HETROSEXISM IN MEDICINE: LESBIANS’ ACCESS TO AND QUALITY OF HEALTHCARE Hannah Banfield Thesis submitted in partial fulfillment of the requirements for the Degree of Bachelor of Arts with Honours in Sociology Acadia University April, 2010 © Copyright by Hannah Banfield, 2010 This thesis by Hannah Banfield is accepted in its present form by the Department of Sociology as satisfying the thesis requirements for the degree of Bachelor of Arts with Honours Approved by the Thesis Supervisor __________________________ ____________________ Dr. Zelda Abramson Date Approved by the Head of the Department __________________________ ____________________ Dr. Jim Sacouman Date Approved by the Honours Committee __________________________ ____________________ Dr. Sonja Hewitt Date ii I, Hannah Banfield, grant permission to the University Librarian at Acadia University to reproduce, loan, or distribute copies of my thesis in microform, paper or electronic formats on a non-profit basis. I however, retain the copyright in my thesis. _________________________________ Signature of Author _________________________________ Date iii ACKNOWLEDGEMENTS There are several people without whom this work would not have been possible. Foremost, I would like to thank the women who consented to be interviewed, giving their time and sharing their experiences. Their collective efforts are the heart of this project. I am especially grateful to my supervisor, Dr. Zelda Abramson, who recognized a potential in me of which I was not aware. Zelda, your guidance and support have been invaluable and your passion infectious. I would like to express my sincere gratitude to Karen Turner, the department‟s administrative assistant. Karen, you go above and beyond in every way. Your insight has been so valuable, but your friendship is priceless. Ali, I am grateful for your friendship, your intellect, and of course, for the endless laughter we have shared. I cannot imagine my experience over the past year without you. Dan, you leave me in awe of your never-ending patience, constant faith, pure love, and support. I feel so fortunate to be traveling through this life with you. Finally, to my Nanny, my Mum, and my sisters, I thank you for showing me what strong, independent women can achieve; your courage is my inspiration. iv TABLE OF CONTENTS ACKNOWLEDGEMENTS ............................................................................................... iv ABSTRACT ......................................................................................................................... vi 1. INTRODUCTION ........................................................................................................ 1 2. LITERATURE REVIEW ............................................................................................ 4 Women and Medicine in History ................................................................................................ 4 Women and Medicine in the New Millennium......................................................................... 10 Heterosexism in Healthcare ....................................................................................................... 13 Lesbians and Gynecological Health .......................................................................................... 16 Attitudes and Behaviours of Healthcare Professionals ............................................................ 17 Aspects of the Procedure .......................................................................................................... 18 Lesbians and Pregnancy ............................................................................................................ 20 3. THEORETICAL FRAMEWORK ............................................................................ 22 4. METHODOLOGY ..................................................................................................... 27 5. FINDINGS AND DISCUSSION ................................................................................ 31 Medicine’s Assumption of Heterosexuality .............................................................................. 31 Sensitivity of Physician ............................................................................................................... 34 Perception .................................................................................................................................... 36 Healthcare Choice and Decision-Making ................................................................................. 38 6. CONCLUSION ........................................................................................................... 40 7. BIBLIOGRAPHY ....................................................................................................... 44 Appendix A ......................................................................................................................... 49 Appendix B ......................................................................................................................... 50 ABSTRACT In this thesis, I ask whether lesbians have equal access to healthcare and whether the healthcare they receive is in an environment of respect, free from discrimination. I use data gathered from various scholarly texts and journals to explore women and medicine in history, women and medicine in the new millennium, heterosexism in medicine, lesbians and gynecological care, and lesbians and pregnancy. Looking through a lens of feminist standpoint theory, I conduct four semi-structured interviews with lesbian women in Nova Scotia to explore their experiences in healthcare. The interviews dissect a variety of themes, including medicine‟s assumption of heterosexuality, physician sensitivity, the effects of patient perception, and healthcare decision-making. My key finding shows that with increased age and education, women are more able to exercise agency and challenge the power relations that exist in healthcare, and thus are better equipped to receive quality healthcare. Finally, I address solutions for a more inclusive healthcare system, involving both policy planners and healthcare professionals. vi 1. INTRODUCTION The World Health Organization states that health is a fundamental human right (WHO Constitution 1946), recognizing that all people deserve equal access to healthcare and to quality treatment in an environment of respect, free from discrimination. However, not all Canadians obtain these basic privileges, perhaps as a consequence of their social class or race, of their intellectual or physical disability, or their self-identity as LGBTTIQQ2S (lesbian, gay, bisexual, transgender, transsexual, intersex, queer, questioning, and two-spirited). Although all of these groups may face specific and equally trying hurdles to access quality healthcare, this thesis focuses specifically on lesbians in Nova Scotia. I ask whether lesbians have equal access to healthcare, and whether the healthcare they receive is in a respectful environment, free from discrimination. To do this, I explore women and medicine in history, women and medicine in the new millennium, heterosexism in medicine, lesbians and gynecological care, lesbians and pregnancy, as well as the role of physician sensitivity, and the patients‟ perceptions and choices. The method used in my research is a combination of secondary data gathered from various scholarly texts and journals and primary sources. The review of the pertinent literature (in Chapter 2) reveals that historically, women have been a marginalized group (Ehrenreich and English 1973, Mendelsohn 1981). Women were long excluded from medical knowledge and lacked the power and control held by men in society (Ehrenreich and English 1973). Even after the rise of the Women‟s Health Movement in the early 1970s, there certainly remains much to learn about women‟s health, especially those women who belong to marginalized groups. The 1 medical establishment, even in the new millennium, does not adequately address women‟s health issues; women are excluded from clinical investigations, provided less funding for studies specific to their gender, are often prescribed unnecessary psychotropic drugs, and receive a higher number of avoidable surgeries than their male counterparts (The Boston Women‟s Health Book Collective 1998). For women who belong to marginalized groups, access to quality healthcare is even more difficult; lesbians frequently encounter heterosexist assumptions and attitudes in healthcare (Hudspith 1999). They operate in a healthcare system that is entrenched in heteropolarity and heteronormativity, which negatively affects healthcare delivery to lesbians in a number of ways (Fish 2006). Most commonly, lesbians speak of negative experiences in regard to gynecological and obstetrical care. Using feminist standpoint theory, in Chapter 3 I examine lesbians‟ access to healthcare. Standpoint feminism states that women‟s lives are very different from those of men. It asserts that women possess a different kind of knowledge; their status as the subordinate group allows them to see and understand the world in a different way. Dorothy Smith‟s (1987) writings are critical in understanding feminist standpoint theory and how it relates to women‟s experiences in their daily lives. In my study I use standpoint theory to offer a better understanding of lesbians‟ access to healthcare, my aim being to establish whether lesbians are receiving the same quality of healthcare as their heterosexual counterparts.