Basics of qualitative research: Grounded theory procedures and techniques

The Woman in the Body: A Cultural Analysis of Reproduction by Emily Martin Beacon Press, 1987 Paperback, 276 pp $1195 Winner of the 1988 Eileen Basker Memorial Prize As anthropology at its best can do, this book exposes hidden cultural assumptions about the nature of reality Martin has produced a powerful study of the dialectic between medical metaphors for women's reproductive processes and women's own views of those processes She and her associates interviewed 165 white and black women, seeking a balance between the three life stages of puberty, childbearing, and menopause 43% of her interviewees were working-class; 57% middleclass Early on Martin came up against one of the greatest dangers of studying one's own society Hearing women discuss uterine contractions as separate from the self and labor as something one "went through," and reading the same in medical texts, she at first thought that her interviews had turned up views of the body that simply reflected actual scientific fact It took her some time to realize that such scientific views are not "fact" but culturally grounded statements of an underlying ideology To get at this ideology Martin studied medical texts for the "grammar" that scientific medicine uses to describe female bodies In this medical grammar, she finds industrial society writ small The female reproductive tract is a machine designed to produce a baby; accordingly, menstruation represents failed production, connoting both a productive system that has failed to produce and one that produces only useless waste Such metaphors, disturbing to a society whose existence depends upon continued production, lead to menstruation's description in medical texts in highly negative terms: The fall in blood progesterone and estrogen, which results from regression of the corpus luteum, deprives the highly developed endometrial lining of its hormonal support    Disintegration starts    The endometrial arteries dilate, resulting in hemorrhage through the weakened capillary walls; the menstrual flow consists of this blood mixed with endometrial debris    (quoted on p 48) (Martin contrasts this with a description of male reproductive physiology which speaks of the "remarkable" cellular transformation from spermatid to mature sperm, its "amazing" nature and "sheer magnitude") Confronting the argument that the above is not value-laden but simply a factual description of menstruation, Martin examines medical descriptions of the analogous regular shedding and replacement of the lining of the stomach, finding in a number of texts no references to degeneration, but instead a stress on the periodic "renewal" of the stomach lining Concluding that writers can choose to depict what happens to the lining of stomachs and uteruses either negatively as breakdown and decay or positively as continual production and replenishment, Martin suggests an alternative medical description of menstruation: A drop in the formerly high levels of progesterone and estrogen creates the appropriate environment for reducing the excess layers of endometrial tissue Constriction of capillary blood vessels causes a lower level of oxygen and nutrients and paves the way for a vigorous production of menstrual fluids    Such a description would far more accurately reflect women's own more positive assessments of the menstrual fluid as the desired product Viewing pregnancy as the sole purpose of female reproductive organs and despising menstruation as a "waste" ignores the reality that most women do not intend to get pregnant most of the time (and so are often joyful when menstruation begins), and conceals "the true unity women have    [Menstruation is] the one thing we all share" (p 112) In spite of ambivalence about the "disgusting mess," most interviewees felt that menstruation defines them as women and insisted that they wouldn't want to give it up Teens spoke of the joy of getting their periods so they could be part of the in-group that shared the women's "special secret," of mothers and sisters greeting their first menstruation with "You're a woman now! …

The Woman in the Body: A Cultural Analysis of Reproduction

&  and the Holacaust. Ovcrall,Ralandhasmadcauaiquc d ~ y a o d i b l e c o n t r i ~ o n t o t h e historical literature on the HoImllst. The book is c;xtmsivdy rekenad with citations to a variety of archival materials, primary litmame, and aubobiagraphical w m , as wdlm bo pmoml interviews conducted by the author. A h to Roland's d r , he diractly codion& conflicts that cxist in c o m e 8 acmunts a£ some wens and offers explando118 when mmmblc. Alehaugh rhis is a scholarly boo4 the resulting tat is concise and wtly integrated, rcadmg much like a novdla. Whik historians of the H o I ~ Judaica, and medial hiswry will h d that thls book provides new irmgh~t~ and detail, it is compdhg andpmwative reading .Ear all who d d e r & d y e s students of hulnaniq.

Deviance and Medicalization: From Badness to Sickness

Women and the public sphere in the age of the French revolution

Charles Webster

Oxford University Press, £9.99, pp 233

ISBN 0 19 289296 7

Doctors in the United States still express a strong distaste for what they perceive as socialised medicine in Great Britain. But, of course, few of them are familiar with the NHS and how it functions. They are not familiar, for example, with how much greater freedom of practice the British doctor has had, at least up to the recent past. It could be argued, as J R Hampton did in his famous 1983 editorial, that clinical freedom was at an end. But Hampton was arguing that it was the freedom to ignore what we now call evidence based medicine that was at an end. It is another kind of freedom, the freedom of what Eliot Freidson has called “the flexible discretionary judgement that is necessary to adapt to individual [patients’] needs” that is being eroded as the NHS adopts the worst of managerial style, American managed care.



Not all conditions of the mouth are due to disease. Tribal tattooing of the upper gums is illustrated in the second edition of Oral Diseases , edited by C Sculley, S R Flint, and S R Porter (Martin Dunitz, £75, ISBN 1 85317 …

The National Health Service: A Political History

Les usages contraceptifs en France et en Angleterre se distinguent fortement du point de vue du recours aux methodes masculines : la vasectomie et le preservatif sont utilises par la moitie des usager.e.s outre-Manche et par seulement15% des personnes en France. A partir des annees 1960, la medicalisation de la contraception est allee de pair avec sa feminisation, mais les modeles contraceptifs de chaque pays semblent ainsi accorder une place differente a la prise en charge masculine des responsabilites en matiere de regulation de la fecondite. Pour comprendre comment ces modeles plus ou moins sexues sont socialement construits, cette these compare les contextes institutionnels de la prescription contraceptive qui contribuent a definir le champ des possibles et du souhaitable pour les usager.e.s. Outre une analyse comparative historique et institutionnelle approfondie, ce travail s'appuie sur 34 entretiens semi-directifs avec les professionnel.le.s de sante dans les deux pays afin d’eclairer les logiques qui structurent leurs pratiques et participent a la definition des normes contraceptives. Cette analyse comparative met en evidence l’impact de traditions politiques contrastees en matiere de regulation des naissances : l’heritage de l’eugenisme britannique est plus favorable au recours a des methodes contraceptives definitives que le natalisme francais. Par ailleurs, les systemes de sante francais et britannique se distinguent par leur degre d’encadrement de la formation et des pratiques medicales. En France, la faiblesse de cet encadrement autorise une grande diversite de pratiques en matiere contraceptive, et notamment une approche paternaliste du choix contraceptif et l’expression de reticences professionnelles genrees vis-a-vis des methodes de contraception masculines. En Angleterre, la regulation publique de la formation et des pratiques tend a standardiser les approches professionnelles du choix contraceptif, et laisse une place plus importante aux preferences des usager.e.s.

Prescrire, proscrire, laisser choisir : Autonomie et droits des usagers des systèmes de santé en France et en Angleterre au prisme des contraceptions masculines

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Prescrire, proscrire, laisser choisir : Autonomie et droits des usagers des systèmes de santé en France et en Angleterre au prisme des contraceptions masculines