gender: health/medicine

Kristina K. sent in a link to an interactive map at the New York Times that shows the results of Gallup’s 2010 polls of well-being. [UPDATE: Reader Danielle pointed out I forgot to provide a link to the map. Sorry! You can find it here.] Gallup surveys 1,000 people per day about a variety of indicators of well-being, including questions about physical, mental, and emotional health, various health-related behaviors, ability to access health care, access to adequate food and housing, and perceptions of their communities. Here are the overall composite scores, by congressional district (a higher score is better):

The general geographic pattern indicates a swath of relatively low well-being curving from Louisiana up through Michigan, while those in the upper Great Plains and the inter-mountain West are doing better than average.

Percent reporting experiencing a lot of stress:

Percent who have ever been told they have depression:

Of course, this may reflect differences in rates of depression, but it could also reflect differences in medical professionals’ likelihood of identifying a set of symptoms as depression and bringing it up with a patient. For example, we see significant differences by state in the frequency of Caesarean sections among pregnant women.

Percent of people who smoke:

Percent reporting an inability to buy sufficient food:

The Gallup page on well-being presents more data. Here is a map of 2009 overall well-being that is a bit easier to read since it’s presented by state rather than congressional district:

Hawaii had the highest overall score, at 70.2; West Virginia had the lowest, 60.5. If you go to their site and click on a state, you can get a breakdown of scores in each area (emotional well-being, physical health, healthy behaviors, and so on).

Finally, the NYT provides some demographic information on who was most likely to have said they spent a lot of the previous day laughing or smiling vs. being sad:

The Guttmacher Institute reports that the decades long fall in the rate of surgical abortions has plateaued:

Decreasing abortion rates is something that most Americans support.  Sharon Camp, president and CEO of Guttmacher, suggests that greater availability of cheap effective contraception might help jump start the decrease.  That seems like a politically safe recommendation.  What say you?

Via Michelle Chen at Ms.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

At Ms., Amy Williams posted about the pre-conception care movement.  Pre-conception care is health care aimed at making the bodies of fertile women most conducive to a healthy pregnancy.  The movement asserts that women of childbearing age should be receiving care with pregnancy in mind, whether or not the woman intends to get pregnant.  The Preconception Care webpage at Healthy Beginnings, for example, reads as follows:

In a presentation on the topic, Rebecca Kukla,  Professor of Philosophy and Obstetrics and Gynecology at the University of South Florida, explains that preconception care is an “official priority” for the Center for Disease Control and the US Office of Minority Health.   So what’s to be concerned about here?

First, the approach reduces women to their potential to make babies. Concern for women’s health is motivated not by concern for the woman herself, but her “merely imaginary future children.”   What is the value of old women, transgender women, involuntarily infertile women, and women who have been voluntarily sterilized?  What principles guide their health?

Second, treating women as potential fetus carriers sometimes interferes with the best practices for treating women. Kukla explains that doctors driven by this approach may be inclined to choose drugs that are known to improve fertility and enhance pregnancy outcomes, instead of the most effective drugs for whatever condition is at hand.  As an extreme example, consider a woman diagnosed with cancer for whom a hysterectomy is the most aggressive treatment?  Whose interests should the doctor consider?  Hers?  Those of her “merely imaginary future children”?

Third, treating women as potential fetus carriers encourages doctors and others to police women’s behaviors more stringently than men’s. Anything she does that doesn’t maximize her fertility and baby-making condition can be seen as a problem needing fixing.  Men’s life choices are simply not subjected to this sort of social scrutiny.  We already see this sort of intervention against women who are told to avoid alcohol even if they are unaware of being pregnant and have no intention of getting pregnant.

Fourth, Kukla points out that the approach skews women’s health towards those things that we think affect fetal outcomes. Should these conditions necessarily take priority over others?

Finally, this approach makes women, like myself, invisible. I am a fertile woman in my 30s who has chosen not to have children.  I truly hope that my health care is not being compromised by my doctor’s concern for the babies I am never going to have.  Nor do I think it’s cute that her concern for me is driven by my reproductive potential.

UPDATE: Heather Leila, in the comments, critiqued this post.  “Having participating in the Office of Minority Health´s preconception campaign,” she writes, “I can attest that none of the above 5 points speak to the reality of the program.”  She continues:

It´s easy for women commenting on this blog to be offended when it is suggested they are not in full control of their fertility. But the truth is that many women are not. They don´t have the access or the education about contaception. 50% OF ALL US PREGNANCIES ARE UNPLANNED.

OMH´s campaign addresses contraception and avoiding unwanted pregnancy. OMH recognizes that many women don´t want to become pregnant, now and later. The campaign seeks to reduce unwanted pregnancy alongside improving preconception health as a way to reduce infant mortality. The campaign also speaks directly to men – taking some of the pressure off women.

This post failed to mention that the OMH campaign is based on the very racial disparity in infant mortality that SI posted on just a few weeks ago.

Lastly, the campaign is geared towards women, not to their doctors. In no way would this campaign promote doctors valuing fertility over a woman´s life. Never would it suggest witholding a hysterectomy to protect fertility. The campaign is NOT about increasing fertility. It is about decreasing infant mortality. Two very different things.

It seems like neither Dr. Kukla nor Sociological Images has taken the time to fully understand this campaign before criticizing it. I think there is a lot to analyze and criticize within the campaign, but Dr. Kukla´s 5 points do not address true aspects of the program. They are invented.

Heather has posted about pre-conception care at her own blog, A Minha Vida.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

In the first five minutes of the clip below, economist Jeffrey Sachs explains to Dalton Conley that ending poverty in Africa requires a demographic transition, one where we move from high fertility and high mortality to low fertility and low mortality.

How to encourage such a transition?

1. Bring down mortality with advanced medicine. Declines in childhood mortality lead families to choose to have fewer children (’cause they don’t have to).

2. Make sure girls go and stay in school; they’ll get married later, and have less babies.

3. Provide free contraceptive services and family planning education.

Also see Dr. Sachs explain why Africa ended up so poor in the first place.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Harmony sent along a set of photographs of a fitness starter kit, a pink one for “ladies” and a green one for, um, “people.”  In any case, putting aside the women-are-women and men-are-people thing for a minute, she also noted that the pink one was breast cancer-themed.  So here is, explicitly, what so many breast cancer awareness-themed items imply: pink = women = breast cancer awareness = boobies = women = pink = pink = pink.  The items, by cultural definition, exclude men from caring about breast cancer.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Many Americans are familiar with “female genital mutilation.”  The term is typically applied to practices occurring in some parts of Africa, Asia, and the Middle East, but not to genital cutting practices that happen in the U.S. and other Western societies (including cosmetic surgeries on the genitals, surgeries on children with ambiguous genitalia, and transsexual surgery) and, by definition, not to genital cutting practices that happen to men in both Western and non-Western countries (male circumcision and other rare but more extreme practices).  “Female genital mutilation” elsewhere, then, is widely condemned by Americans, but rarely condemned in light of these other genital cutting practices, nor America’s own history of genital cutting.  In fact, it was not unusual to subject women in the U.S. to proper circumcision (removal of the clitoral prepuce, or foreskin) until the 1960s and these procedures remained legal until 1996 (though, as far as I’m concerned, their legality is still up in the air).

In any case, RabbitWrite gives us a glimpse into this era in American history. Reading from a Playgirl published in 1973, she recounts the confessions of a woman who chose to be circumcised and offers a short critique.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

In the article “In Pursuit of the Perfect Penis: The Medicalization of Male Sexuality” (available for free if you search for the title and Tiefer’s name), Leonore Tiefer discusses the way that the increasing attention paid by the medical community to conditions defined as “impotence,” and the way it has become medicalized, requiring any number of surgical, psychological, and/or pharmacological interventions. While some men have undoubtedly benefited, the largest beneficiary is the medical community itself. The broadened definition of what counts as “erectile dysfunction,” for instance, has created a larger market for drugs such as Viagra and Cialis.

Dmitriy T.M. sent in a trailer for the documentary Orgasm Inc., which documents efforts to medicalize “sexual dysfunction” among women. In the 3-minute trailer, we see cultural commentators and doctors discussing the shocking prevalence of sexual problems among women (43%! 83%! It’s an epidemic!) and some potential medical solutions. It’s a fantastic example of the medicalization of sexuality (and pretty safe for work). Enjoy!

Cross-posted at Ms. and Family Inequality.

In the early 1990s, Arline Geronimus proposed a simple yet profound explanation for why Black women on average were having children at younger ages than White women, which she called the “weathering hypothesis.”

It goes like this: Racial inequality takes a cumulative toll on Black women, increasing the chance they will have health problems at younger ages. So, early childbearing might pose health risks for White women, but for Black women it makes more sense to start earlier — before their health declines. Although it’s hard to measure the motivations of people having children, her suggestion was that early childbearing reflected a combination of cumulative cultural wisdom and individual adaptation (for example, reacting to the health problems experienced by their 40-something mothers).

She showed the pattern nicely with data from Michigan in 1989, in which the percentage of first births that were “very low birthweight,” increased with the age of Black women, but decreased for White women, through their twenties:

Source: My graph from Geronimus (1996).

If the hypothesis is correct, she reasoned, the pattern would be stronger among poor women, who experience more health problems, which is also what she found.

The most recent national data, for 2007, continue to show Black women have their first children, on average, younger than White women: age 22.7 versus 26.0. And the infant mortality rates, by mothers’ age, also show the lowest risk for White women at older ages than for Black women:

Source: My graph from CDC data.

Note that, for White women, mothers have children in the early thirties face less than half the infant-mortality risk of those having children as teenagers. For Black women, waiting till their lowest-risk age — the late 20s — yields only a 14% reduction in infant mortality risk. So it looks like waiting is much more important for White women, at least as far as health conditions are concerned.

The implications are profound. If you base your perceptions on the White pattern, it makes sense to discourage early childbearing for health reasons. But if you look at the Black pattern, it becomes more important to try to improve health problems at early ages — and all the things that contribute to them — rather than (or in addition to) trying to delay first births.

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Cohen’s previous posts featured on SocImages include ones on the recession and divorce data, the relationship between cell phone use and driving deaths, measuring the number of welfare recipients, delusions of gender dimorphism, and the gender binary in children’s books.