Revisiting Wingate Street: Techno-Science and Women's Health
In my hometown of Alexandria, Egypt, not too far from where I grew up, there is a street called Wingate. Every time I go by this street I am reminded of Sir Wingate's words of "wisdom" when he was Governor General of Sudan during the colonial period. Referring to Sudanese people as "primitives," Sir Wingate considered health services to be a most effective way of domesticating them and gaining their confidence.
Beyond the obvious political incorrectness of Sir Wingate's statement, to use the lingo of our times, his commentary underscores the point that health is a profoundly political issue. This is the case whether health is presented as a vehicle of women's "empowerment," as alias for the regulation of women's bodies, or in connection to the celebration of techno-scientific progress.
In relation to women, feminists have generally embraced a broad sociomedical conception of health which has been subject to variable selective emphasis. Some have given priority to women's control over our bodies, stressing individual choice in matters of fertility regulation. Others bring into focus gender inequity in the distribution of health resources. Still others, while cognizant of women's comparative disadvantage, and committed to our self-empowerment, connect health to broader issues of social equity.
The last orientation holds promise for addressing engendered health concerns, not only in terms of local, national, and regional class relations, but also in terms of global structural power asymmetry.
The significance of the deliberate linking of the local to the global is certainly relevant to those of us interested in the health and reproductive rights of women in the Arab/African World where I originate, and to which I relate in terms of my priorities of political struggle. Women in this part of the Third World are often "targets" of international health policies originating on the drawing boards of development specialists of the global North. The local "ground" on which women experience health or compromised well being is by no means isolated from the structural pathways of power which transcend by far the boundaries of local communities.
Since the U.N's Women's Decade, health issues pertaining to women became integral to international development discourse. The Women in Development (WID) approach which considers women's "integration" a corrective to diminished returns on investments extends to health development programming. Illustrating the current feminization of international health development rhetoric, the World Bank's 1993 World Development Report connects the "investment" in health for economic development to the "empowerment" of women. Although the Report calls for correction of the narrow concern with the health of women as mothers, it preserves this very emphasis in relation to the so-called Middle East.
"Culture," notably women's proverbial modesty, is presented as obstacle to health development. At the same time the Report remains void of any attempt to link health problems to national class relations, not to mention global structural power relations. The latter is of course clearly manifest in the Bank's own imposition of Structural Adjustment Programs (SAP), aka among some Africans as "Suffering for African People."
In the World Development Report the "culture as obstacle" rationale extends to discussion of "stigmas" related to the treatment of sexually transmitted diseases. This proceeds without commentary on the social context of the transmission and spread of such diseases in relation to national or regional political economies. Cultural and psychological reductionism extend to elaborations of the process of "moving from rhetoric to action," and the challenge of trying "to pierce the veil of indifference and inertia that inhibits women health and nutrition programs." In short, the World Bank's "new" agenda for women partakes of the same old logic of cultural reductionism, and the familiar privileging of "fertility rates" as object of health "action."
With fertility rates thus privileged, techno-science as instrument of foreign policy has been deployed with great determination and efficiency in the regulation of women's bodies/cum breeding machines. For Egypt, the Structural Adjustment agenda prepared by Egypt's lenders and presented to President Sadat at the 1981 Aswan donor consortium included a demand of population control. President Sadat's assassination in 1981 provided USAID with an opportunity to get his successor to "speed up population control policies."
As a priority of health development efforts no less, the medicalization of risk, and related contraception so-called technology transfer, has received ample international support, particularly U.S. budgetary allocations. The narrow focus on Egyptian women's health as an attribute of procreative behavior eclipses their susceptibility to a variety of other prevalent health problems.
As population control was barely beginning to constitute an element of concern in Egyptian oppositional politics, the ICPD related CNN filming of a female genital ritual surgery oriented much of the energy of feminist activists towards "eradication" of what is now referred to in the international literature as FGM.
Unlike the mobilization against population control, which is yet to be the beneficiary of adequate funding, concern with genital surgery has become a significant gatekeeping phenomenon and a productive "research" industry. Meanwhile the socio-political conditions conducive to the reproduction of this practice continue to be nurtured within the framework of structural adjustment based international development strategies of the eighties and nineties.
For Egypt, as elsewhere, rationalizations of population control include the medicalization of socially generated risks to women's health. This eclipses the population control character of selective health strategies, notably maternal morality.
Meanwhile science and technology continue to serve as powerful instruments of foreign policy. As Henry Nau, a member of President Reagan's National Security Council argued, superior science and technical expertise allow the U.S. to impose "a more subtle and total form of imperialism than was possible in any previous period of history." This is certainly true with regard to such contraceptive technologies as the surgically implantable five-year contraceptive known as Norplant, the infamous Dalkon Shield, and Depo-provera.
Unlike the overt forms of military and economic domination which characterized classical colonialism, in this age of re-colonization of the Third World, science and technology represent significant instruments of regulation which veil the exercise of control of the bodies and lives of the legendary Others of the so-called developing world.
For Egypt specifically, as science, in its biological and social forms, was deployed to endow population control with undeserved respectability, this has not proceeded without resistance from the Egyptian political opposition albeit in an effectively constrained form. In this regard it is important to point out that this opposition has not been formulated in terms of feminist logic, but, to a large extent partakes of a nationalist orientation. From this position attention has been directed to global political economic forces, of which USAID programs are recognized as embodiment, blocking the integration of regional economies. Such integration would provide flexibility in population movements, as exemplified by the permanent migration of Egyptian peasants to Iraq prior to the emergence of the post Gulf War "New" World Order.
As for the population establishment's "feminists," their posture is one of celebration of the increased "choice" offered to women by technological "miracles" such as Norplant. Beyond the proclaimed interest in "dialogue," one of the Population Council's thought police has characterized certain concerns about Norplant safety as "sensationalist." Another affiliate of the same Council accused critics of Norplant as "lack(ing) understanding of clinical research and practice." Still another affiliate dismissed as "polemic" with "NORPLANT thrown in for good measure," the attempt to link Norplant introduction to "development assistance, population programs, and the problem of power asymmetry..."
On the home front in the U.S. social control is also well served by techno-science. In this society, where minority racial status and social disempowerment often coincide, and where racism/classism are effectively disguised as a fight against "the epidemic of adolescent pregnancies," and "ending welfare as we know it," Norplant contraception threatens the civil liberties of impoverished women.
In the global North women of the middle and upper classes are far from immune of societal attempts at regulation of female bodies. Such regulation is exemplified by the restricted access to contraception by Japanese women, and in its most extreme form by abortion clinic terrorism in this country. Pro-natalism is also expressed by what Renate Klein has described as "the exploitation of (the) desire" of infertile women who are subjected to the physical and mental pain of technology-assisted conception. For all the rhetoric of freedom of choice, which one would assume to include the choice of childlessness, the anguish endured by women of the North in pursuit of conception suggests that motherhood remains central to the cultural construction of womanhood.
With techno-science serving as powerful instrument of regulation of women's bodies and lives, there is an urgent need for the involvement of feminists who are conversant in the language of medicine, biology, and biotechnology, among other fields of knowledge. The work of Judith Richter and the Boston Women's Health Book Collective are exemplary in this regard.
In addition to Taking Back the Night, we need to take over the laboratory, the clinic, the library, and certainly the inalienable socially legitimated right to controlling our bodies and to the deployment of our brain power in the pursuit of the type of happiness that derives from working towards a just world and the preservation of human dignity.