© 2017 Ekaterina BORODZDINA
2017 – №1 (13)
Keywords: gender studies, sociology of health, sociology of medicine, feminism
Abstract: In the work of scientific centers, social studies of medicine can take many different forms, depending on the disciplinary field, theoretical and methodological frameworks, research tasks. This text presents one of the possible approaches to studying health and disease – their analysis trough the lens of gender studies. In this text I consider the main principles of gender approach in the studies of medicine, as well as trace how this approach is applied in the scientific and educational activities of the “Gender Studies” program, European University in St. Petersburg.
Social studies of medicine is a vast thematic area that allows to use of different theoretical frameworks and raise various issues. In the Russian academic landscape, this area is represented by studies of health professions (Mansurov, Yurchenko 2010, Prisyazhnyuk 2013), projects on post-Soviet transformations in the institute of medicine (Shishkin et al., 2004, Yarskaya 2011), works on traditional medicine and healing practices (Sadykov 2013), socio-historical analysis (Michel 2000), etc.
This text is intended to draw the readers’ attention to one more area that is significant for studying health and illness as socially mediated phenomena – the perspective of gender studies – and its development in Russia. As an example, we will consider the program “Gender Studies” at the European University in St. Petersburg. The author graduated from the Master’s program at this university and is currently working here as a researcher. This experience and reflections on it (subjective, perhaps prejudiced, but at the same time as close as possible to what is happening “in fact”) are at the heart of this text.
The program “Gender Studies” is developing in line with the critical approach to gender and health issues. The main topic of projects implemented by the researchers at the program is medical assistance in the field of obstetrics and gynecology. Methodological priority is given to the qualitative paradigm of sociological research, ethnographic study of medical interactions, attention to the experience and opinions of patients and health professionals. Following feminist principles, researchers seek to demonstrate the many dimensions of inequality that are reproduced in healthcare, to identify and deconstruct power relationships in this field.
The program was opened on the basis of the Faculty of Political Science and Sociology of the European University in the autumn of 1997. Initially, the main directions of its research activities included the analysis of various aspects of the Soviet and post-Soviet gender order: the study of sexuality scenarios in the former union republics, transformation of masculinity, politicization of motherhood.
Research in the area of sociology of medicine and health started to be carried out under the Program since 2005. This topic became a priority in 2012 which was related to designation of a separate professorship inside the University on sociology of public health and gender. Anna Temkina became the head of this direction. Among the topics of research, one can mention the study of contraceptive practices (Temkina 2012), the study of abortion and legislation on abortion (Zdravomyslova 2009).
In their work, the researchers rely primarily on the qualitative methodology of sociological research: the questions they pose and solve relate not so much to macro-social laws as to how individual participants in social interactions interpret their own actions and the actions of others, what practical strategies they work out. The projects of the “Gender Studies” program incorporate feminist research principles: 1) reflexive attitude to the position of the researcher in the field, to how it influences the process and results of scientific inquiry; 2) not taking for granted “impartiality” of science; explication of the ideological (feminist) message; 3) giving prior attention to the voices of oppressed groups in the study of inequalities; 4) developing emancipatory potential of sociological work – both the research practice itself (for example, through the use of action-oriented methods of research) and its results (through attracting public attention to revealed manifestations of social injustice) (Zdravomyslova and Temkina, 2014).
In the past few years, the focus of the academic interests of the Program has been the issues of trust between the doctor and the patient in obstetric and gynecological care (Zdravomyslova and Temkina 2009). Emphasizing that this area is simultaneously gender sensitive and politicized, researchers analyze how the personified contact between physicians and their clients is achieved. This contact compensates for the overall institutional mistrust of the Russian system of obstetrics. Most attention is paid to educated, urban women who, in the context of commercialization of healthcare, have the opportunity to choose where and with whom to give birth, as well as the birth scenario. Some studies carried out under the Program also highlight the organization of obstetric care in maternity homes of Russian district centers (Novoknskaya 2016).
In addition to the perspective of patients which is traditionally significant for the feminist approach, the perspective of health professionals is also the subject of study. The studies carried out by the Program’s researchers shows that not only the clients but also the doctors themselves are interested in forming trustful, emotionally involved relationships with patients (Zdravomyslova and, Temkina 2012).
Studying the intersections of gender and medical professionalism, the authors largely rely on the analytical instruments of the sociology of care. Care is considered by them in two senses: 1) as a set of practices associated with professional care and emotional work, 2) as the logic of the organization of these practices, a particular modality of the relationship between agents and caretakers. Particular emphasis is placed on the needs of pregnant women and women in childbirth in the care of doctors, nurses and midwives, and not only in qualified medical care (Borozdina 2010, Melnikova 2014, Temkina 2016).
Borozdina, E.A. (2010) Na prieme u ginekologa: zabota kak sostavliaiushchaia professional’noi deiatel’nosti vracha [At a gynecologist’s appointment: caring as a component of the professional activity of a doctor], Zhenshchina v rossiiskom obshchestve [A woman in Russian society], 1, p. 77–90.
Borozdina, E.A. (2014) Iazyk nauki i iazyk liubvi: legitimatsiia nezavisimoi akusherskoi praktiki v Rossii [Language of Science and Language of Love: The Legitimation of Independent Midwifery Practice in Russia], Laboratorium6(1), p. 30–59.
Zdorov’e naseleniia i natsional’nye reformy: sotsial’no-antropologicheskii analiz[Public health and national reforms: socio-anthropological analysis] (2011) Pod red. V.N. Iarskoi, M.: Variant, TsSPGI.
Zdravomyslova, E.A. (2009) Gendernoe grazhdanstvo i abortnaia kul’tura [Gender citizenship and abortion culture]. Zdorov’e i doverie: gendernyi podkhod k reproduktivnoi meditsine[Health and trust: a gender approach to reproductive medicine], E.A.Zdravomyslova, A.A.Temkina (eds.), SPb: Izdatel’stvo Evropeiskogo universiteta v Sankt-Peterburge, s. 108–135.
Zdravomyslova, E.A., Temkina, A.A. (2009) «Vracham ia ne doveriaiu», no… Preodolenie nedoveriia k reproduktivnoi meditsine [“I do not trust doctors,” but … Overcoming distrust in reproductive medicine]. Zdorov’e i doverie: gendernyi podkhod k reproduktivnoi meditsine[Health and trust: a gender approach to reproductive medicine], E.A.Zdravomyslova, A.A.Temkina (eds.), SPb: Izdatel’stvo Evropeiskogo universiteta v Sankt-Peterburge, s. 179–210.
Zdravomyslova, E.A., Temkina, A.A. (2012) Doveritel’noe sotrudnichestvo vo vzaimodeistvii vracha i patsientki: vzgliad akushera-ginekologa, Zdorov’e i intimnaia zhizn’: sotsiologicheskie podkhody, pod red. E.A. Zdravomyslovoi i A.A.Temkinoi, SPb: Izdatel’stvo Evropeiskogo universiteta v Sankt-Peterburge, s. 23–53.
Zdravomyslova, E.A., Temkina, A.A. (2014) Feministskie refleksii o polevom issledovanii [Feminist reflection on the field study], Laboratorium, 1, p. 84–112.
Kuznetsova, V., Bogdanova, L.-M. (2014) Akusherskoe delo: vremia peremen (vzgliad iznutri) [Obstetrics: time of change (a look from within)], Zhurnal issledovanii sotsial’noi politiki [Journal of Social Policy Research], 12(4), p. 467–473.
Mansurov, V. A., Iurchenko, O. V. (2010) Professional’naia ideologiia al’truizma rossiiskikh vrachei [Professional ideology of altruism of Russian doctors], Vestnik Instituta sotsiologii[Bulletin of the Institute of Sociology], 1: 397–410.
Mel’nikova, O.O. (2014) Meditsinskaia pomoshch’ vo vremia rodov: zabota i tekhnologii [Medical care during labor: care and technology], Zhurnal issledovanii sotsial’noi politiki[Journal of Social Policy Studies], 12(3), p. 337–352.
Mikhel’, D.V. (2000) Voploshchennyi chelovek. Zapadnaia kul’tura, meditsinskii kontrol’ i telo[Embodied Human. Western culture, medical control and the body], Saratov: Izd-vo Saratovskogo un-ta.
Novkunskaia, A. (2016) Raspredelenie otvetstvennosti v oblasti Reproduktivnogo zdorov’ia: perspektiva akusherov-ginekologov [Distribution of responsibility in the field of reproductive health: the perspective of obstetrician-gynecologists], Laboratorium8(2), p. 50–75.
Prisiazhniuk, D. I. (2013) Dinamika professional’nogo statusa vrachei poliklinik v 2000-kh godakh [Dynamics of professional status of doctors in polyclinics in the 2000], Professii sotsial’nogo gosudarstva [Professions of the welfare state], P. V. Romanov, E. R. Iarskaia-Smirnova (red.), M.: OOO «Variant», TsSPGI, s. 75–90.
Sadykov, R. A. (2013) Osobennosti professionalizatsii vrachei al’ternativnoi meditsiny: sluchai vrachei-gomeopatov [Features of professionalization of alternative medicine doctors: the case of homeopathic physicians], Vestnik Tomskogo gosudarstvennogo universiteta. Filosofiia. Sotsiologiia. Politologiia[,Bulletin of Tomsk State University. Philosophy. Sociology. Political science,], 23(3), p. 162–178.
Temkina, A.A. (2012) Kontratseptivnye praktiki rossiiskikh zhenshchin: (bez)opasnost’ i medikalizatsiia. «Zdorov’e i intimnaia zhizn’: sotsiologicheskie podkhody» [Contraceptive practices of Russian women: (without) danger and medication. “Health and intimate life: sociological approaches”], Zdorov’e i intimnaia zhizn’: sotsiologicheskie podkhody [Health and intimate life: sociological approaches], E.A. Zdravomyslova i A.A.Temkina (eds.), SPb: Izdatel’stvo Evropeiskogo universiteta v Sankt-Peterburge, p. 210–240.
Temkina, A.A. (2016) Oplachivaemaia zabota i bezopasnost’: chto prodaetsia i pokupaetsia v rodil’nykh domakh? [Paid care and safety: what is sold and bought in maternity hospitals?] Sotsiologiia vlasti [Sociology of Power], 28(1), p. 76–106.
Shishkin, S.V., Besstremiannaia, G.E., Krasil’nikova, M.D., Ovcharova, L.N., Chernets, V.A., Chirikova, A.E., Shilova, L.S. (2004) Rossiiskoe zdravookhranenie: oplata za nalichnyi raschet [Russian health care: cash payment], M.: Nezavisimyi institut sotsial’noi politiki.
Annandale, E., Clark J. (1996) What is Gender? Feminist Theory and the Sociology of Human Reproduction, Sociology of Health and Illness, 18(1), p.17–44.
This article is available in full version in Russian