Medicine is draped in the language of commerce and science that hide the social forces that sustain and shape health in society. Gender is particularly central both to the experience of health industries and in the sustenance and production of health. Our contribution today comes from Melissa Sepúlveda Alvarado, a Chilean medical student and anarchist organizer. Her argument shows not only how patriarchy shapes health, but also how medicine reproduces patriarchy itself.
By Melissa Sepúlveda Alvarado (@melissasepulvda)
Member of Solidaridad –Federación Comunista Libertaria and La Alzada –Acción Feminista Libertaria–.
Translation by Sara Rahnoma-Galindo
Lately, I have been pleasantly surprised, after many years of feminist pleading, by the existence of a particular intention within the popular movement to incorporate a feminist perspective in its analysis and praxis. It is now so common to use inclusive language in assemblies and meetings, to the point that the words are uncomfortable to those who aren’t used to them. Nonetheless, when the time comes to apply this intention to the plans for struggle by the diverse social movements developing in the Chilean and Wallmapu [Mapuche territories and universalities], the lack of tools for a day-to-day feminist analysis is evident.
The objective of this article is to contribute to the construction process of a feminist perspective in the healthcare sector, and to strengthen the building of programs that are evolving within the Movimiento Salud para Todas y Todos, MSPT (Health Movement for All). To achieve this, it is fundamental to identify the ways in which patriarchy operates and is reproduced within health clinics, be it those administered by the state or those provided by other social agents which women and children tend to utilize.
To my judgement, the first central point is to recognize patriarchy as a system of domination, different from and preceding capitalism, the latter nourishing from it to exploit women and girls throughout the world. The health model is directly related to the prevailing systems of domination, articulating the worldview and social relations that determine the economy, politics and culture of societies. The health system meanwhile, is the materialization of this model and is expressed as a series of formal knowledge, expertise and practices exerted from the state institution or outside it for health control of the population. This framework, particularly within capitalist societies, was conceived with the objective of guaranteeing a “healthy” mass of workers who could fulfill production duties, and in the case of women, to ensure the reproduction of this working class. Consistent with this, the biomedical system – focused on individual pathologies that ignore the social determinants of health, builds the existing healthcare system in Chile, which remains, despite academic attempts showing its inefficiency to achieve a healthier population, because it achieves its productive and reproductive objectives.
On the other hand, it is necessary to acknowledge that the hegemony of this healthcare model is directly related to colonization and western led genocide, strengthened via the fight against other and former ways to carry out medical practices: machis [traditional indigenous Mapuche healers], midwives, healers and doulas were excluded from technical medical knowledge, and all forms of knowledge not coming from institutional scientific backed standards were displaced. Therefore, the first big task is to acknowledge, within the analysis of the healthcare model we live under, that it corresponds to a patriarchal, capitalist and colonial model.
I propose to identify at least four levels in which patriarchy operates in the hegemonic healthcare model and system. These are related to one another and are expressed in the daily practices of healthcare.
i) Historically, the biomedical model had has an androcentric character, that is, one that identified men as the center of reality from which the system and worldview are derived. The subject addressed by the healthcare system is masculine and based on it, a universality is established, being unable to observe gender as a determinant of health conditions and ailments. For example, it is affirmed that being a woman is a risk-factor for developing mental pathologies, though the social conditions that increase the likelihood of psychoaffective pathologies are not taken into consideration. On the other hand, the healthcare system’s approach toward women has been mainly through their reproductive functions, relegating social roles of mother and wife, in a way that their health has been mainly linked, in western medicine, to their reproductive physiology, that is to say: gestation, contraception, family-planning and recently, menopause.
ii) Patriarchal link to the healthcare system. It is irrefutable that in our society exists a customer relationship with the healthcare system, inherent in the [capitalist] market model. What we highlight is that this link is possible due to the patriarchal relations that hide much more than the buying-and-selling of healthcare and that is incorporated early on in our first socialization space: the family. In the [nuclear] family structure, the one who condenses all power is the “pater,” including [the power of] life and death of children, wife/wives and slaves. The stability of this model that we know well is based on dependency. The condition of vulnerability posed by an ill body makes us look for protection, and while this link is reflected in men and women, the latter are particularly dependent on the healthcare system, as they are the most seen – be it [treated] as patients or as caregivers.
iii) Medical violence against women and others with non-masculine identities. We observe the daily infringement of basic rights in healthcare practices. The prejudices and lack of gender perspective by healthcare professionals, translates into violence, where the lack of knowledge about our bodies is transformed into fertile terrain for medical authoritarianism. The abuse towards women and transexuals with mental health disorders, special needs or obesity, as well as obstetric and gynaecological violence, are only a few examples that reveal the inability to recognize women and other identities within the healthcare system derived from the androcentric model of healthcare.
iv) Female subjectivity regarding the health-illness process. Directly relating the patriarchal link to the healthcare system, us women do not perceive ourselves nor are we socially identified as subjects with the capacity for self-determination, thus the incorporation of favorable changes in our health is continuously boycotted. For example, we can assume that there exists a process of feminization of obesity in western societies, particularly among poor women, related to low self-esteem and self-sufficiency when it comes to incorporating changes to their eating habits.
We need to build a new model and system of healthcare that can dignify our peoples, that can decentralize the production and reproduction of capital, and prioritize health over the administration of pathologies and that can actively contribute to the dismantling of patriarchal relations. This will be a long road of reflection, self-criticism, generating new knowledge and recuperating ancestral knowledge. Fortunately, we have taken the initial steps. The invitation to join this process is now on the table.