Feminist Theories and Concepts in Healthcare

An Introduction for Qualitative Research

Kay Aranda

• Publisher: Bloomsbury Academic
• Year: 2017
• ISBN:
  9781350311169
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Feminist theories and research approaches are committed to generating relevant, morally accountable knowledge and understanding, as well promoting social and political change. Through them, we have the potential to understand more fully the urgent global health concerns that individuals, families and communities face on a daily basis. This unique text provides students across a range of health care disciplines with a clear and accessible introduction to feminist theory and conceptual frameworks, as well as how to apply them to health-specific issues. With a particular focus on students' own qualitative research activities, each chapter guides the reader through challenging and sometimes highly contentious theories with clarity and eloquence, and demonstrates the ways in which feminist theories and research approaches can be used to help analyse the wide range of contemporary issues encountered by health practitioners daily. This is a fascinating read for health science research students and practising health professionals – or indeed anyone wishing to learn more about feminist theories and concepts within health care.

PART I

INTRODUCTION

This book aims to offer an introduction to the contemporary, challenging and lively debates within feminism, with the hope of encouraging and supporting practising health professionals and health science students with their health-related research. I hope to show the potential of feminist theories and concepts for understanding more fully the urgent, pressing global health concerns that individuals, families and communities face, which health practitioner researchers frequently come to explore, understand or trouble in everyday practice. For ten years or more, I have worked with and supported children and mental health nurses, health service managers, district nurses, health visitors, midwives, health promotion and public health specialists, physiotherapists and occupational therapists, studying for either master’s or doctoral degrees in a number of health science disciplines, and who are researching practitioners of health, illness and healthcare. I want this book to make a useful contribution to their studies. I hope the book might equally inspire a broader audience of undergraduate health students seeking an introduction to feminism, health and healthcare.

Both feminist theories and critical qualitative health research approaches are committed to generating relevant, morally accountable understandings and knowledge, but equally aim to promote social and political change. In exploring feminist theories, students will hopefully gain an understanding of how their choice of particular theories and concepts can form a framework that actively underpins or drives their research and how these theories and concepts can promote deeper analysis or suggest critical implications for practice and social change. While health practitioners research an enormous range of topics, they commonly have to demonstrate the implications of their research for participants, patients, practice, or policy. I will suggest that feminist theories, concepts and qualitative research are especially compatible with these ends and well suited to this task.

Qualitative approaches are frequently utilised by feminist researchers but are not the only type of research undertaken (Hesse-Biber, 2012). Indeed, given the contemporary drive for mixed methods advocated by health research funders and governments, to insist on the value of qualitative research is, as I will show, a highly political act. Moreover, I will argue not only for the value of qualitative health research but also for research informed by critical or post-foundational feminist theoretical approaches. I will show these theories and related concepts offer unique insights into the entangled, emergent nature of the complex, affective and embodied experiences of health and illness, as well as the challenging, rapidly changing organisation and practices of healthcare.

Bringing together feminism and health is not new. There is a vast body of scholarship evident historically in the political activism found in social movements like the women’s health movement that has made visible health concerns or the inequalities people experience, or, for example, the gendered nature of poverty, physical and mental health and illness, violence, abuse and discrimination. In the academy, the presence of disciplinary subjects such as women’s studies, gender or queer studies and medical sociology produced and continues to contribute valuable research and knowledge, for example, in exploring sexuality and the gendered patterns of health and illness, equity and access, or the organisation policy effects or delivery of healthcare, along with the gendered nature of chronic illness and disability.

In acknowledging the scholarship and earlier contributions of Western feminism, the main focus of the book is on the critiques of these positions and the emergence of the contemporary, critical post-foundational positions within feminism. By critical and post-foundational, I mean feminist debates and scholarship resulting from the cultural or linguistic turn in social theory, with more recent turns towards the material world. These theoretical turns in feminism towards postmodern, queer, postcolonial or poststructural and post-humanist accounts, and the more recent return to matter, pose serious challenges to the key assumptions and foundational claims of modern feminism. These debates are extensive, thus the book offers a purposefully selective, focused and concise exploration of key feminist theories and concepts that may fail to do justice to this complexity, but which I hope will continue to inspire and enthuse.

These diverse post-foundational feminist positions are indicative of mounting critiques over white feminism’s inherent racism and heterosexism especially, and the theoretical aftermath following the ‘cultural turn’. Through interrogating modern feminism and especially its core categories, post-foundational feminisms do not suggest doing away with modern feminist concepts; as we will see, it is often a revision or reimagining of core ideas like agency that takes place. Moreover, these earlier versions of feminism remain a familiar presence in popular media or lay accounts of feminism. Interrogating the shifts and revisions in feminist theory is therefore complex; feminism never was a linear movement, nor was it ever a singular theory. Furthermore, there are no straight-forward stories of progress and success, or of demise or loss, or indeed, currently, renewal or return within feminism (Hemmings, 2011; Woodward & Woodward, 2009; Fraser, 2008). Feminism is best understood as feminisms, in the plural, with contradictory, complex histories and responses that remain relevant, partly for the value of the lessons they impart, but also because these struggles still have a continuing legacy. These pasts define the way we understand contemporary post-foundational feminism as well as the application of such thinking for researching the world of health and healthcare. Feminist theories also offer an invitation to think again about contemporary health concerns; this is becoming ever more necessary with rapidly increasing developments in bioscience and genetics that are radically changing the nature of health and care.

A further problematic for feminist theory is to be found in relation to much of its geopolitical location. It seems that conventional feminist theory remains derived from a recognisable Anglo-American canon, or from academies and scholars, both queer and straight, based in rich income countries such as the United Kingdom (UK), North America, Canada, those countries in North Europe, Australia and New Zealand (Hill Collins, 2000; hooks, 1982). Indeed my own research and many of the empirical examples I cite pertain to these locations. However, there are important exceptions and challenges to this eurocentric, ethnocentric focus; these are to be found in the significant contributions of postcolonial women of colour and black feminist and critical, transnational and indigenous feminist theorising which I explore (Nayak, 2015; McClintock et al., 1997).

A further caveat is the difficulty of naming who is a feminist; the tensions involved in such a practice reveal a politics we discuss more fully later. I know all the authors I refer to in this book would not necessarily identify themselves as feminist, but I draw on their work where I believe they think and research ideas and concepts central to the concerns of feminism and/or healthcare; moreover, many feminists have extended and reworked key problematics in both feminist but equally in male theorists’ work, for example Pierre Bourdieu, Michel Foucault or Gillies Deleuze; again I refer to these where relevant as feminist theorising here often points to the invisibility of gender in these theories.

In my argument for a critical, reflexive use of feminist theories and concepts, I want to suggest that these ideas and canons of thought may help rethink global concerns and urgent issues in contemporary health and healthcare; many of which appear entrenched, increasing and enduring. The fact that these social and health inequalities are social, cultural and gendered in nature reveals how these inequities are still disproportionately affecting women and shows how women’s bodies remain key sites of material and symbolic struggles, especially during neoliberal times (Phipps, 2014).

My own introduction to feminism was from taking a women’s studies course as part of my undergraduate degree. This was followed by my subsequent involvement in the women’s health movement in the middle to late 1980s in London, England, where I worked in the voluntary sector and the National Health Service (NHS) in a number of roles focusing on women’s health needs. The feminist theories I learnt were from the established ‘second wave’ feminist canon of the ‘big three’ approaches of liberal, radical and Marxist/socialist feminism. My political involvement formed part of a broader set of feminist struggles taking place in response to Thatcherism and the New Right retrenchment and restructuring of the welfare state in the UK. In healthcare, the now familiar private sector principles were being introduced into public sector services, promoted through what was then termed a ‘new managerialism’, but fuelled by monetarist economic policies and a neoconservative morality.

My return to academic studies in the early 1990s revealed a very different landscape. The irrevocable shift in feminist theorising arising from the challenges of postmodern and poststructural theory meant the demise of grand narratives to explain women’s exploitation or oppression; familiar understandings and problems had disappeared from academic focus. Instead there were intense philosophical debates over cultural and political identity, concepts of subjectivity and the self and, significantly, questions of difference. My doctoral research into discrimination and the equality practices of community nurses made use of these feminist postmodern, poststructural theories (Aranda, 2005). Since that time I have continued to be inspired by and draw upon feminist poststructural, queer theorists and, more recently, materialist, posthuman feminist writing.

From these experiences, my understandings of feminism changed considerably, moving from naively enthusiastic endorsement to what I consider a more modest but, critically, reflexively open, sceptical stance towards all theory, including feminist theory and practice. Feminisms, with their range of inspiration from philosophies, theories, activism and research practices, I now see as global networks of emerging, entangled, relational knowledges and politics, concerned with and connected to ethical practices that are historically contingent or situated, which in trying to ‘stay with the trouble’ (Lather, 2007, 2016) hope to remain fully accountable to the shared worlds in which we live. And although this book intends to advocate more use of feminist thought and research in the health sciences, I do not wish to promote naive readings, asserting self-evident truths. Rather, I argue for a critical engagement with feminism in order to explore, confront, expand, extend and revise our understandings of contemporary feminism.

Key themes

There is a central underlying set of binaries that structure many of the debates in healthcare and feminism, but these are contested. The competing terms are premised upon historical disputes arising from philosophical positions, with terms placed in opposition to each other but in a hierarchal manner. This means that one term is always more valued, considered more desirable than or superior to the other. Feminists have adopted many strategies to deal with these binaries, as we will see, with some feminists now questioning whether it is possible or meaningful to distinguish between these terms; more recent forms of feminist theory have even rejected the implied separate nature of these terms. However, they remain very influential, often as taken for granted, common-sense understandings or debates in health, and are therefore frequently invisible within related debates. They include, among others, binaries of male and female; masculinity and femininity; sex and gender; subject and object; sameness and difference; agency and structure; nature and culture; mind and body; health and illness; rationality and emotion; thought and feeling; order and conflict; and so on, and perhaps as importantly, the self and other.

These relations of self and other, or what Honneth (2012) calls ‘the I in We’, arguably shape our private, intimate, personal lives, as well as our social and collective lives. These relations influence the operation of more formal institutions such as the family, education, the workplace and, of course, healthcare. The underlying importance of these relations is that they take distinctive forms and pose critical questions of the self, which in healthcare often becomes characterised as the privileged and powerful practitioner in relation to an abject, disenfranchised, marginalised or excluded other. Many of the feminist theories discussed implicitly and explicitly engage with these positions of the self and the other.

A further key idea is that of agency and structure. Questions over how much voluntary action or freedom or autonomy or independence people have, or how habitual or reproductive of societal norms and values our actions are, tend to be debated in relation to the extent to which we are considered to be determined. The ideologies or values instilled through socialisation in, for example, family, peer groups, education and cultural values via the media are said to have an extensive reach. They shape people’s thoughts, actions and interactions, subjectivities and identities. Thus agency is often assumed to be something we have, a free will that exists as a psychological or cognitive attribute.

More recent accounts, however, emphasise agency as something that is inter-subjectively generated, shaped by broader discourses, and as something we do rather than have. This is agency as practice or as a ‘set of discourses that mediate our relationship to the world’ (Hemmings & Kabesh, 2013: 29). Discourses construct or paint a particular picture of the world and involve a particular way of knowing, talking and doing, so discourses always involve knowledge, language and power, that then have material or real world effects such as interventions or policies or help shape our view of our self and our identities.

A further related binary is that of individual or social explanations that arise often from these accounts of agency and structure. Individual explanations are often dominant in explaining the social problems in a society or in healthcare, like poverty, alcohol consumption, drug use, or obesity; whereas social explanations move the focus to the broader context, exploring social factors and how society is organised, asking questions over its purpose and goals. In relation to health, for example, in a capitalist society, industries’ pursuit of profit will often be at odds with any measures designed to promote health.

Together these binaries consistently refer back to questions of power and many of the theories recognise this in their various understandings and in research. Recent theories of power have challenged the possessive accounts of power, with power being held or exercised by one group over another, as can be found in earlier second wave feminist theories or the classic critical theory, such as Marxist or conflict and political economy approaches. Hence poststructuralists, and specifically feminists utilising Foucault’s theories, view power as dispersed or non-possessive because power is inherent in all relations, in all knowledge and ways of talking and acting in the world.

A further useful trope – as in a linked set of ideas that create a story – is to think of the transitions between modern feminist and postfeminist theorising as the movement between two sometimes three stories or narratives of feminism as lost and found, of retrieval and renewal, or of progress, loss and return (Hemmings, 2011; McRobbie, 2009; Woodward & Woodward, 2009). These categories represent over-simplifications but are useful motifs or heuristic devices with which to trace the major shifts and movements across these different bodies of thought and political action. The framework of progress, loss and return narratives provides a particularly useful map of the complex shifts in theory and politics for those new to feminist theory.

The structure of the book that follows is in three parts, though all are inter-related. The first part considers more fully the contemporary contexts of feminism and healthcare and the stories of modern or second wave feminism. I show how modern feminism, as a progressive social movement, was based on the grand narratives of the European Enlightenment and the limitations and challenges that arose from this. However, there were changes made during this time in the West, in terms of legislation, policies and services aiming to tackle women’s equality, their invisibility and specific experiences, but equally their problematic encounters in healthcare. I then move to discuss the critiques of these modern theories and the turn to culture, and what I term post-foundational feminist theorising – namely postmodern, poststructural, postcolonial, queer feminist theorising and, more recently, new material feminism and the turn to matter.

The second section aims to explore in more detail key debates through a number of concepts relevant to health research. These include discussions of gender and health, questions of identity, difference and intersectionality, as well as debates over recognition and redistribution. A further key concept is care and the understandings of the body as central to healthcare; here I explore core ideas of feminist care ethics, as well as embodiment, using examples of obesity and motherhood. I conclude with an exploration of feminism’s past and more recent encounters with age and ageing. This exemplar usefully reveals the entangled and relational nature of health and care with biography, subjectivity, identity, the body and intersectional understandings of difference.

The final section of the book discusses the relationship between feminist theorising and critical qualitative health research practices, again both previous and since the post-critical turn. Here I examine significant debates taking place in post-foundational research approaches concerning voice and experience, reflexivity and power, as indicative of the continuing dialogues over dualistic binaries, but especially in relation to the subject and object. This section concludes with an exploration of what these theoretical turns mean for ontology and epistemology, using examples of theoretical and conceptual frameworks and methodologies that are developing and drawing upon these ideas in qualitative and qualitative health research.

1

CONTEMPORARY CONTEXTS OF FEMINISM AND HEALTHCARE

Contemporary contexts of feminism

In the United Kingdom (UK) and more generally in the West, across Northern Europe, North America, Australia and New Zealand, feminism appears to be experiencing both a ‘political ice age’ for its projects, with visible examples of misogyny or gender-based violence (Broom, 2014: 171; Phipps, 2014), and a vibrant, visible activist social media-based response to these observable incidents, alongside renewed academic feminist theorising (Barad, 2007; Coole & Frost, 2010). There is, however, a continuing recognition that, despite years of equality legislation in the West, sexism is still firmly evident in everyday life across the globe (Adichie, 2014; Banyard, 2010; Bates, 2014; Broom, 20...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• Acknowledgements
• Part I Introduction
• Part II Introduction
• Part III Introduction
• Bibliography
• Index