Women & the Health System
Spring, 2002
WOST 297D
Tu, Th 11:15-12:30
Prof. Janice Raymond

This is a survey course on women and health that will examine five areas: 1) Women and the Professionalization of Medicine: Critical Medieval and Modern Case Histories 2) The Politics of Women's Health: Focus on Cancer; 3) Violence Against Women; 4) Women, Health, and Development: Inter-national Women's Health Issues; 5)Menstruation and Menopause.

This is not only a course about women and health issues. It is an attempt to locate such issues in a larger context of feminist theory, basic health science, medical ethics, and the sociology of the professions. The emphasis of the course, however, is ethical and political; i.e., the course constantly asks why. What has produced, and continues to produce women's current health status in different parts of the world? What are the political, economic, and cultural values and structures that have an enormous impact on women's health? And how do these factors combine to structure medicine as an institution? What is the impact of gender, race, and culture on women's health and disease and on institutions and practices of medicine. Finally, from a feminist perspective(s), what ought to be?

Each of the course areas include readings, lectures and discussions that address, in various ways, how certain health issues affect different populations of women. The violence of racism contributes significantly to the health status of women of color. Class has a major impact on the health of women with low incomes. Because of racial stereotypes, health practitioners give different diagnoses and often differential treatment to women of color and financially-disadvantaged women, often even when they have the same symptoms as white, middle-class women. Race and class are barriers to obtaining needed care, to the kind of care women receive, and to women's survival.

While this course is not primarily concerned with the mechanics of "Our Bodies, Our Selves," a basic knowledge of health science is critical to the learning process. You will be encouraged to, and indeed you must, acquaint yourself with the basic science of, for example, menstruation. But this is done with a view toward exploring the ethics and politics of women's health care.

Ethically speaking, medicine is very normative. Norms are principles, phenomena, values, and definitions of reality that people regard as decisive or authoritative for their attitudes, actions, or relationships. In examining the history of women as healers, but also women as patients, we are also investigating the social and political institution of medicine, and the values on which its treatment of women, is based.

Life demands that we act. There is an urgency to life that demands an active response to oppression. But life also demands that we constantly step back to reflect on the quality of our actions. There is a need for women to confront, on an organized political, economic, and institutional level, the care that women receive from the medical system. Yet there is as great a need for women to understand not only the facts, but the deepest ideas and values that generate this treatment of women.


COURSE CALENDAR

I - Women and the Professionalization of Medicine: Critical Medieval and Modern Historical Case Studies

January 29 - General introduction to the syllabus and class requirements.

January 31 - Lecture and discussion on the History of Women and Healing and women's healing traditions in medieval Western Europe

February 5 - Discussion of readings on regular medical educa-tion in the United States and its exclusion of women and African-Americans.

Readings:
1) Mary Roth Walsh, "Male Backlash," from Doctors Wanted, No Women Need Apply).
2) Melissa Blount M.D., "Surpassing Obstacles: Pioneering Black Women Physicians," from The Black Women's Health Book.
3) Vanessa Northington Gamble M.D., "On Becoming a Physician: A Dream Not Deferred," from The Black Women's Health Book.

Supplementary Reading (Not Required But Encouraged)
l) Mary Roth Walsh, Doctors Wanted, No Women Need Apply
2) Rosemary Stevens, American Medicine & the Public Interest
3) Regina Markell Morantz-Sanchez, Sympathy & Science: Women Physicians in American Medicine

February 7- Lecture and discussion on the professionalization/politicization of medicine and the rise of the medical experts.

Readings:
1) C. Dreifus, "The Woman's Health Movement: Past Roots," from Seizing Our Bodies
2) Ehrenreich & English,"Witches, Healers, and Gentlemen Doctors," from For Her Own Good

Supplementary Reading 1) Ehrenreich & English, For Her Own Good (complete book)

February 12 - Lecture/Discussion on the American Midwife's History: immigration, race and feminism

Readings:
1) Dorothy C. Wertz, "Man-Midwifery and the Rise of Technology," from Birth Control and Controlling Birth
2) Linda Janet Holmes, "Thank You Jesus to Myself: the Life of a Traditional Black Midwife," from The Black Women's Health Book

February 14 - Lecture on the Sociology of the Professions and the process of professionalization

February 19 - In Class Essay Exam on Lectures, Readings and Discussions from Section I


II - The Politics of Women's Health: Focus on Cancer

February 21 - The State of Women's Health: statistics re women's health, gender and racial differences in morbidity and mortality, the politics of health research and care, and women's challenges to the health care system.

Readings:
1) Aida L. Giachello, "Cultural Diversity and Institutional Inequality," from Health Issues for Women of Color
2) Angela Davis, "Sick and Tired of Being Sick and Tired: the Politics of Black Women's Health" from The Black Women's Health Book

Supplementary Reading
1) Nancy Worcester, "The Politics of Women's Health," in Women's Health: Readings on Social, Economic, and Political Issues
2) Mary Halas, "Sexism in Women's Medical Care" in Women's Health: Readings on Social, Economic, and Political Issues

February 26 - Discussion of Reading

Readings:
1) Chap. 28 from Our Bodies, Ourselves; "The Politics of Women's Health" (Assumptions about women; poverty and racism; medicalization; the doctor-patient relationship; the women's health movement; the health care industry; the drug industry; technology; insurance; profits and health care; medicare and medicaid; for-profit and non-profit care; corporate power; health workers; hospitalization; information; patients rights)

February 28 - Lecture/Discussion - Health Issues for Women of Color (Also discussion of editorial assignment due, in first draft, on March 14)

Readings:
1) Lillian Tom-Orme, "Native American Women's Health Concerns: Toward Restoration of Harmony" from Health Issues for Women of Color
2) Ruth E. Zambrana and Britt K. Ellis, "Contemporary Research Issues in Hispanic/Latino Women's Health," from Health Issues for Women of Color
3) Grace M. Wang, "Health Issues for Asian/Pacific Island Women," from Health Issues for Women of Color

March 5 - October 2 - Lecture on Environmental Factors in Health and Medi-cine. Theories of Disease Causation. What difference a theory makes

Readings:
1) Rene Dubos, "Environment and Disease" from The Mirage of Health

Supplementary Readings:
1) Ivan Illich, Medical Nemesis

March 7- Lecture on the Politics of Cancer: facts and fig-ures; treatment controversies

March 12 - Discussion of Readings on Cancer: an Environmental Issue

Readings:
1) Rita Arditti with Tatiana Schreiber, "Breast Cancer: the Environmental Connection," from Resist, Newletter #246, May/June, 1992, pp. 1-8
2) Audre Lorde, "Living with Cancer," from The Black Women's Health Book

Supplementary Reading
1) Logan et al, "Environmental and Occupational Health," in Our Bodies Ourselves, pp. 131-57.
2) Carol Ann Rinzler, Estrogen and Breast Cancer: a Warning to Women
3) Susan M. Love, M.D., Dr. Susan Love's Breast Book
4) Midge Stocker, ed., Cancer as a Women's Issue
5) Audre Lorde, The Cancer Journals

March 14 - In-Class Discussion of Editorials. Group reading and critique. Choose one editorial from the group to be read aloud to the class. Over the Spring break, take your editorials and put into a final draft to be passed in after the Spring break.

Assignment - Choose a newspaper, magazine or newsletter in which you would like to publish an editorial. Make this media organ clear at the beginning of your editorial. Select one issue related to any aspect of Section II of the readings, lectures and/or discussion and write a 500 word editorial.


III - Violence Against Women - the Number One Health Issue Facing Women Today

March 26 - Lecture on Violence Against Women: More than Just a Health Issue. The Scope of the Problem

Pass in Editorials to Instructor

March 28 - Discussion of Readings on Battering and Domestic Violence

Readings:
1) Evelyn C. White, "Black Women and Domestic Violence" from The Black Women's Health Book
2) Nancy Worcester, "The Unique Role Health Workers Can Play in Recognizing and Responding to Battered Women" in National Women's Health Network News, March/April 1992
3) "Domestic Violence in the Immigrant Community," National Women's Health Network News
4) Nancy Worcester, "A More Hidden Crime: Adolescent Battered Women"
5) Evan Stark and Anne Flitcraft M.D., "Medical Therapy as Re-pression: the Case of the Battered Woman" (Packet)

Supplementary Reading
1) Lori Heise with Jacqueline Pitanguy and Adrienne Germain, Violence Against Women: the Hidden Health Burden, World Bank Discussion Paper 255
2) Evan Stark and Anne Flitcraft, M.D., Women at Risk: Domestic Violence and Women's Health

April 2 - Film on Violence Against Women; Discussion

April 4 - Battering, Rape and Other Forms of Violence Against Women - Discussion of Readings

Readings:
*1) Another article to be assigned
2) Beth E. Richie and Valli Kanuha, "Battered Women of Color in Public Health Care Systems: Racism, Sexism and Violence" from Wings of Gauze
3) Patricia Eng, "Domestic Violence in Asian/Pacific Island Communities," from Health Issues for Women of Color

April 9 - In-class assignment


IV - Women, Health, and Development: International Women's Health Issues

April 11 - Key Health Issues for Women in Developing Countries: Impact of Development and Urbanization on Women's Health
1) "The Global Politics of Women's Health," from Our Bodies, Ourselves

Supplementary Reading:
1)Women and Health, Patricia Smyke, Women and World Development Series

April 16 - Lecture/Discussion of Reading

Readings:
1) Section on "Health" from The World's Women: Trends and Statistics 1995 (United Nations)

Supplementary Reading:
1) Koblinsky, Timyan and Gay, The Health of Women: a Global Perspective

April 18 - Film/Lecture/Discussion of Refugee Women and Health

Readings:
1) Readings on "Refugee Women," from the journal Refugees (UN High Commissioner for Refugees)

April 23 - Health Effects of Sex Trafficking and Prostitution

Readings:
1) Melissa Farley, "Prostitution: the Business of Sexual Exploitation," from Encyclopedia of Women and Gender, 2001
2) Janice G. Raymond and H. Patricia Hynes, "Sex Trafficking and Prostitution: Human Rights and Health Consequences," from Women's Rights and Bioethics, UNESCO, 2001

Supplementary Reading
1) Kathleen Barry, The Prostitution of Sexuality


V - Menstruation and Menopause

April 25 - Lecture and discussion on attitudes toward menstru-ation; remedies for menstrual cramps

April 30 - Lecture/Discussion of Reading

Readings:

1) "Understanding Our Bodies: Sexual Anatomy, Reproduction, and the Menstrual Cycle" from Our Bodies, Ourselves

May 2 - Lecture/Discussion of readings on menstruation and toxic-shock syndrome

*Readings to be Assigned

May 7 - Lecture and discussion on menopause as a "deficiency disease"

May 9 - Discussion of Readings on Menopause and Hormone Replacement Therapy

Readings:
1) Healthsharing Women, Research Forum Series II, "A Critical Look at Hormone Replacement Therapy," Papers and Proceedings, April 1992
2) "Hormones and Breast Cancer," U.S. News and World Report, July 24, 1995

Supplementary Reading
1) Sandra Coney, The Menopause Industry
2) Susan Love, M.D., The Hormone Book

May 14 - Last Class - Evaluation Day; you will be asked to do an in-class self-evaluation; noone will complete the course without doing this evaluation; it is required! Discussion of Final essay exam to be passed out and covering Sections IV and V of the class material

Exams due May 17 at 4:00 under my office door or in my mail box.

Class Requirements

  1. In-Class Essay Exams, Editorials, Assignments (each exam counts for 20%)
  2. Class attendance and participation. More than 3 absences lowers the class attendance and participating part of your grade to an F. Late arrivals will count for of an absence (20%)
  3. Take-home final exam Women, Health, and Development: International Women's Health Issues (20%)

*All of the assigned readings for the class have been dupli-cated and compiled in a course packet at Copycat Print Shop on N. Pleasant St. in Amherst.