Women and reproductive health: A case of epistemic injustice

For both Philosophy and Ways of Knowing, I have talked time and time again about the medical negligence towards women and individuals assigned female at birth. I particularly focused on the negligence of womens’ concerns in reproductive healthcare and the invalidation of menstrual issues. I talked about this specifically in the capacity of epistemic injustice, where womens’ concerns about their own bodies are overlooked and dismissed as just being sensitive or dramatic. 

The onset of the Covid-19 pandemic has taught me how this act of epistemic injustice transcends beyond mere microaggressions, into a realm of serious threats to the health and wellbeing of people with uteruses. 

Recently, my friend Laiba Mubashar wrote a blog post underscoring the impact of Covid-19 on menstruation. In this blog, Laiba cites a research article based on a survey carried out by specialists at the Society for Endocrinology annual conference in Edinburgh. 1300 women were surveyed in April 2021 regarding their stress levels, sleep, and menstrual cycles. 56% reported an overall change in their menstrual cycles since the beginning of the pandemic; 64% reported a worsening in premenstrual symptoms. 

In her blog, Laiba makes the conclusion from the cited research article that investigating the long-term effects of the pandemic on female reproductive health is necessary.

Keep in mind, the article Laiba cited was published in April 2021. This was around four months after Covid-19 vaccines started rolling out to the general public. When I personally went to receive my Covid-19 vaccine in March (first dose) and April (second dose), I was barely able to find any official studies or information about the impact of the vaccine on menstrual cycles. All I could really find were posts on Reddit by people saying that their menstrual cycles are impacted. 

I think it is worth mentioning that the people posting about their disrupted menstrual cycles were also heavily questioning themselves and the validity of their own experiences. They thought maybe they were mistaken and it wasn’t the vaccine toying with their cycles. While it is valid to be skeptical before drawing a conclusion about an experience so new and unlike anything before, to see people with uteruses question their own judgment about their own reproductive health is not uncommon.

Only after several women reported disruptions in their menstrual cycles, the National Institutes of Health (NIH) released grants to five institutions to carry out research about the impact of the vaccine on menstruation. John Hopkins’ Gynaecology Department was one of these five institutions and they released their study in September 2021. The problem is, this was after thousands of individuals had already been vaccinated and experienced menstrual disruptions without being aware of it or prepared for it. I strongly believe that this was due to insufficient testing on diverse bodies and lack of consideration for womens’ reproductive health. 

Another friend of mine, Makeisha, has excellently explained this topic in a blog post. She unpacks the article, “Epistemic Injustice and Resistance in the Chiapas Highlands: The Zapatista Case,” by Sergio Gallegos and Carol Quinn and uses it to draw parallels with the global systematic oppression of women in healthcare. 

Why do we see women constantly questioning and invalidating their own pain and symptoms in terms of reproductive health? It is because that is what they have heard other people say about their pain and symptoms. Where I come from, seeing a gynecologist is already a huge taboo. The stigma is even twofold if you are “unmarried” read: sexually inactive. There is a general dominant belief that nothing can go wrong with “unmarried” women, hence they are not checked or tested, especially if the procedure is supposed to be invasive. 

“Unmarried” girls are asked “What will your future husband have to say about this?” when they demand a procedure. More autonomy and control are placed in the hands of a non-existent husband than the individual whose body is in question. I believe this dismissal and invalidation of the concerns of people with uteruses when it comes to reproductive health is an example of epistemic injustice that has not only hurt me and people close to me but has also caused structural risks as seen in the case of the lack of investigation about the impact of Covid-19 vaccines on menstrual cycles.

Similar to my idea about non-existent husbands, Makeisha talks about a ‘hypothetical male partner’. In their blog, they elaborate further on why this epistemic injustice is harmful since it leads to illegal and unsafe abortions as well. They further talk about how medication and procedures are specifically tested on men as healthcare uses an unfair one-size-fits-all-approach. This makes it difficult to diagnose and correctly medicare non-men. 

The culture of not believing women about their own symptoms terrifies me. Last summer, I talked to Ramma Cheema about her experience with endometriosis and how difficult and slow her diagnosis was. Endometriosis refers to a condition where tissue similar to the endometrium grows outside the uterus. After experiencing the issue of doctors disbelieving her, she Googled about her condition, and only after getting married did she convince a doctor to carry out an investigative laparoscopy, the only procedure that provides a conclusive diagnosis for endometriosis. Ramma concluded by sending out a message to young women to listen to their bodies and believe their bodies. 

The Spectrum of Sex

I remember watching a video on Facebook about “a man who gets his period”. The association of menstruation with women is so intense that the concept of menstruating men is very surprising to some people. Such people were in the comment section of the aforementioned video. But for me, the most appalling aspect of the video was that it declared the menstruating man transgender, even though it was likely that the person was intersex because he had ovaries according to an ultrasound shown in the video. The reason why I am referring to this anecdote is to underscore the lack of education about gender and sex in general. People do not know the difference between a transgender person (an individual who does not identify with the gender they were assigned at birth), and an intersex person (an individual whose reproductive and/or sexual anatomy does not align with “male” or “female” anatomy). Despite the fact that I was appalled, reflecting back on my own prior convoluted knowledge and understanding of gender and sex made me realize how much misinformation there is regarding sex, gender, and their distinction in South Asia, much like the rest of the world. I also grew up confused and uninformed about these topics. 

Before I decided that it is unnecessary to label people’s genders and sexuality, my internalized cis-heteronormativity would make me want to put every individual around me into boxes. Dembroff talks about how critics like to accuse people like them of being obsessed with gender, but I think it is cisnormative people who are obsessed with putting people in boxes. I am so grateful I unlearned this and that is why Dembroff’s idea of how the biological world is far messier than XX and XY chromosomes is so important to me (Dembroff, 2018). 

Up until a few years ago, I used to refute the “there are only two genders” argument by suggesting that there are various genders, but two distinct, opposite sexes, which is a phenomenon termed the sex binary. 

I was so wrong. In fact, as early as the 20th century, scholars started to challenge and contest the idea of the sex binary. They argued that all males had female aspects and vice versa (Alok, 2021). Where I come from, educating yourself about sex and gender is discouraged, and you are encouraged to think of the two as synonymous and fixed. This is possibly done to prevent South Asian children from exploring their sexualities and gender identities to prevent “sexual deviance” according to our traditions. There is a commonly held belief that sexuality is a choice, and it is believed that if children are talked to openly about sexuality, they will “turn” queer. This is factually incorrect, ignorant, and harmful.

Reading the Dembroff text helped me realize how cis-heteronormativity not only impacts trans people but also intersex people. One particular resource I have found helpful in comprehending the spectrum of sex is the Instagram account of author and performer, ALOK

One really shocking piece of information I learned from their page is the racist history of the sex binary and how the binary is a colonial invention. According to Alok’s research, in the pre-Enlightenment era, males and females were seen as different forms of the same sex. To be a male or female was cultural, not biological (Alok, 2021). 

View this post on Instagram

A post shared by ALOK (@alokvmenon)

However, after the enlightenment, male scientists started to try and distinguish between what they regarded as the two binary sexes. Consequently, organs that used to have the same name such as ovaries and testicles were linguistically distinguished. Scientists regarded the white people as superior because they had a clear distinction between “males” and females while this didn’t necessarily apply to racial minorities. In 1886, a German sexologist wrote that the higher the development of a race, the stronger the contrast between man and woman. This was echoed by others. This is also because the white people were considered the most “civilized”, which in this case was almost synonymous with “conforming to gender roles” (Alok, 2021). 

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A post shared by ALOK (@alokvmenon)

What is so vile about the sex binary is that it allowed men to justify limited women’s rights in the name of nature. This is because they would argue that women are biologically weaker, or more emotional, and less rational. This is why they would be given limited tasks and be expected to conform to strict gender roles. Their intellect was also questioned because they were labeled as “too emotional”. According to Alok, it was a method of naturalizing inequality, which I think is so important to note because of the extent to which the inequality between the sexes is socially constructed rather than innate. 

 

No Longer Simon – an Ice King analysis in context of the Memory View

Olive skin, dark hair, a love for archaeology, and a tender heart – Simon Petrikov had quite an inviting personality. 

However, soon after, he almost turned into the complete opposite of the aforementioned description. Pale blue skin, white hair, a beard, and the sick wish to kidnap a princess – Ice King would not even respond if you used the name Simon to address him. 

How did this happen? 

In the show Adventure Time, Simon was a regular human before the near annihilation of the human species during the Mushroom War. He was kind-hearted and loving to everyone around him including his fiancee, Betty, and to his young friend, Marceline the vampire queen. He was studying to become an antiquarian (a specialist in the knowledge of ancient artifacts) and was passionate about archaeology. Due to this, he purchased an ancient jeweled crown which caused him to blackout and experience odd visions. This frightened Betty away from his life. The crown erased his memory and influenced and twisted his mind and body to a point where he quite literally lost his humanity and started being considered a twisted wizard called Ice King.

The Memory View 

The Memory View or the Psychological Continuity view suggests that the self is made up of an individual’s collection of memories. In A Dialogue on Personal Identity and Immortality by John Perry, Miller quotes Locke’s view of memory that suggests that the relationship between two people or stretches of consciousness is shared memory. In class discussions, many people brought up questions of how memory loss comes into play in this whole situation and whether people with memory loss lose their “selves” with their memory and I couldn’t help but think of Ice King’s story. 

So, did Ice King lose his self?

As disappointing as it is, I think there isn’t an absolutely concrete answer to this. However, it can be speculated that Ice King did largely lose himself when his memories were wiped out. This was even further depicted when his body and species changed due to his change in memory. This obviously would not happen to a person with memory loss, but it really goes to show that his memory loss was the root cause of him losing everything that made him Simon Petrikov. In the episode “I Remember You”, it is even hinted that Simon was aware that he would lose himself because, in a message written to Marceline, he mentions losing himself and being afraid that Marceline would lose him as well. He also mentions that he feels himself slip away. When he sings these messages later as Ice King, he has no understanding of them. 

However, there was the residue of his life as Simon that traveled into his life as Ice King, such as how his heartbreak about Betty made him want to marry a Princess (for which he wanted to kidnap Princess Bubblegum, which was extremely messed up)

An important difference between Simon and Ice King is degrees of self-awareness. While Simon is aware of himself while he is losing himself, Ice King does not know what is happening. 

There is an irony in Ice King’s loss of self because the readings about the self talk a lot about immortality and permanence. Ice King’s crown has made him immortal, yet his self has changed drastically compared to that of mortals. This raises larger questions about personhood and permanence. Perhaps the real personhood and humanity lie in the limited mortality and impermanence of human life. 

Fans of the show have commented on online forums about how the representation of Ice King and his dynamic with Marceline resonated with them because they had relatives with memory loss. While Marceline values Ice King, she is easily frustrated by his memory loss and lack of self-awareness. If anything, the show teaches an important lesson about empathizing with someone with memory loss, even if you believe they have completely lost their original identity. 

*For context about the above gif, her name is Marceline and he mistakenly calls her Gunter (which is the name of his penguin)

 

 

Ice king. Adventure Time Wiki. (n.d.). Retrieved October 1, 2021, from https://adventuretime.fandom.com/wiki/Ice_King. 

Perry, J. (1978). A dialogue on personal identity and immortality. Indianapolis: Hackett Pub. Co.

Sarah Consumes Media Mindlessly(ish)

Since I can’t shut up about films and television shows relevant (mostly) to the course content for both Philosophy and Ways of Knowing, here’s a list of films, shows, videos, or music that I find applies to what we’re reading about.

The Good Place

Category: Show

10/10 show, lots of content about moral Philosophy, might give you an existential crisis.

Where to watch: Netflix

Russian Doll

Category: Show

PLEASE watch it. A good substitute for Groundhog Day if you hate misogyny as I do. Very time loopy also. 

Where to watch: Netflix (Yes, I’m aware I’m throwing all my money at them)

Unpaid intern

Category: Song 

Just listen to it, very relatable content. Never thought I could relate to a white man. 

Where to watch: YouTube but you can watch Bo Burnham’s inside on Netflix

English Vinglish

Category: Movie

Very cute movie, it’s like a coming-of-age film but the protagonist is older than your usual coming-of-age protagonist because some South Asian women get their coming-of-age stories late and that is perfectly fine >:(

Where to watch: Prime Video

 

Unrelated, but enjoy some music:

My Past Isn’t in The Past, It’s in the Facebook Database

According to Jenny Odell’s text, The case for doing nothing, phones are shaping the attention economy and are controlling how we think and how we view things. The attention economy is the idea that human attention is a valuable currency or commodity. So while digital and social media might be free to use, there is still a valuable amount of attention paid.

A few months ago, I would have honestly dismissed this rhetoric as “boomer” discourse (at least I’m self-aware enough to call myself out on it). However, recently I have developed an aversion to social media and my phone after realizing the impacts that it has on my brain. The impact I experience is different from what negative impacts of social media are stereotypically considered to be. I am grateful that looking at perfect bodies and faces does not fill me with a sense of negative body image, however, it is a perfectly valid concern and happens to a lot of people. In fact, it is an important pressing issue that needs to be talked about. 

My issue is a little different. I grew up on the internet. Facebook witnessed my entire childhood as I foolishly overshared every little thought I ever had. Facebook saw me play Pet Society for hours on end and witnessed my One Direction phase. Now that I want to distance myself from my past mistakes and acknowledge my growth, the past isn’t really in the past, it’s in the Facebook database. Every time I want to present a refined, curated version of me that was genuinely birthed out of self-growth and introspection, the Memories feature reminds me of my unfiltered and flawed past. I think it is ironic how we think that social media helps us hide behind a screen and present ourselves as whatever we want to be because I think my social media has seen me at my most authentic and vulnerable.

Here is a video of 12-year-old me either being extremely wise by saying that using my laptop all the time isn’t good for me, or being an absolute hypocrite because I used my laptop all the time anyway. 

 

Every single word you type, even if you delete it before posting it gets stored. It is a sense of vulnerability like no other. During an internship, I accidentally copy-pasted a YouTube lyric video instead of a link to the company’s blog post on the company’s Facebook page. While I deleted it in time and did not post it, Facebook knows. Facebook always knows. Well, whoever’s reading this now also knows so maybe this anecdote was a little counter-intuitive. Please don’t tell my former boss. 

What scares me is that I didn’t even think twice about the surveillance and amount of my information that was being stored. Only after a lot of reflection and introspection this summer, did I finally realize that I spend hours of my time aimlessly scrolling and providing information to mobile apps that don’t do much for my mental health besides making it worse.

In addition to this, since I grew up on the internet, I feel like I owe it all my thoughts. I think I have to read every single article I find on my social media and interact with it. I think that if I do not voice my political opinions on everything, I will be in trouble. It is paradoxical because I do believe that everyone with a platform has some sort of social responsibility to raise their voice for the marginalized.  In the text, Odell talks about how “doing nothing” entails an active process of listening that brings about real change in terms of racial and environmental justice among other issues. I thought that was so important because I always felt like I was being complicit if I was logging off and doing nothing. However, Odell creates a distinction between being complicit and stopping to introspect. 

Using social media became incredibly difficult for me this summer due to the rapid politicization of Instagram and the new wave of the #MeToo movement in Pakistan. I would typically be so grateful for the fact that sexual harassers and assaulters are being outed, but this summer I found myself losing control and reading posts disregarding the trigger warnings that accompanied them. In Stand Out of Our Light, Williams points out how social media triggers distract our navigation through informational space. While at first glance, this seems to be limited to frivolous distractions, in my experience, it isn’t just limited to those. 

For example, I would glance at my phone to check my emails and before I knew it, I would have spent an hour reading in-depth posts about a femicide case that had happened in my country. After that hour, I would be reading comments victim-blaming the victim and fruitlessly interacting (read fighting) with those comments. Then, I would be reporting extremely offensive, threatening, and misogynistic comments on the posts, only for them to not be taken down because they were made in Urdu and apparently the Facebook and Instagram algorithm isn’t smart enough to recognize that comments made in another language can violate their community guidelines. (This is very puzzling because it is smart enough for targeted advertisements and adding links to vaccine information if Covid is mentioned). Even with my phone off, I would constantly be thinking about the horrible things I saw on my screen for hours and how I wasn’t able to do anything about them. This is why I decided to give myself a social media break and begrudgingly deleted my Facebook and deactivated my multiple Instagram accounts.

Odell’s idea of productivity consisting of the maintenance of what exists instead of just a production of something new was so eye-opening for me. I was so immersed in gaining new information and creating new content on social media, that I wasn’t even looking back at the information I already knew and content I had already created. I was not asking myself if what I already knew was right and authentic because I wasn’t even asking myself if I was doing alright. I spent my social media break (which is still ongoing) journaling, listening to music, walking outdoors, and mostly studying. It made me realize how using phones is such a huge part of social situations. Sometimes when I sit around with my friends, I find them silently scrolling through their phones for minutes on end. I only recently noticed this because I used to do the same. Scrolling through social media is genuinely such an easy distraction and life has not been the easiest without it. However, I’m really grateful that I caught myself in a toxic spiral and took action at such a young age. This social media break is one of the healthiest things I’ve done in a while. 

 

Stuck in Subservience – The Educational Dichotomy

Glossy four-seater tables, congealed Maggi noodles eaten out of plastic lunch boxes, chipped pastel green wall paint, being told what conduct makes a good wife, asking for permission to drink water out of bright-pink plastic water bottles, unquestioned chants of Two one “za” two, two two “za” four echoing in a classroom, copied words off a chalkboard on three-lined notebooks to later be rote-learned — middle school looked a lot like adventure. Reading Paulo Friere’s Pedagogy Of The Oppressed deeply resonated with me since I had experienced what Friere describes as the banking model of education for most of my school years. 

Not being taught how to analyze situations affected me severely when it came to topics I deeply cared about. One such topic was climate change. Last year, I realized that a lot of the climate education we were provided with lacked nuance, and when I learned the actual gravity of the situation, I was overwhelmed and uncomfortable. Additionally, I experienced some trouble explaining this new information to those around me. Having had this experience, Plato’s allegory of the cave made perfect sense to me!

“You start out learning about global warming and the greenhouse effect in school, nobody talks about it outside of school, and one day, you grow up, leaving behind awareness of environmental degradation like a discarded binder in a locker.”, writes Sarah Elahi (2020) in an article unpacking motherhood during the Anthropocene. Including me, most Pakistani kids have shared this experience where the environment is treated like an abstract entity divorced from reality. In middle school, I was told to paint “Save The Earth”, bright green and blue, on fresh single-use and non-biodegradable paper with paints containing non-biodegradable acrylic polymers.

Friere describes the fundamentally narrative character of schools, artfully saying that the educational system is suffering from narration sickness. He extrapolates on this, stating that the banking structure places the teacher in an authoritative position as a narrator, and students in a subservient passive position as listeners (Friere, 1968).

Reading, reflection, and introspection with respect to the model have made me realize the intensity of the dichotomy that the banking model creates between students and teachers. I had never dared to question this dichotomy before because I just believed that was how things were supposed to be. 

An obvious reason why I never questioned this dichotomy was that I could not dare to question authority. I remember always being really excited to learn, reading random end-of-chapter activities in my textbooks, doing them at home, excitedly going up to my teachers, and telling them about my at-home educational adventures. 

I wish I could say my teachers were always warm and welcoming in response to my excitement. When I was in the fourth grade, a teacher literally told me to shut up when I told her that I wanted to build a terrarium. I remember this so well because, after this, I kept my excitement to myself and stopped telling my teachers anything at all. After that incident, I have only had two teachers in my entire school life who supported anything I had to say that was even a morsel out of the strict syllabus content. 

On Perusal and in discussions, I highlighted how Friere’s ideas mirror Friedrich Engels’ ideas of class consciousness and how the dichotomy between teachers and students mirror larger oppressive systems and power structures. However, I believe that it is important to acknowledge how in South Asian or desi societies, this dichotomy stretches into families as well, existing between adults as narrators and children as passive obeyers, also mirroring larger oppressive systems. 

Growing up in a South Asian household, I was never allowed to question anything any adults around me said. It was genuinely a rule set in stone. Referring to this culture, writer Nuur Hasan (2020) writes:

You are told to walk in a straight line after you are thoroughly told what a straight line is, and how it is iron-clad into our society. Deviating from it is evil and unwise.

The straight line? – What is it? It is the root cause of all problem; the outdated, boring, even hurtful and restrictive self-proclaimed “laws” of our elders. Some call it culture, some call it traditions.

It becomes even harder to subvert the banking model in South Asia because of how deeply rooted obeying adults in the name of respect is in our culture. While there is absolutely nothing wrong with respecting adults. I completely endorse respecting everyone, however, the aforementioned obedience entails a lack of agency or autonomy. This might be to uphold the tradition of more concrete family structures which uphold the patriarchy along with neoliberal economies. This is due to the patriarchal and patrilineal notion that women are lower than men, it is automatically assumed that they are not primary breadwinners and hence require less money (Mitchell, 2016). Hence, women are not only systematically oppressed in workplaces but are also rapidly proletarianized and trapped in a cycle of poverty.

 

References:

 

Elahi, S. (2020, March 2). Apocalypse babies. https://www.sochwriting.com/apocalypse-babies/. 

Freire, P. (1972). Pedagogy of the oppressed. New York: Herder and Herder.

Mitchell, A. (2016, September 7). Neoliberalism’s Exploitation of Women Workers: the true price of our clothing. Institute of Asia and Pacific Studies. https://blogs.nottingham.ac.uk/asiapacificstudies/2016/09/07/neoliberalisms-exploitation-women-workers-true-price-clothing/. 

Nuur Hasan 1 year, 5 months. (2020, April 1). 

What is wrong with our elders and ‘desi’ culture? Mashable Pakistan. https://pk.mashable.com/opinion/2311/what-is-wrong-with-our-elders-and-desi-culture.