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

Context.—Breast cancer mortality is higher among African American women than
among white women in the United States, but the reasons for the racial difference
are not known.Objective.—To evaluate the influence of socioeconomic and cultural factors on the
racial difference in breast cancer stage at diagnosis.Design.—Case-control study of patients diagnosed as having breast cancer at
the University Medical Center of Eastern Carolina from 1985 through 1992.Setting.—The major health care facility for 2 rural counties in eastern North
Carolina.Subjects.—Five hundred forty of 743 patients with newly diagnosed breast cancer
and 414 control women from the community matched by age, race, and area of
residence.Main Outcome Measures.—Breast cancer stage at diagnosis.Results.—Of the 540 patients, 94 (17.4%) presented with TNM stage III or IV disease.
The following demographic and socioeconomic factors were significant predictors
of advanced stage: being African American (odds ratio [OR], 3.0; 95% confidence
interval [CI], 1.9-4.7); having low income (OR, 3.7; 95% CI, 2.1-6.5); never
having been married (OR, 2.9; 95% CI, 1.4-5.9); having no private health insurance
(OR, 2.5; 95% CI, 1.6-4.0); delaying seeing a physician because of money (OR,
1.6; 95% CI, 1.1-2.5); or lacking transportation (OR, 2.0; 95% CI, 1.2-3.6).
Univariate analysis also revealed a large number of cultural beliefs to be
significant predictors. Examples include the following beliefs: air causes
a cancer to spread (OR, 2.8; 95% CI, 1.8-4.3); the devil can cause a person
to get cancer (OR, 2.1; 95% CI, 1.2-3.5); women who have breast surgery are
no longer attractive to men (OR, 1.9; 95% CI, 1.1-3.5); and chiropractic is
an effective treatment for breast cancer (OR, 2.4; 95% CI, 1.4-4.4). When
the demographic and socioeconomic variables were included in a multivariate
logistic regression model, the OR for late stage among African Americans decreased
to 1.8 (95% CI, 1.1-3.2) compared with 3.0 (95% CI, 1.9-4.7) for race alone.
However, when the belief measures were included with the demographic and socioeconomic
variables, the OR for late stage among African Americans decreased further
to 1.2 (95% CI, 0.6-2.5).Conclusions.—Socioeconomic factors alone were not sufficient to explain the dramatic
effect of race on breast cancer stage; however, socioeconomic variables in
conjunction with cultural beliefs and attitudes could largely account for
the observed effect.

https://jamanetwork.com/journals/jama/articlepdf/187622/joc71375.pdf

Influence of Socioeconomic and Cultural Factors on Racial Differences in Late-Stage Presentation of Breast Cancer

Patient–doctor communication

In the ethnographic context, where answers to questions are unknown, consensus theory estimates the culturally appropriate or correct answers to the questions and individual differences in cultural knowledge. The cultural consensus model is a formal model of the process for asking and answering questions and is limited to categorical response data. An informal version of the model is available as a set of analytic procedures and obtains similar information with fewer assumptions. This article describes the assumptions, appropriate interview materials, and analytic procedures for carrying out a consensus analysis. Finally, issues that sometimes arise during the application of a consensus analysis are discussed.

/pdf/cultural-consensus-theory-applications-and-frequently-asked-sadbiskuhs.pdf

Cultural Consensus Theory: Applications and Frequently Asked Questions

Objective.To systematically review all studies examining sociocultural factors influencing cervical cancer screening among immigrant and ethnic minorities in the United States along the theoretical framework of the Health Belief Model.Materials and Methods.MEDLINE/PubMed, Cumulative Index to

Cervical cancer screening among immigrants and ethnic minorities: a systematic review using the Health Belief Model.

This article reports on a study ofperceptions of breast and cervical cancer risk factors among 27 U.S.-born Chicanas, 39 Mexican and 28 Salvadoran immigrants, 27 Anglo women, and 30 physicians in northern Orange County, California. In open-ended responses explaining why women might be at risk for both cancers, Latinas expressed two general themes: physical stress and trauma to the body, and behavior and lifestyle choices. Interviewees ranked the specific riskfactors that they themselves mentioned. Cultural consensus of ranked data revealed that Mexican and Salvadoran immigrants had a model of cancer risks that was different from those of Anglo women and physicians. U.S.-born Chicanas were bicultural in their views, which overlapped with both Mexican women's and Anglo women's views, but less so with physicians' views. Comparing views about the two cancers revealed that general themes apply across both cancers, that Latina immigrants agreed less on the risk factors for cervical cancer than for breast cancer, and that there is a consistent pattern in the different ways Latinas, Anglos, and physicians perceive risk factors for both cancers. [Hispanic women and cancer, cervical cancer, breast cancer, cultural consensus analysis and cancer]

Comparison of Perceptions among Latinas, Anglo Women, and Physicians

This article reports on a study of perceptions of breast and cervical cancer risk factors among 27 U.S.-born Chicanas, 39 Mexican and 28 Salvadoran immigrants, 27 Anglo women, and 30 physicians in northern Orange County, California. In open-ended responses explaining why women might be at risk for both cancers, Latinas expressed two general themes: physical stress and trauma to the body, and behavior and lifestyle choices. Interviewees ranked the specific risk factors that they themselves mentioned. Cultural consensus of ranked data revealed that Mexican and Salvadoran immigrants had a model of cancer risks that was different from those of Anglo women and physicians. U.S.-born Chicanas were bicultural in their views, which overlapped with both Mexican women's and Anglo women's views, but less so with physicians' views. Comparing views about the two cancers revealed that general themes apply across both cancers, that Latina immigrants agreed less on the risk factors for cervical cancer than for breast cancer, and that there is a consistent pattern in the different ways Latinas, Anglos, and physicians perceive risk factors for both cancers.

/pdf/structure-and-meaning-in-models-of-breast-and-cervical-4pbqn7susb.pdf

Structure and Meaning in Models of Breast and Cervical Cancer Risk Factors: A Comparison of Perceptions among Latinas, Anglo Women, and Physicians

Author(s): Chavez, LR; Hubbell, FA; McMullin, JM; Martinez, RG; Mishra, SI | Abstract: ObjectiveTo evaluate knowledge and attitudes about breast cancer risk factors among Latinas, Anglo-American women, and physicians.DesignEthnographic interviews employing systematic data collection methods.ParticipantsTwenty-eight Salvadoran immigrants, 39 Mexican immigrants, 27 Chicanas, and 27 Anglo-American women selected through an organization-based network sampling and a convenience sample of 30 primary care physicians in Orange County, Calif.Main outcome measures and resultsData analysis using qualitative content analysis and quantitative cultural consensus analysis, a mathematical technique that determines the degree of shared knowledge within groups and estimates "culturally correct" answers (cultural models), was employed. The content analysis revealed different beliefs about breast cancer risk factors, particularly between the Latinas and the physicians. The cultural consensus analysis found two broad cultural models (defined as groups with ratios between the first and second eigenvalues of g or = 3 and no negative competency scores). A Latina model (ratio = 3.4), formed by the Salvadorans, Mexicans, and Chicanas, emphasized breast trauma and "bad" behaviors, including drinking alcohol and using illegal drugs as risk factors. A biomedical model (ratio = 3.0), embraced by physicians and Anglo-American women, emphasized risk factors described in the medical literature, such as family history and age. Within these broad models, each group of respondents also differed enough in their beliefs to form their own, often stronger, cultural models.ConclusionsEthnography can provide important insights about culturally based knowledge and attitudes about disease. An understanding of the distinctive cultural models regarding breast cancer risk factors will aid future cancer control interventions.

/pdf/understanding-knowledge-and-attitudes-about-breast-cancer-a-9pfictag49.pdf

Understanding knowledge and attitudes about breast cancer. A cultural analysis.

This paper examines how physicians' beliefs about risk factors for cervical cancer compare with Mexican and Salvadoran immigrant women's views (hereafter Latina immigrants). Between August 15, 1991 and August 15, 1992, we conducted ethnographic interviews with 39 Mexican immigrant women, 28 Salvadoran immigrant women, and 30 physicians in northern Orange County, California. Physicians and Latina immigrants converge on their beliefs that sexual behavior is a predominant risk factor for cervical cancer. They diverge, however, on their reasons. Latina immigrants' perceptions of health risks are embedded in a larger set of cultural values centering around gender relations, sexuality, and morality. Latina immigrants also emphasized men's behavior as risk factors. Physicians' views, on the other hand, are largely based on the epidemiology of cervical cancer risk factors. They emphasized beginning sexual relations at an early age, multiple sexual partners, and infection with sexually transmitted viruses. Some physicians, however, displayed moral interpretations of the sex-based risk factors for cervical cancer through the use of the culturally-loaded term "promiscuous" in place of "multiple sexual partners," through specific references to morality, and through characterizations of women at risk for cervical cancer. Both the physicians and the Latina immigrants in our study paid considerably less attention to socioeconomic factors. Our results have important implications for physicians who provide health care for Latina immigrants. Physicians should be clear to point out that women need not be "promiscuous" to get cervical cancer.

/pdf/purity-and-passion-risk-and-morality-in-latina-immigrants-4h7eaijvg4.pdf

Rebecca G. Martínez

Papers

Comparison of Perceptions among Latinas, Anglo Women, and Physicians

Structure and Meaning in Models of Breast and Cervical Cancer Risk Factors: A Comparison of Perceptions among Latinas, Anglo Women, and Physicians

Understanding knowledge and attitudes about breast cancer. A cultural analysis.

Purity and passion: risk and morality in Latina immigrants' and physicians' beliefs about cervical cancer.

"What's wrong with me?": cervical cancer in Venezuela--living in the borderlands of health, disease, and illness.