health

Politicians, pundits, and critics in Germany, England, and the Netherlands have recently advocated for harsher restrictions on migrants’ access to social assistance in their countries. This has led scholars to evaluate whether increased immigration is eroding historically strong support for welfare in Europe.

Earlier in the decade, the answer seemed clear. Drawing on basic public opinion data from various European countries, scholars found that rising immigration levels preceded a spike in favorability for restrictive welfare laws. More recent and sophisticated analyses, however, suggest that a rise in restrictive welfare attitudes is not directly connected to increasing immigration. Rather, this relationship appears to be better explained by a combination of factors such as national economic conditions, political ideology, individuals’ self-interest, and prejudice towards racial and ethnic minorities.

• David Brady and Ryan Finnigan. 2014. “Does Immigration Undermine Public Support for Social Policy?” American Sociological Review 79(1): 17-42.
• Jan Mewes and Steffen Mau. 2013. “Globalization, Socio-Economic Status and Welfare Chauvinism: European Perspectives on Attitudes toward the Exclusion of Immigrants.” International Journal of Comparative Sociology 54(3): 228-45.
• Maureen A. Eger and Nate Breznau. 2017. “Immigration and the Welfare State: A Cross-Regional Analysis of European Welfare Attitudes.” International Journal of Comparative Sociology 58(5): 440-63.
• Alexander W. Schmidt-Catran and Dennis C. Spies. 2016. “Immigration and Welfare Support in Germany.” American Sociological Review 81(2): 242-261.
• Daniel Degen, Theresa Kuhn, and Wouter van der Brug. 2018. “Granting Immigrants Access to Social Benefits? How Self-Interest Influences Support for Welfare State Restrictiveness.” Journal of European Social Policy 1(1): 1-18.

This work shows that social attitudes about welfare are complex and linked to a variety of factors. Though critics of immigration in Europe have been vocal, it is unclear exactly whether and how attitudes about immigration and migrants relate to beliefs about welfare.

The newest Apple Watch can now warn users when it detects an abnormal heartbeat. While Apple may be on the cutting edge, many people have been using apps to track their food intake and exercise for some time. Social science research demonstrates that health-tracking technology reflects larger social forces and institutions.

These health-tracking apps are part of a larger trend in American medicine that researchers call “biomedicalization,” which includes a greater focus on health (as opposed to illness), risk management, surveillance, and includes a variety of technological advances.

• Adele E. Clarke, Janet K. Shim, Laura Mamo, Jennifer Ruth Fosket, and Jennfier R. Fishman. 2003. “Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine.” American Sociological Review 68: 161–94.
• David Armstrong. 1995. “The Rise of Surveillance Medicine.” Sociology of Health and Illness 17: 393–404.

Benefits of using these apps include empowering patients and not having to rely on doctors for knowledge about one’s body, which — as many of the apps advertise — may save time and money by potentially allowing them to avoid doctor visits. However, self-tracking may put more onus on the individual to maintain their health on their own, leading to blame for those who do not take advantage of this technology. Further, using this technology could lead to strain in doctor-patient relationships if doctors believe patients are undermining their authority.

• Deborah Lupton. 2016. The Quantified Self: A Sociology of Self-Tracking. Cambridge, UK: Polity Press.
• Deborah Lupton and Annemarie Jutel. 2015. “‘It’s Like Having a Physician in Your Pocket!’ A Critical Analysis of Self-Diagnosis Smartphone Apps.” Social Science & Medicine 133: 128–35.

As more and more Americans use smartphones, the promise of digital technology, including health-tracking apps, for reducing existing health disparities grows. However, the Pew Research Center shows large income and educational gaps still exist in smartphone use, meaning the health benefits of using such technology — as well as potential downfalls — for the greater population, may be a long way off.

This past August, the Incarcerated Workers Organizing Committee, a labor union for prisoners, began a nationwide strike to protest against inhumane conditions, the use of solitary confinement, and precarious work in U.S prisons. Fighting prison conditions and labor precarity has been a long-standing struggle for prisoners in the United States and around the world, and social science research explains the dynamics underlying this struggle.

As ‘total institutions” prisons provide poor substitutes of basic needs, or limited access to basic items, services, and comforts like hygiene items, clean clothing, nutritious food, education, and health care services.  Consequently, prisons end up depriving inmates of their wellbeing, autonomy, sense of self-worth, and control over their fates. In the United States, the indignities of prison conditions range from major maltreatments, such as the abuse of long-term solitary confinement, to minor cruelties, such as restricting the use of showers and toilet paper (imagine being limited to just one roll per month), in overcrowded facilities.

• Erving Goffman. 1961.  Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Garden City, New York: Anchor Books.
• Keramet Reiter. 2016.  23/7: Pelican Bay Prison and the Rise of Long-Term Solitary Confinement. New Haven: Yale University Press.
• Heather Ann Thompson. 2017. Blood in the Water: The Attica Prison Uprising of 1971 and its Legacy. New York: Pantheon.

The specific conditions of prison labor reflect long-standing contradictions. On the one hand, social science evidence suggests that providing jobs to inmates has a positive effect and can reduce their involvement in future crime activities. On the other hand, prison labor has also led to abuse and exploitation. Correctional facilities use prison labor to serve private industries, to perform cleaning and maintenance functions within facilities, or even to repair public water tanks and fight wildfires. Prison labor has also served as an instrument of economic policy in the labor market. In the 1990s, for example, rates of unemployment declined when a massive number of able-bodied working age men went to U.S. prisons.

• Christopher Uggen. 2000. “Work as a Turning Point in the Life Course of Criminals: A Duration Model of Age, Employment, and Recidivism.” American Sociological Review 65(4): 529-546.
• Phillip Goodman. 2012. “‘Another Second Chance’: Rethinking Rehabilitation through the Lens of California’s Prison Fire Camps.” Social Problems 59(4): 437-458.
• Bruce Western and Katherine Beckett. 1999. “How Unregulated is the US Labor Market? The Penal System as a Labor Market Institution.” American Journal of Sociology 104(4): 1030-60.
• Joshua Page and Joe Soss. In Progress. Preying on the Poor: Tough on Crime as Revenue Racket. Chicago: University of Chicago Press.

Imprisonment often has devastating consequences for inmates, their families, communities, and society at large. Even though certain policies like prison labor may involve potential benefits, their positive effects only occur when there is a genuine effort to achieve inmates’ social inclusion. Inmates’ struggles to achieve effective changes in their living conditions therefore require sustained and special attention from the public and policy makers.

Originally Posted October 19, 2016.

The rain and wind of Hurricane Matthew may have stopped, but much of North Carolina is still under water. The hard work of repairing and rebuilding has begun across the southeastern U.S. and the Caribbean, particularly in Haiti where they are still reeling from the 2010 earthquake. Hurricanes – so called natural disasters –  are not simply the result of the weather but become “disasters” because of how society shapes people’s risks and how people prepare, adapt, and respond.

Extreme weather events like hurricanes often become problems because of the ways society has changed the environment, such as locating cities in areas at risk of flooding, filling in wetlands for development, and building homes on eroding coastlines. Government policies are also major factors in where, why, and when an event becomes a human disaster because development policies have contributed to creating risky areas while response plans are often inadequate.

• David L. Brunsma, David Overfelt, and Steven J. Picou. 2007. The Sociology of Katrina: Perspectives on a Modern Catastrophe. Lanham, MD: Rowman & Littlefield Publishers.
• Raymond J. Burby. 2006. “Hurricane Katrina and the Paradoxes of Government Disaster Policy: Bringing about Wise Governmental Decisions for Hazardous Areas.” The Annals of the American Academy of Political and Social Science 604:171–91.
• Susan L. Cutter, Bryan J. Boruff, and W. Lynn Shirley. 2003. “Social Vulnerability to Environmental Hazards.” Social Science Quarterly 84(2):242–61.

The risks and burdens of disasters are not evenly distributed. Communities with the least economic, social, and political power often face the greatest threats from natural disasters and are also the least able to prepare, evacuate and rebuild. Socio-economic status affects where people live and the quality of their housing. Poor and working class communities also tend to bear greater physical, emotional, and psychological impacts of displacement and have fewer resources and government support to rebuild and recover after a catastrophe.

• Piers M. Blaikie. 1994. At Risk: Natural Hazards, People’s Vulnerability, and Disasters. London; New York: Routledge.
• Alice Fothergill and Lori A. Peek. 2004. “Poverty and Disasters in the United States: A Review of Recent Sociological Findings.” Natural Hazards 32(1):89–110.
• Walter Gillis Peacock, Betty Hearn Morrow, and Hugh Gladwin. 1997. Hurricane Andrew: Ethnicity, Gender, and the Sociology of Disasters. London ; New York: Routledge.

Economic inequality and race also contribute to different levels of vulnerability and resiliency between countries around the globe. Communities of color are more likely to be threatened by environmental disasters and be less prepared, while government evacuation and reconstruction programs tend be limited for these communities. Researchers who studied Hurricane Katrina point to how experiences of the storm were shaped by institutional racism and how the effects exacerbated racial and class inequalities. For example, government aid was slower to reach African American communities who also spent more time in shoddy temporary housing and had more trouble rebuilding their neighborhoods.

• Robert D. Bullard and Beverly Wright. 2009. Race, Place, and Environmental Justice after Hurricane Katrina: Struggles to Reclaim, Rebuild, and Revitalize New Orleans and the Gulf Coast. Boulder, Colo.: Westview Press.
• Kristin Ann Bates and Richelle S. Swan. 2007. Through the Eye of Katrina: Social Justice in the United States. Durham, NC: Carolina Academic Press.

Women and children also bear a greater burden and risk from disasters because they tend to have fewer resources. Women typically have more responsibilities of caring for children and aging relatives, yet they have also been leaders in the recovery process after countless disasters, organizing their communities to rebuild and demanding a government response. Natural disasters have a large impact on children due to the trauma, displacement, and disruption of their lives. Research found that childrens’ ability to respond and adapt after Katrina was related to their family’s race and class, with more vulnerable children experiencing greater detrimental effects on their well-being after the storm.

• Emmanuel David and Elaine Pitt Enarson. 2012. The Women of Katrina: How Gender, Race, and Class Matter in an American Disaster. Nashville, TN: Vanderbilt University Press.
• Elaine Pitt Enarson and Betty Hearn Morrow. 1998. The Gendered Terrain of Disaster: Through Women’s Eyes. Westport, CT: Praeger.
• Alice Fothergill and Lori A. Peek. 2015. Children of Katrina. Austin, TX: University of Texas Press.

Recently, Utah and Idaho legalized public breastfeeding, finally making the practice lawful in all parts of the United States. Yet, even where public breastfeeding is legal — and has been for some time — breastfeeding mothers still face stigma. For instance, a pool patron and a staff member recently asked a breastfeeding mother in Mora, Minnesota to cover herself while at a public pool. Many have pointed out the contradictions between observers’ acceptance of women’s skin in certain public domains (like at the beach or on the cover of a magazine) and the public shaming women receive when their skin is exposed during breastfeeding.

In U.S. society especially, breasts are sexual symbols. And since motherhood is not highly sexualized, public breastfeeding presents a cultural contradiction in the United States. Because of these shared understandings of breasts as sexual, mothers must consciously negotiate spaces where they can breastfeed. For example, mothers report they engage in a variety of behaviors, like avoiding breastfeeding in certain spaces where they might face scrutiny or draping a blanket over the baby to hide their breasts, in order to not be viewed as sexual while breastfeeding.

• Cindy A. Stearns. 1999. “Breastfeeding and the Good Maternal Body.” Gender & Society 13(3): 308-325.
• Nicole Owens, Shannon K. Carter, Chelsea J. Nordham, and Jason A. Ford. 2016. “Neutralizing the Maternal Breast: Accounts of Public Breastfeeding by African American Mothers” Journal of Family Issues 39(2): 430-450.
• Michele Acker. 2009.  “Breast is Best…But Not Everywhere: Ambivalent Sexism and Attitudes Toward Private and Public Breastfeeding.” Sex Roles 61: 476-490.

In other words, one reason people respond to public breastfeeding with discomfort and sometimes hostility is that breasts have a particular meaning within U.S. culture and breastfeeding in public challenges that meaning.

The word “rave”evokes different responses depending upon one’s generation. For many it symbolizes fun all-night dance parties with friends. While the public may be quick to associate rave culture with youth delinquency, social science explores the broader range of social, spiritual, and cultural elements of raves and electronic dance music (EDM). Raves began in 1980s Britain and quickly spread to the United States. Youth created these anti-establishment and and underground events to celebrate peace, love, unity, and respect — otherwise known as “PLUR.” However, heavy drug consumption resulted in media scrutiny and government crackdowns of these underground locations in the 1990s and early 2000s, pushing raves into more formal spaces like clubs.

• Tammy L. Anderson. 2009. “Understanding the Alteration and Decline of a Music Scene: Observations from Rave Culture.” Sociological Forum 24(2): 307-336.
• Tammy L. Anderson. 2014. “Molly Deaths and the Failed War on Drugs.” Contexts 13(4): 48-53.
• Shadi Kardan. 2003. “The Government’s New War on Drugs: Threatening the Right to Dance!” New England Journal on Criminal and Civil Confinement 29(1): 99-124.

Social scientists have explored raves and the electronic dance music scene from two different perspectives. The cultural perspective emphasizes a sense of community and empathy for its members as the roots of the scene. From this perspective, drug use enhances these experiences. The rave has been portrayed as a youth cultural phenomenon, characterized by belonging, self-expression, acceptance, camaraderie, escape, and solidarity, and where drugs — particularly ecstasy or “E” — are often central to the scene or tools in rebellion. From the public health perspective, excessive drug use is the defining feature of rave culture. Here raves and the electronic dance music scene are perceived as dangerous drug subcultures that increased drug-related health problems in the United States. However, some debate these claims and argue that the effects of ecstasy itself are linked to feelings of closeness and solidarity at raves.

• Philip R. Kavanaugh and Tammy L. Anderson. 2008. “Solidarity and Drug Use in The Electronic Dance Music Scene.” The Sociological Quarterly 49(1): 181-208.

While typically not linked to public perceptions of rave culture, some scholars connect raves and electronic dance music culture (EDMC) to religion and spirituality. In particular, scholars point to the non-Christian religiosity of rave’s dance “ritual,” likening it to the non-denominational “new church.” Further, EDM inherits its ritualistic, chanting, and percussive elements from African, Asian, and Indigenous cultures in North America, and African American, Latino, and gay communities in Chicago and New York City in the 1970s and 1980s. Thus, youth promoted raves as place of growth, sacredness, and unity, where youth were not divided through class, ethnicity, and gender.

• Graham St. John. 2004. “Introduction.” Pp. 1-15 in Rave Culture and Religion, edited by G. St. John. London and New York: Routledge.
• Graham St John. 2006. “Electronic Dance Music Culture and Religion: An Overview.” Culture and Religion 7(1): 1-25.

Though the shape and form of raves and rave culture continues to change, both cultural and public health scholars agree that these events are much more than sporadic, all night dance parties.

Despite the stressful experiences and the poverty that often accompany immigration, social science research shows that Hispanics as a whole fare better in health outcomes than non-Hispanic Whites. The ‘Hispanic Paradox’ refers to the fact that these good health conditions in Hispanic populations represent a curious puzzle for researchers. This is because Hispanics also exhibit low-income status, disproportionate exposure to stress factors associated with the immigration process such as learning a new language, adapting to an unfamiliar environment, and encountering persistent discrimination — factors associated with poor health outcomes.

• John M. Ruiz, Patrick Steffen, and Timothy B. Smith. 2013. “Hispanic Mortality Paradox: A Systematic Review and Meta-analysis of the Longitudinal Literature.” American Journal of Public Health 103 (3): 52-60.
• Linda C. Gallo, Frank J. Penedo, Karla Espinosa de los Monteros, and William Arguelles. 2009.”Resiliency in the Face of Disadvantage: Do Hispanic Cultural Characteristics Protect Health Outcomes?” Journal of Personality 77 (6): 1707-1746.

Some studies explain the ‘Hispanic Paradox” based on Hispanic culture-specific features that act as protective factors of health and wellbeing. They include the cultural emphasis in the development of social resources, family ties, and religious affiliations. Hispanic mothers in the United States, for example, enjoy favorable birth outcomes due to their close relationships with family, friends, and community members who provide a protective network of informal prenatal care. However, new research has found that Hispanic mothers’ adaptation to the norms of U.S. society — known as acculturation — erode these healthy behaviors.

• Michael S.McGlade, Somnath Saha, and Marie E. Dahlstrom. 2004. “The Latina Paradox: An Opportunity for Restructuring Prenatal Care Delivery.” American Journal of Public Health 94(12): 2062-2065.
• Ana F. Abraido-Lanza, Maria T. Chao, and Karen R. Florez. 2005. “Do Healthy Behaviors Decline with Greater Acculturation?: Implications for the Latino Mortality Paradox.” Social Science & Medicine 61(6): 1243-1255.

Notably, the Hispanic Paradox may not remain consistent when researchers consider the specific composition of Hispanic populations living in the United States, compared to Hispanic populations in their places of origin. For instance, Hispanics who migrate may have better health conditions than those who stay in their home countries, known as the ‘healthy migrant effect’. On the other hand, less healthy Hispanics may be more likely to return to their home countries and thus less likely to participate in research studies, what is called ‘the salmon bias’. A study of Hispanics tested both the ‘healthy migrant’ and ‘the salmon bias’ effects among Cubans (for whom returning to their home countries is not feasible), Puerto Ricans, and U.S.-born Hispanics (whose deaths are recorded in the U.S. national statistics). Findings reveal that lower mortality for Hispanics remains constant, even when controlling for these alternative hypotheses.

Alberto Palloni and Elizabeth Arias. 2004. “Paradox Lost: Explaining the Hispanic Adult Mortality Advantage.” Demography 41(3): 385-415.

Ana F. Abraido-Lanza, Bruce P. Dohrenwend, Daisy S. Ng-Mak, and J. Blake Turner. 1999. “The Latino Mortality Paradox: A Test of the” Salmon Bias” and Healthy Migrant Hypotheses.” American Journal of Public Health 89(10): 1543-1548.

Studies on the Hispanic Paradox shine a light on how ethnicity can affect health outcomes. However, concerns about health outcomes among minorities require both strengthening the benefits and preventing potential harmful consequences of being Hispanic in the United States.

With the appointment of a new Supreme Court Justice looming, Roe v. Wade — the landmark legislation that legalized abortion across the United States — faces an increasing threat of being overturned. While we often talk about the women who have or seek abortions, we tend to forget about the providers who perform them. Abortion providers today certainly face many challenges to performing this service, but before Roe v. Wade, choosing to perform abortions was usually illegal and dangerous. Despite this precarity, many providers risked their lives to ensure women had access to abortions.

Abortion didn’t always receive public concern. In fact, prior to the mid 1900s, abortion was considered a strictly medical matter. In the late 1800s, medical professionals began advocating for the criminalization of abortion, arguing that women who sought them were medically ignorant about pregnancy. And, at a time when a growing number of immigrant groups seemed to threaten the dominance of White, Anglo-Saxons, doctors vehemently opposed abortions for White, Anglo-Saxon women who defied their “natural” purpose — to reproduce. Many doctors remained opposed to abortion into the mid to late 1900s, but not all. These others doctors — known as “doctors of conscience” — performed illegal abortions, often requiring the women they served to wear blindfolds so they could not identify the doctors if they were later arrested.

• Kristin Luker. 1984. Abortion and the Politics of Motherhood. University of California Press.  
• Nicola Beisel and Tamara Kay. 2004. “Abortion, Race, and Gender in Nineteenth-Century America.” American Sociological Review 69: 498-518.
• Carole Joffe. 1995. Doctors of Conscience: The Struggle to Provide Abortions. Beacon Press.

It was not only trained medical professionals who performed illegal abortions. Some providers had little to no legitimate medical training. For example, members of the underground abortion service in Chicago — known as “Jane” — sought training so they would not need to rely on outsiders to perform services. Surprisingly perhaps, many clergy used their status and privilege of confidentiality with clients to provide referrals and assistance to women seeking abortions through an organization known as the Clergy Consultation Service (CCS).

• Laura Kaplan. 1995. The Story of Jane: The Legendary Underground Feminist Abortion Service. University of Chicago Press.
• Kelly Suzanne O’Donnell. 2017. “Reproducing Jane: Abortion Stories and Women’s Political Histories.” Signs 43(1): 77-96.

The CCS alone estimates that the abortion providers they worked with were able to supply hundreds of thousands of women with abortion services before Roe v. Wade. And this was only possibly through the collaborative efforts of individuals who formed organizations and networks, and used their privileges and resources to help women who sought their assistance. Today women continue to fight for reproductive rights, and with the possibility of Roe v. Wade‘s overturning, many worry that women will once again need to rely on providers like doctors of conscience to meet their reproductive needs. 

This episode of the podcast, Criminal has more about the Clergy Consultation Service.

From PRIDE parades to drag brunch, we tend associate queer people and queer-friendly places with cities. While some LGBTQ individuals do migrate to the metros, many also reside in rural America. Social scientists illustrate how queerness in the country functions differently than in the hustle and bustle of the city.

Distinguishing urban and rural is one way that LGBTQ people construct their identities in the context of small towns. Some feel that the popular images of gay individuals in urban spaces partying and enjoying nightlife are extreme and run contradictory to the experiences of queer folk who live quieter lives. Others feel that city gay bars are more impersonal than local small-town dive bars. Like in the show Cheers where “everyone knows your name,” a person’s character and long-term local status seems to matter more than their sexual orientation. In addition, some gay and lesbian individuals choose to return to their rural roots after trying out city life and rationalize this choice by deciding not to conform to cultural, urban-based understandings of what being gay means.

• Emily Kazyak. 2011. “Disrupting Cultural Selves: Constructing Gay and Lesbian Identities in Rural Locales.” Qualitative Sociology 34(4): 561-581.

Queer visibility also differs in rural versus urban areas. Finding other LGBTQ people in rural areas  generally takes more legwork. While cities tend to have specific locations where queer communities congregate, rural communities have fewer designated queer enclaves. This means that meet ups for queer people in rural places involve circulating information and using space temporarily. One consequence of limited space is that many LGBTQ people have more trouble accessing social support, which may lead to worse health outcomes.

• Mary L. Gray. 2009. Out in the Country: Youth, Media, and Queer Visibility in Rural America. New York: NYU Press.
• Mary L. Gray, Brian J. Gilley, and Colin R. Johnson, eds. 2016. Queering the Countryside: New Frontiers in Rural Queer Studies. New York: NYU Press.

Residents in rural areas tend to have poorer health outcomes compared to those in cities overall, but the disparities are stronger for LGBTQ people. Not only do many queer folks face discrimination and stigma in healthcare facilities, rural healthcare is less likely to be equipped with the resources to meet the specific needs of gay, lesbian, queer, and non-binary patients.

• Brandi Woodell. 2018. “Understanding Sexual Minority Health Disparities in Rural Areas.” Sociology Compass 12(2): 1-17.
• Christopher M. Fisher, Jay A. Irwin, and Jason D. Coleman. 2014. “LGBT Health in the Midlands: A Rural/Urban Comparison of Basic Health Indicators.” Journal of Homosexuality 61: 1062-1090.
• James M. Dahlhammer, Adena M. Galinsky, Sarah S. Joestl, and Brian W. Ward. 2016. “Barriers to Healthcare Among Adults Identifying as Sexual Minorities: A U.S. National Study.” American Journal of Public Health 106(6): 1116-1122.

During PRIDE month Americans celebrate gender and sexuality spectrums, but many social arenas still rely on a rigid binary. Athletics is one of the spaces where gender segregation still dominates. In fact, its strict separation of sports into male and female competitions actually requires sport administrators to set and police the boundaries between the sexes and has created many controversies and conundrums in recent years. Sociological research illustrates how actors use gender verification, or sex testing, in athletics as a weapon of nationalism, sexism, and racism, thus reinforcing a medical view of the gender binary in an attempt to ensure “fair play.”

Gender verification in international athletics was part of the battlefield of the Cold War. Systematic sex testing in the Olympic Games began in 1968, largely in response to concerns about the dominant performances of the East German women and fears or rumors of men posing as women. In addition to being used as a weapon of nationalism, gender verification testing targeted athletes who did not conform to white, Western norms of femininity. Even after systematic sex testing was (briefly) eliminated by the International Olympic Committee in 2000, “suspicious” athletes such as the middle-distance runners Santhi Soundarajan and Caster Semenya were forced to undergo gender verification in 2006 and 2009.

• Stefan Wiederkehr. 2009. “‘We Shall Never Know the Exact Number of Men Who Have Competed in the Olympics Posing as Women’: Sport, Gender Verification and the Cold War.” The International Journal of the History of Sport 26(4): 556–72.
• Lindsay Parks Pieper. 2014. “Sex Testing and the Maintenance of Western Femininity in International Sport.” International Journal of the History of Sport 31(13): 1557–76.

Sport federations continue to defend gender verification of women — but not men — on the basis of “fair play,” or the idea that women competing against men face an unfair athletic disadvantage. Feminist scholars have critiqued the fair play reasoning as a smokescreen for the policing of women, especially as sex segregation and drug testing are two of the only ways that sport federations attempt to enforce a level playing field. Additionally, sex testing forces a medical definition of sex and draws sharp lines that punish individuals who are intersex, have chromosomal abnormalities, or have higher than average levels of androgens.

• Cheryl Cooky and Shari L. Dworkin. 2013. “Policing the Boundaries of Sex: A Critical Examination of Gender Verification and the Caster Semenya Controversy.” Journal of Sex Research 50(2): 103–11.
• Claire F. Sullivan. 2011. “Gender Verification and Gender Policies in Elite Sport: Eligibility and ‘Fair Play.’” Journal of Sport and Social Issues 35(4): 400-419.

How sex has been defined and verified has shifted as the medical understanding and technology available has advanced, but all gender verification methods will continue to struggle with how to fit the wide spectrum of gendered individuals into only two boxes.