Women and Health Care

Abstract

Women and Health Care Jennifer J. Davis and Sandie Holguín Kismet brought together these five articles that focus on women, health, and health care. This issue’s contributors provide historical perspectives that deepen our collective understanding of women as patients and as providers within health care systems of the past. They reveal how access to safe and reliable health care served as a foundational demand of feminist movements around the world and shifted definitions of women’s health beyond the reproductive. Finally, these authors recover women’s roles as health care providers in the past, providing evidence that contests the masculinist narrative central to so many medical professional organizations. This is crucial information if we are to make sense of the present. After all, in 2018, the US Census reported that women held over 76 percent of all jobs in health care. Around the world, women occupy nearly 70 percent of health care jobs, skewing towards the lower-paid nursing and sanitation positions. While our experiences of the COVID pandemic over the past two years have emphasized these professionals’ essential work, we also have witnessed how efforts to educate and provide care encountered virulent skepticism and politicization. Collectively, this research documents the health impacts of social inequities and points to the devastation that results from prejudiced policies. Allyson Poska’s article “‘An Operation More Appropriate for Women’: The Gendering of Smallpox Vaccination in the Spanish Empire” reminds us that where vaccines are concerned, disease prevention has always entwined the personal with the political. Inoculation—purposefully introducing small amounts of the smallpox virus through an incision—long practiced in China, India, and the Ottoman Empire, became more common in Europe by the eighteenth century. In 1798, Edward Jenner observed that exposure to the milder cowpox virus provided immunity against smallpox, in a dose that he termed a vaccine. This method provided much safer and more effective immunity against smallpox than did inoculation. Medical practitioners and social elites in Spain and throughout the Americas quickly acted to use the cowpox virus to immunize populations against smallpox. Poska documents how gender ideals shaped the debates that surrounded the administration of the vaccine in the Spanish Americas, including who should be vaccinated, and who should do the vaccinating. Early vaccination advocates appealed particularly to women, calling on them as mothers and as those responsible for nursing their households to master this new technique. Many authors even provided women with straightforward instructions for domestic administration of the cowpox vaccine, arguing that this was an “operation more appropriate to women,” the evocative quote Poska uses as her title. However, in 1803, the Spanish [End Page 1] Crown invested substantial funds in a vaccination effort across the empire and enacted several policies that privileged male medical professionals as “professors of vaccination” and excluded women from the process. The result? Poska makes a compelling case that these factors restricted access to a safe and effective vaccine across the Spanish empire. By partnering with medical professionals rather than women healers as vaccinators, the Crown pursued an elitist health strategy rather than a popular one. Diana Martha Louis inserts mental health into the historical consideration of health care. Her research article, “Black Women’s Psychiatric Incarceration at Georgia Lunatic Asylum in the Nineteenth Century,” takes us to the crossroads where gender, race, and mental illness meet incarceration in the United States. Narrating the lives of five Black women incarcerated at the GLA, Louis observes the institutional refusal to consider or document women’s perspectives of their own mental states. While the voices of mental health professionals and white asylum inmates abound, Black women almost never recorded their own experiences of mental illness. Louis must reconstruct their perspectives from accounts left by partisan witnesses, circumstantial evidence, or contextual clues. Louis reveals how white medical professionals’ expectations about gender and race shaped the category of “insanity” after the Civil War. She exposes the interlocking familial, judicial, and medical systems that condoned assaults on Black women by family members, employers, or police, but pathologized those individuals who responded in kind to such violence. Louis draws on extensive scholarship to give voice to the intergenerational emotional traumas resulting from family separation and racialized...