S TRUCTURALISM, G ENDER, S OCIAL C APITAL AND M OTHER Replicating social structure through human replication: Implications for Health Research

O VERVIEW Social capital Structuralism Bourdieu Replications of structures Sex as Structure Concept of mother as conflation of sex/gender structure Health implications of social capital and construction of “mother” Case Study/Methods Implications

S OCIAL C APITAL Marx: Society is the ensemble of social relationships, and these relationships exist independently of individual consciousness and will. 3 Types of Capital : Social, Economic and Cultural Social Capital has many definitions, but can be generalized to: the extent to which members of a community view themselves as an “us” and the extent to which they work towards a common good that produces a network of resources; it is a type of productivity that is only possible “en masse”. This is then complicated with the idea that the “…creation of difference is the foundation on which inequality rests.” (Risman, 2004) Social Capital is then both an asset and a constriction, as the creation of a group is simultaneously a creation of difference and therefore inequality as well as a positive asset created by social interactions.

S TRUCTURALISM "the belief that phenomena of human life are not intelligible except through their interrelations. These relations constitute a structure, and behind local variations in the surface phenomena there are constant laws of abstract culture ". Similar to Marx, in that these structures operate outside of human agency. Social structures reproduce themselves. Claude Levi-Strauss: meaning is produced and reproduced in culture through various practices due to underlying, universal structure. Actions are governed by the structure, not individual agency. He believed that as every culture has an underlying structure which governs every interaction, studies of culture should examine cultural practices, such as kinship systems, food preparation and myth, as these will demonstrate the underlying structure of the society. He believed that these structures governing human behavior were based on/created by the human mind, which operates on binary oppositions (male/female, hot/cold, cooked/raw, “us”/ “them”).

B OURDIEU Bourdieu “sociology of culture”: Critique on structuralism by questioning how much human agency and practice engages with the structures to which we belong; instead of us being governed by the “deep” structures of Levi-Strauss, how do we negotiate our actions within these structures? (How do we negotiate multiple concepts of mother?) Social Capital :"Social capital is the sum of the resources, actual or virtual, that accrue to a group by virtue of possessing a durable network of more or less institutionalized relationships of mutual acquaintance and recognition“ (Bourdieu, 1986). (How does the concept of mother improve social capital and disable social capital?) Habitus: the result of the objective social structures into the subjective experience of agents; predisposes one to appreciate and prefer certain practices over another (Ex. Smoking?) As social capital is based on networks, and individual agents operate in their “habitus”, structures are maintained and social capital re-ifies Social Economic Status and therefore reinforces inequality. (As we’ll discuss in the case-study further on) Each individual occupies a position is a multidimensional “social space” that is not defined by class membership, but by every kind of capital articulated through social relations. What happens when this social capital is removed?

S EX AS STRUCTURE ? Sex is biological, but is the concept of sex in Western science necessarily biological? Concept of sex in Western science has changed through history: Through time, ideas of sex have been based on different criteria, Laqueur, 1990 used images and words from historical medical documents to argue that a one-sex model dominated from the Classic period until the Enlightenment (e.g. Christopher Columbus court case) Sexing practices within contemporary America use gender to define sex. “…standard Western clinical practice recognizes four components of the term sex: chromosomal, gonadal, morphological, and pyschosexual or gender identity,” (Arnold, 2002: ). Throughout the 20 th century, medical practitioners regarded intersex as pathological and advocated surgical and hormonal intervention soon after birth (Fausto-Sterling, 2000); (Geller, 2008). American Academy of Pediatrics (AAP) in 2006 issued a “Consensus Statement on the Management of Intersex Disorders”, where intersex is defined as a disorder. This statement was written to define best practice for these “disorders” (DSD’s or ‘disorders of sex development’). “A key point to emphasize is that the child with a DSD has the potential to become a well-adjusted, functional member of society’ (AAP, 2006: e490). One key definer of quality of life is “the opportunity to marry and raise children” (AAP, 2006: e493). How might the authoritative discourse of abnormal from medical practitioner to parents replicate/re-ify histrionic responses? Expensive, invasive surgeries that are often cosmetic? What if the re-assigned gender is not he “correct” one? What about death resulting from surgery? How much power should biomedicine have in influencing decisions about sex/gender? Public Health Issue: large number s of intersex individuals are forced into sex work and therefore have higher rates of STIs and drug addictions. Should they simply conform to male/female roles to avoid this fate? Is this a public health issue?

S EX AS S TRUCTURE ( CONT.) Sex itself is not static: “…both males and females display increasing ‘masculinization’ of the greater sciatic notch as they grow older,” (Walker, 2005); (Geller, 2008). Also, securely sexed women develop more robust crania as they age (Walker 1995). These differences exist between populations as well as among them. That said, I am not suggesting that male/female biological difference does not exist, just that it is not quite so binary as we would perhaps like to think and that perhaps “…maintaining the distinction while viewing sex and gender as part of an interconnected continuum rather than as a set of distinctive binary oppositions,” (Arnold, 2002: 239) would be a better way to conceptualize the relationship between sex and gender. Is this a possible endeavor? How can we change this dichotomy into a continuum? (Ex. Surveys, logisitic regression, etc.)

F EMALE ROLE OF M OTHER A useful concept for understanding the intersection of sex and gender is through the concept of Mother. (Bolen, 1992) “Motherhood integrates bio-procreational and social processes; it includes notions of sexuality, reproduction, personhood, child care, social order, domestic organization and power,” (Bolen, 1992). “In our society, childbearing and child care hinders participation within wider society,” (Bolen, 1992) “Women’s perceived natural “motherly” instincts of caring and concern make them good nurses, care providers, elementary teachers; job patterns reflect this,” (Bolen, 1992) How might mothering roles limit ones’ social capital?

M OTHER : B IOLOGY Biological fact that women give birth. BUT: distinction between mothering labour and birthing labour. Human reproduction requires pregnancy, however, the physical “limitation” of this act varies: Lactation varies at many levels: frequency, length of time, multiple feeders of children, non-biological mothers feeding; proximity between mother and child is convenient, but not necessary-they only need to be fed; some women can’t breast feed at all. (e.g. formula) “ Constraints on activity and divisions of labor change if one can feed sporadically and leave the baby with others in between,” (Bolen, 1992). Ex. Women in 18 th century and wet nurses. The required physical intimacy/closeness of the human baby does not have to be from the mother: multi-attachment system, not just monotrophy in primate systems. Mother Instinct : Ensuring the baby lives is a cultural construction based on how “mother” is conceptualized: if a society cannot support the baby, the culture develops ways that the child may be killed (i.e. “passive” neglect, where the biological mothers are not responsible for this “tragedy”.) Children born of biological mothers dying in childbirth would require alternative care-takers. In fact, biology seems to prefer a multi-attachment system of child rearing instead of a monotrophic “mother” system.

M OTHER ( CONT.) In anthropological conceptions, cross-cultural and ethnographic research demonstrate tremendous variety in cultural conceptions of “mother”. “Bowlby’s classic work on attachment suggests that the patterns of attachment shown by men (as fathers) resembled that of women (as mothers)…reinforces the interchangeability of women mothers and men fathers as care givers,” (Bolen, 1992). Only by addressing our Western conception of Mother can we then move past gendered assumptions of what being female entails

C ASE -S TUDY : I NUIT WOMAN GIVING BIRTH IN OTTAWA Background: “Although midwifery was an integral part of traditional Inuit culture, the official “standard” of maternity care that developed in the mid 1970s for many northern Canadian communities was the evacuation of all pregnant women to hospitals to give birth, often in distant southern Canada. Women were flown south at 36 weeks’ gestation or earlier, spending weeks and sometimes months away from home. As stated in a report to the Quebec Ministry of Health, “This intimate, integral part of our life was taken from us and replaced by a medical model that separated our families, stole the power of the birthing experience from our women, and weakened the health, strength, and spirit of our communities,” (Van Wagner et al., 2007). Inuit woman giving birth in Ottawa: Social Capital of this woman? If Social Capital is: “…members feel they can, and should, cooperate and take collective action to support the good of the community,” how does this fit into the Inuit and First Nations issues in Canada? 1 st Nations/Inuit more likely to participate in community care than their Canadian counterparts both at an elementary school level and as adults Interpersonal trust and norms of mutual aid and reciprocity are highly valued in Inuit culture. Social structures underlying her giving birth in Ottawa in the first place? Possible ways that this could have been prevented? The Western concept of “mother” and this woman: Western notion that biological mother is primary care-taker automatically. (Conflates biological birth labor with mothering labour).

S EX / GENDER AND H EALTH RESEARCH “…we do not live as a ‘gendered’ person one day and a ‘sexed’ organism the next; we are both, simultaneously, and for any given health outcome, it is an empirical question, not a philosophical principle, as to whether diverse permutations of gender and sex matter,” (Krieger, 2002). “…epidemiological and other health research has been hampered by a lack of clear conceptual models for considering both, simultaneously, to determine their relevance—or not—to the outcome(s) being researched,” (Krieger, 2002)

E PIDEMIOLOGICAL M ETHOD I MPLICATIONS “Because our science will only be as clear and error- free as our thinking, greater precision about whether gender relations, sex-linked biology, both, or neither matter for health is warranted,” (Krieger, 2002) Example: CCHS asks interviewer to determine sex on site, and then if they don’t know, to ask the participant: this answers neither sex nor gender.) Therefore, epidemiology as a practice re-ifies sex as a structure through this process (questionnaires and then studies based on those questionnaires both define sex as binary and then replicate this definition throughout society when the study is published. How much/in what ways might epidemiology be harming internal/external study validity through mis- conceptualizations of gender and sex? Much debate about BMI not being an extremely accurate estimate of body composition, but less on quantification of sex/gender.

F INAL THOUGHTS “I believe the rainbow always has more colors than society has categories, and that society is always trying to cram humanity’s rainbow into the few categories it does have…The biology I know tells of endless variation, not of a few universals,” (Roughgarden, 2004: 396). Natural differences as foundation for cultural (re)formations and responses? Public health implications? On Depression? Social support? Vulnerable populations? We changed conceptions of homosexuality and reduced stigma for HIV/AIDS, but how to change format of those pesky questionnaires? Public consciousness?