Tag Archive for: reproductive rights

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.

 

Mastectomy, Then and Now: The Cases of Frances Burney and Marie-Claude Belzile


Author: Heather Meek, Ph.D., Associate Professor of English Studies, University of Montreal | Editors: Negin Nia & Romina Garcia de leon (Blog Co-coordinators)

Published: July 1st, 2022

Mastectomy and Women’s Health

Frances Burney (1752-1840) and Marie-Claude Belzile (1987-2020), separated in time by two hundred years, can be aligned to the extent that they both underwent mastectomies and felt the impulse to share their stories in writing. Burney’s 20-page letter, written in 1812, and addressed to her sister Esther, and Belzile’s essay Penser le sein féministe, published in 2019, offer accounts of breast surgery written from the perspective of the sufferer. Despite their historical distance from each other, and the significant differences in the virulence of their illnesses and the technical particularities of their treatments, reading Burney’s letter alongside Belzile’s essay reveals, strikingly, how certain aspects of the experience of mastectomy have remained consistent over time. 

Belzile’s text draws out the latent political potential of Burney’s account as it moves beyond the personal into larger contemporary feminist and LGBTQAI+ contexts and explores the politics of breast reconstruction. Both works serve as testaments to the importance of patient narratives to the history of women’s health, especially as explorations of the complexities of women’s relationships to their post-surgical bodies and appraisals of institutionalized medical practices and rituals. Burney’s and Belzile’s narratives depict medical encounters that exceed an ethos of biomedical conquest as they capture remarkable encounters with bodily variation and death.

Burney and Belzile’s Point of View

Burney and Belzile both grapple with physical and psychic loss as they contemplate the prospect of surgery and the fate of their breasts. Anticipating what she believed would be a tumour excision, Burney confesses to her feelings of “dread & repugnance, from a thousand reasons besides the pain”. She gestures implicitly to what it meant to lose a breast, which in this period was understood as a material entity integral to the life of the female body, and as a powerful symbol of maternal tenderness, feminine beauty, and sexual pleasure. 

Belzile acknowledges explicitly such multivalent cultural meanings of the breast and brings them into the current moment, explaining that hypersexualized breasts are, rather puzzlingly, displayed everywhere even as they are viewed as objects to be “concealed from male onlookers, revealed only in intimacy”*. She at once denounces and transcends such patriarchal notions as she mourns, in a way uniquely her own, the loss of her own breasts, remembering how she was forced to “think about the future of my chest in the urgency of a few weeks” when she received her cancer diagnosis. 

 While Burney’s account predates the consolidation of a distinct medical profession, and Belzile’s case is situated in our current age of rapid medical innovation, both authors offer critical accounts of entrenched rituals and systems that silence, objectify, or disregard female patients. Burney is unprepared when “seven men in black” enter her operating room, when her face is covered in a semi-transparent veil, and when she learns, for the first time, mere minutes before the surgeons begin the excision, that her entire right breast will be removed. 

 One might assume that such astonishing details are relics of Burney’s period, but Belzile describes not being listened to by her surgical team, which she fortuitously discovered had planned to insert, during her operation, tissue expanders to make possible an eventual reconstruction which she had made adamantly clear she did not want. She presents this not as a rarity but as a systemic problem – as one among many instances of breast cancer patients’ choices being discounted or trivialized.  

The Idealized Female Body

Both Burney and Belzile refuse to elevate an idealized, supposedly ‘whole’ female body, forcing their readers to come face-to-face with the physical realities of mastectomy. Burney, whose 20-minute operation took place before the advent of anesthetic, describes how “the dreadful steel was plunged into the breast – cutting through veins – arteries – flesh – nerves” . Evoking her own bilateral mastectomy, Belzile celebrates the altered realities of women’s bodies, and affirms that “a flat chest is a chest that exists”. Belzile’s essay and Burney’s letter resonate with Audre Lorde’s lyrical embrace, in her Cancer Journals (1980), of a vocal coterie of one-breasted women.

A final link between Burney’s and Belzile’s accounts is found in the way they resist triumphant narratives of the sort Susan Sontag scrutinizes in her foundational essay Illness as Metaphor (1978) – ones in which medical cure is “the great destination,” ‘survivor’ and ‘military’ metaphors of illness flourish, and the realities of mortality are averted. Burney, even as she assures her sister of her “perfect recovery”, maintains that she is traumatized by this “terrible business” whose recollection is “painful”. She thus refuses a comfortable return to her previous self. Belzile’s raw recognition of the departure of her “before body” is described, paradoxically, in poetic and exultant prose as she insists that a woman can reclaim her “body, welcoming with compassion its history, its scars, and its transformations”. This optimism does not, however, preclude a recognition of what Lorde calls our temporary status “upon this earth”. The specter of death looms, since, as her reader knows, Belzile’s cancer is incurable and will eventually consume her. 

Transcending historical boundaries and speaking to each other across centuries, Belzile and Burney, together, provide stunning images of flat and one-breasted chests, brave recollections of bodily violation and transformation, and extraordinarily honest confrontations with mortality.  

*All quotations in this essay from Belzile’s Penser le sein féministe were translated into English by Heather Meek.

Are All Women in Canada Really Free to Choose?


Author: Kennadie Chaudhary, AccessBC Campaign Coordinator | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: February 26th, 2021

Access to contraception, as a reproductive right, is a basic human right. However, many Canadians are unable to exercise this right for a variety of reasons. One of these reasons is the significant barrier of cost. People who can get pregnant are disproportionately affected by the often high costs of contraception. These costs can include between $75 and $380 for an intrauterine device (IUD), $20 per month for oral contraceptives, and up to $180 per year for a hormone injection. Lack of coverage for contraception means youth, people with low-income, and those from marginalized communities face a severe disadvantage when making choices about their bodies. Thus, acknowledging the factor of cost is essential to making universal access to contraception a reality. 

There are numerous benefits to accessible contraception, which are evident in studies in North America and around the world. In Canada, the cost of contraception is almost entirely the responsibility of the user, with few exceptions. This is in contrast to several countries which similarly have universal health care, but have chosen to subsidize prescription contraception, either in full or in part. Countries with universal healthcare that subsidize contraception include over 11 members of the European Union, the UK, Australia, and New Zealand. Countries with universal access to prescription contraception have recognized the social and public health benefits of doing so, and their programs are often revenue positive. A 2015 study in the Canadian Association Medical Journal​ estimated that the cost of delivering universal contraception across Canada would be $157 million. Yet, the savings for direct medical costs of unintended pregnancies alone would be approximately $320 million. 

A Colorado program offering free IUDs to young people saw a 54% reduction in teen pregnancies and a 64% decline in teen abortion rates over eight years. The program came to a cost of $28 million, saving the US government an estimated $70 million. In Canada, about 59,000 adolescent pregnancies per year are unintended. Studies such as the Colorado program show the immense impact that access to contraception can have. Unintended pregnancies are expensive and can significantly alter an individual’s life plans. Further, reducing unintended pregnancies and allowing women to properly space births by providing them with access to contraception prevents over 200,000 maternal deaths worldwide each year.

Access to contraception is not only an issue of health. Contraception is also an issue of gender equality. While condoms are often easily accessible at little or no cost and vasectomies are covered under provincial health insurance plans, people with uteruses face significant barriers to autonomous contraception due to cost and requiring a prescription. Advancing gender equality requires recognizing that the costs of prescription contraception should not disproportionately fall on women alone. Women’s right to decide if and when they want to get pregnant should not be based on what they can afford. The ability to make that decision freely will contribute to the status of women, their right to health, and their empowerment as decision-makers.

AccessBC is a province-wide campaign that advocates for universal no-cost prescription contraception in British Columbia. AccessBC is currently running a letter writing campaign to urge the BC Government to include this policy in the upcoming 2021 budget. You can learn more about AccessBC, the need for, and benefits of, making all prescription contraception universally available at no cost, at www.accessbc.org.

Photo by Reproductive Health Supplies Coalition on Unsplash