health

Reproductive Technologies and Social Inequality

Sarah Catherine Billups on November 3, 2016
Photo by Torsten Mangner, Flickr CC
Photo by Torsten Mangner, Flickr CC

Scientific and technological innovations have given humans a number of new methods to manage fertility and create families. One of the more recent advances in this area is the controversial birth of a child with genetic material from three parents, rather than two. Social scientists find that while these new technologies have helped countless individuals grow their families, their use and availability often reproduce class and gender inequalities. 

Families have always come in forms other than that of the Cleaver’s. Many parents have children from more than one partner. Other families have same-sex parents, single parents, or are childless, whether voluntarily or involuntarily. Invitrofertilization (IVF) and surrogacy are options for some women who have trouble conceiving, but the procedures are very expensive and not as easily available for people across socioeconomic lines. As a result, research finds that the framing of infertility as an individual issue rather than one related to structural constraints places stigma on childless women.
These conditions have created an exploding market for new reproductive technologies. The science of freezing eggs and sperm has resulted in egg and sperm banks where people can donate sex cells for compensation. Although both an egg and a sperm are required to create an embryo, the recruitment and marketing for these services is different for men than women. Women are more likely to be recruited to provide an “altruistic service” and donate their eggs to infertile women; the staff at egg banks have been found to capitalize on cultural norms of motherhood to construct egg donation as a gift exchange. As a result, there are far more women than men participating in this kind of service, even though it is much less physically invasive for men.

Katherine M. Johnson and Richard M. Simon. 2012. “Women’s Attitudes Toward Biomedical Technology for Infertility: The Case for Technological Salience.” Gender and Society 26(2): 261-289.

Lauren Jade Martin. 2010. “Anticipating Infertility: Egg Freezing, Genetic Preservation, and Risk.“ Gender and Society 24(4): 526-545.

Rene Almeling. 2007. “Selling Genes, Selling Gender: Egg Agencies, Sperm Banks, and the Medical Market in Genetic Material.” American Sociological Review 72(3) 319-340.

Indigenous Health

Allison Nobles on October 10, 2016
Sequim Bay Late afternoon at Sequim Bay, Washington (as seen from the Jamestown S'Klallam Indian Reservation). Photo by Jan Tik, Flickr CC
Late afternoon at Sequim Bay, Washington (as seen from the Jamestown S’Klallam Indian Reservation). Photo by Jan Tik, Flickr CC

Today some cities are celebrating Indigenous People’s Day in an attempt to counter the celebration of Columbus’ arrival in the Americas that led to years of disease, death, and the removal of native peoples from their homes. One thing to reflect on is how this turbulent past has had lasting health effects for Native Americans. According to the Indian Health Service (IHS), Native Americans and Alaskan Natives have a lower life expectancy than any other US racial group and they are more likely to die from heart disease, cirrhosis, and suicide.

Social science researchers point to a number of social and historical factors that help explain the high suicide rates for Native Americans, including racial discrimination, a long history of colonial exploitation, poor health outcomes, and poor communities. Many of these communities also lack access to quality reproductive healthcare, a disparity that researchers associate with high rates of c-sections among Native American women giving birth.
Poor health outcomes are also closely related to environmental injustice. The remote areas of land originally chosen for Native American reservations tended to be lands that were least attractive to White Americans, but perfect for military testing. The US military used adjoining lands and sometimes seized reservation lands to test military equipment, leaving toxic and dangerous materials in close proximity to Native American land. Native Americans living in areas with high levels of pollution attribute various health problems in their communities to pollutants, but are often unable to validate their concerns through institutional channels.

 

Morality and Maybe-Moms

Allison Nobles on May 9, 2016
"Drinking for Two" via Edmonton Fetal Alcohol Network
“Drinking for Two” via Edmonton Fetal Alcohol Network

Pregnant women are under attack—or so it seems. Actually, according to the Center for Disease Control (CDC), all women who might become pregnant ever are at risk. In February, the CDC released a report estimating that around 3 million women “are at risk of exposing their developing baby to alcohol because they are drinking, sexually active and not using birth control to prevent pregnancy.” Since then, many have bashed the CDC for advising women to live as though they are “pre-pregnant,” abstaining from drinking if they are not on birth control or if they are even considering getting pregnant. Coupled with growing threat of the Zika virus and its links to birth defects, such suggestions have propelled discussions of women’s roles in preventing catastrophic disability. Sociologists suggest that perceptions of women’s behavior are closely tied to ideas about the morality of motherhood. In particular, women who appear to resist common conceptions of what it means to be a “good” mother are subject to greater social control.

In American culture, motherhood is inextricably tied to morality. Moral arguments against abortion often rely on particular conceptions of sexual behavior, family life, and care for children. The ideology of “intensive mothering” demands that women be self-sacrificing and devote extensive time and energy to their children’s wants and needs — time and energy that many working women cannot afford.
This emphasis on mothers’ devotion to their children places them under considerable scrutiny, not only while raising children, but also during pregnancy. For instance, the “discovery” of Fetal Alcohol Syndrome heightened concerns over drinking during pregnancy. This made pregnant women the individual bearers of responsibility for the well-being of future children, and made them susceptible to moral outrage for behaviors like drinking. (Bucking the trend, the New York City Human Rights Commission has just recommended that visibly pregnant women cannot be discriminated against if, for instance, they order a glass of wine in a bar.)
Poor women, especially poor women of color, face a greater burden under dealized conceptions about what it means to be a “good” or “fit” mother. Not only are they regularly depicted as immoral or unfit, they are also criminalized and sanctioned at higher rates. Historical analyses show pregnant women are arrested for stillbirths, miscarriages, using drugs while pregnant, as well as incarcerated to prevent abortion. Poor women labeled “high risk” are prosecuted for failing to comply with medical advice when their fetus or baby dies, thus they are ironically discouraged from seeking care during pregnancy. Just as the “crack baby” became a symbol of the irresponsibility of poor, black women in the 1980s and ‘90s, Zika exposure and alcohol use are invoked today to place mothers and potential mothers under continued scrutiny.

Rural, White Women Getting Sicker, Dying Quicker

Sarah Catherine Billups on April 21, 2016
Graphic via Washington Post. Click for original and animation.
Graphic via Washington Post. Click for original and animation.

The Washington Post highlights the growing morbidity and mortality rates of rural white women. The rates of sickness and death for white women have climbed steadily over the past couple of decades, but the most dramatic increase is in rural areas. Sociologists and demographers have long investigated these trends. Poverty, stress, and timing of childbirth all matter for mortality, but the combination of these factors have stronger effects on rural, white women—surprising, because poverty confounds our typical understandings of race and inequality.

Mortality rates have decreased overall since the latter half of the 20th century, though several factors, many related to poverty and education, contribute to the increasing death rates of certain groups. Those with less education tend to have higher mortality rates and rates of heart disease and lung cancer.
Less education tends to correlate with lower socioeconomic status and difficulty finding employment. Sociologists Link and Phelan point to poverty as a “fundamental cause” of mortality and morbidity. Low socioeconomic status means difficulty is accessing resources: not only do poor people have trouble obtaining the means to maintain a healthy life, they also tend to lack the time, transportation, social networks, and money to help them recover from sickness.
Some of the health issues tied to poverty affect women more than men. Women with high stress levels are more likely than men to die from cancer-related illnesses. Other health patterns related to social class, such as the timing of childbirth, matter, too. Poorer women are more likely to have children before age 20, which correlates with increased risk of death, heart and lung disease, and cancer.

Bringing Harm Reduction to America’s Heroin Problem

Austin Jenkins and Allison Nobles on April 12, 2016
Urban Seed, an Australian organization, considers harm reduction programs part of their mission to help disadvantaged communities. Flickr CC.
Urban Seed, an Australian organization, considers harm reduction programs part of their mission to help disadvantaged communities. Flickr CC.

The mayor of Ithaca, New York recently proposed a facility for people to use heroin and other injected drugs safely. It’s part of a larger plan to focus on prevention and treatment of drug use, and the facility’s trained medical staff would provide clean needles, referrals to treatment programs, and naloxone, an opioid overdose antidote. Today’s opioid epidemic—which kills an estimated 78 Americans every day—has shocked many, given that other forms of illicit drug use have generally declined in prevalence and mortality during recent decades. Ithaca’s plan falls under the umbrella of “harm reduction” approaches, which attempt to mitigate personal and societal harm from drug and alcohol use. Social science shows us how and why these programs work.

Supervised injection facilities are relatively recent, originating in the Dutch and Swiss harm reduction movements of the 1970s and ‘80s. The first site in North America opened in Vancouver in 2003 and is linked to drastic declines in public injection and overdose deaths. Today a number of supervised drug consumption rooms operate throughout northern Europe, Canada, and Australia. Ithaca’s would be the first in the U.S.
Substance use was once a popular element of social events, like election day, but by the 20th century, “drug scares” stigmatized drug use, associating it with racial stereotypes, immigration, and crime. Smoking opium was first outlawed in the U.S. in the 1870s, for instance, as a result of anti-Chinese sentiments in California. Non-smoking opioid use remained popular among the white middle class—for supposed medical reasons, but by the turn of the century though, users who preferred injection became the stigmatized face of opiate addiction.
Stigma remains a critical issue in drug treatment, preventing users from accessing clean injection tools, uncontaminated opiates, information about safe injection practices, and life-saving overdose antidotes. Harm reduction efforts, like needle exchanges, have the potential to restore self-respect and autonomy to populations generally believed to lack these characteristics. Programs that provide work to formerly incarcerated individuals who have undergone drug treatment has been shown to reduce certain crimes, like robberies. Harm reduction communities also offer a space for drug users to empathize with and support each other, creating networks that bolster success.

Colorism and Divisions Among Black Women

Amber Joy Powell on April 3, 2016
Zoe Saldana, left, and Nine Simone, right. Image via ABC News Entertainment.
Zoe Saldana, left, and Nine Simone, right. Image via ABC News Entertainment.

Zoe Saldana’s portrayal of singer and activist Nina Simone in an upcoming biopic has proven controversial, even before the film’s premiere. In press photos, Saldana, a light-skinned woman of color, is clearly wearing dark makeup and a prosthetic nose to appear more like the late singer. Some argue using “blackface” in order to cast Saldana is particularly troubling considering Nina Simone’s own life-long dedication to encouraging the acceptance and embrace of dark skin tones. It also ignores the realities of colorism, which reproduces social inequalities and hierarchies among people of color.

Several studies address the benefits that accrue to light-skinned women. Employers, for example, often evaluate women applicants on physical attractiveness, regardless of job skills. This includes privileging physical features that suggest lighter-skinned women are friendlier and more intelligent. Lighter skin tones also make their female bearers more likely to marry spouses with higher incomes, report less perceived job discrimination, and earn a higher income. In schools, studies find that teachers expect their lighter-skinned students to display better behavior and higher intelligence than their darker peers, and public health research shows lower rates of mental and physical health problems among lighter-skinned blacks.
Colorism may provide socioeconomic, educational, and health benefits to light-skinned women, but it also challenges their identity as black women. Other blacks may perceive them as not “black enough,” assuming that they are more assimilated into white culture and lack awareness of black struggles. Those with lighter skin may feel isolated as members of their ethic group openly question their authenticity and belonging.

Safer Sex for Male Inmates

Sara Anderson on March 1, 2016
Robert Elyov, Flickr CC https://flic.kr/p/8RUdpc
Robert Elyov, Flickr CC

In July 2015, four California state prisons began supplying condoms to prisoners, and more will follow suit in the next next five years. California, however, is only the second state to address infectious diseases in prisons. Prison officials are skeptical of the new law, though its ability to slow the spread of HIV and other sexually transmitted diseases among inmates may prove significant.

Sexual contact amongst U.S. prisoners is a complex issue emanating from societal expectations of sexuality and masculinity. Many of those who are incarcerated are young, unmarried, working-class men who are effectively cut off from the outside world and heterosexual encounters. As a result, many who identify as straight engage in male-to-male sex behind bars. This “institutional homosexuality” separates sexual behavior from sexual orientation.

Preventing the spread of sexually transmitted diseases in prison populations is a complicated matter. In the past, condom distribution was refused for two main reasons: the denial that male-to-male sex occurred in prison, and the illegal status of such encounters. To slow the spread of sexually transmitted diseases in prison and when inmates are released, both facts must be acknowledged.

U.S. prisoners are guaranteed access to health care. Unfortunately, rather than receiving cost effective, preventive measures to combat STIs, inmates usually only receive treatment after contracting one—and that’s costly in terms of money and health.

Sara Anderson will graduate from University of the Pacific in May 2016 with a degree in social sciences. She will attend law school in the fall.

There’s Something in the Water

Sarah Catherine Billups and Caty Taborda on February 24, 2016
Photo by Keoni Cabral, Flickr CC.
Photo by www.liveoncelivewild.com, Flickr CC.

To cut costs, the city of Flint, Michigan moved its residents from the Detroit city water system to water sourced from the Flint River. It was a temporary fix until Flint could access Great Lakes water directly. Now, as the world knows, there’s something in the water: lead. In Flint, more than 40% of residents live below the poverty line, and the high lead levels (10 times higher than originally estimated) have caused skin lesions, hair loss, vision loss, memory loss, depression and anxiety, and Legionnaires’ disease. According to sociologists, it’s no fluke that a disenfranchised community pays the ultimate price for environmental damage.

Nature is a battleground where the privileges of wealth and whiteness prevail. Race and class inequalities perpetuate practices that harm the environment, and the poor, immigrants, and minorities are most likely to live in areas with environmental damage (some 60% of African Americans and Latino/a people live in in places with uncontrolled toxic waste sites). This is largely due to the ways that bureaucracies and the state exercise power over resources in a capitalist economy. Flint, MI is just one of many examples of wealthy governments and corporations exporting hazardous material to poor communities of color.  
Poor communities of color also receive lower government response and assistance in environmental emergencies. From Hurricane Katrina to the Flint water crisis, African Americans tend to lack the economic resources and transportation necessary to evacuate an environmental danger zone, exacerbating its impacts on minority communities.

Un-Making a Murderer Still Leaves a Mark

Ryan Larson on February 2, 2016
Innocence Project Stats
Click to visit the Innocence Project.

Netflix made a big splash in “true crime” with its series Making a Murderer, chronicling the investigations and trials of Wisconsin man Steven Avery. Exonerated after 18 years in prison for sexual assault in 2003, Avery was arrested for a new crime—murder—in 2007. Public debate about the documentary revolves around whether Avery’s innocent, potential misconduct in the justice system, and the ethics and consequences of documentary “vigilante justice,” but there is little doubt Avery was wrongfully convicted the first time around, in 1985. Social science helps us understand the more systematic consequences of incarceration and exoneration that cultural phenomena like Making a Murderer, the Serial podcast, and even the upcoming miniseries “The People v. O.J. Simpson: American Crime Story” bring to our attention.

Pop culture tends to focus on errors, like witness misidentification and shoddy forensics, but those are not the only things that lead to wrongful convictions. Sociological research shows blacks and Hispanics are at a higher risk, and these groups are, in fact, overrepresented in samples of exonerees. Black exonerees suffer longer periods of incarceration between their conviction and exoneration than other groups. And exonerations often raise questions about the criminal justice system’s authority and legitimacy in the eyes of the public.
Exonerees, even those who aren’t in a media spotlight, face practical problems after they are released from prison. The stigma of having served time diminishes chances in the employment and housing markets, even for those who are exonerated. Like others experiencing reentry after incarceration, exonerees also face unmet needs with regard to physical, dental, and mental healthcare, as well as the myriad challenges of rebuilding social networks and reintegrating to everyday life.

#MedicatedAndMighty: The Social Construction of Stigmatized Illness

Sarah Catherine Billups on November 26, 2015
Vicodin tablets photographed by frankieleon, Flickr CC.
Vicodin tablets photographed by frankieleon, Flickr CC.

In September, blogger Erin Jones posted a photo on Facebook that would spark a fight against the stigma of mental health and medication for it. Her hashtag #medicatedandmighty has inspired others who take prescription medication for depression, anxiety, and a host of other mental health needs to share their own photos and “come out.”

What makes it possible for the #MedicatedAndMighty to fight back against stigma in mental illness? Since doctors and researchers do not have complete monopoly over medical knowledge, the lay person (non-medical person) plays a role in constructing the meaning of mental illness. Patients’ lived experiences with an illness confirm or challenge expert knowledge, contributing to the continual shaping of the biomedical and cultural understandings of the condition.
Cultural meanings of illness shapes responses to them, making all mental illnesses socially constructed experiences . Claims-makers and interested parties, not just doctors and scientists, create medical knowledge—what makes an illness “real,” and what constitutes its symptoms, diagnosis, and treatment. Often, negative understandings of specific illnesses come from elite moral entrepreneurs whose elite socioeconomic status and moral legitimacy give them framing power.