Women’s Health Seeking: Understanding Different Authorities

Gabrielle Richards

April 2018

Abstract

Health seeking has regularly been debated and discussed within the social sciences. However, these articles often fall short of fully addressing the vast ecosystem within which women obtain knowledge. This paper aims to address the authorities and networks through which women obtain healthcare information within the digital era. This paper looks at multiple socializing authorities, including the Church, education, families, peers, and doctors to understand the ecosystem that women tap into to gain information about their bodies. I argue that these institutions, many of which have existed for hundreds of years, continue to contribute to women’s understandings of themselves.

Introduction

I was fifteen when I first decided I needed to go on birth control. It was not because I was sexually active. I went on birth control to mitigate long, heavy, and irregular periods. The fear of going on birth control was not prevalent, but rather the fear of speaking to my mother about this issue seemed to weigh heavy on my chest. At fifteen this was not an easy conversation to have with my mom, who would still have to drive me to my doctor’s appointment and often still came into the office with me. I knew I could not avoid this conversation, so I took a deep breath of courage and confronted her: “Mom, I want to go on the pill.” She knew of the problems I had, missing days of school each month and waking up in the middle of the night. Unfortunately for me, my socially conservative mother still felt obligated to have the sex talk with me, explaining that just because I went on birth control did not allow me the right to be sexually active. She also shared her fear of adding additional hormones to an already moody teen, and explained how she believed it could permanently alter a woman’s hormones. However, she put these concerns aside, scheduled my appointment with me and sat in the doctor’s office to learn about the different types of birth control pills available that my doctor was willing to prescribe.

Two years later, I realized that the pill was not working for me for a plethora of reasons, including the moodiness my mother warned me of, headaches, and weight gain, all common side effects of an or oral contraceptive regimen. This required another conversation with my mother and three more doctors’ appointments.

My friends and I began discussing these issues as we started dating. One day my friends and I were sitting around in the women’s changing room of my dance studio discussing our experiences with birth control, asking what birth control are you on? And, how does that method of birth control work? One friend shared that she had a Copper Intrauterine Device (IUD), all of my friends sitting around were intrigued. She explained that IUD’s attack sperm, but did not help mitigate periods or entail extra doses of hormones in the body. This conversation was disrupted when our dance teacher told us we were late to class, but this was the start to many deep and intimate conversations surroundings the topic of birth control. It was from these conversations with our mothers, friends, and doctors that we learned about becoming women. Through these conversations we began embarking on our lifelong journey that required us to learn about ourselves and how to best navigate our health as women.

These conversations began in 2012, a time when there were multiple resources available through our smartphones, which would entail less embarrassing interactions about our information on health, than our conversations with our mothers’, and may have offered more detail than our doctors had at the time deemed as necessary to give us. However, my memory does not recollect these online searches as being overly informative or important when contrasted to conversations with my mother, friends, and doctors. This is not to say that women do not utilize the internet as a tool to learn about their bodies. In my research, the internet was often rendered as a way to gain preliminary information, fact check peers, and even help self-diagnose minor ailments. Yet these Google searches led to more conversations with peers, families, and doctors. The internet was never the end tool, but rather a passageway to other forms of health informative exchanges. Therefore, my research suggests that women learn about themselves through an ecosystem which embodies multiple sources in order to create a personal and nuanced perspective of health. Furthermore, my research concludes that, unlike some researchers have suggested, women have not turned exclusively to internet resources within the age of new media, but rather, have tapped into the internet as one of many resources to educate themselves on their body and healthy practices. The internet then led women to more informative conversations with friends and mothers, and offered information that led to future doctors’ visits.

Contestations of Authorities

Drawing on concepts of authorities and networks as conceptualized by Foucault (1989) and others, this paper argues that multiple mediated authorities exist to teach women about their health. These authorities coexist to create a versed ecosystem of information sharing from which women may draw. Drawing on concepts originally discussed by Weber (seen in Martin 1970), authorities can be defined as those who have gained power through norms that a society has developed which help create a social order. Women in my research discussed those who have obtained authority as people that were valued to society due to their specialized roles, and therefore, gained power, some examples discussed by participants were, doctors, priests, and peers who were assessed as knowledgeable within the area of sexual health. These authorities then created an ecosystem within which women would listen to these authorities and then be required to understand and navigate them to obtain optimal health.

Foucault (1989) addresses this ecosystem stating that: “the Société no longer consist[s] solely of doctors who devote themselves to the study of collective pathological phenomena” (p. 28). Thus, doctors are not necessarily the centre of the healthcare sharing ecosystem, as they are not the sole authority, but rather an organ of a larger ecosystem of health makers which also includes other authoritative institutions. These authorities identified by participants in my study included, but were not limited to, the Church, education, families, doctors, and peers. These authorities were valued as knowledge keepers and gatekeepers to optimal health who guided health seeking practices as women entrusted these institutions to offer valuable information. However, utilizing Foucauldian (1989) logic as he proposes that the individual is a “unique nucleus of a range of cross-checking viewpoints, in repeated corrected information” (p. 25), these authoritative institutions work both in tandem and contradiction for women to attempt to gain comprehensive understandings of their health. While institutional authorities offer suggestions on how to obtain women’s health based on their knowledge and power, women do not solely look to one authority. These authorities may contradict one another, in which case women must re-evaluate and re-assess what the authorities have told them to form their own nuanced beliefs of their ideal health. This was evident when women internally debated how to value the Church while wanting to become sexually active.

These authoritative institutions leverage their authority in different mediated forms. Daniel Fisher (2016) questions representations of different authorities demanding, “how ought such authoritative or representative voices be staged” (p. 6). Questioning how authorities should leverage their position within the ever-changing networked sphere. While women expressed that the internet often offered the most convenient authority, women found it untrustworthy or only used it for preliminary information. This was expressed when participants I spoke with explained their criteria for navigating websites and the online sphere which offer a plethora of advice on women’s health. Understanding the representations of authorities enabled participants to believe certain sites worthy and others not, or how one view represented fit into their larger understanding of their health.  

Similar to Fisher’s finding (2016), my research expressed that media often became remediated as it became the content of another (p. 15) as authorities recreated and developed platforms to share information. Most notable were the ways in which doctors used media tools to disseminate their knowledge through networks, such as WebMD and Mayo Clinic. Several websites pertaining to health knowledge are edited by doctors and health professionals, these websites were rendered most valuable by participants’ due to their backing of medical authority. However, navigating the internet sphere requires specific skills and knowledge in order to do so effectively. Each interview participant in the study stressed the notion that the technological forms of medical knowledge were not adequate substitutes for consulting a medical doctor. Thus, these authorities were often renegotiated and remediated as women’s networks of knowledge expanded. These women experienced “tensions and contradictions, relationships and social networks in an attempt to make sense of their experiences” (Marshall, Godfrey, & Renfrew, 2007 seen in Bissell & Alexander 2010 p. 951). Despite the contested authorities that participants expressed, “people and societies [ continue to] seek out ritual authorities to guard and guide them through these transitions” (Turner 1974, seen in Kaufman and Morgan 2005 p. 332). These transitions refer to womanhood and the understanding of women’s bodies as they fluctuate and develop throughout their lives. Many of these rituals and authorities have existed for hundreds of years, teaching women about themselves and forming spheres of knowledge, leading to the creation of certain knowledge holders.

Throughout the past three months I have conducted ethnographic fieldwork research, conducting interviews with a nurse practitioner who works in an obstetrician and gynecologist office, a student who is obtaining her Masters’ in Public Health and hosted a blog on women’s health, and two students who volunteer with the University of Ottawa’s Sexual Health Promotion team. These women discussed their experiences of learning about their bodies and how they negotiated authorities and obtained their roles of authority as mentioned earlier. Each woman brought their perspective on how to navigate the internet and how they negotiated with different authorities and sites of information. I also explored online spheres of health seeking, through websites, such as, Mayo Clinic and WebMD.  

 Below I outline the different authorities that participants discussed, including the Internet, education, peers, the Church, family, and doctors. Through these authorities, women are introduced into understandings of their body, with which they then negotiate their values and subsequently developed their understandings of themselves. These authorities do not work in silos, but rather form a larger ecosystem of knowledge through which women learn about their bodies and contest authorities to seek an ideal state of health and learn to best navigate health ailments.

Internet

The internet represents the most contemporary form of authority through which women seek health information. However, in women’s health seeking practice, the internet does not appear to be its own entity. Rather, it is representative of other forms of authority that use the internet to share information about women’s bodies and aid in self-diagnostics. Throughout conversations with participants it was evident that questions of authority were constantly in the conscious awareness of women’s minds as they navigated the internet. For example, the blogger I spoke with argued that there are:

markers to look out for, is there citations? Does this person talk about the resources that they use…are they recognized as credible (WHO, Health Canada) ... [if the website is] less formal does it encourage you to confirm with someone else? Especially if it’s not run by a professional…does it link you to real life resources?

She is not using the internet as an authority, but rather acknowledging that the internet is a platform for other forms of authorities. She outlines how to understand which authorities may place themselves on the internet, articulating the importance of their remediation and how such media allows for potential growth and developments of old medias and technologies (Peters 2009 & Fisher 2016). For example, often times the internet acts as a new technological tool which doctors employ in order to disseminate information. While evidently health bloggers and quasi-professionals discuss women’s health on the internet, it may be regarded as a discussion of peers, the participant then claims that these peers gain authority through their knowledge of “real professionals,” or doctors and health centres whom they can refer their readers.

If women discuss the internet as a remediated form of health care professionals’ knowledge, the question is: how do women use the internet? There are two ways that the internet can be used: to fill knowledge gaps; and also, to become a means of self-triage. As women understand and believe that the websites they use are sites that represent knowledge from doctors, the sites often become a means of “self-triage,”. These are spaces in which women can make an attempt to self-diagnosis which may determine whether or not they deem a visit to the doctor’s office necessary or instead try and strike a conversation with family and friends. For example, when one Googles the symptoms of yeast infections and urinary tract infections (UTIs), they are presented with multiple sources which discuss the causes and symptoms of such health issues. Interestingly, quizzes were also presented through the search engine, which allowed women to click on a series of multiple choice questions to determine if their symptoms were representative of a yeast infection or UTI.

This picture exemplifies the idea of “self-triage”. This quiz asks seven direct and personal questions, such as the colours of vaginal discharge and its consistency. It then diagnoses its user based on the information provided from 7 single sentenced, open ended questions. It assumes that the information provided should answer whether the user is suffering from a yeast infection or a urinary tract infection (UTI). Important to note here is that these two infections require a different course of treatment. According to Mayo Clinic[1] (2018) it is not necessary to go to the doctor right away unless this is your first yeast infection, you’re not sure what this is, your symptoms don’t disappear, or you develop other symptoms. Whereas, Mayo Clinic[2] (2018) tells its users to contact a doctor right away at the sign of a UTI. Through basic internet research and quizzes, similar to the one above, patients can learn about the possibilities of diagnostic categories related to their somatic symptoms. Users can then use this information to decide the next course of action. According to many interviewees, after the internet research phase has lapsed, many people then consult their peers or family for a more thorough understanding of symptoms.

Furthermore, I will conclusively address the internet as a different site to gain heath information, through its mediation of pornographic content. Pornography offers an example of porn stars that are acting as authorities by indirectly informing women about sexual intercourse. During the interviews, many participants did not value pornography as a “good” way to learn about women’s health. However, for one participant, it became a default health seeking tool as she and her peers felt that they were deprived of concrete and accurate information regarding their sexual health. One participant explained:

I remember like guys my age were like, like porn. They learned about sex through porn and that’s not a healthy way to go about it. So like I just kinda, like my friend would send me a porn video…that’s like what I knew about, sex was like.

The interviewee attributes this poor method of learning about sexual interactions to the poor educational system in which she was raised. Therefore, porn became a default educational tool that circulated around her high school do discuss sexual intercourse. Participants described that more conservative educational and familial upbringings led to feelings of more stigmas around sex and women’s bodies. One interviewee attributed the Church’s upbringing to low self-esteem and lack of general knowledge.

Church and Education, Peers, and Family

Participants believed that conservative families and the Church led to limited knowledge regarding her health, at home and in Catholic school they were taught that topics such as sex were “taboo”; religiosity was thus a theme that two participants discussed as limiting their knowledge and their peers’ knowledge around sexual health. However, both participants discussed ways in which they, along with their peers, contested these understandings given by the Church. For example, when talking with one participant about her choice to start birth control she claimed: “I didn’t want to risk it. I was really not ready to have a baby and I knew like in my views I would never get an abortion. So let’s go on birth control from the getgo and not risk it. Not have that worry.” This woman held the values and beliefs that were taught by the Church regarding abortion, as the Church believes that abortions are wrong. However, the participant chose to remediate their beliefs that the Church and her family taught her to develop a new understanding of what her sexuality meant to her. This renegotiation leads to the:

emergence into social subjecthood [which] creates new relationships and obligations (among strangers and kin, between doctors and patients, and between individuals and institutions), new forms of knowledge, and new kinds of normalizing practices at the same time as the foster tensions about political, ethical, and medical responsibilities (Kaufman & Morgan 2005, p. 329)

This participant discussed the tensions that lead to the renegotiation of authorities. With me, she openly questioned who has authority and what types of ethical and moral obligations are required to be upheld in order to still value her authorities, meanwhile disputing part of the Church’s doctrine at the same time.

In addition, another participant discussed her relationship with her religious peers and how she used her blog as a tool of mediation to help others understand their personal beliefs intertwining with forms of sexual health practices. This participant entered a conservative Christian group later in her life explaining how she came “from a very conservative Christian culture that was very closed off from talking about anything sexually related…people knew I had access to condoms and that I had done an actual health class in a public school.” This rendered her an authoritative figure for these women as they believed her previous education deemed her knowledgeable. She then discussed how women were taught of the issues of birth control in the religious setting and how some women felt birth control was worse than abortions and becoming pregnant before marriage. Therefore, they questioned how to safely have intercourse without birth control or getting pregnant as they did not want to get married. Allowing the negotiating of their beliefs and questioning how to morally be Christian, but at times dispute what they were taught. These women are turning inwards, against the authorities they have known, to renegotiate how they view the Church and those values.

Moreover, at times families perpetuated the Church’s values which participants claimed made them uncomfortable discussing certain topics and would lead them to discussions directly with doctors, peers, and the internet. On the other hand, one participant openly discussed her health and well-being with her mother which led to open conversations surrounding the sex and her sexual health. This participant even discussed occasions where her mother sent her articles regarding sexual health and questioning whether she has been “having good sex recently.” These represent two extremes of the continuum. These discussions created two different types of authority figures out of mothers that were contrary to one another but exist on a larger continuum.

Women did not just turn to their mothers for advice, but continued these conversations which their peers. Peers offered advice and guidance on how to navigate and negotiate what they had found on the internet, spread information they received from the medical doctors, and discuss how to negotiate the Church. However, some peers have become leaders amongst their networks on women’s health. As stated earlier, two of the participants were on the University of Ottawa’s Sexual Health Promotion Team (seen below):

The Sexual Health Promotion team is represented by a group of University of Ottawa students who volunteer their time around campus to teach fellow students about sexual health. They go through trainings, offer informational tabling sessions on campus, and walk around study areas to discuss sexual health. These peers have become authorities in sexual health knowledge and guides to resources around campus. Once a week they walk around campus, as pictured above, to distribute condoms and discuss safe sex, consent, and other sexual health related issues. The costumes are an attempt to demonstrate not only their positions, but their welcoming and light attitude that may encourage fellow students to initiate a conversation. The goal is to position themselves as an accessible authority through which students can access information on sexual health, including resources available to them on campus. Both of the participants on the sexual health team discussed how they had become resources for their own peers and friends to discuss how to access doctors on campus, common STIs, birth controls, and where to get tested.

Doctors

Equally important in this context, is the role of the health care providers in the understanding of women’s own health. Every participant valued doctors as vital to women’s well-being. Doctors and health care professionals gained their authority through their ability to diagnose and treat patients, the gateway to obtaining optimal health. A nurse practitioner was one of the participants involved in the study, she discussed how women came into the office to discuss birth control, and would come in with prior knowledge based on conversations with peers, friends, family, and the internet. She then felt it was her role to navigate this plethora of information to find the best birth control. For example, she discussed a woman wanting an IUD.  However, the woman lacked knowledge about it possibly causing acne. This young woman had discussed an IUD with her friend and decided she had wanted one, yet, the nurse practitioner discussed how she lacked the full understanding of an IUD and, instead, worked with the patient to find the best birth control method for her.

While many doctors often aid in the production of web mediated health knowledge, they also find them a problematic source for information. The nurse discussed a patient who adamantly refused the Gardasil vaccines, which prevents against Human Papillomavirus (HPV) because after discussions and internet searches she worried about the vaccine causing death. The nurse expressed her frustration to me on the phone. Interestingly, after researching the vaccine on the U.S. Centre for Disease Control (CDC) website (2018) it states under the “Frequently Asked Questions” section, that “June 2006 through September 2015…117 reports of death after people received Gardasil”[3]. However, the website clearly stated disclaimers that the cause of death is not necessarily due to the vaccine itself and that the statistical probability that the vaccine could cause death is very low. This contention of authority and information can be difficult for women to navigate. This reflects Foucault (1989) as he discusses that medicine and medical practioners’ coincide with social spaces (p. 31) today, this often refers to online spaces. All the participants involved in the study believed that medical doctors were the main forms of knowledge keepers that often were the best and most reliable resource in discussing women’s health issues. However, doctors’ authority was at times undermined by previous discussion with friends, peers, family, Church values, and internet searches.

Doctors were not only in contestation with other authorities, but also amongst themselves. Often times women discussed what doctor they felt comfortable with, based on their location and previous relationship with the patient. One participant discussed how they, “think it’s easier to discuss things of a sensitive nature…with someone that you don’t have a personal relationship…people like the anonymity of a walk-in clinic [when getting tested for STIs]”. This suggests that not all doctors are valued as equal when women are navigating their beliefs of health. This does not undermine that participants’ beliefs that doctors were highly valued and knowledge keepers, but does explain that doctors are contested and negotiated amongst other authorities and even amongst themselves.

Conclusion

Conclusively, women develop health seeking practices and understandings of their bodies through an ecosystem of knowledge which is remediated and contested throughout their lives and amongst authorities. Women in this study often contested their past understandings and knowledge while they developed and furthered their understandings of authorities that played a role in shaping women’s understandings of their health.

This is contrary to other studies which may claim that women “just Google it” (Sundstrom 2016). Rather, they are part of a larger ecosystem of exchanges of knowledge.  These arguments claim that mass media has gained authority and become a socializing role through which women develop their understandings of themselves. While it is clear that women depend on the internet to learn about themselves, it was evident in my research that the internet was never the basis of gaining knowledge but rather a new place to further develop understandings of themselves. The authorities described above create a vast wealth of understanding and knowledge in which women adhere and remediate to fit their lives and beliefs about both their morals and their health.

References

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Kaufman, S. R., & Morgan, L. M. (2005). The anthropology of the beginnings and ends of

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Ryan, K., Bissell, P., & Alexander, J. (2010). Moral work in women's narratives of

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Spencer, M. E. (1970). Weber on legitimate norms and authority. The British

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University of Ottawa

Ethnography of New Media

April 18th, 2018

[1] https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447

[2] https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447  

[3] https://www.cdc.gov/vaccinesafety/vaccines/hpv/hpv-safety-faqs.html