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Reproductive Healthcare Ramblings
Reproductive health in England and Wales is a shambles: particularly for women and people who menstruate. The failings start early, where, as with most things, stereotypes and ‘norms’ are enforced upon children from GPs, schools, from parents/guardians who have experienced worse, or who do not know any different, which keep children from speaking up. These standards and stereotypes come from a male dominated health care system especially in relation to gynaecology, and our patriarchal society silences children without the children even realising they are being silenced. As a child, you are expected to go about your daily routine, sit your exams, look after your siblings, represent the school at the tournament of the week, and do all this while, for some, bleeding, cramping, being fatigued but not be expected to talk about it. After all, you are told time and time again: it’s normal.
Moving through life, women and people who menstruate face similar stigma, standards, assumptions during adulthood as they faced during childhood. There is more awareness now of endometriosis, adenomyosis, uterine fibroids, Polycystic Ovary Syndrome Condition (PCOS) to name but a few. But women and people who menstruate report feelings of being gaslighted by [male] gynaecologists, encouraged to have children in order to regulate their hormones (pregnancy and childbirth comes with a whole new set of healthcare problems and conditions), to take the contraceptive pill and deal with the migraines, mood swings, weight gain and depression which many women and girls report. Some of the above chronic illnesses impact fertility, so ‘try for a baby’ is not an easy, or even a wanted path. Diagnosis is also complex: for example a diagnosis for endometriosis takes on average 8 years (Endometriosisuk, 2023), and can only be confirmed with surgery. That relies on women and people who menstruate going to their GP, reporting their symptoms, listening to the ‘have you tried the pill’ or ‘having a baby will help manage your symptoms’: which relies on trust. Not everyone trusts the NHS, not everyone feels comfortable being dismissed by a nurse, or GP or then their gynaecologist. Especially when a number of these illnesses are framed and seen as a white-woman illness. Communities of women and people who menstruate remain hidden, dealing with the stigma and isolation that our reproductive health system carries in England and Wales. And this is not a new issue.
The reproductive healthcare for women and people who menstruate is dire. Just ask anyone who has experienced it. What then is it like for women in prison? The pains of imprisonment are well documented: deprivation of goods, loss of liberty, institutionalisation, no security, depreciation of mental health (Sykes, 1958; Carlen, 1983). The gendered pains, fears and harms less so, but we know women in prison are fearful about the deterioration of relationships (especially with children), lack of facilities to support new mothers, physical and sexual abuse, and poor mental and physical health support including reproductive health. The poor reproductive healthcare available to women and people who menstruate within society, is a grade above what is available in prisons. These women are quite literally isolated, alone and withdrawn from society (through the process of imprisonment), and for some, they will become further isolated and withdrawn via the pains of their chronic illness.
There isn’t really a point to this blog: more like a rambling of frustrations towards all the children who will journey through our subpar reproductive healthcare system, who will navigate the stigma and assumptions littered within society. To all the women and people who menstruate who are currently wading through this sh*t show, educating themselves, their family, their friends and in some cases their GPs, those people unable to speak out, not knowing how or simply not wanting to. And to those in the Secure Estate, grappling with the pains of imprisonment and having their reproductive healthcare needs ignored, overlooked or missed.
I haven’t even mentioned menopause…
References:
Carlen, P. (1983) Women’s Imprisonment, Abingdon: Routledge.
Corston, Baroness J. (2007) The Corston Report: A Review on Women with Particular Vulnerabilities in the Criminal Justice System, London: Home office.
Endometriosis UK (2023) Endometriosis Facts and Figures [online] Available at: https://www.endometriosis-uk.org/endometriosis-facts-and-figures#:~:text=Endometriosis%20affects%201.5%20million%20women,of%20those%20affected%20by%20diabetes.&text=On%20average%20it%20takes%208,symptoms%20to%20get%20a%20diagnosis. [Accessed 24th August 2023]
Sykes, G. (1958/2007) The Society of Captives: A Study of a Maximum Security Prison, Princeton: Princeton University Press.
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Organisational reputation: A euphemism for institutional corruption and violence
The Independent Inquiry into Child Sexual Abuse published a damming report regarding child protection in religious organisations and settings. One of the findings was that ‘In many cases, concerns about external involvement are connected to a desire to protect the reputation of a religious organisation’. Of course, there are many other issues highlighted in the report, but I wanted to concentrate on this notion of protecting organisational reputation. When I hear the phrase ‘organisational reputation’ my blood generally runs cold because I know that behind these words lay a multitude of sins.
Companies and public sector bodies have policies that are designed, at least in part to protect organisational reputation. The rationale behind these policies often lacks transparency. It might be that the protection of the organisation’s reputation ensures it maintains its customer or client base, an enhanced reputation sees more customers or clients, a poor reputation might see this dwindle, to the detriment of the organisation and ultimately to the detriment of its employees and owners. It is difficult to recover from a poor reputation and in the case of business, this is sometimes catastrophic.
However, behind the notions of organisational reputation and policies lays a multi-layer of complex organisational and human behaviours which ultimately lead to institutional corruption and violence. Things will go wrong in organisations, whether that be as a result of human behaviour such as poor decision making or illegal activity or as a result of system failure, such as the failure of software or hardware. Any of these failures might harm the reputation of the organisation and herein lies the nub of the matter. When there are failures, because of organisational culture, which often finds its basis in finding someone to blame, there is a propensity to try to keep the issues ‘in house’, to protect the organisation. By doing so, managers and those in charge ensure that they are not scrutinised regarding the failure, be that individual failures, failures of policies or failures of systems and processes. So, the organisational reputation is not necessarily about protecting the organisation, it is more about avoiding scrutiny of those individuals in power. The mention of organisational reputation in policies and processes has another effect, it silences employees. Whistle blowing policies are subjugated to notions of organisational reputation and as a result silence is maintained for fear of some form of informal sanction. The maintenance of silence ensures organisational reputation, but this corruption also ensures continued institutional violence and corrupt practices. The longer it continues the more those in power have a vested interest in ensuring that the issues are not addressed, lest they are uncovered as offenders through their inaction. ‘We are all in this together’ takes on a new meaning. Thus, corrupt or criminal practices simply continue.
And if the wrongdoing is uncovered, becomes public, then the first reaction is to find a scapegoat thus avoiding the scrutiny of those in power. Rarely in these inquiries do we find that those put in the dock are the managing directors, the chief constables, the heads of children’s services, the archbishops or politicians. Rarely do we see those that caused the problem through inadequate or unworkable policies or strategies or working conditions are ever brought to book. Often its simply portrayed as one or two bad apples in the organisation. Thus, organisational reputation is maintained by further institutional violence perpetrated against the employee. That is not to say that in some cases, the employee should not be brought to book, but rarely should they be standing in the dock on their own.
For ‘organisational reputation, just read institutional corruption and violence.
Thoughts from the criminology team 