‘Aren’t the days of “doctor knows best” over?’: Why healthcare needs a feminist revolution

Q&A with Jennifer Block, author of Everything Below The Waist: Why Health Care Needs A Feminist Revolution

Block - cover art

Published in July 2019, Jennifer Block’s second book, Everything Below The Waist, explores problems with the American healthcare system from a feminist perspective.

American women visit more doctors, have more surgery, and fill more prescriptions than men. In Everything Below The Waist, Jennifer Block asks: Why is the life expectancy of women today declining relative to women in other high-income countries, and even relative to the generation before them?

We sat down with her to find out what a feminist healthcare revolution would look like. It’s worth noting that, while much of what Block talks about in this Q&A is relevant to the UK, some of it is specific to the US healthcare system.

Jennifer Block (c) Jade Beall
© Jade Beall

Of all the ‘below the waist’ issues you address in the book, which do you feel best epitomise the problems in women’s healthcare?

Maternity care really offers the most complete metaphor (it’s also the focus of my first book, Pushed, and what really led me to write this one). There is vast research evidence showing that the best outcomes, for both mother and baby, derive from care that supports “physiologic” childbirth: allowing labour to begin spontaneously, allowing for the labouring person to move around, offering physical touch and water immersion to cope with the contractions, offering food and drink, providing emotional support, and helping people push in upright positions. US medical management doesn’t typically follow this model: the majority of women are stuck in hospital beds, their contractions are induced or sped up with drugs, they can’t eat or drink, and they push in bed in positions that increase the likelihood of a tear or a C-section. Of course sometimes people need medical help to stay safe and healthy, but with nearly 1/3 of births happening by major surgery, we know these interventions are being overused. They’re being used beyond the threshold of benefit and are in fact causing harm – the concept we now call “over-treatment.” There’s also the documented problem of “obstetric violence,” in which patients’ rights are being violated.

The US healthcare system is failing all kinds of people, but I think women are especially vulnerable to over-treatment and mistreatment. One reason is because we dismiss and suppress healthy female physiology, not only in childbirth but throughout the lifespan: we routinely suppress the ovulatory cycle for years, perhaps decades, with hormonal contraception that has also become a panacea for treating everything from endometriosis to PCOS to acne. Later in life women tend to lose their uterus to hysterectomy – 1/3 of women by age 60. They’re often coping with real symptoms and the solution offered is “take it out,” as if the uterus has no function but procreation. But physiologists and physical therapists will tell you that the uterus is at the crossroads of many important pelvic structures – ligaments, nerves, blood vessels – and removing it can have enormous consequences for sexuality, mobility, continence, and mental health.

As one physician put it to me, in women’s health the approach tends to “cover up the symptoms, suppress the normal functions, and remove the organs.” We’re cavalier about female biology and organs, and it’s having a cost. We have a rising maternal death rate in the United States. Women’s life expectancies aren’t keeping up with our peer countries.

How has feminism’s relationship with women’s health changed since the 1970s?

When I talk to veterans of the feminist health movement of the 70s, their eyes light up and they sit on the edge of their chair. Back then they were curious about the female body, which had essentially been off-limits to them. So they grabbed specula and mirrors, started “self help” groups, reclaimed their bodies from male physicians, and demanded more respect. They resurrected midwifery and stood up for better research and transparency – the early birth control pill was causing strokes, and feminists demanded safer formulations and adequate labeling.

Then the self-help fervor died down and the focus of “women’s health” became access to medical technology, rather than a healthy skepticism of it. Part of this is political: “women’s health” and “reproductive rights” have largely been synonymous with abortion and contraception, and the bulk of movement energy and resources have had to go to defending access. And patient advocacy groups began taking industry money to survive, compromising their missions, and becoming conduits for pharma campaigns.

Do you see the over-treatment and medicalisation of women’s bodies as symptomatic of broader feminist issues?

Part of this is also ideological: as feminists we’ve associated medical technology with empowerment, i.e. the Pill, egg freezing, epidurals, mammograms, “pink Viagra” – whatever Medicine throws at us, we seem to embrace and defend it as giving us “more choice.” There’s also a line of feminist thinking that female physiology is itself oppressive, and therefore medical technology is liberating. So, for example, we end up fighting for “lactation rooms” rather than actual time with our babies. We’ve been settling for technological solutions to what are major social justice problems.

The framework of “reproductive justice” is more centered on people and their lived realities, rather than drugs and procedures. I think a healthy feminism thinks more critically about medical technology, rather accepting the banner of empowerment that industry often wraps each product or procedure in. On a positive note, I think the spirit of curiosity and skepticism of the 70s health feminists is having a resurgence, especially in the full-spectrum doula community, who are learning fertility awareness and perhaps even methods of early abortion.

What would a feminist healthcare revolution look like for you?

I think at its heart is a re-evaluation of how much we value female organs and physiology. If we start there, we’ll see more egalitarian contraceptive options; we’ll see more support for physiologic childbirth – funding for training up more midwives, for birth centres and doulas, more respectful care – and we’d see more nuanced treatment for our hormonal imbalances, fibroids, and perimenopausal symptoms, with fewer organ removals.

We’d also see major structural changes, so that people can have families and raise them in a healthy way. Babies need their parents – again, we have so much research on how critical the “fourth” trimester is for brain development, physical and mental health, and yet this country [the US] still has zero guaranteed parental leave. If we made it easier to have families, fewer people would need IVF, which carries risks that we’re not tracking in any meaningful way.

How can both healthcare practitioners and feminists work to make that happen?

As several physicians explained to me, OB/GYNs have a LOT on their plate. They’re doing primary care, “well woman” GYN care, high risk OB, low risk OB, hormones, and pelvic surgery. And they have a 4 year residency to learn all that. In other countries with better outcomes, they are more specialised, and they are not doing low-risk OB – that’s called midwifery in most places. I think women need specialists to more effectively treat things like endometriosis, PCOS, pelvic floor dysfunction, and fibroids. But what physicians told me is that many of these diseases exist in an area “where no one is an expert.”

A new feminist health movement thinks bigger and asks for more. Egg freezing is not the answer (the success rate is 2% to 12%). The Pill was revolutionary when it came into use in the 60s, but we’re in a different time. We’re no longer ignorant about how it’s impacting metabolism, bone health, mental health, sexual health. Even with abortion, we are still clinging to the idea of clinics. Clinics made sense in the 1970s, but they also ghettoised abortion into something other than “healthcare.”

Writing about women’s health today, I’m always struck by how much confusion there is. How can women navigate the division between, for example, contemporary medicine and traditional, holistic women’s health practitioners?

It can be so confusing, I agree! I think it’s important to understand that, historically, medical doctors have only had authority over healthcare for about 100 years, and that history is very tied up with patriarchy, white supremacy, and capitalism. They have a lot of the answers, but they don’t have all of them. And what’s accepted practice today may be refuted by research in ten years – the term is “medical reversals,” and there have been quite a lot of them, even in recent years. I think the best doctors are humble about the unknown, understand their place in history, and are open minded to their patients’ individual needs and journeys.

The most progressive physicians I talked to are partnering with physical therapists, nutritionists, acupuncturists, massage therapists, and midwives. They are calling themselves “integrative” and “functional” medical doctors. They understand that they’re a piece of the puzzle. Unfortunately there’s a huge burden on people who are trying to find effective treatments – to do research, seek second opinions, and pay out of pocket for everything – I want to recognise that, and that not everyone has equal access to those things. But I also think individuals should have more control over their care. Aren’t the days of “doctor knows best” over?


You can find Jennifer online and on Twitter

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