(EN)GENDERING HEALTH:
A BRIEF HISTORY OF WOMEN'S
INVOLVEMENT IN HEALTH ISSUES
HEMA NAIR
ABSTRACT ---The question of entitlement - the question of who gets what, why and how of the available resources of the society at any given point of time is at the base of the gender justice and equity issue. The interlinked and interwoven nature of these entitlements with the entire gamut of structurally determined gender relations makes the analysis of the relationship between feminism, health problems, political rights, social issues and economic issues very difficult. This paper traces the history of women's involvement in health issues from the 1 850s to the present day. Many women's organizations were involved in identifying core issues of health and struggling to establish the basic rights of women.
Women and Rights
The question of entitlement - i.e. the question of who gets what, why and how much of the available resources of the society at any given point of time is at the base of the gender justice and equity issue. The interlinked and interwoven nature of these entitlements with the entire gamut of structurally determined gender positions makes the analysis of the relationship between feminism, health problems, political rights, social and economic issues very difficult. The most problematic of these eras was the latter half of the nineteenth century when women shook off the shackles of centuries of oppression.
The awareness of the discrimination against women in various fields caused them to protest against the oppression. The fight for political equality was one of the areas that women concentrated on. The first treatise in defense of the rights of the women, Mary Wollstonecraft’s A Vindication of the Rights of Women, inspired by the French Revolution, was published as early as 1792 but had to wait for more than five decades to gain prevalence and adequate supporters in the western world. By the 1850s, the word “feminism” had gained universal acceptance and was included in the Oxford English Dictionary.
The women’s agitation to get their right to vote surfaced in Britain as the Suffragette Movement that began in the 1860s and developed into the National Union of Women’s Suffrage Societies in 1872 nearly a century after the Wollstonecraft treatise. The overwhelming attention to political rights subsumed the awakening interest of the feminists in the representation of women’s bodies. Yet the politics of body coverings-- the clothing, is an ironic subtext in many a writing by women. The clearer gender distinction between men’s and women’s dress in the 17th, 18th and 19th centuries led to a total inundation of the women in yards of fabric. Scientific sexism and racism sought to keep under wraps the rights of the marginalized, underprivileged women. One of the key concepts in feminist theory, one that underpins the Women’s Movement’s analysis of the subordinate status assigned to the women in the phallocentric culture, is the distinction between biological sex on the one hand and socially constructed gender on the other. This concept involves the recognition that while the sex of the individual depends upon the anatomy, gender is a culturally constructed artifact. As gender is the outcome of cultural and social artifacts, it conditioned responses to the body. Just as the body was kept “under wraps”, the problems of the body too were kept under wraps and could only be whispered behind closed doors.
Social Medicine
All 19th century texts of health have a section called Diseases of Women-- diseases that are related to reproductive health that is prioritized over other health related issues. Any study of anatomy or dissection focused more on the woman’s sexual parts and only skimmed her brain. The equation of womannature- body as opposed to man- nurture- culture sought to discriminate and confine the woman. This led to the woman’s sense of dissatisfaction and hatred of her body, an area that women writers of the age investigated. The instances of mental illness, the taboos that prevailed and the harsh treatment meted out to women, who were victims, were subjects explored by many women writers of the time-- examples: Charlotte Bronte, Charlotte Perkins Gilman and others. Institutions like St. Mary of Bethlehem Hospital for the insane in London were established as early as 1247 and were incorporated as a Royal Foundation in 1547. The doctors were all male till the 19th century after which women began to join the profession. Mental depression ranging from post partum depression to ante natal depression that raged among women added to problems related to repeated pregnancies and childbirth. The taboos related to contraception and abortion further clouded the issues.
Apart from quinine discovered by the Spaniards in America, iron and digitalis that were specific for diseases like malaria, anemia and heart diseases, medical drugs were not disease- specific. But the dream of medical men to use drugs like magic bullets aimed at the specific cause of the disease was finally a reality only by 1928 when Fleming discovered penicillin at St. Mary’s Hospital, Paddington. Other antibiotics like streptomycin, tetracycline, erythromycin and many others followed. Though antibiotics made a late appearance, England did have an established health service manned by the male doctors with a fair sprinkling of nurses after Florence Nightingale’s intervention in the Crimean War (1853- 56).
By 1842, an attempt had already been made in the field of social medicine, by Edwin Chadwick who first thought in terms of social control of diseases by dealing with their causes so that they were prevented from rising at all. His argument that it was necessary to provide clean drinking water to eliminate typhoid and cholera found favor with the legislators who took several measures for this, including framing laws. Chadwick helped to found the Poor Law Commission that produced a report in 1842, the principal suggestions of which were (a) a municipal water supply for all towns (b) a scientific drainage both in town and country (c) an independent health service with large powers for dealing with those who endangered the lives of others by polluting water and causing other inconveniences and (d) a national service for the internment of the dead for in those days bodies often remained for days without burial. Chadwick’s proposals were the earliest efforts to prevent bad health and had later been complemented by many efforts to maintain good health or rather the idea of positive health which led to the formation of the National Health Service which attempted to take care of the health needs of both the men and the women.
Medical Education for Women
If the idea of having a male doctor to attend or take over the service of the mid--wife was revolutionary in England in the 19th Century, the idea was outrageous to India, Britain’s colony. Indian families did not relish the idea of having male doctors to attend on women because of segregation. Dr. Ida Scudder of Vellore was inspired to go in for a medical education when she saw two young women dying within 24 hours of each other because their families did not allow male doctors to attend on them. Medical education for Indian women came about when medical missions from abroad observed the plight of Indian women. English education was introduced in India as early as 1813 but the education of the Indian women was largely ignored until 1840 when girls’ schools began to function. By the mid century, however, many girls were sent to schools-- especially after Lord Dalhousie, the Governor- General of India issued an education despatch in 1854 detailing the need for female education in India. Higher education, especially medical education remained a dream till 1883 when the Universities of Madras, Bombay, Calcutta and Lahore opened their doors to women for medical studies. Western medical training had long been available to Indian males but it was not until 1885 that Lady Dufferin, wife of the Viceroy, established the National Association for supplying Female Medical Aid to the Women of India— otherwise known as the Dufferin Fund. This association provided financial assistance to women willing to be trained as doctors, hospital assistants, nurses and midwives, aided in establishing medical training programs for women and encouraged construction of hospitals and dispensaries. Miss Anne Walker, a domiciled English woman was the first to qualify as doctor from the Mumbai University. Dr. Anandibai Joshi who studied at the Women’s Medical College at Philadelphia was the first Indian woman to qualify in medicine. Kerala was not far behind in women’s education. Mary PoonenLukose, born in 1886 graduated in medicine in 1915 and was appointed superintendent of the newly constructed 100 bed women’s hospital in Trivandrum in 1916. In 1924, she achieved distinction as the first woman to be made Acting Head of the Medical Department of Travancore State controlling 32 government hospitals, 40 government dispensaries and 20 grant-in-aid private institutions. 95% of the medical corps of the state was then constituted by men. What has to be noted is that the small State of Travancore had by 1915 more than 30 hospitals but even more importantly had introduced allopathic medicine and vaccination in the beginning of the 19th century itself. The indigenous medical systems like Ayurveda, Sidha and Unani flourished, for many people were interested in those systems of medicine.
Growth of Women’s Organizations
Practice of allopathic medicine and more concern with woman’s health that emerged by the end of the second and third decade of the 20th century coincided with the establishment of women’s organizations. But foregrounding this was the publication of Bankim Chandra’s Ananda Math (1882) that portrayed revolutionaries sacrificing their lives for the motherland. Bankim’s emotional hymn “BandeMatharam” served to link idealized womanhood with nationalism— thus attempting to place the body in political role. The women however, viewed this representation of the motherland as a call to women to join the political movement— something they desisted.
Between 1917 and 1927 three major organizations emerged in India-- the Women’s Indian Association, the National Council of Women in India and the All India Women’s Conference. The more important of the women’s organizations and the most truly Indian of the three was also the last to be formed. The AIWC-- All India Women’s Conference met in Poona in January 1927. Delegates to the Conference included a large number of professional educationalists as well as social reformers, women associated with the nationalist movement, the wealthy and the titled. Their specific resolutions stressed the importance of moral and physical education, deplored child marriage and urged special arrangements for educating women doomed to wear purdah. They believed that education should complement gender roles. By 1929 AIWC widened its scope to include all questions of social welfare. They opted to remain apolitical in order to preserve their identity. They traced the role of women historically and maintained that in ancient India, women had equal access to education, political power and wealth.
Child marriage had long been a thorny topic in British India. In 1860, the criminal code set the age of consent for both married and unmarried girls at ten years. The issue reappeared in 1880s and in 1891 the criminal code was amended to raise the age of consent to 12 years. A revival of interest in the age of marriage that happened in the 1920s can be traced to discussions in the League of Nations. In the wake of such interest, the new Sarada bill was to be implemented after the establishment of a select committee. The committee, in order to access public attitude sent out 8000 questionnaires. The women’s organizations promoted the legislation at every stage. They generated propaganda against child marriage, commented on proposed bills, petitioned, met with Joshi committee and lobbied to secure the passing of the Bill. Throughout the country AIWC branches organized meetings at which women’s opinion could be expressed. In their speeches women refused to confine their remarks to child marriage. Many women expressed the view that this was only one of the many customs that crushed their individuality and denied them opportunities for education of mind and body. Enforcing the act was an uphill task for many who practised child marriage. It was difficult to make a change and difficult to obtain a guilty verdict.
In the 1920s and 1930s, women’s organizations demanded educational and medical services for females. Separate institutions were required to deliver these services, for sex segregation norms prevented women from using institutions designed for men. Women leaders wanted new institutions to be staffed by female professionals. As is already stated, medicine was one of the new careers opened to Indian women in the late 19th century. In the early decades of the 20th century demand for women medical professionals grew. The demand came from middle class Indian women who regarded western medicine as modern and scientific. This led to the establishment of a new sector which was mandated to provide medical services for the government employees and the public and to establish clinics, hospitals, dispensaries. Most middle class women sought the services of women doctors. The supply of trained medical women did not equal the demand in those times. By 1929 however 19 men’s medical colleges and schools admitted women and there was one medical college and four medical schools for women alone. Attending men’s medical colleges presented a distinct set of challenges for young women. They faced a number of challenges as they embarked on their careers.
(a) It was difficult for them to combine family life with professional demands. Society had little tolerance for the
single woman.
(b) They had to contend with sexual harassment in work places. A case in point is the widely reported case of Dr (Miss) AhalyabaiSamant, the director of the municipal dispensary of Nadiad who was abducted and assaulted by
Dr BalabaiHarisankar Bhatt ended with Dr Bhatt getting off with a mere fine.
(c) The female doctor received less pay and had to contend with racial and gender discrimination.
Abortion and Social Issues.
The women however prevailed and by sheer grit and determination made themselves a powerful force in the sphere of health. The major problems women and by extension women doctors the world over faced were in the field of contraception and abortion. These issues were moreover part of a wide range of social issues ranging from perspective of social order, concern with overpopulation, solution to social problems, attitude to the concept of family, sexual freedom, sex equality, sexual deviation and/or abstinence, right of fertility control and the overwhelming question of abortion.
In Britain before the 19th century, it was only the middle class who had conservative sexual attitudes, who often attacked the upper class for its behavior. Amongst peasant groups, the young were allowed to express sexual feelings but premarital pregnancy was not encouraged. Contraception of a sort was therefore practised. Chastity was neither the dominant practice nor the ideology. The change in perspective is linked to the social and economic changes that occurred in the early part of the 19th century and influenced life considerably during the middle of the 19th century. This included:
(a) The worsening Economic situation of the working class which resulted in lower standards of morality among working
girls.
(b) The changing position of the middle classes which attempted to restrict women. Women were placed on a pedestal
and were supposed to embody the virtues of the home and not soil their hands with the evils of the world-- an idealization which led to chastity being greatly valued,
(c) Myths about sexuality; and
(d) Education and middle class virtues which led to the strengthening of conservative attitudes.
The fight for sex equality was thus part of an overall struggle for a changed society. Women argued that restrictions on women’s behavior were designed to support the patriarchal family and ensure safe transfer of property to the next generation. To counteract women’s oppression, they had to make marriage and divorce, personal decisions, while abortion and contraception had to be made available on demand. Although the supporters of Malthus were radical on contraception, they were totally opposed to abortion, while the medical profession was totally opposed both to contraception and abortion in the latter half of the 19th century. However the medical profession did take a more sympathetic view to the plight of women. Most doctors of 1890s were of the view that while illegal abortion was wrong, it was unfair that women should have to shoulder the blame. The church was opposed to birth control as surprisingly were the socialists too.
By the 1920s people became increasingly concerned with the change in sexual morality which had shown definite changes even before the war. However, it was only during the 1920s that the new attitudes became widely discussed. One focal point was the behavior of young people and the growth of a new youth culture with a distinctive style of dress. A new term “flappers” was coined in England to describe those who were assertive, independent and granted “permissive favors” to young men. Sex was no longer a sin to the young. For the first time the problems of sexually transmitted diseases and the need for birth control were hotly debated. By the 1930s the Malthusians had become respectable but the Catholic Church was their major enemy. Moreover some supporters of birth control like Mary Stopes, a member of Malthusian league in the war years, opposed abortion and even feared that the issue might harm her fight for birth control.