Gender Based Discrimination and Reproductive Health: Insights from a Seattle Medical Trauma Therapist
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Happy Pride Month Everyone!
*When I discuss women—that includes ALL women (transgender, cis) and non-binary folks as well. At times I use the word ‘women’ for brevity sake and when referring to what we know from research.
**Trigger Warning** Discussion of gender-based discrimination, trauma, and suicide.
I am a Seattle based therapist that works with people dealing with grief, anxiety, acute and chronic health conditions and medical trauma. Much of my work focuses on reproductive health, including infertility, pregnancy loss, menopause and more. I’ve always been passionate about reproductive justice and healthcare. The needs, vulnerabilities, and strengths of people who menstruate and carry life is incredible. The rage I experience around the lack of societal support for women and gender minorities (including non-binary and trans folks) led me to get my perinatal mental health certification four years ago. My 13-year career has only contributed to the anger I feel towards the world as misogyny and the patriarchy are alive and well. One of the ways that I can make an impact as a single individual is through my work as a therapist. Times where women and gender minorities tend to experience the most intense neglect, hostility, control, and disempowerment is related to reproductive health. Instances of anxiety, depression, and body image issues often increase around puberty, pregnancy and menopause. Throughout a lifetime, women and gender minorities experience cumulative trauma, resulting in short- and long-term negative effects. Research shows that women experience more anxiety, depression, violence, physical illness and eating disorders. When people are taught to keep their mouths shut in a world that is actively hostile towards them can lead to internalized rage, resulting in self-monitoring, self-destruction, self-objectification, physical and mental health issues. I’ll address some of the negative experiences that happen during reproductive health milestones such as paps, periods, pregnancy and peri-menopause. I’ll then address the mental health impacts of such discrimination, hostility and disempowerment.
Reproductive Mental Health Milestones:
Paps, Periods, Pregnancies, and Peri-menopause
Paps—Introduction to Medical Misogyny
Do you remember your first pap smear and pelvic exam? I sure do. A speculum is not something you forget. For many people, this introduction into adulthood is also an introduction into a medical system that isn’t built for them. The medical system is rooted in a hetero-normative, white, male care model. The woman is ‘other’ and queer folks are non-existent. The FDA didn’t reverse a ban on women of ‘childbearing potential’ participating in clinical trials until the early 90’s. Yes, the 1990’s! Today, women and transgender folks are still highly underrepresented in clinical trials. If you are someone with reproductive health issues such as PCOS (polycystic ovarian syndrome), Endometriosis, PMDD (Premenstrual Dysphoric Disorder), Fibroids, or more, you most likely know what it’s like for a medical professional to brush off your complaints and symptoms. The undue burden of preventing and stressing about either getting pregnant when you don’t want to or getting pregnant when you do want to disproportionately falls on people with uteruses. If you’re diagnosed with a sexually transmitted infection, you’re a gross slut, according to society. You’re damned if you do, you’re damned if you don’t.
Periods—Blood Shame
The fact that around half of the population bleeds monthly and aren’t dying is incredible. Bodies are amazing. Society doesn’t supply messages like that to people who menstruate. Instead, messages around bleeding and menstruating are shameful. People who menstruate are taught not to discuss this “gross” phenomena and suffer silently with pain, mood swings, acne and more. The period tax is real, with people spending thousands of dollars on period products throughout a lifetime, not to mention stalking up on extra undies and bedsheets you may bleed through. Not to mention the work you had to miss because you felt like your guts were ripping out of you. The main message is ‘you should be ashamed that you bleed’ because when people are ashamed, they hide and stay quiet, exactly what the patriarchy wants you to do.
Pregnancy—You Are a Vessel, and Other Dehumanizing Mentalities
The ability to create and carry life is a miracle. And pregnancy is also a time where people discover the depths of discrimination, hostility, and downright disregard that still exists in this world. In our society, the focus and priority from conception is on the fetus. Investment into programs that help babies outweigh the help given to mothers, especially after the child is born. Among industrialized countries, the US leads with the highest maternal mortality rate. That number keeps rising and the numbers are worse for women of color. If we value women, why do we let them die? If we value women, why are pregnant people objectified, starred at, and touched without permission? People with uteruses no longer get to decide when and how they become parents in this country. When people don’t get to decide when or if they become parents have higher rates of depression and anxiety. If you’re unable to get pregnant on your own, it’s automatically seen as the person with the uterus’ fault, even though we know it’s generally half and half when it comes to issues with fertility in heterosexual relationships. All of this gets even harder if you’re queer, non-binary or transgender due to limited access to reproductive and family building services. The reproductive years are defined by questions from others around planning, becoming, or being pregnant. Your body is seen as an object, open to unsolicited touching, questioning, and comments. Your individual choices and thoughts can become public discord in your family or with strangers. In heterosexual relationships, parenting tends to push even well-intentioned couples into more traditional gender roles. In my work, many women in hetero-normative relationships come to me postpartum with feelings of rage toward their partner who isn’t pulling his weight, being supportive, or taking on parenting enthusiastically. Workplaces commonly reveal they’re reticent to hire reproductive aged women in fear they’ll get pregnant and take time off.
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Peri-Menopause—We Don’t Talk About It
The menopause transition is not one that’s typically openly discussed. Not only is the menopause transition one of hormonal, physical, and mental changes, but it can also be a time of significant relationship, career, health, and priority changes too. Peri-menopause is the time between a final period and a year after. An official diagnosis of menopause can’t be confirmed until a year after the last menses. Proper care and attention for people going through this transition has not historically been favorable. Tales and ideas made up to describe the process was void of lived experience. Like many things in life, men thought they could be experts in something they never experienced. People experiencing menopause who speak up to the wrong medical professional about distressing symptoms often find they’re dismissed, written off, or unheard. Societally, the worth of a woman who can no longer reproduce and isn’t seen as a sex symbol is deemed minimal to nothing. As men age, society doesn’t see them as ‘worn out’ but see postmenopausal women that way. The idea that the vagina is dead after menopause is akin to saying the penis is dead after 55. Men are allowed to age like a good wine, while women are seen as moldy cheese that needs to be put in the garbage, away from sight. This may also be a time where you’re sending your kids out of the house, realizing you don’t fit with your partner anymore, or dealing with aging parents. Women and gender minorities are assumed to be the ‘carers’ not only in nuclear families but extended family relationships as well, increasing overall stress.
Trauma and Other Mental Health Impacts of Systemic Gender Based Discrimination
Trauma:
Looking at the examples of gender-based discrimination elevated during reproductive health milestones shows that it’s not a one-time event. The way that society treats women, non-binary and transgender folks is traumatic and is cumulative throughout the lifetimes. The negative impacts of trauma can be quite severe. Trauma creates a stress response in the body which over time and decrease a person’s physical and mental health, leading to increased illness and pain. Stress and trauma can compound as women and gender minorities are expected to care for others regardless of what’s going on in their lives. Primary caregivers are at higher risks for mental health issues such as anxiety and depression.
Anxiety:
When you don’t feel safe to live your life on a regular day to day basis, anxiety about your ability to safety move through the world can arise. This may even make you anger, which can lead to more anxiety. You may avoid certain places or situations, have panic attacks, or overly monitor your thoughts or actions. You may experience anxiety related to monitoring how you look, how you are perceived, or what you say.
Grief:
Facing the reality of gender-based discrimination is tough. For many people, reproductive milestones increase the intensity of this reality. Grief and anger are tightly related and due to the societal mandate that women and gender minorities don’t feel or express anger, this can be a challenging emotional landscape to navigate in a safe environment.
Anger:
I hope reading the examples above makes you mad and that you can use that anger to create change. Repressed anger can lead to things like heart disease—the leading cause of death for women. Internalized anger can manifest as anxiety, OCD, depression, eating disorders and more; all seem as more ‘socially acceptable’ forms of pain.
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Poor Health Outcomes:
Women experience significantly higher rates of chronic pain than men and auto-immune illnesses. The majority of chronic illnesses are experienced by women. Women experience more chronic fatigue, fibromyalgia and neurodegenerative diseases. Women, especially women of color have higher rates of maternal mortality. Women in general, but especially black women are also less likely to be believed regarding reports of pain. Sit in a doctor’s office of hospital and you’ll most likely see a cis-gender man express his anger and demand he be seen immediately. Women and gender minorities are taught to be polite and accommodating, which sometimes can put your life at risk.
Poor Financial Outcomes:
Even though most divorces in heterosexual relationships are initiated by women, women tend to lose financially the most when relationships break up. Women and gender minorities are paid much less than men. Pregnancy and childcare disproportionately fall on women. Companies are biased against women during reproductive age. The US has no federal parental leave or childcare assistance. The more “feminized” a job is deemed by society; the less people are willing to pay. Many jobs women work in are emotionally intensive and underpaid. Women also carry the bulk of student loans in the US.
Gender Based Violence:
Men can be victims of abuse, but the vast majority of intimate partner violence, rape, and abuse is towards women, non-binary and transgender people. I won’t get too far into this here, but violence and rape culture are supported in both large and small ways every day in our culture. Gender based violence is based in power and control and disgusting.
Suicide:
Suicide is an act taken by people who are desperate and at the end of their rope. Negative emotions are no longer bearable. All of the challenges I’ve discussed above are chances to intervene, get support and care while we all work on changing our culture. Suicide is the ultimate act of self-silencing.
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Reach out to a Seattle Trauma Therapist Today
As an LMFT who sees the world from a systems perspective, I believe it’s important that your mental health challenges are seen within the wider context. Your lived gender experience is a primary way of how you engage in the world. The intersection of your complex identifies, socialization, and privilege interweave into how you see and experience the world. It’s imperative that we understand your unique context in order to fully understand and work on challenges you’re experiencing in your life. Most likely what you’re feeling is a natural reaction to a messed-up world. Therapy is a safe space to explore thoughts, emotions, and possibilities that aren’t typically encouraged or celebrated by the outside world. Let’s move forward together, empowering you to live a life full of emotional experiences and expression. Reach out and schedule a free consultation today.
Learn more about Chelsea’s specialties: grief, anxiety, infertility, pregnancy loss, chronic illness, menopause
Learn more about Chelsea
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