What Makes Women Sick: Gender and the Political Economy of Health
By Lesley Doyal
Macmillan Press, 1995. 280 pp., $34.95 (pb)
Reviewed by Karl Miller
Lesley Doyal and her partner Len Doyal have, separately and together, written several books critiquing modern medicine from a radical perspective. What Makes Women Sick continues in that tradition, despite being somewhat thin in the analysis department.
The current wave of radical critique of modern medicine has its roots in the '60s, and is much stronger in Britain and the US than in Australia. Radical critiques are frequently composed in opposition to liberal critiques of medicine.
These radical writings found their origins in the feminist movement, in such works as Our Bodies Ourselves (Boston Women's Health Book Collective, 1971).
Important general books by Marxists in this area include Medicine Under Capitalism by Vicente Navarro, and The Political Economy of Health by the Doyals.
Probably the best known example of a liberal critique is Limits to Medicine: Medical Nemesis by Ivan Illich. Illich presents plenty of horrific statistics about health problems caused by the medical community. His analysis is that medicine has become overly reliant on technology and technocrats. Some books taking up a radical, if not Marxist, critique of some areas of medicine include Anti-Psychiatry, 'he Coming Plague and Origins of AIDS.
Having read The Political Economy of Health, and noting the author and subtitle of What Makes Women Sick, I expected something combining data and analysis. What Makes Women Sick certainly succeeds on the data front.
The first chapter, "In Sickness and In Health" takes up some general issues, including the author's position on post-modernism (subheading: "rejecting crude difference theories"). There was potential for these discussions to be continued in the rest of the book, but that potential was, sadly, forgone. Despite the book's subtitle, Doyal does not take a position on questions like class or imperialism, other than noting their existence.
The middle six chapters present well-organised, interesting and useful statistics on women's health in a series of areas. On the hazards of home work, the author states: "According to a study conducted in the Karnataka region of India, the labour of women and children together contributed almost 70 per cent of the total human energy expended on village work, even though strictly domestic tasks such as sweeping, washing clothes and child care were excluded".
In the chapter on safe sex, she writes: "Female genital mutilation is a major health hazard affecting between 85 and 140 million women worldwide". On reproductive health: "While free abortions under Medicaid are now denied in most [US] states, sterilization receives 90 per cent funding, giving women a major incentive to 'choose' the latter. By 1982 some 15 per cent of white women in the United States were sterilized compared with 24 per cent of black women, 35 per cent of Puerto Rican women, and 42 per cent of Native American women.'
On the hazards of formal work: "Around the world more than 50 per cent of workers on electronics production lines are women". "Evidence from California shows the rate of occupational illness among microelectronics workers to be some three times that of workers in general manufacturing industry." On the dangers of substance consumption (alcohol, smoking, prescribed drugs): "In the United Kingdom 60 per cent of benzodiazepine [valium] prescriptions are written for women over 40".
The last chapter looks at the state of movements for women's health around the world. An opportunity to discuss some of the politics of the movements is also lost. Strategy for the women's movement is never mentioned; it is only hinted at when the author refers to the decline of grassroots groups in the US, Europe and Australia, and to the growth of UN-linked non-government organisations.