Wouat and r{cdicalization:

Ncw pcrtpcctipc

4V

our expcriencc of thcm has bcen transformeci. For rvomcn

t nomen have bccn thc main

targ:6 in thc cxparxion of mcdiclic. Thcsc scholars havc analrzed ho*,

prcvious rcligious justifications or pauiarchy rvcre transformcd into

scientific
ones (Ehrcnrcich and English 1979). They he'c described ho*- nomen,s
traditional s.kills for rnanaging birth aad cuing for c sick rrerc cxpropriated
by psychomcdical expcrrs at e end of the ninetccnth ccntu4,
1hrenreich
T1 _r"d.rtt 1973). Feminisr *ritcrs ha'e describca oe mitpte rvays in

4
Women and Med icalization

c contcmporary pcriod is being icoparized

a male coatrolled, rechnologl'-dorninated medicat .r.. q,i..- jDreifus
1978; Frankfort 1972; Ruzek 1978; Seaman 1972). Thcse .tio h",o b..r,
vgices in changing * omen's consciousncss about eir hcalth. They
1mno11nt
ha'e idendfied the scxual polirics embcdded in conccptions of sckness an
beliefs^about appropriate care. In addiiion, ey havc providcd e anall'tic
basis for a social mol/ernent at has as im primary g"d rh. reclainrinj of
know'ledgc about and control orer nomen's bodics.
femiiiists have not
*4rich *'omcn's heal in
b1,

Netv Perspective

CernrzuNp

Kolrun furssrm-x

:\
ofnro h1'porheses. The 6rst is that
ofsocial
deviation
can be consiucred an illntss. Thus,
ctcri'torm
an illncss, thcn crininals
bcharior
can
be
ccnsidcred
ifcrirrinal
' - r?c'nr-td bi idn'dcmrid or punishef b:ut tcr bt urdenlood-(as.
Illncss expands bv mcans

"

docror understands), trcated, curcd. Thc second is

at

'

'

siqcdand lost ,i the

everr'

illncss carr be considtrcd psl'chologicalh'. Illness is interpreted as,

besicelli', a ps1'chological elcnt, and people are encouraged ro

belicrc that thev get sick bccausc the (unconxiouslr) s'sn1 16,
and that thcl'can cure cmscltcs b.v e rnobilization oiuill; thar
thet can choosc not to die of thc discasc. These nvo hrpthescs
arc <omplcrncntarl'.

rcinstates

it.

fu thc first scems to reliete guilt, the

This papcr s,ill eltend e feminisr critique \ emphasizing som neglected dimcnsions ofrnedicalization and * ome nos rires. iu,il argue at bo
physicians and rvomen ha*e contributed to e redening of *'omen's cxpe-

second

Pstchological thcorics ofillncss arc a pou'crfirl means

of phcing tlrc blamc on thc ill. Paticnts *'ho arc insuucted that
tlret hatc, unt'itting[1', causcd thcir discase are also made to ttel
that thcv heve <lescn'cd it.
Sus.ru Sosra, 1979

It is s'idcl1' acknorvlcdged that illncss has becomc a culrural rnctaphor for

a vxsr arrrv of hurnan problcms. Thc rrrclllcai n!{ci is trsc.i froni birtl: to
d.t'ad}.[n-tLelo.ikonqtructial]realiq:-Iii$o-kllv,
of critical

as,

!]llsr

cvcruBl-l]uman

()rir.:n:llv irutrlisircd

"\ibrncn

and Mcdicaii;:ator:: Ncrr lcrste

.\v..:.|::,:)l,(\'()l:!]]:l1t'l,i'I1l..)_l..)/r.,nl,,'l1l,})ilUt|l|\l|Cr1()\.\1^i.1'
\' ... \' -,1- \'\' I rrlr lr.
irs

nuntbe!

ricnce into medical categories. .\Iore prcciscll', I u'ill suggesr thar physicins
scek to medicalize expericnce becausc of rhcir specific b.ti.6 *a i.onomic
interests. Thesc ideologicai and material :,oti'es arc rerated ro e development of e profession and e speciiic market conditions it faces in an1, gi.,en
period- lvomcn collaborate in e rnedicalization proccss bccausc of ttrcir o*.n
nceds and morives, u'hich irr rurn gro\r'our of c class-specific narure of their
subordination. In addition, oer groups bring economic intcrcsts to which
both ph1'sicians and *'omen arc responsi'e . Thus a conseflsus dererops that a
particular human proble m rvill be understood in clinical terms. This conscnsus
is tenuous because it is fraught *'ith contradicdons for s,omen, since as statcd
,
before, e1'stand borh to gain and to losc iiom this redcfinition.
I *ill explore tliis thesis b' c.ranrining . . . chilcibirtir [anci] rcproductivc

control. . .

'

fh6 |',[sdiceIization
ctilc,- (lathcriiic

K- llic:;:;iil:n
-.. 1...-.,. .,...:..,.

Frameri.ork

Tlre term mzditalizirti,;t,l rci-;-s

(ici5 ro
li, lrio
r\\r, ::t:Jri('lJtcd
iirrtt-relatcd nri)ccsscs. F-i
itrsl. ccrtJiij
IlCil;'.'iCrSCfCOnd:l;)i:i:,;-i.::,,.- r..:,.-: ,...,,,;,,,,-.i.r,;.,i,.ii.,,,,iirrt,..,r,.

THE SOCIAL CO}'STRUCZON OF WOMET|'S BODIES

lltouuu and ){cdicali=ttion:

New Prrryectioe

49

of the populace takes piace u'hen cxperrs mnge human erpericnces, The
application of medical definitions makes it more likch'that medica.l remedics
MEDICALIZATION
ndl be applied, therebv increasing the risk of iatrogenic diseasc. In addidon-

culpa/doena
phcres of deviance

at

havc come under mccal social control (Ehrenreich and Ehrenreich 1978;
Freidrcn l97A1,Z-ola 1972). \rariou human conditions such as alcoholism,
opiate addiction, and homoscxuality-s'hich at one time u'ere categorized as
'bad'-have morc rccendr becn classified as 'sick" (Conrad and Schrreider
I980a). Currently, more and more of human experiencc is coming under
medical scrutinl', resulting in rr'hat Illich (1976)has calleci'..-.p"digliaqgo:
af [L] For cxarnple, it is nou'considered appropriate to consult physi.;"r'tt
about scxualiq', fertiliq, childhcod behavior, and old-age men'rorv problems.
It is important to note that the nredical profession's iurisdicrion over thesc
and oer human conditions crtends considerabll' beond iu demonstraterl
capac to 'cure" cm (Freidson 1970).
Thcre is disagreement abiout rvhat causes medicalizarion. Some hai'e
*medic.rl
is e outcome of
assumed at e cxpansicr, of rr,edical iuriilction
-pittssio"
-imp;alisri--",i
-pait'or
ro ii',cii"i.-i1-Jpo*'e r
iroir on e
*e
(Illich 1976). Oers have argued tht an increasingh'complex tecl'rnical and
bu;eaucratic society has lcd to a relucmnt reliance on scientific erpcrts (Zola
L972, L975). Othcr scholars have stresscd the u'als in rvhich the medical
establishment, in its rust to professionalize, organized to create aud thcn
control markcts (I^arson l97V). ln order for the occupational strateg' of
is ernerging professional class to succeed, it rtas necessarv to control rhc
mcaning of ings, includin-s interpretations of s1'mptoms and beliefs about
heal carc. Stated d.ifferenrlr; professional dominancc could be achieved onlv
if people could bc convinced of the medical nature of eir problenrs and tl.re
appropriateness of medical tcatment for em. Thus phvsicians, as par! of
an occupational strategl', creatcd conditions under u'hich thcir advicc seemed
appropriate (Starr 1982 )In spitc of the disagrcemenr alrout u'hat motivares medicalization, therc
is a consensus at it has mired cffects. Grcatcr humanitarianisnr, tolcrancc,
*progrcss" na1' be morc like h'u'ith medical
and oer benefits associated n'ith
definitions than u,ith crinrinal oncs. Yct medical labcling also has ncgarivc
social consequences. Far from reducing stignra, thc labcl of illncss nla)' crr:ate de'.'iance. For exainplc, thc carccr of a psychiatric p,rtierit lregins u'itli
a cliagnosis of schizophrcnia. s a rcsuit, fanrih' and tricnds perccive and
intcrpret the patient's bchavior in light <-lf rhc illness, cvcn rficr thc acutc
s\lnptoms subsiCc (I'lills l92;. t:othcr c()nscqiicrtcc oi nrcciic;riizatiorr is
tl:at the shroud of nrcd;c;l iengulqt i.-r,r;tiiits hltniait pr'<;lt!ttns. :rnd tltus
ptrl:iic ,ic'l ,ti. i il,.,,i rrt'-i ;ii':.1 3cli ncitl':r i >r li ).r r. .:. ricskiiit lr :
'.'cmovcs thcm fron-r

both the meaning and intcrpretation of an erperience is tran.?rmed rvhen it

is scen as a diserse or svndrome (Freidson 1970). For example. rhe mcaning
of murder is significandl altered x'hcn rhe label of "sociopathic personaliq.;

is uscd ro ccounr for the behavior. In this s'av, moral issues tend not be
faced and nlal- nor eren be raised (Zola 1975). Finallv and most imporrant,
of e social causes of disease is diminishcd rvith medicalization. s
Stark and Flitcraft (1982) state:
a\\'re ness

r\{edicinc amracts public resourccs out ofproportion to its capacin tor hcalth
e nhancemcnq bccausc ir oen categorizes problems fundemcntallr social in
origin as biological or personal de6cits, and in so doing smothcrs e impulse
lor social chenge s'lulh could offcr c onll'serious resolution.

\ledica[zadon

is a prardcularll' crirical

because

it emphasizes e

ior an
constructed r}r:ough human action

nor sufEcicnt

illne:s
is rto-t-inheren-t in ani

is

to nredical labeling. For cxample, children's beharior is medicalized under

ruLrric of jurcnilc delinqucncy and h1'perkincsis (Conrad and Schneidcr
1980a). Old preoplc's mentl funcdoning is labclcd organic brain srndrome
or senilin'. Racial minorities, s'hen thev come in contact ui psvchiatrists,
arc morc likclr rhan n'hites to bc given more severe diagnoscs for comparable
svnrpt()ms and to receire more coercirc fornrs of medical social control, such
as pstchiatric hospitalization (Gross er al. l99). \Vomcn, as I sill argue,
arc lnore likel rhan nren ro have problenratic clpericnccsdcfineci and trcatcd
nrcdicaiiv. In e ach of rhe se e xamplcs, it is important ro note that c particular
{iroup's economic and social pou'erlessncss legitimatcs its 'protection' bv
mcclicrl autlrorities. Of course, ph1'sicians act on behalf of the largcr socieq',
ihu: ti:: tl:cr rcinhrrcing cristing pori'er rclarions.
liirough nrctl;calization theorv has ernphasized pos'cr, it h:s tendcd to
n.':i;rir:;i,rc thc signiliclncc <.riciass. Historicaiii; as i rviil suggest. thc medical-

i.'.:,,;: .ij-i'i'i;.;ii':pi',,i,1,.,-<.i.rsroott,li!.tE-lGTffi.

l[i:si.iai

Womcn

THE SOCIAL CONSTRJCTTON OF I'I/OEN'S BODTES

50

very differcnt
\l'omcn from the donrinant class joined togcther-albeit out of
wblcn
ctBorie'
nredical
into
erents
moti{es*to rcdcfine ccrtain human
these
resisted
timcs
at
other
and
enrbraccd
groups
dmcs
er
tiom othcr class
cxperiencc'
of
definitions
class-bascd

Insum,enrc+licalizadonframcrr.orkpror,idcsusefulanallticcategones

the
(
ror.*"rn*i"g e mcdicalization ofx omcn's problems as a funcdon of t )
and
wornen;
of
needs
(2)
class-spccific
thc
inr.r.r* arrd"bcu.f, of phrsicians;
(3) c *fit' ber'ccn cse, resulting in a consensus that redc6nes a human
*p".i.n* as a medical problcm. ls itated before, I *l use this framc'ork to
;.. childbir [and] reproducri'e conrrol. . . . clearll" bccause of spaccI
Instead,
considerations, it is imjossible to discuss each exmple in dep.
I pcrcci'e
as
issues
the
la1'out
and
problem
each
at
i,of. ,o prortae a frcsh tok
thenr at is Point.

Childbir
This rvas not
Todal', pregnancl' and birth are consiciercd oredical ecnts'
condidon
in
either
inhcrcnt
nothingis
there
.1.,.r,.-.'ihe-crse. Moreor.er,
an uncomplicated
is
birth
fct,
In
scrudnr'.
m.di."l
routine
that nccessita;es
\ltrtz 1979)' In order
f.o..r. in roughll' 90 percent of ca-se1 -fy:*: and
be analyzed as the
it
must
to unCerstand the medicalization of childi;irth,

;;r;;iri;:"tleopt."

icioplitilal

prcesls

iri i'tiich'both

'
ptrviiiLns anc -

\\'omen parciPated

In mid-ninctcenth-ccnturl' merica, rirruatll' anr'one could bc a doctor'

of hcale rs-a series of compering sects 'itil

physicians'
varl,ing ler:els of training. Theslncluded "regular' college-trarned
mde
ph1'sicians'
botanic
homeoPaths,
phisiclans rrained ty aiprcnticeship,
s a result, the re 'as n ot'ersupplv

,...oo.h.u,,'midvives,.andothcrhea.ler-s(Drachman1979)'The*rcgu.

profe^ssional
lar" phlsicians-rvhite, upqcr'class nlales-suuggled to chi\'e
shifted' 1.
la'
control
and
domin"".. as boundaries bet*,ecn professiona!
hcaling
the
over
control
sought
group
this
is important to cmphasizc that
compctitors
their
rhan
cffecti'e
morc
n,
thc.v,,or.
*hen
.n,.rprir. ar dme

incu,ingdistase.Asl-arson(1977)hastroted,thedit.lusionofknorr'lcdge

medical carc
abour scientific discorrrics in microbiologt'that rcYolutionized

occurredonll'aftcrmedicincsuccessfullt,gainedcontrolor.erehcaling
to convert
markcr. Thui, in the absencc ol superior skill, it \1.s necesery
publicperceptions'Inordcrtogain.culturalauthoriq.,(Starr1982)or'er
healthserces,
clcfinitions of lrealth and discasc and ovcr thc proYision of

*rcgular,' doctors had to transform gctreral hltman skills into tl'reir cxclusive
thc political activities
craft. socia! historians cf mcdicine lra.,'e doc'.rr::ented
*reeular" doctors in late
for
shoP
cl<;scd
a
guaranteeing
in
succeeded

that

nincteenth- ,nd
\\illSll

lv,/ /

J'

"r.ly

rventictli-ccnttlr' Amcrica (lkrcrbv antl

Rosner 1979;

'as chilci ccntral arcni tirr thc strrrggic l:r'cr llrtlilssi'Ll'i'ii .ioi-lrii'iriiicc
t,il.tir. ir, tttktni.ri ntelica, tlrir..'.,.,1 \1":.: hrtrr.iicij ircri':r,i'!iil.rilti'r' ll1' fsfi.!'r1c

atd Medicalimtiott: A

New Perspcctioc

5l

midwivcs who, assisted by a nenvork of female relatives and icnds, provided

cmotionl suppoft and practical assistance to thc pregnant l\'oman bo during the acnral

bir

and in thc rveeks at follos,ed. Ovcr a pcriod of more than

centur)','social childbir" s'as replaced (llhrtz and Wertz 1979). The sitc
of cai. siftcd from the homc to thc hospital. The pcrsonncl ro gave care
changed from female midives to mlc phlsicians. The techniques changed
from noninterventionist approaches to approaches relpng on tcchnologl'
and drugs. s a consequcnce, e mening of childbirth for somen ivas
tansformcd from a human experience to a medical-technical problcm.
A crucial historical juncn:re in c medicalization of childbirth occurred
in e sccond dccadc of the nrrnticth cennrn'. In I9I0, about 50 prcent of
all rcported birs wcre attcnded by m:driirrs. Thc mcdicd profcssion and dre
a

laity generally belicved at e midwife--<ssentially a domestic s'orkcr-s'as

an adequatc bir attcndant. Nature s,as thought to control the process of
birth. s a result, ere u'as l.itde to be done in casc ofdificulgr The teaching
ofobsteuics in medical schools rras minimal, and direct cxperiencc s'ith birth
by medical students was rae (Kobrin 196).
Bcginning around 19I0, e contest began bcnveen e emerging specialn'
of obstctrics, c general practitioner, and e midwife. lthough seeminglr'
about issues ofsciencc and efficaq,, is strugglc ..r'as also about class and race.
Obstetricians wcre
from the donlnant c-!rss, whreas- midryiyes u'ere-5ap5tl1'
imigrnr * Eracr o'i',in. 3 n" ggi., g, diff.r.nite- cmsc lr i" fror"
general practitioners, obstctricians fought to upgrade the image of their field.
They searchcd ficr a respcctable science to legitimate cir s'ork. Thel' argued
at normal pregnncy and parturition \\'cre an excepuon rrther an thc
rule- Bccausc ey believed that birth rvas a pathological process, obstetricians
often used igical inten'entions as lr'ell as instruments such as high forceps
preous to sufficient dilation. These approaches, used routinelv and ofter,
unneccssarill', equcndy had dclcterious effccts on bo moer and child.
Over a period of mvcral dccadcs, obstctricians n'erc succcssfi:l in persuading
bo their physician coeagues and e gencral public ofthe 'fallaq'of nornral
pregnanq',' and therefore of the need for a 'science" of obstctrical practice.
Thcir political activitics, couplcd wi changing<cmographic trcnds, resulted
in the dcmisc of midwifcrv (Kobrin 196).
It is important to note at e medical management of childbirth did
not result in grcater safe'for s'omen, at least in e short run. Thc evidcnce
suggests that both maternal and infant mortaliry rates actualll' rose during
the period benveen t9i5 and 1930 u'hen midu'ives'aftcndarrce at tirth
abruptly dcclined (Wertz and \Yertz 1979).In the long run, thcre has bccn
a stcadi' decline in dca rates, ri{rich has ctiincided with modcrn chiitibirth
practice . Hu,ever, it is not clear hos'rnuch of this dccline is due to improvcd
environmental circumstances and nutrition and horv much to nledicai crrc.
ln light of these facts, 11'h21 slslivaie d u'omcn to go alone ii'itir tlrc mcti icalizltion of childbirthi i',ccause chilcil-irth is an event that occurs ri'iihi','.ii
con-rrllicri()ns in m<lst cascr. it is tct'rpiina to cmpiiasizc thi: nl,1n1'los:;ts rir,ll

52

lbun

THE SOCTAL CONSTR UCTION OT II/OMEN'S BO D I ES

romanticize e midu,ifc and pretechnological childbir and fail to consider

e contradictc,ry naturc of the process.
Womcn participatcd in c medicalizauon of childbir for a complex set
of reasoru. First, nineteen-ccnru4'women rvanred freedom from thc pain,
caustion, and lingering incapacitl'ofchildbirth. Pregnanq'errr,v oer year
was the norm for married \vomen, and this took a significant toll on thc
rcproducti're organs. Conuaception was not a riable alternadvc, for reasons
I will discuss shortly. For rvorking-class t'omen, e problems of matcrniq'
wcrc intcnsificd by harsh working and housing condirions. The lencrs of
early tt'enricth-ccntuq's'orking class rvomen vividlv portral' the exhaustion
of mocrhood (Davies 1978). lbcit for diterent resons! rvomen from
differcnt class groups cxperienced birth as a terri'ing ordeal (Dte 1980).
In thc carl,v decades of e nventieth cenrur\; relief fronr the pain of

chitdbir

i
.

rvas promiscd

wi 'nrght

sleep," a conrbintion of morphine

scpo!nrtdrvhch-Europc-r'phJ6'icirsttadtgun"to usel Historical

analpis of e nrilight sleep movement in thc Llnited States reveals at
ir rvas rvomcn rvo dcmanded it. equentlv pitting thcmselves against dre
mcdical profession who both rcsentcd iay interference and eared thc dange rs
ofc drug (Lraviu 1980). Thcsc somen-middle - and uppcr-class reformers
wi a progressirrc ideolg-1,-11'anted to alter c oppressive circunrstances of
women's livcs. Thus, e demand for anesesia in childbirth rvas part of a
largcr social movcment. Prcgnanq'rl,as no longer seen as a condirion to be
cndured u'ith faulism and passiviq'(Smi-Rosenberg and Rosenberg 1973).
As Miller (L979, ariues. people bclieved at citilization had increased e
subjectivc expcricnce of pain in childbirth, and rhat ancsthesi s'ould once
again makc childbirth natural. The upper class experienced greater pain an
*'orking-class icncn, s'ho rrere ought to be morc like prinritive peoples.
Pcople bclio-ed that uppcr-class womcn had been pardculady s'atped b1'
cir.'iiization. (Thc corset also mav have distorteci their inrcrnai organs.) In
oer rvordso pain had accompanicd the progress of civilizarion. If frced from
painfut and crhausting labor, \l'omcn could (thc rcfornrers felt) nrorc futl1'
participate in democradc socien' ( Millcr 1979 ).
Sccond, because of declining fcrtilitv in upper- and nriddle -ciass l\'omen
at thc end of c nincteenth cenrur),, thc mcaning of birth ivas particularll'
significant to thcm. Because childbirth rvas a lcss fiequcnt cvcnt) concern
about ctal death was grcater. In addition, \\'onrcn scrc iarlLri lrccause it
was comnron to have knorvn somconc u'ho hrii t'lied in clriltlbirth (Di'e
1980). Thus..r'e!l-to-do il,omcn rvanted to bc atrtnC,:d !...'iiocicrs not

Nw

Pcrspeetitrc

53

onh' becausc ei' rrerc of higrcr social starus compared to mid*ives but
also because ther possesscd e instruments and surgical techniques at
might be bcneficial in cases of prolorrged labor" toxemia, fctar disticss, and
oer abnormal conditions. of course . phr:icians used thcse fears to gain
conuol over the entire markcr. includine routine births.
Thus, the demise of miduiter'and the resukanr med.icalization of childbir t'ere consequences of tbrces s-iin e rr-onten's communin, as rvell
as from outside ir. Furermore, ir *'as a class-specific process. llUl-to-do
lr'omen 'anted ro reduce rhe control that biologY had ovcr eir lircs. They
rranted freedom from pain. Bccause of eir rcfincmenq mcdical ideology
of the period insisred ar n'ell-do-do \\-omen llrre morc delicate ald hence
morc likely to experience pain and complicadons. Bv contrasr, *orking-class
ll'omen rvere belie.ed to be inherentlv stronger (con 1972). pcrhaps as a

accompenied itsmcdicalization. In modern bir, thct'onran is removcd kom

familiar surrouadings, from kin and social support, and subjected to a scries of
tcchnical procedurcs-many of 'n'hich arc de humanizing and ocrs of s'hich
carry significant hcal risks (Roman 1982; Sharv 1974). rvoman's expe ricncc of bir is dicnated bcc-';c the social rclations and instrumentadon
of e mcdical setting remove hcr control orer the experie nce (Ibung 1984).
Bccause ofthesc ncgativc conscquences of modcrn bir, erc is a tendeno'to

'"': '- ' 'nd

and J{tilicaligttion:

*'a' of

resisting ese idcological assumprions, *'ell-ro-do \\'omen ivanted

conuol o'er rhe biring process-e nght to decide rat kind of labor
and

delirrrt'er s'ould

hare. The contradicrion rr.as

ar e method ese

\r.'omen demanded--eoing to slerg-put em onr ofcontrol (Leavitt

Obstetricians also u'anted conrrol. Thev bclicred that birth u,as a

I9g0).
pao-

ar 'sciendfic birth" *ould resuk in grearer safn. for

affluent \\'omcn esper-iallr. h addition, ir *'as in lhe interest of phvsicians
to caprllre the childbirrh marker, because is event proded a garew\,to
e-famii1,,-and-hcnce .thc 'entirr ealkrg rharlret-lVertz erid Utftz -lg7g)'.logical prrxess and

-'

'

Phlsicians wcre pardcularlr aruiious to attend rhe birrhs ofurll-to-do *,omen,

because the social starus of cse \\omen lent legitimao'and respectabilin,to
the shitt rom mid*'ittn' to obstetrics Drachman L979). rn order to control
childbirth, phvsicians needed drues and tcchnologt' ro appcar indispensable
(r\iller 1979). Theret-ore, rhe'*cn! alons x'ith nr.ilight slcep, ar leasr tbr a
time . The iron' for \\'omcn *'as ar is approach ro thc pain of childbirth
serr-ed to distance llomen from cir bodies and redefinc birth as al c\.ent
requiring hosp:talization and phlsician artendance (Leavin 19801.

Currentl'r; e medicalizarion ol childbirth is taking neu' fornrs. First,

therc is the strikinglt high rare of cesarean delilcries-2I.2% of .{merican
babies

as of-

1994

(\tntura

for maternal health

caesarcans

et al., 199-1
as rvell as infanr

1.

Although sonre ofthcsc are necessar)r

sunital, er{dence suggesr that many

are unnecessrr (O'Driscoll and Folet 1983). In r.ier of medi-

calizidon, it is important to point out that thc potcntial need or ccsarcan

places childbirth squarel.r'and e:iclusivelt in the hands ofthe phvsician. Vaginal
dclilcn; bv conlrast, c:n be e protince of nonphtsicin crperts, such as
nursc

nr id

s'ives.

Scccrnd, there is a rrend to nrake the birtl'r e.tpcricnce morc hunranc.

for both nrothcr and babr'. Hospitals are devcloping *birthing rooms" and

other rltcrnati..es to the usu:l dclivcrv coilr tiiiosphcrc of stcci t:rLrlcs,

stirrui.s, anci brigt lights- .{ficr birth, marcrnai-intinr c()ntcr is pcrnrirtcci
so as ii) fi;,ster "bonding." I)cdiarriciens bclicvc th.rt: critica! pcrioci cxisls br'
tht dcr'11r.'1-.111cnt oi;rit opiii:irl rcl;rrionsl'rio bcnrccll rrrorlrci-:;tii ;:crrirol't

rHE SACIAL CONSTRUCrION OF WOMEN'S BODIES

llToncn and X{cd.icolizaion:

(Klaus and Kcanell 19Z6). Thus, pcdiatricians arc joining o stcuicians

in
nredicalizing c childbirth exp:ericncc. By dcfininj rvhJ should be (and
thcrcforc u'har is) de'iant, pcdiaricians crearc social-norms for parerrting.
Thc contradiction isthat thc rccenr changes in e hospital enuironerrt
of bir have bo helped and hurt *'omen. nirtrring ro.msand earll,contact
l'rnr-ecn rnoer and nervborn arc a *,elcome changom previous oppressi'c
obsteuical and pediatric practiccs (r'hich poor womcr,,ti[ f"c" bccause
these
reforms are more characteristic of cte hospitals than of public oncs). yer
e contemporary feminist critiouc of childbirth practicc has bccn cur shorr
b1' csc reforms. As in mant' reform *orra-a.rar, rarger issues
arc silenced.
challenges to e medical dominadon ofpr.gn*q'* demands for genuine
demedicalization have becn co-opted by an exclusil'c focus on tti" uirtt,

infants.

of caring ,

".h;;;;:,dae responsibilidcs of cir seemingh, biologicallv

termrncd rolc. {ohr (1978) argucs ar physicians led e moral crusaC- rgainst abor_
tion not so much our of thcsc antifeminist fecngs, but primaily
il;;J;,
to restrict c practice of mcdicinc. The' wanrcd to g.t .id
('irreg,lars' and *docrresscs') and gain a monopoly ov-er th. p.r.,i..irn.a"r."-p.uio..
icine. 81- alte ring public opinion and pca*ading regirr*""r, ,r,."
,u.....a i.,
establshing eir codc of eics (rvhich spccifically excludea.u".u""ir.

basis for profcssional practice. These acdons limiied e scopc

compe-ti-tors, espcciallt' ..'omen doctors s'hose practice, ,.,ara

..iJ.

"rn a ao ,t.
do,ot
care.of female complainrs. Br e rate 1870s, anti-abortion staruter.."..
.r-.
the book- Professi.nar dominance *,as furer strengthcned
in the lgg0;

*'hen phlsicians became more organized. They used te scientific

prr.aiil )
to force morc and more blk practitioncrs frorn e ficld.
!t is intercsting ro notc e social relations at
prospcrous families
ITI(,VCmem:

Abortion

for rhc anti-abonion

\l.Omen t

Todai, aborrion is treated as a medica! e'ent. yct in previous historical periods,

ir *as defined in nonmecical terms. phyricians brught specific prossio'al
and ciass inrerests to the abortion issue in e nineteni..ra,rry. To realize
their intcresa, the1, needed to aher public belieG abour e meaning of
un*'anted prcgnan'|. \Yell-ro-do ,om.n formed 3'' rili216 wi doctols ln
this redefinition process because of their ou,n need.s.
- s Mohr ( 1978) documents, abortion before quickening (c perceptio.
of fetal mo,ement) *,as *,idcl1'practiced in thc mid-nineten.inturu

"rrd
\l'as nor seen as morally or legalh'\l.rong. Inforn:adon o., potions, purg"r'cs, and quasi-surgical tcchniques *'as a,ailabrc in home medical rn*udr.

s autoaborti'c instrumen$ came on dre market, \\'omcn became skillful

in performing eir o*'n abordons, and they sharcd information wi one
anothcr- In addition, midnives, herbal hcalers, and oer *kregular, doctors
established lucrative practiccs in rhe trcatment of *obstructe menses.,, lt
is estimatcd that b1' 1878 onc in fir'e pregnancies *.as.inrcnrionally abortcd.
The growing frequencl,of aborcion *'as particurarl* evident in the middie a,tl
upper classes (Mohr i9Z8).

,".lrt ,

55

\1'men *'cre shirliing

Re-p-rodgtlye reedpm

phi'sicians u'cre central figures

. iRegYl,ar"

New perspcctit c

ph1'sician *'arned rhar aborrion rvas bcing used .ro a'oid

the labor
for and rcaring children' (Si.lr.cr as q,rotid in Mohr l97g). Io

en*ironmcnt. Even s,hcn'narurl'childbir occurs in birthing roon:s, birth

still d9fined rnedicalll', is srill under e control ofphrsicians, a-nd still occ,rrs
is
in i-rospitals (Roman t98l).
oreo'cr, thc social meaning of parenting changes *cn scientific ratio-\
nales such as 'bonding' and "artachment' arc uscdio justify moers
being I
;rear-cir babies after gi'ing birth (rney l9g0). In additin, ,.* .o1.. ,r!
h
reinforced *'hen it is moers and not faers who need ro be ..bonde.l,' to
their

i@

1\'e

re concerned ar the uppe r classes *'ould be outbred. Finall1.,

conflici
ilctors and their competitors ,*,", no, onlr. about
issues of science and prossional conuor but also about the issues'of
class
and patriarchr The *irreg;,lar' doctors *.ere, in gcneral, not from
families
of the dominant class. In addition, these practitioners wcre morc likelv to be
female. Thus socia! characteristics proridcd thc rationalc for exclusion,
furthe.
bet*'een

7_

reinforcing patriarchal class relations.

womcn's parcicipadon in e anti-abortion crusade of the lg70s also *,as
class-specific. Feminisu of thc period-r'eil-to-do \1,omcn-*{amc our
against .
abortion, arguing instcad for *oluntan, motherhood. Thcse carly fem"iniss
)
recommcndcd periodic or perrnancnr absdnence as methods of biith cont.ol I
because they di,C nor approle of contraceptive devices (Gordon 197).
I
It is ob*ious thar *'omen lost significant cedorns *'hen abortion rvas
defined as a mcdical procedure and ruled illegal. yct, from the perspectir.e of
t!9 q}ual- qolitics of iate-nineteenth-century nrii;it is ;i;niir ihar "

taneri-\--m ?ail*
}]:*rryT.S=1ry"vi-tiio.
rcsponse to thc po*cr1rrriiri-tfiF-ia-rchal family than a pro-abortion

rate, espcciallij amonq the middle and ugrper classes ri'ho fcarcd tt tiri-.
coulci lcaci rcr "ract:uicidc" (srlirh-Loscni:crg anci Rosenbcre 1973). onc

.7

s'ould hrvc becn.

\.!ci.l-to-do \1:oincn of the latc nincteenth centurv had a ic*el of hostilin,
to*'ard sc-x, both bccru:-c ir brought un*'a'ted ancl danqerou, pr.gnrna,._,,.'
and becruse ir *es :
i.slijl" pll_'_:li]::,{.::titl,"gg: Evr:n more in,prt.,.,i,
stance

,t.1

e "regular'

THE SOCIAL CONST?.{JC'fi ON OF I{/O,IEN'S BODI ES

llbmen and Jkiic'zli:ttriox:

Gordon ( 197) argucs that these rromcn resented the particular kind ofserual
encounter at u'as characteristic of .l.merican Victorian socien': intercourse.
dominated bi the husband's nceds and ncglefiing rrhrt n'light bring plersurc
to a \\,oman. {en's style of lovcmaking repelled \\'or)ren. Thct flt that men
rvere ovcrscled and violent. Furthcrmore, because men fiited prostitutcs,
marital scx for \\'omen nor infrequenrli' rcsr.rltcd in rcnereal diseasc. upder
ese conditions, woman's right to rcfrrse 'as ccntrl ro her indepcndence
and personal integrity.
In sum, the tcrmination of n unl1?nted Pre qnrncY underwcnt a series
of changing definitions: ir 'cnr from a human problcm to a topic of medical
concefn ro a crime . with e 1973 Supreme Courr dccision [in Roc rr Wade],
it rvas remedicalized, but this timc u'ith the support of the medical profession.
Physi6i*t no longcr needed this issue to advaoce dre ir sovcreignry.

Thcsc examplcs illustrarc a qcneral point about mcdical social control:

ere
are rimcs s'hen the inte resrs of rrome n tionr c middle and upper classes
are

se^ed bv the thcrupcuric protissions, u'hose political and cconmic intcrests

sen'ed b'trunsf-ornring drese rr.omen's complaints inro illnesses.
In oer *'ords, both historicalll and currentlr,, rhere has tcndcd to be a -fit"
benr-een medicine's intcresr in erpanding irs jurisdicdon and e
need of
-omen to hare eir experience ackno*1cdged. I ha'e emphasized
that this
n tcrJsion-frlled and fiaueht s.ith conradictions fcr s,omen, rvho

lre in turn

\lhile

irf* ilqlpUgiEnal\i

rrr-rEIiftF Il 9.,Ftg;&g.

economv and a technologicallv donrinated medical care s),stcm, large profits

accompan)'each redefinition of hurnan cxpericnce into medicat terms, since
rnorc cirugs, tests, procedurcs, cquiprnent, and insurancc co\ erage arc needed.
s mentioneci betbre, specific medica! indusris harr plal'ea direct rolc
in influe'cing bo phvsicians' and r'omen's percepior of rcproductire
control, premenstrual 'ndrome, and 1. eight. yet it is impcrtant tolmphasize
-

thc bnle orcr medicalization *'as lost

rvent
in the dircction of high tcchno.logr'.
@ods
ere fore\.er in the hands of
conrraceptivcs
and
injectable
The piil, e IUD,
mcdicinc. because ccess to thcsc drugs and dcticcs is legally controlled. In
conast! c lor-techlology barricr nrethods-tlre condom, cerl'ical caP, or
diaphragn'r-require lirtlc mcdical intcrr"ention or conftolThese historical cxan:plcs underscore the tct tht t1.on:en's cxpcriencc
*staked clrrinrs" for ''
u.as a site for the initial mcdicalization effort. Icdicine
childbirtlr. aborrion, arrd birth control and secured thcnr as "medical turF bv
altering public bclicfs and persuading the statc of th.: lcgitin'racv of thcir clainr
(cf. Conrrd and Schncidcr 1980a). Phlsicians uscrl scictrcc s,tl'rc rationaic for
profcssiorrll dontinane - s I lr:rve suggcstcd, riot:tctt's participation in tl'rc
rcdcfinirion of caclr cxPcrirrrcc s'as tlrc rcsult <lf cor:rPlcx [ristorical :rtrd chssspccific nrorivrs. anri tircl rrr)r <rnlr'rained lrut losi rlith thc nteclicaiizatiotr oi
.,^

^t.

-., .

the pardcular interes$ of *,omen and phr.sicians do not

e erpansion of the clinical domain. ocr iommunides also

influence *'har occurs in the doctor's office. In e context of a capitalist

-suuggle.l to define a "netr

conrot

nece ssn',

alone explain

tr ,1. \'entieth centur\') *'ell-to-do \l'onlen joined phlsicians again in the

I rncdicalizaion of reproduction l'irh rhe issue of contraception. These \\'ornen

'.ir*

Nca, Petspectipe

The Fit Bct'een W'omen's Interests and phl,sicians, Intercsts

Contr&ceptiorl

se nse of \1'omanhood'o dr;rt did nor requirc sexual

nd tlie abence of anrbiuon. In order to
domesricin;
materniq',
passi\1n',
achierr these goals feminists oiercame eir scruples aginst artificial con- --t 4epdon. trrnporandg 'ome$.ultilBately-r1o8 S.e bamie of repro{-uc-tite.
freedom. Tecl.rnolory to limir famiil'size ,as developed in response to the
social demand for it (Gordon 197).
But as s'omcn gaincd fiom this nes'l)'rvotr independence, thel' also
f
(_ torr. Bir conuol tcchnologY is nor $'iot problen'rs, both in its female
centricin'and its risk. Furthermorc, as Gordon argue, thc professionalism
and mcdicalizarion of bir contro_l strippc$ ir_gjit*ry!1!"1:gJg!! .
' a result of its dcfinition as a heal isi, ontraccpdon
bccanie snrervhat

-ti,aprgrpggagionr,-in heir-cttbrt to-maxltrize p.o6ts; welrk tbrougb-bot

phlsicians and s'omen.

Implicit in mv analvsis is rhc assurrrption that *,omcn's experience has
been medicalized more rhan men's. Yet it could bc argued instead rhat
medicine has encroached into mcn's lives in a ditlrent but equal lshio'.
For example, medicine has focused on childhood h'pcractir.in.and rhe adult
addictions-problems more conrmon in malcs than females (Conrad and
schncidcr 1980a). occuparionrl n-rcdicine has tcndcd to focus on male jobs.
In pardcular, 'stress managemcnt' programs are targeting male execui,,es.
Ho*c'sJ, *'hile not to diminish thesc eramples, I believc at *'onren's li'es
har"e undergone a morc total transfornradon as a resurt of medical scrutiny,.
ledicalization has rcsulted in thc cor.'srruction ofnredical meanings of r wnts.l
functions in *omen----cxperienccs rhe n,pical \l,oman goes through, such as
mcnsuatiorr, reproduction, childbirth, and menopause. Bt contrasr, roudnc
e xpe riences thar are unique!r'nrrle rrmain lrrgell'unstudicc br mcdica!
scitnce
and. conscquentll', are rarch'trcarcd brphrsicians as potentiall'patholoeical.
For exanrple, male hormonal cvclcs and the male climactcric ren:ain lrrscrv
unresearchcd. Less is kncr'.'r at,out thc male reproductive svstenr than about
that of thc e male . Male ccrnrraccptii'c technologl' rags far be hind riret is
availablc for s'es1p. Baldncss in nrcn has not Yet becn defined as a ntcdical
condition nceding treatmclrr, c'cn though an industri,cxisrs to rcnrcdv thc
problcnr of hair loss. Mcn's p.5i.i,,riogical livcs irar.c n<;r bccn subje ctcc to
pslchiatric scrutinv ncarll' t. rhc de {arcc that \r,(}ileil's ci:ioti<-rr-rs ira'c brcr.r
studicd. As a rcsult. nralc vioicrrit. nted irr psr*.,ri'. rnd <;i'crruionr.iirr,?.rr iroi

58

Wuten ard Mcdic*lization: A Ntw Pcrspcctile

TH E SOC TAL CONSTR UCTION OF IVOMENT BODIES

dcfined as pathological conditions. Perhaps only imporence has been subject

ro drc same dcgrce of rnedical scrutiny as wonten's problems.
\\/hv has rvomcnns cxpcriencc bccn such a ccntral focus for medicalizationl
In addirion to thc complcx motites at x'omcn bring to cach particular health
issue, ph1'sicians foctrs on \r'omen as a prinran' market for expansion for a
nunrbcr of reasons. First, thcre is a good match bct\r'ecn \l'ome n's biologtr, and
mcdicine's biomcdical orientation. External markcrs of biological processes
crist in $'omcn (rnenstruadon, birth, lactation, and so forth), u'hcrcas c1'
arc more hidden in n'ren. Given modcrn medicinc's biomedical oricntation,
cse external signs makc \\,omen easy targcts for mcdical encroachment. A
ditltrcnt medical paradigm (one that vierved heahh as c conscqucnce of
harnrony bcts,ecn e pcrson and e environment, for example) might have
had less basis for focusing on \l'omen.
Sccond, n'omen's social rolcs make them readill'available to medical
scrutinr'. Women ar more likelr to come in contact's'irh nredical providers
because ey care for children and arc the 'kin kecpers" of e family (Rossi
1980), In concrete terms, rvomen are more likcl,v ro accompan)t sick children
and agcd relatirrs to the doctor.
Third, ri,onren harr grcater exposure to medica.l labeling because of eir
prte rn of dealing t'ith eir o*'n svrnptoms> as t'ell as medicirre's response to
at panern. \lbmen make more visits to ph)'sicians than merr, alough it is
nqt-clc3r_rcrher-this is due to $c rgd]c{iz.arioo o{.eir biolosi41E+icgons:
'rcal' illness, behavior lthen ill, or cultural expectadons (Naanson 1977).
l\trcn thev visit the doctor for an1, serious illness, e1'are more likel1, $q1
nlen to be checked for reproductire implications of the illness. They are
nrore subject to regular check of thcir reproductir-e st'stents, in e form
of vcarll' pap smears or rynecological exams. Importand-v. u,henever e1'
risit c doctor ere is evidencc that drey receirrc more total and extensive
se rtices-in e form of lab tests, proccdures, drug pre sciiptions, and return
appointrnents-ttran do mcn s'ith t}e same complaints and sociodemographic
risk factors (Vcrbrugge and Stcincr 1981). Thus, a q'cle of greatcr medical
scrudnl' ofs'omen's cxpcrienccs is begun with each risit to the docor.
Finalll', tvonrco's structural subordination to men has madc them parricularl,v rulnerable to the xpnsion of e clinical domain. In gencral, male
phlsicians trcat fcmle padents. Social relations in the doctor's officc rcplicate
parriarchal relations in the largcr culture, and this all procccds under the
guise ofscience . (Patriarchal control is most evidcnr s'i'le n ph1'sicians socialize
toung \1'omcn regarding appropriate scxual behavior, pcrhaps s'ithholding
contracepdve adricc, or lecturing them about thc dangers of promiscuiry).
For all these reasons, it is not surprising that u'omen rc more subject to
meciicai dcfinitions oltheir expcricncc thn mcn arc. in thcsc n'ays, dominant
social interests and petriarcha! institutions are reinforccd.
,{s a resu!:, \\'onrerl are cspeciallv appropriate nrarkcts for the expansion
omedicinc. Thcv are suitablc biologicall-v, sociallr', anci 1.rs','ciioiogicaliv. Tirc
nressage that t'onrcn are cxpcctcd to 'oe de1.-en.icni ,.;'i: r':r:11{ ph1'sicians to

59

mangc their livcs is rcinforccd byc pharmaceutical industrv in drug advertisernents and by e mcdia in gcncral. Yct it is far too simple to poruav the
cncroachment of medicincs as a coospiraq'-by malc doctors and rhe *medical

industrial complcx'-to subordinate \\'omen further. lthough somc have

argued at mcdicine is e scicntfic cquitalent of carlier cusroms like marriagc lats and kinship riruals at conuollcd \\.omen b)' conuolllng eir

sexualiq', srrch an anall,sis is incornplete. fu I havc stressed, mcdicalization

is more than what doctors do, al*rough it may bc rough dcctors thar the
intcrests of ocr goups are oftcn realized. Nor docs a conspaq corl'
explain n'h1,, for c most part, \r'omen from certain class groups havc been
willing collaborators in e medicalization process. Rathcr an dismissing
ese s'omen as odupcd,' I have suggested some of e complcx motives at
have caused certain classes of n'omcn to participate ui phrsicians in e
redefinition of particular expcrienccs.
In addition, a conspiraq'theory does not explain th-v medicalizarion has
been rrrore virulent in some historical periods and in some medical specialties
than in others. For cxample, g.rnccologists initialll, trir"ialized menopausal
discomfori, only to reclaim it iater for ucatme nt [as premensuual syndrome ].
At e same time at g1'necologists rrerc unwilling to acknos,ledge e
legitimacr of rvomen's complints, the developing specidn' of ps1'chiatrl'
moved in xith thc pq,'chogenic account. I have argued at these shifu
and interpr?fssr.onal '{ri-o;'cr -tqf u-e ryI4|lgd by qqtrnal igggs. faing
each sp:ciaIry at particular poinu in histon'. Thus, an anaivsis of e market
condidons faced b1'phl,sicians in gcneral, and certain spccialdes in particular,
is ne ce ssarv to cxplain e varf ing 1sporrse of medicine to s'ome n's problems.
Furer research is needed to caprure more full1'the historical aspect of
these shifis in medical perccpdon. Such an anallsis nceds to focus in dcpth
on specic events in tt'omcn's erperience and trace eir mcdicalizadon in
historical and class context: thc issues brought in turn by'groups of uc,men,
by the particular medical spccialies, b1' e pharmaceudcal industrl', and by
the *fit' betu,een ese at resulted in a redenition. A conspiraq' corl'
fails to capture the nuances of is compler Process.

Conclusion
The medicalization of human problems is a contradictorv realin' for s'omcn"
It is part of thc problcm and of e soludon. Ir has grosn out of and in turn

of paradoxes. As rronren havc tried to free emsclves

ironr thc control that biological processes have had otcr cir lives, thcv
has created a series

sir-nuitaneousll, have srrengthened thc control of a bion'redical vieu' of thcir

doctors alrd {ct syn:ptom re lie f, the social causes ctf
c:ipcric;icc. As t'cr:'lc;.i
"'isit
their problcms are iqnored. As doctors acknorvledgc rvonten's expericnce and
trcat thcir problcrns medicallr', problcms are strippcd oitiieir political cootent
-:,r,i n.'!r,,1)r n11\r-.-!.enrs are takcn o..',:r. Bccause <.;' rhcsc contradictions,
ivi)irci-i lll Ji]c;-c:.ir ciiss;rositions llaic sriusltt and rcsistcd rncdicai control.

lAonq nnd ][ttlicalization:

THE SOCTAL CONSTRCTION OF WOMEIi-'"S BODIE5

60

I havc argued that the transformation of such human expcrierrccs as

childbirth, reproduction, prcmenstrual problems, *'eight. and ps1'chological
distress into mcdical cvenc has becn c outcome of a rcciprocal proccss involving bo ph1'sicians and r1'omen. dedicine, as it dereloped as a protcssion,
t'as repeatcdh' rcdcfined. The intcrest of phlsicians in expanding juristiictior,
into net, areas coincidcd riirh the interest ofcertairi class groups in lraving rheir
expericnce in osc areas undcrstood in nes'terms. In other sor,Js, phvsicians
crcatcd dcmand in order to gcnerate neu'markers for eir sen'ices. Thcv also
responded to a markct rlat a class of somen created. . . .
s Conrad and Schneider ( 1980a) note, e potcndal tbr nredicalizadon
increases as sciencc discovers the subde ph1'sfological correlates of human
behavior. A s'eal of knou,ledge is dcveloping about t'omen's ph1'siologr'.
s more bccomcs knos'n, the issue u'ill be hot'to ackno's-1et{ge the conlpler

*rr.

f:4i.rr.-

biochemical componcnts at are related to menstruadon, pregnrncr', seight,

and the like *iout allos'ing ese conditicns to be distorted bv scienci6c
understanding. The issue s'ill be to gain undcrstanding ofour biol.;gl; uiout
submitting to control in e guise of medical o'erperdse -" The anss'er is
not to 'suffer our fate' and rcturn exclusivell'to selt:care. as Illich \L976)
recommcnds, ereb1' tr,rrning our backs on discoteries and trcatrner-1ts lhat
ma)/ cse pai;r and suffering. To "demedicalize' is not to denr rhe biological
components ofexoerience but rather to alter the os'nership, producdon, and
usc of rcicntific knos,iedse. . . .
' in sni, ri'6mn's'h"eaittL ii ficed Lt a ieris'oT'.:halleirges. \t-ned
to expose e *uu claims" (Biuner I98) of medical entrepreneurs u'ho
s'ill seek to rurn ne\i' areas of experience inro medical ele nts, and irrstead
intrcdrrce a healthy skepticism atrout professional .1"1n15. llt nccd to develop
alternadves to the m$cul.inist biomedical tierr'and placc u'orrrcn's hcal

protrlems

in c larger context of eir lives. Specilicalh; it is not at

ll

clear rvhat form pregnanq', rnensffuadon, s'eight, xrualiq; aging, or oer

problems u'ould take in a socieq' 'that allou,ed \1omen to nornrallr and
roudncl.v eripress anger, drive, and anrbitiorr, a socierl in rrhich *'onren telt
more cmpo\r'ered' (Harrison 1982). \\re need to recon(cprualize our u{role
'a). of thinking about biologl' and erplore hou, "natural* phcnontena are,
in fact, an outgroll'th of the social circumstanccs of rtonrcn's livcs (Hubhard
r98 r ).

In the meantime,

because

t'e *'ill continuc to necd hcaltlr carc, the

challenge uill be to alter the tcrms under rvl'rich care is prorided. In the
short te rm, s'c necd to u'ork br spcci{ic reforms arrd eein shat n c can u'hile,
ar the same dme, acknou'ledging thc lirnitation olretbrnr- .\s I irelc argucd,
reform is not rvhat \\'c \\'ant in thc long run. For ccrtain problcnrs in our
livcs, real de medicalization is neccssa:'.,; e rpcriclccs such as rc'.ttinc childbirth,
nrnopause, or srcight in cxccss o cultural nornrs shoul.l rtot be defined
in medical terms, ancl medical-tcchnical trcrtnrer:ts shorrid not lrc sccn as
e1;propriate solutions to thcsc problcnrs. Frir otlrcr conciitions v,'hclc nrctlicinc
nrav bc of assistancc, rhc chrllcnce r.'ili i-.,: to riiijcrci-:ii:ic tirc ircncficial

New Pctspcctive

uermenrs trom those that are harmful and uscless. Thc rcal challengc is
to use eriisring medical knos'ledgc sclcctir"cl,v and to extend knon'ledge with
net' paradignls so s to improre thc qualin'of our lives.

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