north-america/inside-the-deluded-world-of-serial-killer-charles-mansons-fan-club-and-the-fiancee-who-says-hes-innocent/news-story/364fe75d235055d38186b3e84347d035.

Tuttle, Kate. “Why Do Women Love True Crime?” The New York Times, 16 July 2019, http://www.nytimes.com/2019/07/16/books/review/kate-tuttle-true-crime-women.html.

“Woman’s Hour – True Crime: Five Reasons Why Women Love It.” BBC Radio 4, BBC, http://www.bbc.co.uk/programmes/articles/5BQCFMQd3mPqj7YT4hlvdCL/true-crime-five-reasons-why-women-love-it.

“Women Who Love Serial Killers.” Psychology Today, Sussex Publishers, www.psychologytoday.com/us/blog/shadow-boxing/201204/women-who-love-serial-killers.

Whyman, Tom. “The Myth of Ted Bundy as a Charming Guy.” The Outline, The Outline, 5 Feb. 2019, theoutline.com/post/7043/ted-bundy-netflix-efron-handsome?zd=1&zi=godwptow.

Yates, Diana. “Women, More than Men, Choose True Crime over Other Violent Nonfiction.” ILLINOIS, 15 Feb. 2010, news.illinois.edu/view/6367/205718.

The Labor of Delivering Gender: A Case Study in Integrating Gender and Sexuality Studies into Medical Education at Stony Brook University

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by Sophia Garbarino, March 3, 2022

Abstract

This essay examines maternal healthcare practitioners’ perspectives about and experiences with incorporating sex- and gender-based medicine (SGBM) into healthcare training at Stony Brook University, a leading medical institute in the United States. SGBM refers to the style of clinical practice that accounts for the ways in which biological sex characteristics and social constructions of gender affect healthcare outcomes. This method is particularly critical for women’s and reproductive healthcare providers because they routinely treat patients that experience gender and its unique interactions with other sociocultural factors. Within the wide range of literature discussing the need to integrate an SGBM lens into medical education, only a handful of scholars have examined why it is so difficult to actually accomplish. Building on this emerging body of evaluation research, I conducted several oral interviews with faculty at the Stony Brook Schools of Medicine and Nursing, discussing how they have reacted to this relatively new but essential field of medicine from the early 1990’s to today. The university has recently claimed that its health institutions are progressive both politically and practically, but I argue that “progressive” is an exaggerated description. Based on the interviews, instructors continue to face institutional as well as logistical barriers to incorporating an intersectional gender lens into their didactic and practical curricula. Furthermore, this case study offers insight into how practitioners can improve the ways they currently teach gender in order to produce more equity-conscious and diversity-respecting maternal care providers.

Full Text

“Learning is not attained by chance, it must be sought for with ardor and diligence.”

– Abigail Adams (“Abigail Adams,” 2019).

Introduction

Medicine, particularly medical education, has historically ignored the humanities and social sciences, especially intersectional gender and sexuality studies. Maternal and reproductive health scholarship that actually includes women as its subjects and researchers did not emerge until the women’s health movement rooted itself in American academia just over two decades ago. However, the field’s first fifteen years or so focused on biology-based differences between men and women with minimal regard for any individuals identifying outside the cisgender, heterosexual norm. Gender and sexuality only entered the conversation in the last five years, and even now, intersectionality is barely acknowledged. Medicine continues to primarily use the additive model, which considers various forms of oppression (sexism, racism, ableism, etc.) separately rather than examining how they operate inseparably (Kang et al., 2017).

And yet, intersectionality is more important than ever before, especially in the United States. The number of Americans who identify as a person of color and/or LGBTQ* grows every day (Jones et al., 2021; Jones, 2021). Therefore, it is imperative that medical providers understand how to treat their patients with respect for diversity in all its forms. As with any sustainable change, the process of removing heteronormativity from medical practices must begin with medical training. In this essay, I aim to provide a snapshot of where American medical education stands on the inclusivity stage. I will accomplish this by examining maternal, reproductive, and family healthcare practitioners’ perspectives about and experiences with incorporating sex- and gender-based medicine (SGBM) into education at Stony Brook University, a leading medical institute in the United States. These perspectives reflect the larger institution’s state of inclusiveness and progressiveness.

For reference, SGBM refers to the style of clinical practice that accounts for the ways in which biological sex characteristics and social constructions of gender affect healthcare outcomes. This method is particularly critical for women’s and reproductive healthcare providers because they routinely treat patients that experience gender and its unique interactions with other sociocultural factors. Building on this emerging body of evaluation research, I conducted several oral interviews with faculty at the Stony Brook Schools of Medicine and Nursing, discussing how they have reacted to this relatively new but essential field of medicine from the early 1990’s to today.

Stony Brook University has recently emphasized its “progressive” approach to healthcare, especially regarding women’s and LGBTQ* populations. In response, I argue that while the Schools of Medicine and Nursing are certainly more aware of SGBM than they were two decades ago, the university still lacks clear intersectional gender- and sexuality-inclusive training and approaches the education they do have in a non-inclusive, binary way. In this essay, I will provide historical context for my analyses by briefly summarizing key events in the trajectories of feminism, the Women’s Health Movement, and sex- and gender-based medicine (SGBM) in the late twentieth century. I will then conduct an in-depth analysis of my case study research and its implications. Finally, I will conclude by proposing potential ways for practitioners to improve how they currently teach gender in order to produce more equity-conscious and diversity-respecting maternal care providers.

Background

How maternal and reproductive medicine evolved with American politics

When Betty Friedan’s groundbreaking book The Feminine Mystique was published in 1963, America began to realize that many of its women were dissatisfied with simply being housewives (Churchill, 2020). After World War II, women were not especially keen on relinquishing the professional and financial freedoms they had found in the factories while the men were fighting overseas. Simultaneously, the Stonewall Riots in 1969 marked the birth of what is now commonly referred to as the modern LGBTQ* rights movement (Duberman, 1993). In the following decades, both of these marginalized groups would find themselves at the center of the global political and  health stages.

Policy and health were particularly inseparable during this era. The 1990s saw what is now known as Third Wave Feminism, placing women’s experience at the center of American politics and “integrat[ing] an ideology of equality and female empowerment into the very fiber of [American] life” (Walker 400, 1992).Women delayed marriage into their mid-twenties, felt sexually liberated, and entered male-dominated careers (Yarrow, 2018).Yet, the fight for equality raged on in the political and medical arenas, clashing in landmark health-related historical events such as the Anita Hill sexual harassment hearings (Gross, 2021), Planned Parenthood’s fight against conservatives over abortion rights (Prescott, 2019), and the Violence Against Women Act of 1994 (“History of VAWA”).

In the same decade, the Women’s Health Movement was progressing with full-force activism: reproductive endocrinologist Florence Haseltine co-founded the Society for Advancement of Women’s Health Research in 1989, which helped to pass the Women’s Health Equity Act one year later and created the Office of Research on Women’s Health at the National Institutes of Health. In 1993, following the groundbreaking discovery that the HIV virus can pass from pregnant parent to fetus, Congress required the inclusion of women in NIH-sponsored clinical research trials (Liu and Mager, 2016). Prior to this mandate, women of childbearing age were considered too high-risk to participate in clinical research due to the possibility of pregnancy, severely inhibiting knowledge production about sex and gender in healthcare (Participant 3, 2021). It was these socio-political and medical paradigm shifts within women’s health research that gave rise to what is now referred to as sex- and gender-based medicine (SGBM). Within the wide range of literature discussing the need to integrate an SGBM lens into medical education, only a handful of scholars have examined why it is so difficult to actually accomplish.

How sex- and gender-based medicine was born

In the midst of this emerging field of women’s health intervention evaluation, Lorena Alcalde-Rubio et al. reviews 22 articles that evaluate clinical interventions aimed at “reduc[ing] variability in healthcare,” five of which focus on sexual and reproductive health (Alcalde-Rubio, 2020). The majority of the 22 evaluations supported standardizing protocols as a feasible method of systemic change, which is consistent with the faculty’s opinions during my interviews. However, Alcalde-Rubio’s review does not specify what types of protocols should be standardized and importantly notes that 15 out of the 22 evaluations did not utilize gender perspectives adequately. Further, the review significantly reflects a larger fault in medical academia: researchers often focus too much on the purely clinical aspect of change. When it comes to destabilizing social constructions that are ingrained in us and impact every aspect of human life both inside and outside of medicine, education plays a, if not the most, critical role in producing systemic change. In other words, we cannot fix the problem without addressing its roots. As such, I will primarily address the education aspect that Alcalde-Rubio et al. does not.

A 2005 Dutch study (Verdonk et al.) attempts to explore the potential for long-term change in medical education. Researchers concluded that a lack of guidelines, political ideology conflicts, and the educators’ own levels of dedication contribute to the gap between what should be taught and what was actually being taught. Further, certain factors must be present to successfully incorporate gender into medical training, including faculties’ personal experiences and motivations, practical support, and “executable” proposals for adjustment. This suggests that the Western medical educators were generally aware of the need for gender education in the 1990s, the decade during which many of my interviewees were medically trained here at Stony Brook. However, Verdonk, like many others in the field, conceptualizes gender as binary and essentialist.1 To make any meaningful progress, modern medical educators need to start deconstructing the gender binary and validating identities and sexualities beyond the cisgender, heteronormative ones.

Like Verdonk et al., Mary Rojek and Marjorie Jenkins (2016) examined medical schools, but this time in the United States. They surveyed faculty from medical schools that had already successfully integrated SGBM into their education. Their results suggested “it was important to involve all stakeholders… linking curricula to experiential learning and research. It was important to support faculty by providing them with educational resources” (Rojek and Jenkins, 2016). The majority of schools, though, are still behind in adding a sex- and gender-based lens to formal medical education. My research supports Rojek and Jenkins’ conclusions that formal institutional support is a crucial factor in determining integration success.

Also similar to Verdonk et al.’s case study, Hsing-Chen Yang examined the Eastern (Taiwanese) medical world’s perspectives about gender. Asian beliefs and social norms about gender are significantly different from Western ones, and even between individual Asian cultures themselves. Because Stony Brook’s Renaissance School of Medicine began accepting international applicants in 2014 (Medical School (MD) Applicant Profile, 2021), along with the majority of graduate students across the university identifying as people of color (Stony Brook University Fall Headcount, 2021), it is crucial to consider a diverse set of approaches to medical education. Because patient populations are now increasingly diverse—fueled by immigration and globalization—healthcare providers need to have a basic understanding of how gender functions in different cultures. Yang’s surveys found that healthcare professionals and teachers generally believe that sexism, gender awareness, gender equity, and patriarchy are among the most important to teach but this prioritization is not reflected in practice. However, the study omits two key factors: historical context and sociocultural context. Sexism, gender, and patriarchy have various meanings depending on the patient’s and the provider’s respective backgrounds. Therefore, Yang’s conclusions may be limited to predominantly Asian regions.

To see if Yang’s results holds true in Western medical culture, I came upon a 2010s-era study that revealed that American students also lack sex- and gender-based medical (SGBM) training, Majorie Jenkins et al. (2016) surveyed 1097 medical students across five major medical student organizations in order to examine institutional response to these findings. Jenkins’ survey suggests that while medical students are generally aware of SGBM’s existence, the majority do not receive adequate SGBM education at their respective medical schools. While it provides a solid look at what other American healthcare schools are doing about SGBM in relation to Stony Brook, Jenkins focuses solely on students’ perspectives rather than those of faculty, not accounting for logistical and institutional obstacles instructors face that students may not be aware of. I aim to fill this knowledge gap in this case study.

Methods

Stony Brook University

Stony Brook University (SBU) grew alongside the women’s movement. The university was founded in 1957 (“History and Mission”), and its Renaissance School of Medicine (RSOM) opened in 1971 (“History,” 2019). The RSOM currently houses 25 professional departments, including “Obstetrics and Gynecology,” which is an influential player in university progressive politics (“Departments,” 2019; Participant 5, 2021). One year after the RSOM admitted its first class, the SBU School of Nursing (SON) opened in 1972 (Strategic Plan 2016 to 2021, 2017). Graduate-level programs were gradually added in the following years, and the school’s first doctoral-level program, the Doctor of Nursing Practice (DNP) program, admitted its first cohort in 2007 (Participant 2, 2021). Now, Stony Brook’s Hospital is considered one of the best in the United States and boasts progressive and inclusive practices. This makes it an ideal institution to study the emerging field of sex- and gender-based medicine, especially considering its diverse student and faculty profile.

Sample

While gender undoubtedly affects all areas of health, obstetricians (OBs), gynecologists (GYNs), and nurses typically have the most direct patient contact with populations where gender is uniquely related to healthcare outcome (Participant 5, 2021). For example, maternal care and reproductive care specialists may see pregnant trans patients, same-sex couples with fertility concerns, and Black cisgender women, who have disproportionally higher rates of maternal mortality in the United States (“Working Together,” 2021). For this reason, I individually interviewed a total of six faculty at Stony Brook University, including three OB-GYNs from the Renaissance School of Medicine and three from the School of Nursing. Participants were recruited via email outreach based on whether they attended Stony Brook University for their undergraduate degree, graduate degree(s), residencies/fellowships, or any combination of those three. Each interview was approximately thirty minutes long and conducted over Zoom or phone call between the months of September 2021 and November 2021.

Table A. Participants’ Educational Backgrounds

ParticipantType of ClinicianHighest Degree EarnedResidency
1Medical doctorMD*OB GYN*
2Nurse practitioner and midwifeDNP*N/A
3Pediatric nurse practitionerPh.D.*N/A
4Family and acute care nurse practitionerDNP*N/A
5Medical doctorMDOB GYN*
6Medical doctorMD*OB GYN*
Key
DNP – Doctor of Nursing Practice
MD – Doctor of Medicine
PhD – Doctor of Philosophy
*Completed at Stony Brook University

Interview Questions

Educational Background

I asked the participants five main questions about various gender- and sexuality-related topics. The first question asked about the participants’ educational backgrounds, including where they earned their undergraduate degree(s), graduate degree(s), and where they completed their post-doctoral residency and fellowships if applicable.

Gender & sexuality education as a student

The second question asked about the participants’ experiences – or lack thereof – learning about gender as a student, including as a medical or nursing student and graduate-level nursing student or medical resident. 

Current gender & sexuality education

The third question asked participants to compare their own student experiences to what current SBU students learn about gender. The fourth question asked about their experiences and opinions about teaching gender as a professor, including what challenges they may face and how they address them.

Institutional support

The fifth question asked participants if the university has offered and/or currently offers opportunities for faculty to further their own knowledge about gender and sexuality in healthcare, and if so, what types of opportunities and how helpful they were.

Results & Discussion

Participants’ own gender and sexuality training

None of the participants had any formal education about gender nor sexuality, with the exception of studying purely biological sex differences, when they were medical/nursing students. All participants received their first clinical degrees (BSN or MD) in the 1990s or early 2000s. At the time, SGBM was just beginning to grow as a legitimate field of medicine and was more commonly referred to as “gender-based biology” (Madsen et al., 2017).

For example, a few of the participants from both the RSOM and SON recalled learning about sex differences in symptom presentation and risk levels for certain conditions, such as the fact that men are more likely to have a heart attack while women typically show less obvious signs of a heart attack like pain similar to that of severe indigestion (Participant 3, 2021). Participant 2 recalled learning absolutely nothing about gender, especially its interactions with race and ethnicity. As a Black woman, she did not feel supported by the School of Nursing while earning her degree. Therefore, diversifying nursing education is particularly important to her, so a tremendous portion of the efforts to update the midwifery curriculum comes directly from her. This aligns with Verdonk’s 2005 findings, where a specific professor of Women’s, Gender and Sexuality Studies was an “important stimulus” and “trigger” person for SGBM integration. For Stony Brook’s midwifery program, Dr. Findeltar-Hines is the “trigger” person.

Another important consideration is that in the 1990’s, patients were often quite hesitant about revealing their gender identity and/or sexuality to practitioners (Participant 6, 2021). Furthermore, gender-affirming care standards, mostly relating to gender-affirming surgeries, did not exist until 1979 (Frey et al., 2017). The first major case study in hormonal puberty blockers, now a major treatment option for transgender, non-binary, and gender non-conforming pediatric patients, was not published until nearly twenty years later in 1998 (Cohen-Kettenis et al., 2011). Clinical progress took decades, and the curricula were trailing far behind as a result. This aligns with the Verdonk et al. case study of the Dutch medical center (2005), in which faculty’s personal experience and motivation was found to be a key factor in ensuring the success of gender education integration. Unlike the Dutch case study, though, Participant 2 acknowledges that gender exists on a spectrum and does not conceptualize it in mere binary terms, perhaps contributing to the Midwifery program’s progressive success in recent years. According to Participant 2, the program’s instructors have created a trans patient case study, use gender-neutral pronouns whenever possible, and are currently working on implementing gender/sexuality- and race-specific lectures.

This level of dedication to building gender-inclusive training is not consistent across the nursing and medical schools, however. While some participants recalled learning about “special populations” (Participant 4, 2021), which include trans and gay patients, it was from a very “cisgendered” perspective (Participant 1, 2021). This special population education was also added to the curriculum out of political pressure rather than student/faculty motivation. In the 1990s, HIV and AIDS awareness skyrocketed to the top of major health institutions’ priority list as the AIDS epidemic entered its “Middle Era” and gained international attention (Durvasula, 2018). This increased public health attention to women’s and reproductive health disparities, but commonly used terminology like the “4H Club [homosexuals, hemophilliacs, heroin users, and Haitians]” were homophobic and racist, essentially doing the opposite of increasing gender and sexuality awareness (Participant 3, 2021). In fact, prior to the AIDS epidemic, those who identified as female were prohibited from participating in medical research, so it’s not surprising that health practitioners and academics ignored gender education.

What current SBU students learn

Current SBU students learn more than participants’ did but the integration of gender and sexuality into the curriculum is slow. Challenges include time constraints (Participant 1, 2021), disparities in instructors’ own knowledge about the topics (Participant 1, 2021), and resistance from more traditional faculty (Participant 2, 2021). Ultimately, it is up to individual faculty to decide how much they want to adjust their curricula to include diversity education.

The Renaissance School of Medicine did not start internally pushing for inclusive education until two to three years ago (Participant 1, 2021; Participant 6, 2021), and since then, progress has been very slow. The majority of interviewees recognized the need for specialized gay and trans* education, but that was about the extent of their reported knowledge. Only one or two faculty mentioned non-binary and gender-nonconforming patients (Lian, 2021;  Participant 3, 2021), and one mentioned the relationship between race, socioeconomic/citizenship status, and healthcare outcomes (Participant 6, 2021). None offered evidence of education that focuses on the vast variety of other gender and sexuality spectrums, including sexualities that are not strictly straight/gay/bisexual. Only one doctor mentioned how clinical placement affected patient populations. For example, attending physicians working at a Flushing, NY clinic might see more Asian patients while someone working in a “resident clinic” would typically see patients in less privileged socioeconomic groups. The resident clinics have more Hispanic and non-English speaking patients “by default” (Participant 6, 2021).

It is also worth noting that while a few participants mentioned race, gender, sexuality, socioeconomic status, and ability status separately, it was evident that all of them viewed gender and sexuality using an additive lens. The additive model considers systems of oppression to be individual entities rather than structures that cannot operate without one another. Intersectionality was undoubtedly an unfamiliar term, so interviewees were largely unable to answer questions about the intersections of identity factors like gender and sexuality. A potential cause of this issue is the lack of precise terminology in the broader field itself (Madsen, 2017).

The School of Nursing, however, began adding diversity and inclusion to its branding in 2017, which, coincidentally, is the same year the Midwifery Program appointed the first woman of color as its Director. In its academic success goals, the Strategic Plan 2016 to 2021 (2017) specifically lists “recruit diverse nursing faculty” and “expose [nursing students] to global health and healthcare disparities.” Since then, the midwifery program has been adapting lectures to use more inclusive terminology, such as saying “patient” instead of “woman” and “parent” instead of “mother.” Additionally, the program was the first in the SON to add a transgender-specific case study to the curriculum. As the program director noted in her interview, “Education is always evolving… We [educators] have to stay creative and innovative in order to get the basic education things that we want learned [by the students]” (Participant 2, 2021). This is both in agreement and in direct contrast with Yang’s Taiwanese survey of healthcare professionals and teachers regarding gender education expectations. Yang claimed that workplace sexism is a primary cause of the disparity between what instructors believe should be taught and what is actually taught about gender. She also argued that this same sexism prevents educators from viewing gender as a human issue rather than a “woman issue” (Yang, 2020). Participant 2 suggests that all educators must address gender education, including the traditionalists, and simultaneously expresses that workplace discrimination is not an excuse for lack of progress.

All faculty are required to retain clinical practice while teaching, and all participants hold additional leadership positions within their respective schools (Participant 4, 2021). Combined with minimal access to formal training, some traditionalists would say that faculty simply don’t have the time to educate themselves about gender so it is much harder for them to teach it (Participant 1, 2021). However, integration does not necessarily need to involve revamping the entire curriculum (Participant 3, 2021). Faculty could also incorporate gender diversity education into existing training, such as making a simulated patient a woman of color or a child with two mothers. Additionally, instructors could use case studies to emphasize a wide variety of lessons, such as Participant 2’s pediatric case study with a transgender (assigned female at birth) patient named “Timmy” (2021). This case study provides opportunities to practice using proper gender pronouns, learn about hormonal gender affirming treatments, and how to interact with parents of gender-diverse children. Across all interviews, participants said that they would like to improve the time dedicated to gender and sexuality education, so the motivation is there. These sentiments align with those of the students that Jenkins et al. surveyed in 2005, meaning formal course offerings have not improved much since then.

According to the participants, the students are the main driving force behind integrating gender and sexuality training into their healthcare studies. This result was also expected based on the Jenkins et al. survey (2005). On top of being very receptive and eager to learn about diversity, they even provide feedback asking to learn more (Participant 2, 2021; Participant 1, 2021; Participant 4, 2021). Depending on clinical placements, students also have the opportunity to interact with diverse patient populations (Participant 4, 2021), and at Stony Brook Hospital, residents consistently see high levels of diversity (Participant 5, 2021; Participant 1, 2021). While not all healthcare practitioners will work directly with gender-diverse patients, it is still extremely important for all medical providers to understand and be able to apply gender-inclusive theories. According to a recent 2021 Gallup poll, 5.6% of American adults, and one in six adults in Generation Z alone, identify as LGBT (Jones, 2021). Furthermore, the U.S. Census estimated that in 2019, over 36% of women were women of color, and this proportion is projected to grow to over 55% by 2060 (“Women of Color in the United States,” 2021). These statistics are particularly relevant to maternal and reproductive healthcare; therefore, it is critical that these healthcare providers are trained, at least on a basic level, in gender and sexuality studies (Participant 5, 2021).

Institutional support

Based on Verdonk’s 2005 study of a Dutch medical center, institutional support must be present in order to successfully incorporate sex- and gender-based education into healthcare curricula. This may be in the form of financial resources, guest lecture support, accessible educational resources, and visual/presentation support (Verdonk, 2005). With this in mind, I asked participants about how Stony Brook University supports its healthcare faculty in diversifying the curricula, if at all.

Using a binary gender lens

SBU as an institution provides some structured learning opportunities for faculty specifically about using an intersectional gender lens when practicing healthcare, but students and faculty want more. In terms of gender education, because the topic is so relevant to daily patient care for OB GYNs, a few formal lectures have been offered, and OB GYN residents discuss gender- and sexuality- related cases during grand rounds (Participant 5, 2021). For medical students, as of 2020, all SBU medical and dental students are required to take a “Transition to Medical and Dental School” course that talks about gender and diversity issues (Participant 1, 2021)

Using a heteronormative LGBTQ* lens

In terms of LGBTQ* inclusivity, two of SBU’s major medical institutions, Stony Brook Medical Center and Stony Brook Southampton Hospital, scored a 100/100 on the Human Rights Campaign (HRC) Foundation’s 2020 Healthcare Equity Index [HEI] and were named LGBTQ Healthcare Equality Leaders (Healthcare Inequality Index 2020).2 According to Stony Brook, “[t]he HRC is the largest national lesbian, gay, bisexual, transgender and queer civil rights organization” (“Health Equality Leader,” 2021). However, the HRC has received a substantial amount of criticism for, despite its claims, failing to represent and advocate for LGBTQ* folks of color. Much of this controversy surrounded the Don’t Ask, Don’t Tell Repeal Act of 2010 (“H.R.2965,” 2010). In the months leading up to its official passing, the HRC used a disabled, gay veteran of color to promote fake inclusivity while it simultaneously “profited from the practice of diversity management” (Montegary, 2015). Further, the HRC has been called “cisgenderist” and white supremacist for several years (Johnson, 2011; Rosen, 2021). As such, their HEI rating may not have as much practical weight as Stony Brook claims.

Stony Brook University released an LGBTQ+ Health Needs survey in early summer 2021 and received over 1,218 responses from Long Island, NY residents as of September 30th, 2021. Its purpose is to “provide information critically needed by healthcare providers, social service providers, government officials and public health staff to expand service offerings and serve as effective advocates for LGBTQ+ people” (“LGBTQ+ Health Needs Survey”). Moreover, the survey was made available in both English and Spanish, increasing access to non-English speakers. Suffolk County alone is 20% Hispanic/Latinx, according to the U.S. Census Bureau estimates (“Quick Facts”).

Both the Stony Brook Medicine [SBM] and the School of Nursing [SON] have recently created committees to educate practitioners and spread awareness about gender-informed care. The SBM LGBTQ* advisor committee meets monthly and aims to establish a set of priorities for LGBTQ* patient care, as well as create a more welcoming environment for patients, practitioners, and staff (“Two Stony Brook Hospitals;” Participant 1, 2021). Additionally, the SON’s brand new IDEA committee [Inclusion, Diversity, Equity, and Access] aims to use student feedback to build a more inclusive learning environment (Participant 4, 2021; Participant 3, 2021). Faculty veterans accustomed to traditional academic politics may argue that committees are a poor use of resources, especially in higher education; however, as university administration researcher David Farris writes in “Not Another Committee” (2017), with regular communication, perceived equality among members, and actively focused leaders, committees can actually be quite effective. Nonetheless, it is still important to note that the learning opportunities produced by these committees, particularly at Stony Brook, are created for clinician audiences and are less advertised to didactic instructors (Participant 1, 2021).

Hiding behind generalized health inequity

Pre-COVID, nursing faculty went on a few retreats that focused on diversity inclusiveness, but it was addressed in a very general manner (Participant 4, 2021). Recently, Stony Brook Medicine ran a two-day conference entitled “The Long March to Equity,” which covered general healthcare disparities and their historical trajectories into modern day medicine (Participant 3, 2021). This was the only example mentioned by multiple participants, and I was unable to find any other examples.

One OB-GYN did mention Women’s Health Day, an annual conference at the Renaissance School of Medicine that focuses on various health issues (cardiovascular, eyesight, muscle, breast cancer, etc.) and is exclusively targeted at an all-female audience (Participant 6, 2021; “Women’s Health Day,” 2019). This participant noted that the OB-GYN department also hosts a women’s health clinic on the same day at which anyone can get a routine check-up for free. The department has also started a bi-weekly clinic that provides discounted services for uninsured patients (Participant 6, 2021). However, she also explained that basic needs such as transportation already inhibit many of their regular patients from accessing necessary healthcare appointments. While treating women for free or at lower rates is somewhat helpful, it does not address the issue of inequitable access in an intersectional way; essentially, these clinics are just a Band-Aid solution to a deeper, more complex problem.

Distinct differences between medical and nursing education

The next result I will discuss was unexpected but certainly worth noting. I found clear differences between the perspectives/openness of the medical doctors and nurses. While the medical and nursing models have been known to be incredibly separate for decades (Reed and Watson, 1994), I was surprised by how much the models impacted the providers’ perspectives on sex- and gender-based medicine. For reference, the medical model focuses on “diagnosis, treatment, and cure” and has been widely criticized for its “narrow and unsatisfactory view (Reed and Watson, 1994). On the other hand, the nursing model “offers a more humanistic approach to patient care” (Reed and Watson, 1994).

The Medical Model’s Shortcoming

During the interviews, OB-GYNs consistently steered their responses towards healthcare outcomes, while I found the important connection between education and patient experience to be missing. For example, medical doctor participants mentioned “sobering” maternal mortality statistics, grand rounds3 (Participant 5, 2021), and student feedback being important (Participant 1, 2021), but only one explicitly said they prioritized making patients “feel more comfortable… and heard” (Participant 5, 2021). Yet, is the entire reason for improving medical education to benefit the patients?

Additionally, all three of the OB-GYNs discussed referrals4 as a way to support gender- and sexuality-based diversity. While having and being knowledgeable about sufficient resources is absolutely necessary, it does not address the alarming fact that many maternal and reproductive care providers are entirely unfamiliar with the concepts of intersectionality and non-binary gender and sexuality spectrums. Patients should not need to see another doctor in order to be treated with bare-minimal respect and dignity.

The Nursing Model’s Humility

On the contrary, nursing faculty were much more open to discussing how their personal experiences and medical training affects the quality of care they deliver. For example, Participant 3 took a few gender studies courses during her undergraduate career at Stony Brook, which exposed her to “thinking about other cultures, other health belief systems that wasn’t just coming out of a textbook” (2021). This, she said, impacted both the way she teaches and the way she cares for her queer5 patients, particularly helping her grasp new concepts like non-binary genders and different cultural understandings of disability. Here, the connection between the importance of inclusive education and patient experience is clear. Further, Participant 4 explained how crucial it is for students to work with diverse patient populations during school so that when they enter the workforce as licensed providers, they will already have achieved at least a basic level of intercultural competence.

Faculty diversity

One final point I must discuss is that all six participants identified as women, and four identified as women of color (see Table A on page 9). This sample is not representative of the Renaissance School of Medicine’s and School of Nursing’s faculty at all. The School of Medicine’s Obstetrics and Gynecology department has 42 physician faculty, of which only 13 (about 30%) are women of color. Furthermore, not a single woman is a full professor (with tenure). The department Director and Chair, the two highest leadership positions in the department, are also both white men (“Our Providers,” 2021). Within the School of Nursing, there are 32 faculty, of which 27 (about 84%) are white women and 4 (12.5%) are women of color. There is only one woman of color who holds a director-level position (“Faculty & Staff Directory,” 2021). It seems, then, that the School of Nursing has not yet met its goal to “Recruit diverse nursing faculty” (Strategic Plan 2016 to 2021, 2017).

With these numbers in mind, it is not surprising that Stony Brook University is lagging behind when it comes to incorporating SGBM into healthcare training. The key “trigger person” suggested by Verdonk’s 2005 study is hardly present, which may be why the Midwifery Program is the most progressive program within the School of Nursing (Participant 2, 2021). Verdonk also notes that personal experiences are significant contributors to SGBM’s successful incorporation into medical education (2005). Therefore, because the School of Medicine’s OB-GYN department has two white men occupying its highest leadership positions, and because the School of Nursing only has one woman of color in a leadership position, gender-inclusive training may be extremely difficult to accomplish with the existing faculty structure.

Conclusion

In summary, when the participants, the majority of whom were initially medically trained in the late 1990s to early 2000s, were students, they did not receive any education about SGBM with the exception of purely medicalized topics. Today, Stony Brook medical and nursing students are taught more gender-inclusive curricula but not as much as faculty nor students would like. Participants expressed facing challenges such as finding time to create new content, lacking personal knowledge and familiarity with SGBM, and lack of institutional support in the form of formal, specific training opportunities. Overall, Stony Brook’s “progressive” practices and curricula continue to use a heteronormative lens and show no intentions of trying to dismantle it.

This case study provides a snapshot of the American medical system, which currently faces discrimination and disparities on both clinical and educational fronts. With more Americans openly identifying as LGBTQ* than ever (Jones, 2021), and with populations of color continuing to grow (Jones et al., 2021), addressing gender- and sexuality-based healthcare disparities is an essential piece to improving the health of the nation. If the COVID-19 pandemic has shown us anything, it’s that we are in a deep crisis, and we have been for decades, leaving marginalized groups with inexcusably inequitable care. One of the most effective ways to produce long-term, sustainable change is by educating future generations of providers. This is why it is so important to ensure our healthcare students are receiving, at bare minimum, adequate training on these topics.

Potential ways to improve SGBM education and ensure competency is 1) provide formal, structured training for educators; 2) incorporate SGBM into the didactic and clinical curricula using updated lectures, new case studies, more diverse patient populations, and inclusive simulations; 3) appoint more (qualified) individuals from marginalized groups to leadership positions; 4) allot more funding to gender- and sexuality-inclusive educational initiatives; and 5) continuously assess, collect feedback, and adjust accordingly.

To form a more robust understanding of the medical educators’ attitudes towards SGBM education, future research could involve more individual case studies of academic medical institutions and/or comparing multiple universities. Faculty and student demographics differ between schools and geographic regions, which may affect attitudes as well as financial and socio-political ability to incorporate SGBM into formal medical education.

Footnotes

1 Essentialists believe that certain groups (categorized by race and sex especially) have traits and behaviors that are determined by biological factors. Gender essentialism inherently supports gender inequality by viewing gender as a binary concept, i.e. man versus woman (Hepburn).

2 HEI LGBTQ scores were calculated based on four major criteria: 1) quality LGBTQ patient-centered care, 2) “Patient Services and Support,” 3) “Employee Benefits and Policies” including “transgender inclusive healthcare benefits,” and 4) Patient and Community Engagement” (Healthcare Inequality Index 2020 14).

3 “A grand round is a formal meeting at which physicians discuss the clinical case of one or more patients. Grand rounds originated as part of residency training wherein new information was taught and clinical reasoning skills were enhanced. Grand rounds today are an integral component of medical education” (Stöppler, 2021).

4 A referral is when a healthcare provider does not have sufficient expertise in a particular field and suggests that the patient see a more knowledgeable specialist in that field (“Referral,” 2021).

5 Here, I use the term “queer” to mean “not aligning with the norm” rather than the more conventional “non-heterosexual” meaning.

Acknowledgements & Disclosures

Thank you to Liz Montegary for providing guidance for my research process, and thank you to all faculty who interviewed with me. This research was not funded in any way by any institution and was a fully independent project.

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“Health Equality Leader.” Stony Brook Medicine, 2021, http://www.stonybrookmedicine.edu/LGBTQ/goal.

Hepburn, Alexa. An Introduction to Critical Social Psychology, SAGE Publications, 2003.

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“History and Mission.” Stony Brook University, http://www.stonybrook.edu/about/history/. Accessed 27 Oct. 2021.

“History of VAWA.” Legal Momentum, http://www.legalmomentum.org/history-vawa. Accessed 27 Oct. 2021.

“H.R.2965 – Don’t Ask, Don’t Tell Repeal Act of 2010.” Library of Congress, 22 Dec. 2010, http://www.congress.gov/bill/111th-congress/house-bill/2965.

Jenkins, Marjorie, et al. “Sex and Gender in Medical Education: A National Student Survey.” Biology of Sex Differences, vol. 7, no. 1, 2016. doi:10.1186/s13293-016-0094-6.

Johnson, Karlee. “Equality for some: A critique of the Human Rights Campaign.” Daily Sundial, 9 Oct. 2011, sundial.csun.edu/45167/opinions/equality-for-some-a-critique-of-the-human-rights-campaign/.

Jones, Jeffrey. “LGBT Identification Rises to 5.6% in Latest U.S. Estimate.” Gallup News, 24 Feb. 2021, news.gallup.com/poll/329708/lgbt-identification-rises-latest-estimate.aspx.

Jones, Nicholas, et al. “2020 Census Illuminates Racial and Ethnic Composition of the Country.” United States Census Bureau, 12 Aug. 2021, http://www.census.gov/library/stories/2021/08/improved-race-ethnicity-measures-reveal-united-states-population-much-more-multiracial.html.

Kang, Miliann, et al. Introduction to Women, Gender, Sexuality Studies. University of Massachusetts Amherst Libraries, 2017.

“LGBTQ+ Health Needs Survey.” Stony Brook Medicine, http://www.stonybrookmedicine.edu/LGBTQ/survey. Accessed 27 Oct. 2021.

Liu, Katherine, and Natalie Dipietro Mager. “Women’s involvement in clinical trials: historical perspective and future implications.” Pharmacy Practice (Granada), vol. 14, no. 1, 2016. doi:10.18549/PharmPract.2016.01.708.

Madsen, Tracy, et al. “Sex- and Gender-Based Medicine: The Need for Precise Terminology.” Gender and the Genome, vol. 1, no. 3, 2017, pp. 122–128. doi.org/10.1089/gg.2017.0005.

Medical School (MD Program) Applicant Profile – By Entering Class. Stony Brook University, 2021, http://www.stonybrook.edu/commcms/irpe/fact_book/data_and_reports/_files/admissions/MDApps_20.pdf.

Montegary, Liz. “Militarizing US Homonormativities: The Making of “Ready, Willing, and Able” Gay Citizens.” Signs: Journal of Women in Culture and Society, vol. 40, no. 4, 2015, pp. 891–915. doi:10.1086/680333.

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Prescott, Heather. “We Must Not Allow a Contraception Gap: Planned Parenthood’s Campaign for New Birth Control and Feminist Health Activism in the 1990s.” Technology and Culture, vol. 60, no. 3, 2019, pp. 816–832. doi:10.1353/tech.2019.0074.

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Hijras

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by Zarya Shaikh, December 31, 2021

Spending time between Pakistan and the United States as a child, I have learned about different receptions to the LGBTQ+ community in two cultures. I thought that the first time I met a transgender individual was as a 14-year-old in America. After reading Jeffrey Gettleman’s article “The Peculiar Position of India’s Third Gender,” I realized I have met transgender individuals as early as age 8 (and possibly even earlier) in Pakistan. Similar to the Fa’afafine in Samoan culture, Hijras are individuals in Pakistan’s and India’s Muslim history who do not subscribe to a single identity as male or female.1 “Hijra” in Hindi translates to eunuchs, who are sexless individuals. They are castrated to eliminate the desire for love or lust and are meant to be sexless beings who are sexually receptive to men.1 It is important to note that not all transgender individuals in India identify as Hijras. Hijras are an entity that exists under the umbrella identity of transgender.1 During my visits to Pakistan, my family would donate money to Hijras whenever they stopped by our home or knocked on car windows. Gettleman finds that the identity of Hijras stems from a Hindu myth that Lord Rama, a Hindu god. Gettleman describes that Lord Rama “was exiled from Ayodhya and his entire kingdom began to follow him into the forest.” Lord Rama told men and women to leave him and regroup in Ayodhya.1 Hijras were known for their loyalty as they awaited Lord Rama’s return for 14 years in a folktale.1 Scholars of Hindu mythology discount the anecdote, claiming it is not in early versions of ancient Hindu texts. Regardless, the devotion of the Hijras demonstrated by the folktale is a significant characteristic of the Hijra identity.1 Before Britain’s colonization of India, Hijras were “revered as demigods.”1 Britain stripped Hijras of their identity upon colonization and enforced the binary gender system of female and male by suggesting they existed against the “order of nature” and thus criminalized “carnal intercourse.”1

In the modern-day, Hijras dress in sparkly saris and makeup while dancing and offering blessings in the streets. Indians perceive Hijras as beings with the power to bestow blessings or curses on those they meet. Radhika, a 24-year-old Hijra, shared that they were uncomfortable with resigning to a single-gender while in school. Her mother condemned these thoughts and told Radhika to “stick to” the gender binary.1 Soon after this interaction, Radhika’s parents split and her mother died. With no one else to turn to, 8-year-old Radhika met an older sex worker who made her a sex worker in a park.1. Radhika continues sex work today, as there is no other source of income. Hijras are still essential to the hierarchy of harems, which often operate like street gangs. They rely on gurus, also Hijras, who “fulfill the hybrid role of den mother, godfather, spiritual leader and pimp.”1,3 Beneath Hijras in the pyramid are chelas (disciplines) who are used to increase cash flow to the guru. For Hijras, there is not much social mobility due to restrictions placed on education and employment.2 Their rights as humans are often violated; these factors contribute to the cycle of being exploited through sex work and facing humiliation through castrations and social isolation.1 For a majority of the time following colonization, there were no modes of medical care that are easy to access. Countless deaths occurred as a result of the castrations by unqualified individuals.1 In recent years, however, India has recognized being transgender as another gender. Hijras can now undergo gender-affirming surgeries in some hospitals and access government benefits including welfare.1,2 Although this is a step in the right direction, Hijras are still considered inferior oddities who are not respected. The attitudes of society on their roles as sex workers have yet to change.

References

1 Hylton, S., Gettleman, J., & Lyons, E. (2018, February 17). The peculiar position of India’s third gender. The New York Times. Retrieved from https://www.nytimes.com/2018/02/17/style/india-third-gender-hijras-transgender.html 

2 UK Essays. (2021, August 12). The khawaja sara and hijra: Gender and sexual identities formation in post-colonial Pakistan. UK Essays. Retrieved from https://www.ukessays.com/essays/society/the-khawaja-sara-and-hijra-gender-and-sexual-identities-formation-in-post-colonial-pakistan.php?vref=1 

3 Stief, M. (2016, November 22). The sexual orientation and gender presentation of Hijra, kothi, and Panthi in Mumbai, India – Archives of Sexual Behavior. SpringerLink. Retrieved from https://link.springer.com/article/10.1007/s10508-016-0886-0#:~:text=Hijra%20are%20androphilic%20(sexually%20attracted,networks%20that%20are%20hierarchically%20organized

The United States is Overdue for a Film Like Pixote (1980)

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by Cassandra Skolnick, November 22, 2021

Press the “channel up” button on your television remote several times. Every channel you stop on features colonial concepts of gender and power, concealing relevant truths about actual lived experiences. This is how those in the status quo maintain systems of oppression; unchanged, unchallenged, and uninterrupted. We need an escape from political ideology in film and television, centering our focus on social problems, like the film Pixote (1980) did in Brazil, under the direction of Héctor Babenco. I intend to examine how Pixote created an uncompromised and devastating view of the lived experiences of street children in São Paulo, forcing people out of their comfort zones and to finally address social problems; supporting my argument that a film like Pixote is long overdue in the United States.

Set in the 1980s, Pixote brings attention to the social problems experienced by abandoned children living on the streets of São Paulo and falls under an artistic genre known as social realism. Héctor Babenco originally set out to produce a documentary, but after nearly a dozen visits to the juvenile reformatories he reported that “…the authorities closed the door on me” (Csicsery 3). Instead, he created a fictional film based on the experiences of the children he interviewed. Concerned that it would not be genuine enough, Babenco hired non-actors from the low-income regions of São Paulo. The boys were not given a script or screenplay and were encouraged to speak in their own language (Csicsery 3). They were only told about the situations in workshops and improvised genuine responses. The result is a film that highlights “…the dark side of life for abandoned children in Brazil” (Shaw 149). 

Beyond extreme poverty, street children experience abuse and exploitation at juvenile reformatories by the men in power, demonstrating an overarching depiction of toxic masculinity that filters down to the boys. Our first glimpse of this transference of toxic masculinity occurs when a few older boys at the reformatory violently gang rape a younger and weaker boy (Pixote, 09:29). The abuse waged against the boys by the men at the reformatory is also responsible for enabling a primitive survival instinct in them. The boys frequently showcase their strength to one another, as well as to the men running the reformatory. This survival instinct is clearly present when one of the boys is framed for murder, and he grabs a knife in the cafeteria and threatens the guards (Pixote, 52:48). The will to survive drives the boys to turn to drugs and criminal behavior as an escape mechanism.

Pixote is the central character, and the point of view in the film is often deployed through his eyes as he encounters an accelerated coming-of-age transformation from childlike innocence to deviant delinquent. Following an escape from the reformatory, Pixote and a few friends form a familial pact and engage in criminal activities to support themselves. This begins with thievery, stealing purses, briefcases, and wallets from pedestrians (Pixote, 01:05:44), and ultimately leads to involvement in drug trafficking (Pixote, 01:14:32), prostitution (Pixote, 01:34:13), and murder (Pixote, 01:30:52; Pixote, 01:57:20). 

The themes of strength and survival showcased by the boys influence a third theme, sexuality, which is explored in an uncensored and often uncomfortable way throughout the film. The character Lilica, a transgender woman, is abused and sexually assaulted by the boys; rarely does she enter a sexual encounter on romantic terms. Sueli is a prostitute who sells her body for her male pimp, giving up her autonomy to support herself and her addiction. At one point, Sueli admits to Pixote that she got pregnant from one of her sexual encounters and gave herself an abortion (Pixote, 01:35:27). Pixote sees the aborted fetus discarded in the bathroom trash can. The boys also explore their sexuality, entering non-heteronormative sexual encounters. Dito, a boy who escaped the juvenile reformatory with Pixote and serves as a patriarchal leader of the group, engages in both romantic and sexual relations with Lilica and Sueli, exploring his sexuality and desire in the process. Pixote, on the other hand, never engages directly in sexual relations but learns about sexuality and desire through his observations of the other boys.  

The purpose of social realism is to illustrate real-life conditions and experiences of people living and surviving in society. Pixote accomplishes this by refusing to hold back on the life experiences of abandoned children in Brazil. In the United States, we have become accustomed to censored television and filmmaking, maintaining dominant concepts of heteronormativity, the nuclear family, and positive views of capitalism. However, I argue that a film rooted in social realism in the United States would challenge these concepts. Pixote showed how a group of boys can become family, incorporating common familial traits like shared responsibilities, unconditional love, financial support, and opportunities for learning and growth. This non-traditional nature challenges the dominance of nuclear families and also challenges concepts introduced in capitalist ideology, ideas that propose “…childhood as a separate and protected space of play and of learning” (Reimer 2011). The children are forced into accelerated coming-of-age transformations, leaving no opportunities for them to experience childhood.   We need films like Pixote to force Americans out of their comfort zone, to see the dark side of lived experiences in the United States. There has been some progress with filmmaking moving in a direction of social realism; Moonlight (2016), introduced us to the intersections of race, toxic masculinity, and sexuality in the lived experiences of Chiron, a queer Black boy living in Miami, Florida. The film was able to challenge the concept of the nuclear family, raising the question, “what is family?” Chiron finds himself supported and unconditionally loved by Juan, a drug-dealer, and his girlfriend Teresa; important traits than he rarely experienced from his birth mother. The film addresses poverty within Black communities, and Chiron’s transition to drug dealing for survival challenges capitalist failures in the United States. While this is a meaningful step in the right direction, we need more filmmakers to take the risk that films like Pixote and Moonlight took to challenge dominant societal norms.

Works Cited

Babenco, Héctor, director. Pixote. Embrafilme, 1980. 

Csicsery, George, and Héctor Babenco. “Individual Solutions: An Interview with Héctor Babenco.” Film Quarterly, vol. 36, no. 1, 1982, pp. 2–15, doi.org/10.2307/3697179.

Jenkins, Barry, director. Moonlight. A24, 2016. 

Reimer, Mavis. “On Location: The Home and the Street in Recent Films About Street Children.” International Research in Children’s Literature, vol. 5, no. 1, 2012, pp. 1–21., doi.org/10.3366/ircl.2012.0040. 

Shaw, Deborah. “National Identity and the Family: Pixote by Hector Babenco and Central Station by Walter Salles.” Contemporary Cinema of Latin America: Ten Key Films, Continuum, New York, 2003, pp. 142–179. 

The Pain Before The Birth: Antenatal Anxiety

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by Marcela Muricy, November 9, 2021

Pregnancy is an adventurous time— a time of changes in the body that can be welcoming or scary, peaceful or torment, the feeling of finally having everything put together or the stress of slamming your finger between the car door. Any way you twist it, it is a very complicated and unique time for every pregnant person. Most people will fear the aftermath, the risk of experiencing Postpartum Depression, the more intense version of the “baby blues”. Yet, what many pregnant people, their families, and even physicians and researchers overlook, however, is another mental health change that may impact them — and their baby — during the pregnancy itself: antenatal anxiety. “Antenatal”, or “pre-birth”, represents the time period before someone gives birth, therefore encapsulating the symptoms they may begin to encounter, such as mild to intense anxiety. Experienced by about 10% of pregnant people (Falah-Hassani et al., 2017), antenatal anxiety consists of obsessive and excessive worry that begins to impact their daily function, including concerns of maternal/fetal wellbeing, illness in the partner, and the possibility of maternal mortality (Johns Hopkins). These feelings, when experienced chronically and not treated properly, can have lifelong impacts on the child’s development (Misri et al., 2015). It is crucial to consider the prevalence of antenatal anxiety, how much it flies under the radar, and how harmful it is to mothers and their children, particularly during a pandemic in which treatment is very limited.

According to various studies, high antenatal anxiety can cause a decrease in the child’s head circumference, Apgar scores, and body length, as well as an increase in preterm birth rates, maternal eating disorders— and even cognitive and anger issues that can follow the child into adolescence and adulthood (Sarkar et al., 2017; Grigoriadis et al., 2018). For the pregnant person, antenatal anxiety can be a key predictor of postpartum depression (which is experienced by about 15% of pregnant people), so that high levels of antenatal anxiety are strongly correlated with higher likelihood of postpartum depression (Yim and Schetter, 2019; Slomian et al., 2019). Antenatal anxiety, then, although harder to identify, is also crucial in its correlation to PPD, and can help in the prevention of not only antenatal symptoms, but the gruesome symptoms that may follow the long road of PPD.

The main risk factors for developing maternal anxiety have proven to be high maternal preterm BMI, as well as a history of depression and mental issues (Holton et al., 2019; Dachew et al., 2021). Pregnancy ultimately causes a change in social state, hormonal imbalances, and lack of social support, all of which can serve to strain the pregnant person’s mental state and exacerbate past health issues. The listed risk factors, on top of the typical strains of pregnancy, leaves them very vulnerable to developing antenatal anxiety, making regular screenings and checkups even more crucial to preventing these symptoms as early as possible.

The current primary method of prevention includes frequent screenings, however it is proven that there is a strong correlation between pregnant people experiencing antenatal anxiety and choosing to attend less screenings/checkups, and so they are likely to be overlooked. It has been shown that therapy and social support groups tailored to them aids in decreasing antenatal anxiety in vulnerable populations, as well as populations not considered at risk for anxiety, both of which experienced an increase in overall quality of life (Li et al., 2020). The major causes of antenatal anxiety, then, are well treated and relieved by an increase in social interactions and support.

This explains the increase in antenatal anxiety since March 2020; the COVID-19 pandemic has limited the availability of antenatal anxiety prevention and birthed a unique population of vulnerable mothers. Throughout the pandemic, there was a reported decrease in maternal mental health, and an increase in anxiety, depression, and OCD as a result of the fear of infection and social isolation (Hessami et al., 2020; Hinds et al., 2021). This was especially true for mother’s of high risk pregnancies (for instance, being at risk of preterm labor or a diabetic mother at risk of Diabetic Ketoacidosis) and with lower levels of education (Sinaci 2020). Within this sample set, there has also been an increase in PTSD symptoms because of the high stress level associated with the pandemic and the lack of social support (Hocaoglu et al., 2020). The prevention for this population was only possible within the home (self-prevention methods), or with a specialist over a digital platform— both of which are difficult to maintain and ineffective compared to in-person treatment and support (Akgor et al., 2021). This is also a possible challenge for pregnant people in poorer communities that cannot afford to attend regular checkups and screenings, which is particularly risky considering that, in worse financial conditions, they are significantly more likely to experience antenatal anxiety (Bayrampour et al., 2018; Dennis et al., 2018). The COVID-19 pandemic has exacerbated the impact of certain risk factors and exposed a disproportionate lack of resources available in impoverished communities, especially in times of need. 

Antenatal anxiety, then, should be at the forefront of our conversation around the support pregnant people need during pregnancy. Not only should they undergo physical screenings and pelvic exams (as is customary), but they should receive just as many (if not more) regular check-ups regarding their mental health (Kitchen and Jack 2021; Li et al., 2020). Moreover, this check-up should not only be geared towards the most serious aspects of mental health (such as suicidal thoughts), but also towards the more subtle concerns that can accumulate and negatively impact their health over time. Antenatal anxiety and its symptoms may be experienced independently of anything else, making it more difficult to distinguish between normal and abnormal symptoms (Misri et al., 2015). Persistent screenings, intensive education about these possibilities/distinctions, and further treatment studies are crucial to combatting the high prevalence of antenatal anxiety. This is especially true with vulnerable populations that have previous mental or physical health issues, or have limited access to resources due to their financial situation. Pregnant people should know they are well-supported, and their families should know how best to support them— so that none of them may suffer alone.

1 An Apgar score is a postnatal test performed immediately after birth to evaluate the baby’s health. Each category (Appearance, Pulse, Grimace, Activity, and Respiration) gets its own Apgar score ranging from 0-2, 0 being the least healthy and 2 being the most (“What is the Apgar Score?”).

References

Akgor, U., Fadıloglu, E., Soyak, B., Unal, C., Cagan, M., Temiz, B. E., Erzenoglu, B.E., Ak, S., Gultekin, M., & Ozyuncu, O. (2021). Anxiety, depression and concerns of pregnant women during the COVID-19 pandemic. Archives of Gynecology and Obstetrics, 304(1), 125–130. https://doi-org.proxy.library.stonybrook.edu/10.1007/s00404-020-05944-1

Alipour, Z., Lamyian, M., & Hajizadeh, E. (2012). Anxiety and fear of childbirth as predictors of postnatal depression in nulliparous women. Women and Birth: Journal of the Australian College of Midwives, 25(3), e37–e43. https://doi.org/10.1016/j.wombi.2011.09.002

Bayrampour, H., Vinturache, A., Hetherington, E., Lorenzetti, D.L., & Tough, S. (2018). Risk factors for antenatal anxiety: A systematic review of the literature. Journal of Reproductive and Infant Psychology, 36(5), 476–503. https://doi-org.proxy.library.stonybrook.edu/10.1080/02646838.2018.1492097

Coelho, H.F., Murray, L., Royal-Lawson, M., & Cooper, P.J. (2011). Antenatal anxiety disorder as a predictor of postnatal depression: a longitudinal study. Journal of Affective Disorders, 129(1-3), 348–353. https://doi.org/10.1016/j.jad.2010.08.002

Dachew, B.A., Ayano, G., Betts, K., & Alati, R. (2021). The impact of pre-pregnancy BMI on maternal depressive and anxiety symptoms during pregnancy and the postpartum period: A systematic review and meta-analysis. Journal of Affective Disorders, 281, 321–330. https://doi-org.proxy.library.stonybrook.edu/10.1016/j.jad.2020.12.010

Dennis, C.L., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. The British Journal of Psychiatry: The Journal of Mental Science, 210(5), 315–323. https://doi.org/10.1192/bjp.bp.116.187179

Grigoriadis, S., Graves, L., Peer, M., Mamisashvili, L., Tomlinson, G., Vigod, S.N., Dennis, C.L., Steiner, M., Brown, C., Cheung, A., Dawson, H., Rector, N.A., Guenette, M., & Richter, M. (2018). Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: Systematic review and meta-analysis. The Journal of Clinical Psychiatry, 79(5), 17r12011. https://doi.org/10.4088/JCP.17r12011

Hessami, K., Romanelli, C., Chiurazzi, M., & Cozzolino, M. (2020). COVID-19 pandemic and maternal mental health: A systematic review and meta-analysis. The Journal of Maternal-fetal & Neonatal Medicine: The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 1–8. Advance online publication. https://doi-org.proxy.library.stonybrook.edu/10.1080/14767058.2020.1843155

Hinds, C., Lindow, S.W., Abdelrahman, M., Hehir, M P., & O’Connell, M.P. (2021). Assessment of antenatal anxiety, depression and obsessive-compulsive disorder in pregnant women in the COVID-19 era. Irish Journal of Psychological Medicine, 1–7. Advance online publication. https://doi.org/10.1017/ipm.2021.57

Hocaoglu, M., Ayaz, R., Gunay, T., Akin, E., Turgut, A., & Karateke, A. (2020). Anxiety and post-traumatic stress disorder symptoms in pregnant women during the COVID-19 pandemic’s delay phase. Psychiatria Danubina, 32(3-4), 521–526. https://doi.org/10.24869/psyd.2020.521

Holton, S., Fisher, J., Nguyen, H., Brown, W.J., & Tran, T. (2019). Pre-pregnancy body mass index and the risk of antenatal depression and anxiety. Women and Birth: Journal of the Australian College of Midwives, 32(6), e508–e514. https://doi-org.proxy.library.stonybrook.edu/10.1016/j.wombi.2019.01.007

Kitchen F.L. &, Jack B.W. Prenatal Screening. [Updated 2021 Jul 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470559/ 

Li, C., Sun, X., Li, Q., Sun, Q., Wu, B., & Duan, D. (2020). Role of psychotherapy on antenatal depression, anxiety, and maternal quality of life: A meta-analysis. Medicine, 99(27), e20947. https://doi-org.proxy.library.stonybrook.edu/10.1097/MD.0000000000020947

Misri, S., Abizadeh, J., Sanders, S., & Swift, E. (2015). Perinatal generalized anxiety disorder: Assessment and treatment. Journal of Women’s Health (2002), 24(9), 762–770. https://doi.org/10.1089/jwh.2014.5150

Sarkar, K., Das, G., Chowdhury, R., Shahbabu, B., Sarkar, I., Maiti, S., & Dasgupta, A. (2017). Screening antenatal anxiety: Predicting its effect on fetal growth. Journal of Family Medicine and Primary Care, 6(1), 131–135. https://doi.org/10.4103/2249-4863.214956

Sinaci, S., Ozden Tokalioglu, E., Ocal, D., Atalay, A., Yilmaz, G., Keskin, H. L., Erdinc, S. O., Sahin, D., & Moraloglu Tekin, O. (2020). Does having a high-risk pregnancy influence anxiety level during the COVID-19 pandemic?. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 255, 190–196. https://doi-org.proxy.library.stonybrook.edu/10.1016/j.ejogrb.2020.10.055

What is the Apgar score? Johns Hopkins All Children’s Hospital. (2021). Retrieved November 7, 2021, from https://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/What-Is-the-Apgar-Score#:~:text=The%20Apgar%20score%20is%20a,at%205%20minutes%20after%20birth. 

Yim, I.S., & Dunkel Schetter, C. (2019). Biopsychosocial predictors of perinatal depressive symptoms: Moving toward an integrative approach. Biological Psychology, 147, 107720. https://doi.org/10.1016/j.biopsycho.2019.107720

Racial and Gendered Stratification of The Reproductive Justice Movement

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by Zarya Shaikh, November 3, 2021

The birth control movement, infertility treatments, and abortion rights campaign deliver liberation to all who benefit from them. Black, Indigenous, and people of color (BIPOC) folx are not the intended benefactors of these initiatives. BIPOC individuals, particularly those with lower socioeconomic status in comparison with their white counterparts, are hindered from reaping the benefits of the reproductive justice movement. This is a reflection on “a select group of college-educated, middle and upper-class, married white women” using BIPOC people as a stepping stone towards achieving freedom and privileges in their own lives (Bell, 1984, pg. 1). White women exclude BIPOC folx on the basis that they do not share the same “class, race, religion, sexual preference” (Bell, 1984, pg. 5). This phenomenon occurs on a global scale, stifling the growth and success of BIPOC populations across the world. It is for this reason that the absence of BIPOC folx in these movements is a powerful act of resistance that stands in opposition to BIPOC-life-threatening governmental policies on a day-to-day basis. On a cursory glance, birth control and abortion rights may not seem tied to infertility. However, involuntary infertility and abortion on an institutional level have proved to be a discriminatory implementation of birth control designed to limit populations of BIPOC people. To understand how birth control has been used as a limiting agent, one must first understand the prevalence of infertility. Infertility exists with significant global incidence—“some portion of every human population is affected by the inability to conceive during their reproductive lives” (Inhorn, 2002). It is a genderless occurrence by nature. So why do countries explicitly blame women for infertility when statistically men are predominantly infertile? This is a problem that starts not at the time of testing for pregnancy but when trying for pregnancy. In author Carole S. Vance’s chapter “Social Construction Theory,” Vance discusses the archaic notion of “women’s innate sexual passivity” (Grewal and Kaplan, 2006, pg. 31). Women are thought to be submissive and not have any libido until a man awakens a preconceived, insatiable hunger. Sex is painted as a desire that women yearn for, which can only be fulfilled by men. This association between sexual acts and identities perpetuates harmful stereotypes that can incur real-world consequences as seen by the onus falling on women time and time again for not being able to conceive.

In reality, there are several influencing factors, including reproductive tract infections, that can lead to tubal infertility, postpartum complications, post-abortive complications, dietary or environmental toxins, and more. To counter infertility, whether tubal infertility and/or male infertility, new reproductive technologies (NRTs) have been used. They are expensive and, therefore, accessible only by people who can afford them. NRTs elude people with lower socioeconomic status because in vitro fertilization (IVF) services like this are generally offered by a private sector accessible by “elites” (Inhorn, 2002). Options that are available to people who cannot afford IVF turn to formal healthcare alternatives. Those alternatives neglect the physical and mental wellbeing of the individuals they are used on. Tracey Loughran and Gayle Davis, who authored The Palgrave handbook of infertility in history: Approaches, contexts and perspectives, attribute the monopoly of reproductive technologies to the Global North and Global South. These two compete for treatment and “popular, legal, and medical approaches to infertility” (Loughran and Davis, 2017, pg. 397). There is a damning association between status and power in the form of race, gender, and socioeconomic privilege. The feminists of Global North, comprising of developed countries, advocate “for women’s rights to reproductive choice and control . . . [and] that discourse . . . was ill-adapted to the needs of women in other parts of the world” (Loughran and Davis, 2017, pg. 388). The common trend that a select few continue to speak for the collective masses remains true in this case. In the Global South, feminists who work towards accessibility of infertility treatments have been met with pushback from authorities and institutions. Even if there is a recognition of the need for ethical, or at least humane, alternatives to abusive sterilization and birth control, the institutions and authorities in developing countries have made it difficult to find a good support base. While the efforts of these outspoken feminists towards advancements in technologies have been promoted in advertisements as self-empowerment, other feminists condemn the science behind the scenes as unethical and exploitative of women’s bodies.

The histories of birth control, infertility treatments, and abortion movements are fraught with the exploitation and oppression of BIPOC women. In Women, Race and Class, feminist Angela Davis addresses the absence of BIPOC representation in the birth control movement and abortion rights campaign specifically. Davis attributes the apprehension of Black individuals to the underlying danger of the birth control movement—“involuntary sterilization” (Davis, 1982, pg. 354). There is an abhorrent history of abortion among slaves accompanied by limited resources and access to birth control. Starting at the time of slavery and continuing today, the social stratification of feminists is prominent, especially when discussing the rationale for limiting or expanding family size. For instance, lower-income families are expected to restrict their family capacity to accommodate the taxation and superiority complexes of middle-class and rich families. Eugenic, racist and capitalistic views have clouded the “progressive potential of the birth control campaign” (Davis, 1982, pg. 360). In the 20th century, the American Birth Control League dominated the conversation by calling on Black people to pursue birth control as though it were compulsory sterilization. Davis notes, “What was demanded as a ‘right’ for the privileged came to be interpreted as a ‘duty’ for the poor” (Davis, 1982, pg. 358). Years later, we are still seeing the same control enforced through the popular meme: “What’s classy if you’re rich but trashy if you’re poor?” Davis exposes this call as a disillusioned choice that culminates in the forced sterilization of “Native American, Chicana’ Puerto Rican and Black women . . . in disproportionate numbers” (Davis, 1982, pg. 360). One initiative, started under the leadership of President Theodore Roosevelt, forced sterilization of over 35% of all Puerto Rican women. This action was enacted as a means to address the economic problems of Puerto Rico by reducing the birth rate to be less than or equal to the death rate (Davis, 1982, pg. 363). In reality, this surgical sterilization was devastating. It was promoted as an incentive to limit unemployment rates. However, Davis states this is not the case: “The increasing incidence of sterilization has kept pace with the high rates of unemployment” (Davis, 1982, pg. 363). This act of misdirection to harm BIPOC populations is not a new issue.

Daniel J.R. Grey’s ‘She Gets the Taunts and Bears the Blame’: Infertility in Contemporary India presents a timeline of “the relatively abrupt transition from views of assisted reproductive technologies (ARTs) as morally and medically dubious to their widespread acceptance” (Grey, 2017, pg. 242). Grey discusses the myriad of issues characterizing the population control measures established in India. He highlights the (lack of) morality involved in forcing sterilizations upon women and girls who do not consent with the full understanding that these procedures will bar them from having biological offspring. Fallacies embedded in the Indian government’s five-year plans to achieve a reduction in birth rates resulted in direct and indirect fatalities of surrogates, parents, and children involved. Surrogacy as an alternative to infertility is plastered as a “‘mutual benefit’ to both infertile couples (whether foreign or domestic) and to impoverished Indian women” but is not a realistic expectation (Grey, 2017, pg. 246). These examples epitomize failures of the system to foresee and adapt to changes that may not be politically favorable for the government.

For these reasons, it is important to expose forced sterilizations and provide BIPOC folx with the support they need to safely access birth control and abortion procedures without a double entendre facade. One such organization is the National Latina Institute for Reproductive Health which distributes its reproductive health resources to Latine/xs. To make medical decisions, one must have information available to them in an accessible format. Reproductive justice must be for the people it serves just as disability justice advocates for a system that prioritizes disabled peoples and their needs. Piepzna-Samarasinha, a queer disabled femme writer, dreams of disability justice as it relates to the concept of care work. Care work is a practice in which BIPOC individuals also benefit from the work being done behind the scenes and can take care of themselves. Disability justice by itself was created as a counter to white disabled folx who did not recognize or elevate BIPOC activists. White people cannot and should not be at the forefront of conversations intended to prioritize BIPOC peoples. BIPOC and marginalized folx should be able to tell their story and access resources as dictated by what they deem necessary instead of having them dictated by an outsider. 

The Black Mamas Matter Alliance is one organization that approaches reproductive justice by seeking to change policy. They call for Black women-led initiatives and address legislation that leads to poor maternal health outcomes. Alternative modes of resistance can be adjusting literature in academic courses to include BIPOC-perspectives. If not for my Women’s Gender, and Sexuality major, I would not have learned about eugenics. It has not come up in any of the classes I have taken for my Biochemistry major. It is simply not a conversation unless one seeks it out. Universities like our own can be allies to the cause by giving a platform to BIPOC advocates, especially in biology courses that discuss reproduction.

References

Davis, A. (1982). Racism, birth control and reproductive rights. In Angela Davis, Women, Race and Class (pp. 202–271). Lond: The Women’s Press; New York; Random House, Inc. 

Davis, G., & Loughran, T. (2017). The Palgrave handbook of infertility in history: Approaches, contexts and perspectives. Palgrave Macmillan. 

Grewal, I., & Kaplan, C. (2006). An introduction to women’s studies: Gender in a Transnational World. McGraw-Hill Higher Education. 

Grey, D. (2017). ‘She gets the taunts and bears the blame’: Infertility in contemporary 

India. The Palgrave handbook of infertility in history, Approaches, contexts and perspectives. Palgrave Macmillan. Retrieved from 

https://link.springer.com/chapter/10.1057%2F978-1-137-52080-7_13

Hooks, B. (1984). Black women: Shaping feminist theory. In bell hooks, Feminist theory: From margin to center (pp. 1–17). Brooklyn, New York: South End Press.

Inhorn, M.C. (2003). Global infertility and the globalization of new reproductive technologies: Illustrations from Egypt. Social Science & Medicine, 56(9), pp. 1837–1851. https://doi.org/10.1016/S0277-9536(02)00208-3