In Feminist Global Health Security, Clare Wenham challenges the marginalisation of women in global health security, focusing particularly on the case of the 2016 Zika outbreak. The book presents rich and detailed analysis that shows the need for meaningful engagement with gender in global health security systems, writes Smita Choudhury.
Feminist Global Health Security. Clare Wenham. Oxford University Press. 2021.
Clare Wenham’s Feminist Global Health Security sheds light on what she refers to as the ‘conspicuously invisible’ woman in global health security. The book aims to mainstream gender into health security discourse. While vulnerability to disease and health emergencies may at first glance seem universal, a closer look reveals their disproportionate incidence and impact amongst women. Feminist Global Health Security analyses this using feminist concepts, supported by empirical evidence from the 2016 Zika outbreak in Latin America.
Wenham begins the book with the question: ‘Where are the women?’ She clarifies that merely representing women in global health security discussions and addressing the different impacts of global health security on women are not synonymous. Women are not a homogenous group and thus visibility may depend on ‘who you are’. Women whom policies seek to help remain invisible and their needs barely find place in the masculine approach to policymaking. Yet they are responsibilised and used as a means to implement the dictates of the state. This calls for a feminist perspective that shifts the focus from a positivist approach where women are objectified as ‘research cases’ to a normative approach that makes women visible as social, economic and political subjects.
The book consists of seven chapters which clearly lay out the theoretical and empirical framework for understanding how gender-blind health securitisation has failed women. Wenham writes that women’s interactions with health systems are comparatively more frequent as women seek routine healthcare such as maternity or contraceptive services. Besides, women are more vulnerable to contracting infectious diseases, both due to biology as well as social constructs, referred to as ‘the feminisation of disease’. It is in this context that the book introduces us to two concepts: social reproduction and stratified reproduction.
All the unpaid care work, child-rearing and household labour that limit the opportunity for formal paid work by acting as additional burdens come under social reproduction. Stratified reproduction, on the other hand, shows how race, class, sexuality and other intersections determine how experiences of pregnancy, childbirth and child-rearing differ from woman to woman. Often, women in the lower strata of social hierarchies have been the target of state policies and are disempowered from making their own choices about motherhood. During the Zika outbreak too, the state positioned women as responsible for keeping houses ‘clean’ from mosquitoes and ‘avoiding’ pregnancy. It is ironic that men are never brought into the picture. Instead, women are blamed if they become pregnant, thus highlighting how patriarchal governance covers up for systematic failures.
The little visibility that women received during the Zika outbreak was as mothers. This exclusive focus on the reproductive function of women gave rise to several mothers’ groups of women with children born with Congenital Zika Syndrome (CZS). Even in this dominant picture of ‘women as mothers’, the narrative of women in general and their needs got sidelined. One of the complications of the Zika virus is that babies born to affected mothers are likely to be affected with CZS, which can cause multiple disabilities. As these children grow, the mother is likely to become a full-time caregiver, giving up opportunities for formal paid labour, reinforcing further social reproduction. This loss of financial security, resulting in one’s dependence on a partner, may limit the ability of women to make meaningful choices and make them further susceptible to sexual and gender violence (SGBV).
However, these mothers have also been exceptional in being visible to policymakers, with mothers’ associations seeking to secure the best opportunities for their children. They have also been successful in starting a broader disability rights movement, which argues that these children, who have suffered because of state negligence and governance failures, should be more visible to policymakers.
Wenham also brings into focus the presence of structural violence within healthcare systems. Lower socio-economic groups, including women, often bear the greater cost of disease compared to privileged groups, suffering increased rates of mortality and morbidity. This has been seen in the Zika outbreak. During health emergencies, routine healthcare services are often suspended, which puts women at higher risk as they are unable to access antenatal or postnatal care. As a result, when it comes to health security systems, not only are the risks often gendered but the policy effects are also asymmetrical.
Feminist Global Health Security is timely in drawing our attention to two pressing issues. One, the book highlights the interaction of climate change and health security in the context of Zika. Infectious disease outbreaks often follow natural disasters because living conditions and state provision are harmed. Sadly, climate change compounds structural violence because the negative externalities are largely borne by the poorest communities and women. This increases health inequity and can severely alter progress on achieving gender parity. Given that global climate change is an important concern of today, it is time lessons are learnt with acute promptness.
Second, the book’s epilogue provides meaningful insights in the context of COVID-19. The pandemic demonstrated gendered effects in both its incidence and impact. Initially it was thought that age was the key factor in differences in incidence. Yet, women’s social reproduction increases the chances of women contracting the virus. On top of that, women constitute 70 per cent of the global healthcare workforce (192, 194) and they have been championed for their role as ‘warriors’ working for the cause of humanity, labouring for longer hours but at minimum wage. Hospitality, tourism and entertainment industries, which mostly employ women, have also been highly affected.
COVID-19 also increased social and stratified reproduction. With lockdowns and school closures, women have been burdened with additional informal labour. Ironically, while men work ‘from home’, women work both ‘from home’ and ‘at home’! Stratified reproduction has also increased because lockdowns meant that women, and particularly women in lower economic groups, didn’t have access to contraceptives and sexual and reproductive health (SRH) facilities.
Yet the response to COVID-19 has not been that similar to the Zika outbreak. One important change has been increased recognition of the gendered effects of the outbreak. Wenham points out one possible reason for this: unlike Zika, COVID-19 became a global pandemic affecting women in the Global North. As more dominant groups are affected, women have found a voice and become more visible. Thus, Wenham’s idea of a needs-based approach in policy, where states mainstream the needs of those who they seek to support, seems to be materialising to some extent.
Wenham’s analysis is shaped by the same limitation with which she begins the book. She writes that discussions and lived reality are not the same. Yet she consciously chooses not to directly interact with the women affected by the Zika outbreak so as not to ‘burden’ them. She instead ‘hopes to include the authentic voices of those most affected by Zika’. Although this topic needs some deeper research, Wenham still presents rich, detailed and exhaustive analysis in her book.
Feminist Global Health Security is an interesting read for young researchers seeking to gain knowledge in health economics. The narrative style convincingly pinpoints gaps in the present global health security system. The adoption of gender transformative practices will surely be a step forward. The future lies in mainstreaming gender in global health security discourse with due considerations to intersectionality as well.
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