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Geographies of Women’s Health

Around the globe, environmental and social transformations are reshaping women’s
mental and physical health experiences, their access to health care services, and their
roles in care giving.
This international collection explores the relationships between society, place,
gender, and health, and how these play out in different parts of the world. The chap-
ters work together in examining the complex layering of social, economic, and
political relations that frame women’s health. The authors demonstrate that women’s
health needs to be understood “in place” if gains are to be made in improving
women’s health and health care. Policy implications are woven throughout as
contributors explore the close connections between policy structures, access to health
and health care resources, and modes of service delivery. What happens in the offices
of government can have profound influences on women’s ability to create and sustain
healthy lives.
The contributors use both qualitative and quantitative methodologies, representing
the many lenses now being employed in understanding the health of women. Many
chapters use women-centered research strategies and draw on feminist theory in
explicating the links between health and place. What is significant in these accounts
is that women are rarely best viewed as “victims” but as women exploring and using
active strategies in managing health and illness and accessing both formal and informal
health care systems.

Isabel Dyck is a social geographer and Associate Professor in the School of


Rehabilitation Sciences, University of British Columbia. Her research interests
include feminist analyses of the work experiences of women with chronic illness and
health care access for immigrant and minority group women.

Nancy Davis Lewis is Associate Dean of Social Sciences and Professor of Geography
at the University of Hawaii. Her research explores a wide range of health issues
from human ecology to the health transition.

Sara McLafferty is Professor of Geography at Hunter College of the City University


of New York. Her research has explored geographic inequalities in health and access
to health care in cities and the use of spatial analysis methods in examining these
issues.
Routledge international studies of women and place
Series editors: Janet Henshall Momsen and Janice Monk
1 Gender, Migration and Domestic Service
Edited by Janet Henshall Momsen

2 Gender Politics in the Asia-Pacific


Edited by Brenda S. A. Yeoh, Peggy Teo and Shirlena Huang

3 Geographies of Women’s Health


Edited by Isabel Dyck, Nancy Davis Lewis and Sara McLafferty

4 Gender, Migration and the Dual Career Household


Irene Hardill

Also available from Routledge:


Full Circles: Geographies of Women over the Life Course
Edited by Cindi Katz and Janet Monk
‘Viva’: Women and Popular Protest in Latin America
Edited by Sarah A Radcliffe and Sallie Westwood
Different Places, Different Voices: Gender and Development in Africa, Asia and Latin America
Edited by Janet Momsen and Vivian Kinnaird
Servicing the Middle Classes: Class, Gender and Waged Domestic Labour in Contemporary
Britain
Nicky Gregson and Michelle Lowe
Women’s Voices from the Rainforest
Janet Gabriel Townsend
Gender, Work and Space
Susan Hanson and Geraldine Pratt
Women and the Israeli Occupation
Edited by Tamar Mayer
Feminism / Postmodernism / Development
Edited by Marianne H. Marchand and Jane L. Parpart
Women of the European Union: The Politics of Work and Daily Life
Edited by Janice Monk and Maria Dolors Garcia-Raomon
Who Will Mind the Baby? Geographies of Childcare and Working Mothers
Edited by Kim England
Feminist Political Ecology: Global Issues and Local Experience
Edited by Dianne Rocheleau, Esther Wangari and Barbara Thomas-Slayter
Women Divided: Gender, Religion and Politics in Northern Ireland
Rosemary Sales
Women’s Lifeworlds: Women’s Narratives on Shaping their Realities
Edited by Edith Sizoo
Gender, Planning and Human Rights
Edited by Tovi Fenster
Gender, Ethnicity and Place: Women and Identity in Guyana
Linda Peake and D. Alissa Trotz
Geographies of Women’s
Health

Edited by Isabel Dyck,


Nancy Davis Lewis,
and Sara McLafferty

London and New York


First published 2001
by Routledge
11 New Fetter Lane, London EC4P 4EE
Simultaneously published in the USA and Canada
by Routledge
29 West 35th Street, New York, NY 10001
Routledge is an imprint of the Taylor & Francis Group
This edition published in the Taylor & Francis e-Library, 2001.
Selection and editorial matter © 2001 Isabel Dyck, Nancy Davis
Lewis, and Sara McLafferty; individual chapters
© the contributors
All rights reserved. No part of this book may be reprinted or
reproduced or utilized in any form or by any electronic, mechanical,
or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or retrieval
system, without permission in writing from the publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Geographies of women’s health/edited by Isabel Dyck, Nancy Davis
Lewis, and Sara McLafferty.
p. cm.
Includes bibliographical references and index.
1. Women—Health and hygiene—Cross-cultural studies.
2. Women—Medical care—Cross-cultural studies.
3. Medical geography. 4. World health—Case studies.
I. Dyck, Isabel. II. Lewis, Nancy, 1946– III. McLafferty, Sara, 1951–

RA564.85 .G47 2000


614.4′2′082—dc21 00–045838
ISBN 0–415–23607–X (Print Edition)
ISBN 0-203-18602-8 Master e-book ISBN
ISBN 0-203-18725-3 (Glassbook Format)
Contents

List of illustrations viii


Notes on contributors x
Acknowledgments xv

1 Why geographies of women’s health? 1


ISABEL DYCK, NANCY DAVIS LEWIS, AND SARA MCLAFFERTY

PART I
Globalization, structural change, and political
realignment: implications for women’s health 21

2 Women’s health in Europe: beyond epidemiology? 23


CAROL THOMAS AND JAN RIGBY

3 Scales of justice: women, equity, and HIV in East Africa 41


SUSAN CRADDOCK

4 Women workers and the regulation of health and safety


on the industrial periphery: the case of Northern Thailand 61
JIM GLASSMAN

5 Looking back, looking around, looking forward:


a woman’s right to choose 88
PATRICIA GOBER AND MARK W. ROSENBERG
vi Contents
PART II
Providing and gaining access to health care: local areas
and networks 105

6 Home care restructuring at work: the impact of policy


transformation on women’s labor 107
ALLISON WILLIAMS

7 “Thank God she’s not sick”: health and disciplinary


practice among Salvadoran women in northern New Jersey 127
CAROLINE KERNER, ADRIAN J. BAILEY, ALISON MOUNTZ,
INES MIYARES, AND RICHARD A. WRIGHT

8 Babies and borderlands: factors that influence Sonoran


women’s decision to seek prenatal care in southern Arizona 143
CYNTHIA POPE

9 Differing access to social networks: rural and urban


women in India with reproductive tract infections and
sexually transmitted diseases 159
SUPRABHA (SUE) TRIPATHI

10 Walking the talk: research partnerships in women’s


business in Australia 177
LENORE MANDERSON, MAUREEN KIRK, AND ELIZABETH HOBAN

PART III
Embodied health and illness, perceptions, and place 195

11 “The baby is turning”: child-bearing in Wanigela,


Oro Province, Papua New Guinea 197
YVONNE UNDERHILL-SEM

12 Fear and trembling in the mall: women, agoraphobia,


and body boundaries 213
JOYCE DAVIDSON

13 Material bodies precariously positioned: women


embodying chronic illness in the workplace 231
PAMELA MOSS AND ISABEL DYCK
Contents vii
14 The beauty of health: locating young women’s
health and appearance 248
ANDREA LITVA, KAY PEGGS, AND GRAHAM MOON

15 Women in their place: gender and perceptions


of neighborhoods and health in the West of Scotland 265
ANNE ELLAWAY AND SALLY MACINTYRE

Index 282
Illustrations

Figures
2.1 Standardized mortality rates for ischaemic heart disease,
all women 29
2.2 Standardized mortality rates for breast cancer, all women 30
2.3 Percentage of women smoking alongside standardized
mortality rates from cancers of the respiratory system, 1992 31
2.4 Self-perceived health status of women aged 15 and over,
1996 34
2.5 Self-perceived health status of women aged 65–74, and 75
and over, 1996 35
4.1 Map of Thailand 63
4.2 Death rates for major cause groups, whole kingdom,
1957–95 69
4.3 Death rates for major causes of mortality, whole kingdom,
1980–95 70
4.4 Rate of fatal occupational injuries, by country, 1986–95 72
4.5 Occupational injury rate, by country, 1986–95 73
5.1 Abortion ratios (abortions per 100 live births) in the
United States and Canada 91
5.2 Annual therapeutic abortions to Canadian residents by
location 93
5.3 Incidents of violence and disruption at US abortion clinics 97
6.1 The home care occupational hierarchy 110
9.1 Faridabad, Haora, North Arcot-Ambedkar, and Pune
districts, India 164
9.2 Social networks used by women for RTIs and STDs in
Faridabad and Haora, India 168
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Illustrations ix
Tables
2.1 Percentage of women aged 15 and over with disability
due to long-standing illness 28
2.2 Reproductive statistics for Member States 33
2.3 Development indices 33
4.1 AIDS and workplace accident mortality, Thailand and
Chiang Mai-Lamphun, 1984–96 74
5.1 Hospital and freestanding abortion clinics in Canada, 1998 99
6.1 Demographic characteristics of questionnaire survey
respondents 114
6.2 Exploratory factor analysis results for work life item
loadings on obliquely rotated factors 116
6.3 Differences between groups for working life items 117
9.1 Types of qualitative research methods used 163
9.2 Kin and belief systems used by women for all RTIs
and STDs in Faridabad, Haora, North Arcot-Ambedkar,
and Pune 169
9.3 Medical systems used by women for all RTIs and STDs in
Faridabad, Haora, North Arcot-Ambedkar, and Pune 171
13.1 Socio-economic profiles of the four women with chronic
illness 236
15.1 Proportion of women and men reporting a “serious”
problem with various aspects of the neighborhood 270
15.2 Mean local problems and neighborhood cohesion scores:
means by gender, cohort, social class, and neighborhood
of residence 271
15.3 Proportion of women and men reporting “strongly agree”
with individual component statements of the neighborhood
cohesion scale 272
15.4 Mean local problems and neighborhood cohesion scores:
means (adjusted for age) for men and women, by
neighborhood 273
15.5 Mean assessment of local problems and perceived
neighborhood cohesion scores, by gender and employment
status 274
15.6 Mean local problems and neighborhood cohesion scores,
by gender and presence of children 275
15.7 Summary of associations by gender between health
measures and overall assessment of area and perceived
neighborhood cohesion 276
Contributors

Adrian J. Bailey is currently a Senior Lecturer in the School of Geography at


the University of Leeds and Adjunct Associate Professor of Geography at
Dartmouth College. His interests in the health of international migrants
have focused on the experiences of Puerto Ricans and Salvadorans in New
York, and among immigrant children, Latinos, and Asians in New
England.
Susan Craddock is Assistant Professor of Women’s Studies and Geography
at the University of Arizona. Her research interests focus on disease as
both an outcome and a producer of social difference and inequity. Her
publications include Dis/Placing Disease: Poverty, Deviance, and Public
Health Policy.
Joyce Davidson is currently undertaking postdoctoral research at the Institute
of Health Research, University of Lancaster. Her research focuses on
women with agoraphobia, and seeks to make gendered links between
place, embodiment, and mental health. Her current research draws on her
background in philosophy, where she worked with feminist theories of
identity. She has published in Hypatia, a journal of feminist philosophy.
Isabel Dyck is a social geographer and Associate Professor in the School of
Rehabilitation Sciences, University of British Columbia. Her research
interests include feminist analyses of the home and work experiences of
women with chronic illness, health care access for immigrant, minority
group women, and integration issues for immigrant families. Current
research includes examination of the home as a site for long-term care.
Anne Ellaway is a researcher working with Sally Macintyre exploring the
processes by which place of residence might influence health and the ability
to lead healthy lives. Published work includes the role of housing and
neighborhood conditions in producing health outcomes.
Jim Glassman is a Killam Postdoctoral Fellow in the Department of
Geography at the University of British Columbia and Assistant Professor
in the Department of Geography at Syracuse University. His current
Contributors xi
research is on state policies promoting manufacturing development in
Thailand and on the role of the gendering of assembly work in Thailand’s
industrial transformation.
Patricia Gober is Professor of Geography at Arizona State University, where
she has taught since 1975. She has been President of the Association of
American Geographers, and has served on boards and committees for
the National Science Foundation, the Population Reference Bureau, and
the National Oceanographic and Atmospheric Administration. Dr. Gober
is author of numerous works focusing on urban geography, population
geography, and migration.
Elizabeth Hoban is a public health worker with a background in Primary
Health Care education, program development, and public health research.
She has been working in Australian Indigenous health and international
public health in Africa and Southeast Asia for the past fifteen years. Her
research has examined barriers to cervical cancer screening in Indigenous
communities and the development of appropriate service delivery systems.
She is currently working towards a PhD at the Key Centre for Women’s
Health in Society at Melbourne University.
Caroline Kerner is currently a research associate at Boston University. Her
research interests include women’s health and Latino/a immigration.
Maureen Kirk is a Gunggalida Aborigine from Burketown. She was the
cancer support officer for Indigenous women at the Royal Women’s
Hospital, Brisbane, prior to her secondment to The University of Queens-
land to undertake research. She is a member of several national and
regional committees related to breast and cervical cancer and serves on
the National Advisory Committee for Health Promotion for Indigenous
Health Workers. She is currently project director for state-wide efforts to
increase Indigenous women’s access to cancer screening and treatment.
Nancy Davis Lewis is Associate Dean of Social Sciences and Professor of
Geography at the University of Hawaii. Her research explores a wide range
of health issues, including the health of women. Her current research is on
the relationship between climate change and infectious disease in the Pacific
Islands. This is set within a context of gender, social vulnerability, and the
human dimensions of global change. She serves as the Secretary General
of the Pacific Science Association and on the editorial boards of The
Contemporary Pacific, Ethics, Place and Environment and Pacific Science.
Andrea Litva is currently a lecturer in Medical Sociology in the Department
of Primary Care, University of Liverpool. Her teaching and research
interests center on lay perceptions of health, illness, and health care, public
involvement in health care decision making, and using social theory and
qualitative methods in health services research.
xii Contributors
Sally Macintyre is Director of the Medical Research Council’s Social
and Public Health Sciences Unit at the University of Glasgow. Following
on from a general interest in the social patterning of health, her recent
research interests are in the patterning of health by social class, area of
residence, and gender.
Sara McLafferty is Professor of Geography at Hunter College of the City
University of New York. Her research and publications have explored
geographic inequalities in health and access to health care in cities and
the use of spatial analysis methods in examining these issues. She has
also investigated the impacts of economic restructuring and policy trans-
formations on women’s access to employment and health care services.
Lenore Manderson is a medical anthropologist and social historian. She is
Professor of Women’s Health and Director of the Key Centre for Women’s
Health in Society, The University of Melbourne. Her primary research
interests on which she has published widely are related to infectious
disease in poor resource communities, and to gender, sexuality, and
women’s health. She is a Fellow of the Academy of Social Sciences of
Australia.
Ines Miyares is Associate Professor of Geography at Hunter College at the City
University of New York. Her research addresses the formation and function
of urban immigrant, refugee, and transnational communities, and Latin
America. Her publications have focused on the Hmong, Cubans, Russians,
and the Latin American community in the New York metropolitan area.
Graham Moon is Professor of Health Services Research at the Institute for
the Geography of Health, University of Portsmouth. He is editor of Health
and Place and a former Chair of the Royal Geographical Society–Institute
of British Geographers’ Geography of Health Research Group. He has
published extensively on health geography and social perspectives on
health and health policy. His current research interests focus on concep-
tions of place in health policy, health-related behavior, and the genealogy
of post-1945 medical geography.
Pamela Moss is an Associate Professor in the Faculty of Human and Social
Development at the University of Victoria, British Columbia. She teaches
as a socialist, poststructuralist, and feminist, and she is active in feminist
community politics around issues in women’s housing and women’s health
advocacy. Her writing considers the themes of body, self, and identity in
numerous contexts. Publications include an edited collection of essays on
the geographical uses of autobiography, and a feminist methodology text
for students in geography.
Alison Mountz is a doctoral student in geography at the University of British
Columbia. Her research interests include transnational migration, urban
geographies, and feminist methodology.
Contributors xiii
Kay Peggs is lecturer in sociology in the School of Social and Historical
Studies, University of Portsmouth. She has published in such journals as
the British Journal of Sociology. Her present research lies in the field of
gender, aging, and consumption.
Cynthia Pope is a PhD candidate in the Department of Geography and
Regional Development at the University of Arizona with concentrations
in medical and feminist geography. Her MA research focused on women
crossing the border from Mexico into the United States for prenatal care.
For the PhD, she is exploring issues related to women and health in Latin
America, in particular how women perceive and respond to HIV risk in
Havana, Cuba.
Jan Rigby is a teaching fellow at the School of Geographical Studies,
University of Bristol. Her research interests include applications of GIS
and spatial analysis to the geographies of ill-health, and the role of early
environment and life-course events in health outcomes, and she has
recently completed a study of breast cancer.
Mark W. Rosenberg is Professor of Geography at Queen’s University in
Kingston, Ontario. His research interests focus on women’s health,
the elderly population, persons with disabilities, and access to health
and social services. He is currently working on a three-year study of the
geographies of women’s health and is co-author of the book Growing
Old in Canada. He serves as Secretary of the International Geographical
Union Commission on Health, Environment and Development and
Chairperson of the Association of American Geographers’ Medical
Geography Specialty Group.
Carol Thomas is a Senior Lecturer in Applied Social Science at Lancaster
University, and works closely with the university’s Institute for Health
Research. Her research interests include disability studies, especially
disabled women’s social experiences, the psycho-social needs of cancer
patients, and understanding health inequalities. She is the author of Female
Forms: Understanding and Experiencing Disability, together with a wide
range of articles and book chapters on disability and health-related topics.
Sue Tripathi received her PhD in medical geography from Kent State
University. She is currently a research analyst in the Department of Health,
Adams County, Colorado. Her research interests focus on gender and
health-related topics, including HIV/AIDS, STDs, substance abuse, and
related areas.
Yvonne Underhill-Sem is a Lecturer at the University of Waikato/Te Whare
Wanaga o Waikato. A Cook Islands New Zealander with close family ties
to Papua New Guinea, she has taught at the University of Papua New
Guinea and University of Waikato and has also worked as a strategic
health planner. Her research interests include population mobility and
xiv Contributors
ethnic identities among Pacific Islanders in New Zealand. More recently
she has critiqued demographically driven population policies in the third
world and worked on the Pacific Island contribution to the Cairo
population meeting.
Allison Williams is an Assistant Professor in the Department of Geography,
University of Saskatchewan and a research faculty with the Saskatchewan
Population Health and Evaluation Research Unit (SPHERU). Her research
examines how environments operate as determinants of and pathways
to health, particularly for First Nations Peoples, the elderly, home care
practitioners, and specifically women. A major focus is women’s paid and
unpaid caring work that takes place in the home. She is active in research
partnerships with public health departments, community groups, and
various health care organizations.
Richard A. Wright is Professor of Geography and Chair of the Geography
Department at Dartmouth College, New Hampshire. His research
explores the social and spatial construction of labor markets in US
metropolitan areas, and the transnational social and economic lives of
Salvadoran immigrants.
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