As we all know, recent recommendations about mammograms and Pap smears have caused some confusion among both women and doctors. I can understand at a time when we’re discussing cutting costs in healthcare and setting up death panels to kill old people, guidelines to reduce screenings can cause suspicion. Nonetheless, I was surprised that the discussions on my favorite blog (yes, even more than my own!) Feministing generally perpetuated that suspicion/outrage. I expected that feminists would be more skeptical of American healthcare and skeptical of the original mammograms guidelines to be so struck by the changes.

You can read more about the science behind the new guidelines here, and I’m sure in many other blogs. The whole point of revising the once-a-year mammogram rule is that it leads to a lot of over-treatment. Of course, screening too little would be under-treatment. Evidence based guidelines are always trying to find the happy medium, and yearly mammograms are not that happy medium. One author I read complained that the new guideline was not based on new studies, but faults of older studies that lead to the yearly mammogram rule. But if the yearly mammogram rule was based on flawed studies, isn’t that enough reason to question the guideline, especially when it leads to over treatment? A poster on Feministing had asked “how could reduced screening ever be a good thing?” Well, you have to consider the invasiveness and cost of the screening. X-ray imaging, which has more risks, and MRIs which are expensive, are done less often. On the other hand, self breast exams can and should be done more often. I wish the authors of the guideline had done a better job of explaining the reasoning. Instead of highlighting that yearly mammograms lead to unnecessary anxiety, which understandably made women mad, they should’ve made it more clear that previous guidelines were not based on the best evidence, and the risks of over treatment are greater than the benefits of frequent invasive screening. They should’ve also emphasized the importance of breast exams, by self and doctor. It would be useful to know other countries’ policies on this too.

I expected feminists to think about the above reasoning intuitively, given the context of women and healthcare. So I was surprised to see the notion that a right was being taken away, rather than questioning whether yearly mammograms were the best thing to do in the first place. Are we so naive to believe that existing healthcare practices on women’s issues are always in the best interests of women? Haven’t we discussed before that sometimes profit motives of pharmaceutical and biotech companies can interfere with evidence based medicine, and over-pathologize certain issues like PMS and reduced interest in sex, to create a market for drugs? And who can forget “designer vaginas?” Feminist theorists have pointed out that because we have historically considered the male body as the norm, many female bodily processes have seemed inherently pathological. While access to birth control is definitely a positive thing for women, some feminists have also noted the sexism in the drive to regulating women’s fertility with drugs and devices, as opposed to researching birth control on men. For social reasons, women’s bodies are more tampered with on the aspects where women are different from men. In America especially, where healthcare practices are heavily influenced by profit and inequality of access, we tend to have widespread use of technological and pharmacological interventions on women’s bodies, from interventions during labor, C-sections, hysterectomies, pills for PMS, PMDD, etc, etc. It’s not that such high use of gadgetry is unsafe, but it’s not based on scientific recommendations or medical indications either. In countries with more socialized healthcare, cost-effectiveness is always an issue, so the necessity of pills and surgeries are under more scrutiny. I’m not saying that previous mammogram guidelines were based on biotech companies wanting to make more money. I’m saying that given the context of American healthcare, guidelines for less use of gadgets is likely to be a good thing, as the norm for us is usually overuse and waste. Has our widespread use of invasive medical procedures led to much better outcomes for American women? Not really.

I realize that the mammogram issue is different for two reasons, 1) it’s not really in the realm of reproductive health where inequality is clearer, and 2) it’s because of feminist activism that breast cancer awareness and prevention has become such important issues in the first place. Once upon a time, breast cancer research was actually being done on men (!), who comprise a small minority of breast cancer patients. It has been a huge success of feminist activists to shed light on a disease that affected and killed women (for the most part). Breast cancer awareness, screening, and treatment have saved many women’s lives.

But as feminist activism changes society, feminists have to deal with new issues of a new society. Nowadays, breast cancer awareness is so commercialized that merchandise is ubiquitous. Community posts on Feministing have pointed out the sexism in using breast cancer campaign slogans like “Save the Tatas.” It seems now that feminists have legitimized the threat of breast cancer, the interest in the issue is becoming a little sensational. After all, it is about boobies, not non-sexual things like cardiovascular diseases (which kills more women than breast cancer) or colon cancer. So I think we feminists need to take a step back from the notion that fewer mammograms mean that the scientists don’t care about women dying from breast cancer. It just means that as far as we know, fewer mammograms will reduce over-treatment yet not reduce survival rates. This is also an opportunity to think about how breast cancer isn’t women’s only health issue. Let’s start focusing some effort on cardiovascular health, which is also an area where we need more women-specific research.

One the things feminists have to deal with a lot is the issue of “choice.” We are told all the time, everywhere, that somehow we restrict women who “choose” to be housewives, sex workers, or women who “choose” plastic surgery to enhance their looks or women who “choose” not to breastfeed their infants. Many times we know when someone is making a “choice” that is not really a “choice,” but we don’t have the words to explain logically why we’re right.

While working on my senior thesis on American women’s choices about childbirth, I came accross this little gem by Barbara Katz Rothman that put into words what I had known all along:  “There will never be ‘free’ choice, unstructured reproductive choice. But the structure in which choices are made should, and I believe ultimately can, be made fair, ethical and moral.” It’s so true! Every choice that we make in life is constructed, whether it’s constructed by our skills and interests, resources, social expectations, or a desire to defy social expectations, or usually a combination of all these factors. And all these factors provide the structure in which our choices are made. Hence, it’s really important to examine these structures in which the choices are made to decide whether it is a “free” choice or not. “Free” is a misnomer because really what we’re implying is “happy” or “satisfactory.” But anyways, if a structure is oppressive, then a happy choice really can’t be made in it. That’s why some privileged women might experiment with sex work and find it empowering, but it’s not really empowering for poor, abused women who were unaware of other options in life, or never had any. That’s not to say that all these women need rescuing or can’t be empowered by the money they make from sex work, and it’s also not to say that the misogyny in the sex industry doesn’t exist in others, but what I’m saying is choice is really context dependent.

This is also apparent in the area of pregnancy, childbirth, and breastfeeding. Are women really “choosing” a C-section because it’s healthy and cool? Or are they choosing it because they’re not fully informed about the risks to both themselves and their babies from a C-section, and that labor pains need not be excruciating, and vaginal tears are unlikely if their births are attended by a good midwife and supportive system? Are they aware of the better systems other countries use? With the issue of breastfeeding, did the women just wake up one day and decide they didn’t want to breastfeed? Or did they find it annoying because our employment structure doesn’t allow enough flexibility, and our doctors aren’t encouraging enough of an option that is clearly superior to the best formula out there? Worse yet, are the women “choosing” not to breastfeed because they hold on to the notion that it’s poor and uncultured to breastfeed, or that breastfeeding will make their breasts sag which will make their “boys will be boys” husbands unattracted to them?

The “choice” to be a housewife is only a “free choice” for those women who are privileged enough to not worry about earning money or housework (done by a maid). Even then, I guess their choices are constructed by the misfortune of not having and interest or skill they could explore rather than just spend money. Being a housewife is not a “free choice” for a woman who decides that childcare is actually more expensive than what her job can afford. Getting plastic surgery is not a “free choice” when a woman is getting it to conform to society’s standard of beauty. How many white women in America choose to be paler? How many choose to be a size 10 if they can be a size 6? I’m fine with women conforming to certain expectations of society, because I do to, but don’t tell me you’ve made a “free choice” to get Botox in a culture that doesn’t like wrinkles!! Recently I heard friends discussing about how a certain woman’s choice to get breast implants was “awesome” because “she did it for herself.” Some people think that a woman is doing something for herself as long as a man is not directly involved, but I don’t think that’s correct. Where did that woman get the idea that getting breast implants was cool? Where did she get the desire to get the implants in the first place? And why didn’t she have the desire to get flat breasts, or artificial wrinkles, or extra fat injected in her tummy? It’s because the society she lives in considers fake breasts to be beautiful, and even though she didn’t get implants to please any particular man, she got implants because she felt better about herself as she fit society’s beauty standards.

In Bangladesh, many women don’t shave their legs because most women don’t show them. In America, many women shave their legs because they have to appear smooth when appearing in public. That choice is cultural. Most women may not mind it, but it is still not a “free” choice. I myself shave my legs and tweeze my eyebrows, but I wouldn’t have done it id hairy legs and bushy eyebrows were in vogue. Would women have gotten breast implants if the beauty standard was to have flat breasts? I don’t think so. The only kinds of choice that might be considered “free” are the ones a person makes for themselves despite unpopularity and resistance from society.

And finally, this concept of choice is important to be a global feminist. Some ignorant Americans tend to question whether third world women have “choice.” The implication is that third world societies are less equal than Western societies. While that might be true, it’s true because third world countries have been exploited and depleted by the West so now we have to deal with another set of problems. Both men and women have fewer choices in the third world, it’s not just that third world men are more sexist. It annoys me to no end when some American women think their choices to put of make up everyday, wear uncomfortable shoes, or get plastic surgery somehow make them “freer” than third world women. Yeah right, they’re freer now to put more toxins in their body like Botox and now Latisse (for “inadequate” eyelashes). Some ignorant women take it a step further and assume that because America is a land of opportunity, it’s a woman’s choice to do porn. Somehow getting a few bucks for having your head forced down a toilet is a “free” choice.

Hardly any choices we make in our lives is a “free” choice by itself. But it can be a happy choice when made in a free structure that doesn’t have preset standards for what is beautiful or what is acceptable. I realize that is utopia, but until we get such flexible standards, please don’t tell me that you made a “free” choice to use Latisse.

Thunder is Not yet Rain is an African proverb. Not yet Rain is a documentary about unsafe abortions, focusing on the situation in Ethiopia and how a more progressive law in 2006 has improved the condition somewhat.

a post in another feminist blog on women and engineering prompted me to write this reply, and i wanted to add it to my blog as well. i’ve written about sexism in math and science before, but i want to write again, articulating some points differently. this is a passionate issue to me because i know what a difference cultural factors like positive reinforcement, and available opportunities make for women’s careers. some people, including women, have told me there’s nothing wrong with saying perhaps there’s something “innate” about women’s brains that makes them less apt for science. i don’t see scientific basis for that at all.

1) women are underrepresented in almost all good jobs in the public sphere because of historical oppression. women weren’t considered good writers or painters and they’re even underrepresented in professional cooking! i remember someone posted a letter from Disney to his grandmother on Feministing that told her that Disney doesn’t accept female cartoonists – they’re only for secretarial jobs. the lack of women in science has to do with women being confined to the private sphere in all areas of life (except for sex work and cleaning). interestingly, sexists who think women being underrepresented in the sciences is/could be a result of innate differences don’t think that women are over-represented in prostitution because women are innately sex-crazy. they think men are sex-crazy. there was a time when women were considered deficient in typing – oh wait, why then are women secretaries?

2) some studies argue that women are less “spatially” oriented and therefore deficient in math. firstly, even studies done on children have to take into account how culture shapes the brain, let alone studies on adults, whose mental abilities are shaped by they way they have used their brains throughout life. secondly, so what it women are less “spatial?” only some areas of science require spatial understanding and it’s something you can learn. i’ve always gotten A’s in geometry and physics and i can’t play spatial sports to save my life!

3) standards for achievement have been set by men. the scientific process has been defined by men. have you ever heard people complaining about doing poorly in standardized tests even though they do well in class? have you heard of people complaining that they get confused by the way standardized tests frames questions? i have. and it’s because such tests follow a certain system, and to do well you have to understand and work the system, regardless of your level of intelligence/knowledge. similarly,  even if women’s brains were innately different from men’s, women are only challenged in a scientific culture defined by men. which means there’s an even bigger need for women to change the systems for themselves. the fault is not in women’s brains, the fault is in the system.

with all these cultural factors at every step of the analysis, is it anything but sexist to keep on saying perhaps there’s something innately deficient about women’s brains? – vidyarthi

I’m on a science-y roll with all the exams I’m taking. My previous post on female reproduction reminded me of another persistent problem I have with sexism in math and science – specifically the hypothesis that women might have something “innate” about them that makes them less apt in math and science careers.

I grew in a middle class but highly educated household in Bangladesh. I seemed to be a smart kid (!) and everyone encouraged me to aspire to intellectual career options. I had never heard that girls may have anything “innate” about them that makes them less mathematical. In all my grades, the top scorers across all subjects were girls, and often the same ones. Doing well in the math and sciences is something I associated with studying hard in general, not an “innate” interest. Now of course some people might have more trouble than others in certain disciplines, but not so much that a creative teacher couldn’t explain concepts to them. And of course there are people in Bangladesh who believe girls’ brains are not made for the sciences or that girls are dumb in general. But among educated people the understanding was more that both girls and boys who seem smart should be encouraged towards math and sciences since that’s where the money is. And even though patriarchal families prefer women not be careerists, they recognize that it’s a cultural requirement, not lack of intelligence.

It’s only in America, in college as I picked up on some evolutionary psychology that I heard some scientists really thought women were worse at math than men, and many women internalized it. To me the comment is not so much a scientific hypothesis as it is a patriarchal hypothesis. Let’s see where this hypothesis stems from – women are underrepresented in the sciences, and hence, along with some social factors, there could be a biological difference between men and women. Well which fields are women not underrepresented in? Nurses, secretaries and sex work. I’m not sure women are the majority among celebrity chefs and restaurant chefs, even though cooking is a traditional job for women. And if indeed women are more “verbal,” “emotional” or “literary,” then why is the literature we study, at least in English, dominated by men? So think about it, when you’re saying women are worse than men in the sciences, you’re really saying women are worse than men in everything. Or as a feminist sees it, women were kept out of the public sphere for a long time and have only made gains in some areas that society thinks is more womanly, like nursing, secretarial work, modeling, some interior decoration, etc. Some other areas have been harder to break into because not all women are willing to deal with the added misogyny of a male dominated workplace.

Another point to note – representation in math and science careers does not require an interest in math and science. Interest makes it much fun, of course, but the interest of money can also make good engineers or doctors. I don’t think the majority of men in math and science based professions are geniuses. I think they’re mediocre, and yet have made a decision to pursue a job that they understand well enough to make money. Yet, when women are mediocre in the math and sciences, they’re made to feel that it’s because they’re women, and not because they’re like the mediocre men. If a man isn’t a great computer programmer, it’s because he’s not the best in his field, if a woman is a mediocre programmer, it’s because of her womanly brain. And it is attitudes like this that keep women out of male dominated fields, unless they’re in the minority of men and women who have a burning desire for one career.

Even if a person doesn’t have an “innate” interest in something, practice makes perfect. How did I get into medicine? Around  6th grade when I realized my face and fat disqualified me from being a Bollywood actress, I decided to focus more on academics. That and my parents being South Asian acted like the world would freeze if I made a 95 on a math exam (as opposed to 100). Now I’m not condoning strict parenting, I’m just saying that our brains and bodies are shaped by the way we use them. The more we use our brains, the better our memories are. The more we use a certain part of the brain, the more active it gets. So in cultures where girls are not actively encouraged to break stereotypes, it’s plausible that their brains are being shaped by stereotypes. And as adults, when brains or bodies are not as plastic, it’s harder and harder to change. Judith Butler has written quite a lot about this plasticity and culture. She’s pointed out how social discussions seem to come to a halt when “biology” is mentioned because there’s a sense in Western science that biology is destiny. But biology itself is constructed, as is every level of an experiment of biology, from how we define the variables, to how we ask the question, to how we interpret the answers.

So am I saying that there’s absolutely no possibility of a link between genetic and phenotypical femaleness and less interest in math? No, but I don’t even see any basis of making such a connection. And in a patriarchal society where girls already have an uphill battle in being involved in the public sphere, it’s detrimental to perpetuate stereotypes by calling them “innate.” It’s probably worse to say “a woman can’t do this” than saying “a woman shouldn’t do this.” That’s Sexism OS XII. – vidyarthi

Sobia on Muslimah Media Watch covered the topic very well. Here’s her article.

Sigh. I thought Barbie set up white blonde plastic surguried beauty ideals, well now Desi girls have something more to be insecure about. The whole problem over the doll creators confusing Desis, Muslims, Arabs and God knows what not has been covered by Sobia. I just wanted to add my frustrations about perpetuating a light-skinned beauty ideal among ethnicities where the majority are dark skinned. Perhaps Unilever, maker of Fair and Lovely fairness cream gets a share of the sales from these dolls. – vidyarthi