Tag Archive for: oppression

How Oppression in Iran Impacts Women’s Health

 

Authors: Shayda Swann, MD/PhD Candidate, University of British Columbia & Bahareh Azadi, Graduate Student, University of British Columbia

Editor: Negin (Events & Communications Specialist), Romina Garcia de leon (Blog Coordinator).

Publication date: Oct 7th, 2022

In light of the recent death of Mahsa Amini, a 22-year-old Iranian woman, while detained by Iran’s “morality police”, we sought to explore and expose the impacts of oppression in Iran on women’s health. While we could consider this issue from many vantages, we focus here on how systemic oppression impacts women’s reproductive and mental health. 

Before delving into the topic, we felt it critical to declare our positionality. Shayda is an Iranian-White MD/PhD student whose research involves women’s sexual and reproductive health. Shayda has never lived in Iran but feels a deep attachment to the country where her family originated and escaped religious persecution as members of the Baha’i Faith. 

Bahareh is an Iranian graduate student and health researcher who lived in Iran until the age of 14 before immigrating with her family to Canada in pursuit of a better future. Since immigrating, Bahareh has frequently visited Iran as a young woman where she has had several encounters with the “morality police” and has experienced first-hand the consequences of the oppressive norms of the regime. 

Impact on women’s sexual and reproductive health

Sexual and reproductive health refers to upholding rights and freedoms concerning body autonomy, reproductive choice, prevention of sexually transmitted infections, menstrual hygiene, and various other aspects of women’s lives.

A 2015 report by Amnesty International points to numerous ways in which oppression in Iran limits women’s sexual/reproductive health. Before 2012, Iran’s Family and Population Planning program met several successes, including reducing the fertility rate from 6.5 to 1.6 births per woman between 1976-2012. This program was cut in 2012, accompanied by statements from high-ranking officials that contraception should only be used with consent from the husband, thus limiting women’s autonomy. These changes, unsurprisingly, were accompanied by an increase in sexually transmitted infections among women, with a 550% increase in the prevalence of HIV from 2007 to 2015. 

In 2021, women’s reproductive choices were further restricted by the “rejuvenation of the population and support of family” bill, which severely limits women’s access to contraception. The bill further mandates the creation of materials that denounce contraception and abortion, while encouraging women to have more children. Policies such as this violate women’s body autonomy and reproductive rights, put them at higher risk for unsafe pregnancy and sexually transmitted infections, and limit their educational and occupational opportunities; therefore, these policies compound the socio-structural barriers faced by Iranian women.

Menstrual education is another important aspect of women’s reproductive health. A 2018 review found “weak knowledge” about reproductive physiology and menstrual health among Iranian girls, attributing this to sociocultural and political barriers that limit reproductive health education. Importantly, one study found that only 26% of adolescent girls report receiving adequate information about puberty.

Another study emphasized how shame and anxiety shape young women’s experience of menstruation in Iran. Shockingly, a study investigating knowledge about menstrual health among girls found that less than half (41.2%) of participants considered menstruation to be a normal physiological process, and only 1.6% had “good knowledge” about menstrual hygiene. These studies underscore a concerning lack of education and understanding of menstruation, which is likely perpetuated by culturally-rooted shame and lack of political will to incorporate this into public education, thus depriving young girls of the necessary information about their bodies.

Women’s reproductive health is further threatened by the country’s marriage laws. The legal age of marriage for girls in Iran is thirteen-years-old, or younger if allowed by the court, compared to age fifteen for boys. Child marriage is not only legal in Iran, but is tacitly encouraged through government loans, with rates of child marriage rising drastically since the introduction of these loans. In the first half of 2021, more than 16,000 Iranian girls between the ages of ten and fourteen were married. This unquestionably leads to younger pregnancy ages – which increases the risk for complications, fetal illness, and maternal mortality – along with violence and reduced educational/employment opportunities. We concur with statements by the United Nations that child marriage is a human rights violation and “can lead to a lifetime of suffering”. These are but a few examples of how oppressive and discriminatory policies threaten the health of Iranian women and girls.

Impact on women’s mental health

Mental health is defined as emotional, psychological, and social well-being. State of mind affects many aspects of life, including how people think, feel, act, deal with adversity, relate to others, and make decisions. Women living in countries affected by war and political instability have a higher risk of developing mental health disorders than men. 

A 2014 study reported that more than 25% (as high as 36% in the capital, Tehran) of Iranian women suffer from mental disorders. Iranian women are particularly vulnerable to experiencing mental health disorders due to social and cultural factors, including being of lower overall social standing, having inferior rights, and being subject to strict laws that dictate their everyday lives. They are treated as ‘second-class’ citizens and live in a patriarchal society with male-dominated attitudes and discriminatory laws that impose restrictions on their rights and personal liberties, such as laws that require women to cover their body with loose-fitting clothing and cover their hair with hijab from the age of nine-years-old. 

This law is enforced by the “morality police” and authorities have long detained, fined, and jailed thousands of women for “improper hijab.” Those who resist detention are brutally beaten. Iranian women are left to constantly assess their performance against gender norms and strict laws; being subject to this constant scrutiny renders them unable to attend to more important issues that affect their lives (Figure 1). 

 

Figure 1: Persepolis by Marjane Satrapi.

Another factor that greatly contributes to the vulnerability of Iranian women to mental health disorders is related to discriminatory labor laws and regulations that limit the financial freedom of women and their participation in the job market. 

The link between financial standing and mental health comes as no surprise. Financial instability is a major cause of stress and contributes to mental health challenges. Women who experience financial instability are at a higher risk for developing mental health disorders, such as anxiety and depression. According to a report released by the Statistical Center of Iran in 2015, although women make up over 50% of university graduates, their participation in the job market is as low as 17%. 

This is a direct consequence of domestic laws that limit women’s access to employment, in addition to placing restrictions on the types of professions that women can participate in. Further, Iranian law grants men the authority to prevent their wives from obtaining employment, and some employers go as far as to require consent from a woman’s husband. Thus, it is not surprising that the chronic exposure of Iranian women to societal pressures and their continued struggle for basic rights places them at higher risk for developing mental health disorders. 

Conclusion

Here, we chose to highlight only two of the many ways that women’s health is jeopardized by oppressive social and political circumstances in Iran. As Iranian women in health research, we felt compelled to highlight these issues, with the hopes of drawing greater awareness to these inequitable and unjust circumstances. We stand in solidarity with the women of Iran as they fight for freedom.

 

Challenging Oppressive Maternity Healthcare in Canada

Authors: Stephanie Ragganandan Hon. BSc, York University & Dr. Karen Lawford midwife and PhD, Queen’s University | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: August 9th, 2021

At no time in the present era have healthcare systems been subject to the same extent of research, analysis, critique, and challenge as they have been during the global COVID-19 pandemic. There is a temptation to view any failings in these systems as a matter of contemporary shortcomings. While the health outcomes facing marginalized populations are certainly exacerbated by 21st century technological, economic, and social disparities, in addition to being disproportionately impacted by COVID-19, it is crucial we remember the root cause of these disparities. It is only by understanding the past that we can make sense of the present and imagine a future that liberates us all from oppressive, ineffective, and unsustainable healthcare services.

Canada, like many other countries across the world, was founded on colonialism. Colonialism is often framed as something from the past and as having no association with current times, but this is not the truth. We are living in an ongoing colonial project that is geo-politically known as Canada.

What is colonialism? It is the process by which one group takes control of another group’s lands, resources, and governance authorities and maintains that group in a state of subordination based on the beliefs of racial and cultural inferiority of the subordinated group. In Canada, the legal, education, and healthcare systems—for example—are deeply rooted in Eurocentric, Christian ideologies and practices that purposefully oppress Indigenous Peoples’ philosophies, values, ways of making knowledge, and kinship relationships.

As healthcare researchers, we strongly assert it is vital to acknowledge and recognize the existence, maintenance, and practice of the ongoing colonization project in Canada via Euro-Canadian healthcare services, programming, and education, and within medicine itself, because Indigenous Peoples’ knowledge systems are currently marginalized, made irrelevant, and tokenized. The invisibility of these areas of colonization is ethically unsound, immoral, and does not contribute to the Truth and Reconciliation Commission of Canada’s Calls to Action, specifically Calls 18-24.

We are especially committed to drawing attention to the implications of colonization on the sexual and reproductive health of Indigenous Peoples. Since contact with white Christian colonizers, Indigenous Peoples have fought to protect their customary practices, languages, and ways of health and wellness. Yet, nationally coordinated and funded assimilation efforts via various genocidal mechanisms, such as the Indian Residential School system, have resulted in the degradation and criminalization of Indigenous Peoples including their customary healing practices and practitioners.

We strongly assert that the process of improving current systems-wide healthcare must begin by recognizing the interconnected webs of colonization that are woven into all colonial healthcare systems in Canada.

Comprehensive Gender-Inclusive Sexual and Reproductive Health Care

Indigenous customary practices and practitioners that support and manage pregnancy, labour, birth, and postpartum periods have sustained Indigenous Peoples on these lands since time immemorial. In fact, their technologies, skills, and medicines were used by white Christian settlers when they first invaded these lands to ensure their own pregnancies were conducted in a safe manner. Over time, the Euro-Canadian biomedical model and its practitioners purposefully marginalized and criminalized Indigenous knowledge and practices. The ability of Indigenous Peoples to determine how to achieve their own health and wellness eventually became—and continues to be—oppressed. Consequently, the health of Indigenous Peoples from a Euro-Canadian lens shows that Indigenous people are less healthy than non-Indigenous people. But, healthcare systems in Canada continue to refuse to see, let alone acknowledge, the harm they have caused to Indigenous Peoples via neglect, refusal of care, and structurally ingrained colonial oppressions.

While the term decolonization has become a buzzword, especially following the Truth and Reconciliation Commission of Canada reports, we advocate for the recognition of colonization in health, which includes education, training, programming, funding, and practice. High-quality, comprehensive gender-inclusive sexual and reproductive health care for Indigenous Peoples can be achieved, but we must first come to terms with the extent to which colonization has purposefully obstructed the health and wellness of Indigenous Peoples.

Canada’s Evacuation Policy for Indigenous Peoples

Beginning in the late 1800s, the Government of Canada decided to introduce European-trained obstetricians to those who live on reserve. Alongside the medicalization of childbirth, the criminalization of Indigenous healthcare practices and practitioners, the immigration of British trained nurse-midwives, and the establishment of Indian hospitals, birthing for Indigenous Peoples shifted from home and community to nursing stations, then Indian hospitals, and now urban hospitals. The federal policy driving this relocation of birth is underpinned by the Government of Canada’s evacuation policy, which requires that pregnant people between 36- and 38-weeks of gestation are relocated to urban settings to await labour and birth. In addition to physically removing pregnant people from their families, communities and pregnancy customs and practices, the evacuation policy results in increased experiences of racism as well as feelings of isolation, fear, distress, sadness, and loneliness, which can lead to post-partum depression.

Canada’s evacuation policy supported “…colonial goals to civilize and assimilate [Indigenous Peoples] into a generic Canadian body.” So, colonial maternity care practices established during a time of aggressive assimilation and civilization tactics, which were implemented and funded by the Government of Canada, have resulted in the current, disjointed approach to maternity care practices for Indigenous Peoples. In fact, evacuation for birth has not resulted in comparable outcomes: the infant mortality rate for Indigenous Peoples in Canada ranges from two to four times that of non-Indigenous people. Clearly, the justification that the evacuation policy improves the maternal and infant outcomes is unfounded. It is thus clear that the Euro-Canadian biomedical model of maternity care must change so that Indigenous Peoples can realize the health and wellness they so deserve.

What’s Next?

Indigenous Peoples’ customary practices and practitioners must be reframed as necessary components of healthcare systems across Canada and globally. The exclusion and even criminalization of Indigenous People who are healthcare providers—like Indigenous Midwives—deliberately creates oppressive barriers to health and wellness for Indigenous Peoples.

It is extremely important to understand colonialism within the historical and contemporary contexts because it globally impacts Indigenous Peoples byways of land destruction, separation from family through colonial training programs (e.g. the Indian Residential School System), and the oppression of Indigenous customary philosophies, values, ways of making knowledge, and kinship relationships.

For those of us with influence in Euro-Canadian healthcare systems, we must work towards the creation of inclusive healthcare that promotes a plurality of knowledge systems, and put these systems and practitioners who provide care for Indigenous Peoples at the forefront of our agendas. We must also contemplate the nature and extent of repairs that are required to bring justice to those who have suffered at the hands of colonial systems.

It is time to acknowledge the ongoing colonial violence in healthcare and dismantle the oppressive cultures that constitute Canadian healthcare systems.

 

**If this is an issue you are passionate about, consider becoming a supportive member of the National Aboriginal Council of Midwives (NACM) here.**

Here is a list of benefits of a supportive membership from the NACM

  • Act of reconciliation and allyship
  • Promote the growth of Indigenous midwifery
  • Contribute to the improvement of reproductive and child health in Indigenous communities
  • Receive NACM newsletter