health

Several abortion providers have come under intense criticism for offering free abortions to women affected by Hurricane Harvey. While this criticism echoes decades of social and political debates regarding women’s reproductive rights, the control over women’s bodies extends far beyond the second-wave feminist movement during the mid-20th century. For example, recent calls for the removal of a statue honoring J. Marion Sims, a doctor known for medical contributions to the field of gynecology and who performed experimental surgeries on non-consenting enslaved black women without anesthesia, illustrate the historical links between reproductive control, gender, and race. Sociologists allow us to trace the long history of controlling black women’s reproduction.

While historical accounts of reproductive rights rhetoric in the 19th century point to the gendered issue of men’s control over women’s bodies and the valorization of traditional motherhood, they neglect how political rhetoric also drew on ideas of white superiority. As more immigrants migrated to the U.S., Anglo-Saxon political elites worried that greater migrant representation would quickly dismantle their political power, and so American physicians encouraged Anglo-Saxon women to bear children for the sake of continued political power among whites.

• Nicola Beisel and Tamara Kay. 2004. “Abortion, Race, and Gender in Nineteenth-Century America.” American Sociological Review 69(4): 498-518.

Even though white women were subjected to political rhetoric that sought to control their reproduction, their capacity to reproduce the white race meant they were privileged relative to black women. This privilege was shaken when white women gave birth to mixed-race children, however, and these women were sometimes forced into indentured servitude. On the other hand, racially mixed children born to black women during slavery were not threatening to a white racial order. Instead, they were viewed as symbols of white men’s social and economic control over black women.

• Abby Ferber. 1999. “Planting the Seed: The Invention of Race.” in White Man Falling: Race, Gender & White Supremacy. Oxford: Rowman and Littlefield.
• Aida Hurtado. 1989. “Relating to Privilege: Seduction and Rejection in the Subordination of White Women and Women of Color.” Signs 14(4).

During and after slavery, black women were commonly depicted as sexually deviant, hypersexual and promiscuous. State-sanctioned practices to control black women’s reproduction–like coercive birth control and mass sterilization campaigns where doctors performed hysterectomies on black women that were not medically necessary–reflected these cultural images. When black women did have children, restrictive welfare policies limited the state support they could receive, further drawing on racialized constructions of black women as lazy, ignorant, “welfare queens.” Both sets of state practices reflect the attempt to control black women’s sexuality, reproduction, and families.

• Patricia Hill Collins. 2004. Black Sexual Politics: African Americans, Gender, and the New Racism. New York: Routledge.
• Dorothy Roberts. 1998. Killing the Black Body: Race, Reproduction, and the Meaning of Liberty. New York: Vintage.

For more on the ways mothers are controlled and policed, check out this TROT on morality and maybe-moms.

Despite increased awareness surrounding transgender identities and experiences, the National Coalition of Anti-Violence Programs (NCAVP) has tracked 36 anti-LGBTQ homicides in 2017 alone, 16 of whom were transgender women of color. Along with President Trump’s recently proposed military ban of transgender persons, there is evidence that personal prejudices and institutional discrimination continue to affect the lives of those in the trans community.

One way institutions like the military discriminate against transgender individuals is by advancing the assumption that trans bodies are a problem and should conform to “normal” standards. For example, medical professionals that work with transgender patients often discourage them from undergoing transitional surgery too soon. This discouragement reinforces traditional ideas that treat gender and sex as the same thing, and recognize both as binary. This discrimination shapes psychological and physical well-being, as transgender people who appear as gender nonconforming have a greater risk of engaging in self-harm acts, including suicide.

• Georgiann Davis, Jodie M. Dewey, and Erin L. Murphy. 2015. “Giving Sex: Deconstructing Intersex and Trans Medicalization Practices.” Gender & Society 30(3): 490-514.
• Lisa R. Miller and Eric Anthony Grollman. 2015. “The Social Costs of Gender Nonconformity for Transgender Adults: Implications for Discrimination and Health.” Sociological Forum 30(3): 809-831.

Transgender people are also at a greater risk of being the victims of violence. Surveys indicate that roughly 50% of transgender people report experiences of sexual violence or assault. The continuous threat of violence influences everyday decision making and quality of life across communities. For example, transgender women are more likely to perceive an association between acts of physical violence with sexual assault. Moreover, individuals transitioning from male-to-female are more likely to experience violent victimization than those transitioning from female-to-male, with a heightened risk during periods of transition and gender ambiguity.

• Rebecca L. Stotzer. 2009. “Violence Against Transgender People: A Review of United States Data.” Aggression and Violent Behavior 14(3): 170-179.
• Doug Meyer. 2012. Violence Against Queer People: Race, Class, Gender, and The Persistence of Anti-LGBT Discrimination. Rutgers University Press.
• Daniella Jauk. 2013. “Gender Violence Revisited: Lessons from Violent Victimization of Transgender Identified Individuals.” Sexualities 16(7): 807-825.

Sex education is a contentious subject in U.S. politics. Before Obama’s presidency, the federal government only funded abstinence education, but in 2009 Obama created the Office of Adolescent Health and diverted some of these funds to create an approved list of practices shown to prevent teen pregnancy (several sources show abstinence-only education does not) through research. With Trump as president, the future of sex ed is an open question, but sociologists can offer some insight regarding what we already know.

Public sex education or “social hygiene” appeared in the U.S. at the turn of the 20th century in response to concerns about increasing urbanization and growing sexual temptations. During the 1960s and 70s, sexual cultures in the U.S. underwent further shifts, influenced by feminism, youth culture, and the gay rights movement. However, anxieties about sex, especially for youth in the U.S., remained. Debates about what kind of sex education to provide for youth seemed to occur between two poles — sexual liberals who supported a comprehensive sex education in schools and sexual conservatives who supported abstinence-only education. 

• Jeffrey Moran. 2000. Teaching Sex: The Shaping of Adolescence in the 20th Century. Cambridge, MA: Harvard University Press.
• Kristin Luker. 2007. When Sex Goes to School: Warring Views on Sex–and Sex Education–Since the Sixties. New York: W. W. Norton & Company.
• Janice Irvine. 2004. Talk about Sex: The Battles over Sex Education in the United States. Berkeley: University of California Press.

No matter which type of sex education is implemented, sex ed is ultimately about regulating youth sexuality. Political actors and popular conversations alike frame youth sex as a social problem that requires intervention. Much of this discourse focuses on sex as a danger for children and young adults. Thus, sex education in the U.S. draws on an assumption of risk, relying on prevention-based education.

• Jessica Fields. 2012. “Sexuality Education in the United States: Shared Cultural Ideas across a Political Divide.” Sociology Compass 6(1): 1–14.

However, sex educators and the curriculum they use do not assume all children are equally innocent or at risk. Scholars show that sex education often draws on racial stereotypes of youth of color as sexually deviant. Youth of color are “adultified” and thus perceived as more sexual than their white peers. For instance, teachers often characterize African American girls as sexually opportunistic and assume Latina teens are inherently at risk of teen pregnancy. Further, boys are assumed to be sexually aggressive, and girls are held responsible for dealing with boys’ desires.

• Jessica Fields. 2008. Risky Lessons Sex Education and Social Inequality. New Brunswick: Rutgers University Press.
• Lorena García. 2009. “‘Now Why Do You Want to Know about That?’ Heteronormativity, Sexism, and Racism in the Sexual (Mis)education of Latina Youth.” Gender & Society 23(4): 520–41.

In response to the Trump administration’s crackdown on undocumented immigrants, cities and universities all across the United States have declared themselves “sanctuaries” from the threat of deportation. One aspect of this has been a revival of the sanctuary church movement. Over 800 churches nationwide have declared themselves sanctuaries for undocumented immigrants who fear deportation since Trump took office. While it is technically illegal to harbor undocumented immigrants, immigration enforcement officials have typically avoided raiding “sensitive locations” like churches and hospitals to avoid disrupting institutions that provide social services. Social science shows that protecting sensitive locations like churches is key to providing essential social services to marginalized populations. 

This is not the first instance of religious institutions attempting to shield undocumented immigrants from deportation on moral grounds in the United States. In the 1980s, thousands of refugees fled political violence in Central America, many to the border states of Arizona and Texas. In response, hundreds of religious congregations declared themselves to be sanctuaries for Central American refugees. With the exception of a notable trial in Arizona in 1986 in which several activists were convicted for violating immigration law, most congregations suffered minimal, if any, legal reprisal for their efforts during this period.

• Christian Smith. 1996. Resisting Reagan: The U.S. Central American Peace Movement. University of Chicago Press.
• Gregory L. Wiltfang and Doug McAdam. 1991. “The Costs and Risks of Social Activism: A Study of Sanctuary Movement Activism.” Social Forces 69(4): 987-1010.

Churches are unique from other types of sensitive locations like schools and hospitals because of their long history of offering sanctuary to people in need, a history that goes back to the 1600s. It was not until the late 20th century that states began intervening and requiring churches to hand over people they were protecting. In the U.S. today, churches are a critical resource for low-income, minority, and immigrant communities, especially in small towns and rural areas. They often serve as primary distribution sites for a number of rural social services including food aid, shelter, clothing, basic healthcare, and English language and employment tutoring.

• Philip Marfleet. 2011. “Understanding ‘Sanctuary’: Faith and Traditions of Asylum.” Journal of Refugee Studies 24(3): 440-455.
• Mark Chaves and William Tsitsos. 2001. “Congregations and Social Services: What They Do, How They Do It, and With Whom.” Nonprofit and Voluntary Sector Quarterly 30(4).
• Stephanie C. Boddie. 2002. “Fruitful Partnerships in a Rural African American Community: Important Lessons for Faith-Based Initiatives.” The Journal of Applied Behavioral Science 38(3).

Research studying the long-term effects of ICE raids on hospitals and clinics shows that immigrants stop seeking medical services when they no longer feel safe from law enforcement. If sanctuary churches are no longer recognized as safe from ICE raids, there is some concern that the same problem will make it difficult for churches to reach immigrants in rural places.

• Mark Berk and Claudia Schur. 2001. “The Effect of Fear on Access to Care Among Undocumented Latino Immigrants.” Journal of Immigrant and Minority Health 3(3).
• Karen Hacker et al. 2011. “The Impact of Immigration and Customs Enforcement on Immigrant Health: Perceptions of Immigrants in Everett, Massachusetts, USA.” Social Science Medicine 73(4).

It remains to be seen whether the Trump administration will stay out of churches, but social science shows that raiding these spaces could affect all immigrants, especially those in rural areas. And it may very well ignite an intense reaction from the churches and communities trying to keep people safe. 

A recent study in the medical community has shown a decrease in teen suicide, particularly among high schoolers who are sexual minorities, since same-sex marriage was legalized. This is evidence that change in social policy impacts health outcomes among those who experience discrimination. This is important because social science has documented the negative impacts of gender and racial discrimination on mental and physical health.

A person’s status as a racial or sexual minority impacts their exposure to stress through perceived discrimination — a key way that racial, gender, and class inequalities in physical and mental health occur. The centrality and/or visibility of racial or sexual differences in a person’s life affects if and how often discrimination is perceived — the higher the salience or visibility of one’s racial or sexual identity, the higher level of perceived discrimination and the higher level of stress that person experiences.

• David R. Williams, Harold W. Neighbors, and James S. Jackson. 2003. “Racial/Ethnic Discrimination and Health: Findings From Community Studies.” American Journal of Public Health 93(2): 200-208.
• Peggy A. Thoits. 2010. “Stress and Health: Major Findings and Policy Implications.” Journal of Health and Social Behavior 51: 41-53.
• Robert M. Sellers, Cleopatra H. Caldwell, Karen H. Schmeelk-Cone, and Marc A. Zimmerman. 2003. “Racial Identity, Racial Discrimination, Perceived Stress, and Psychological Distress Among African American Young Adults.” Journal of Health and Social Behavior 44(3): 302-317.
• Ellis P. Monk, Jr. 2015. “The Cost of Color: Skin Color, Discrimination, and Health among African Americans.” American Journal of Sociology 121(2): 396-444.
• Lisa R. Miller and Eric Anthony Grollman. 2015. “The Social Costs of Gender Nonconformity for Transgender Adults: Implications for Discrimination and Health.” Sociological Forum 30(3).

Those who are disadvantaged in multiple ways, like being both a racial minority and a sexual minority, find themselves at higher levels of exposure to discrimination and have higher rates of depression and worse self-rated health.

• Eric A. Grollman. 2012. “Multiple Forms of Perceived Discrimination and Health Among Adolescents and Young Adults.” Journal of Health and Social Behavior, 53(2), 199-214.

Employees under strict attendance policies face a difficult choice when they are “technically” physically able to be present at work, but may not feel healthy enough to perform their job well. Debating whether or not to call in for the day, employees ask themselves not only if they feel sick, but if they seem sick enough to convince their superiors and coworkers. Talcott Parsons’ classic work on “the sick role” helps us understand why. Sickness inhibits a person’s ability to perform as others expect them to. However, people in the sick role are excused if their symptoms seem to be beyond their control and if they try to get better. Whether or not a person is really sick, taking on the sick role requires those around them to be convinced, granting the sickness legitimacy. Social science research shows how the ease of attaining the legitimated sick role differs depending on gender and class.

• Talcott Parsons. 1975. “The Sick Role and the Role of the Physician Reconsidered.” Milbank Memorial Fund Quarterly, Health and Society 53(3): 257-278.

More recent and critical research shows why taking the plunge and calling into work can be so difficult. First, a person has to ascertain whether they are truly sick by analyzing how their body feels, and whether or not certain symptoms constitute true illness in the eyes of others. The dripping nose and general malaise of a cold, for example, is never pleasant. Perhaps as children we might think it truly disrupts our daily routines. As we grow older, however, we learn what sociologists of health call illness behavior, which is how an individual interprets specific bodily symptoms (like those of a cold) and reacts to them. Adults learn that the proper reaction to a cold is taking some over-the-counter medicine and heading into work with a box of tissues. This means that learning to interpret the way your body feels is in large part a social process.

• J.T. Young. 2004 “Illness Behaviour: A Selective Review and Synthesis.” Sociology of Health & Illness 26(1): 1-31.
• David Mechanic. 1995. “Sociological Dimensions of Illness Behavior.” Social Science and Medicine 41(9): 1207-16.

Many working-class jobs perpetuate “toughing it out” illness behavior; employees often attribute moral value to being “hard working” and going into work no matter what. This comes with a set of beliefs about what constitutes real illness and what is mere laziness. Research finds that this kind of labor market shapes working mothers’ illness behavior. After developing a worker identity, working mothers often recognize physical symptoms as relatively unimportant compared to building a good reputation with their superiors and defending themselves from job insecurity. The economy, then, is at play when they assess how they physically feel. They then encourage their children to “tough out” common health problems. This learned behavior does not end when a child leaves home either – they are socialized into this practice and are likely to continue “toughing it out” when they are adults.

• Sarah Cunningham-Burley, Kathryn Backett-Milburn, and Debbie Kemmer. 2006. “Constructing Health and Sickness in the Context of Motherhood and Paid Work.” Sociology of Health & Illness 28(4): 385-409.
• Maria Carla Barnes, Rhiannon Buck, Gareth Williams, Katie Webb, and Mansel Aylward. 2008. “Beliefs About Common Health Problems and Work: A Qualitative Study.” Social Science & Medicine 67(4): 657-665.
• Claus D. Hansen and Johan H. Andersen. 2008. “Going Ill to Work.” Social Science & Medicine 67(6): 956-964.

More and more popular media outlets are talking about why purposely stopping your period might be a good thing. Many medical professionals now advocate for menstrual suppression, usually through hormonal treatments that many people are already using. Birth control options like the pill are being used as a way to improve the quality of life for those of us who get periods, but this medical development affects the social meaning of menstruation.

Menstruation is not simply a biological phenomenon. Rather, people experience menstruation within a social context. In a society that often assumes heterosexuality, girls’ first periods mark them as sexual objects, indicating their ability to reproduce, and differentiating them from boys. After their first period, girls report feeling sexualized by others, as well as more ambivalent about their bodies. Menstruation often evokes disgust by both men and women, often becoming a social stigma that must be hidden.

• Janet Lee. 1994. “Menarche and the (Hetero)Sexualization of the Female Body.” Gender & Society 8(3): 343-362.
• Ingrid Johnston-Robledo and Joan C. Chrisler. 2013. “The Menstrual Mark: Menstruation as Social Stigma.” Sex Roles 68(9)

While menstruation is typically discussed as something natural, what counts as menstruation is socially constructed. In the light of new drugs specifically designed to suppress periods, the FDA and companies marketing the products make distinctions between bleeding that occurs while taking hormonal birth control and bleeding that occurs without it. They argue that “pill periods” are not in fact “real” periods because they are artificially modified and therefore unnecessary. This redefinition demonstrates how bodily processes, like menstruation, can be redefined and reimagined, and how the way they are experienced is influenced by social context.

• Katie Ann Hasson. 2016. “Not a ‘Real’ Period? Social and Material Constructions of Menstruation.” Gender & Society 30(6):958-983

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.

• Mary Lyndon Shanley and Adrienne Asch. 2009. “Involuntary Childlessness, Reproductive Technology, and Social Justice: The Medical Mask on Social Illness.” Signs 34(4): 851-874

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.

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.

• Nicholas A Guittar. 2012. “On and Off the Reservation: A Discussion of the Social, Physical, and Mental Health Indicators of Suicide in the Native American Community.” Sociology Compass 6(3):236-243.  
• Louise Marie Roth and Megan M. Henley. 2012. “Unequal Motherhood Racial-Ethnic and Socioeconomic Disparities in Cesarean Sections in the United States.” Social Problems 59(2):207-227.

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.

• Gregory Hooks and Chad L. Smith. 2004. “The Treadmill of Destruction: National Sacrifice Areas and Native Americans.” American Sociological Review 69(4):558-575.  
• Thomas E. Shriver and Gary R. Webb. 2009. “Rethinking the Scope of Environmental Injustice: Perceptions of Health Hazards in a Rural Native American Community Exposed to Carbon Black.” Rural Sociology 74(2):270-292.

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.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.

• Sharon Hays. 1996. The Cultural Contradictions of Motherhood. New Haven, CT: Yale University Press.
• Kristin Luker. 1984. Abortion & the Politics of Motherhood. Berkeley: University of California Press.

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.)

• Elizabeth Armstrong. 2008. Conceiving Risk, Bearing Responsibility: Fetal Alcohol Syndrome and the Diagnosis of Moral Disorder.

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.

• Lisa Handwerker. 1994. “Medical Risk: Implicating Poor Pregnant Women.” Social Science and Medicine 38(5):665-675.
• Enid Logan. 1999. “The Wrong Race, Committing Crime, Doing Drugs, and Maladjusted for Motherhood: The Nation’s Fury over ‘Crack Babies’.” Social Justice 26(1):115-138.
• Jeanne Flavin. 2009. Our Bodies, Our Crimes: The Policing of Women’s Reproduction in America. New York: New York University Press.