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ETHN 142
February 17, 2012

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Intersectionality in Biomedicine

The meaning of race and gender pervade the hierarchical composition of society.
Although each category of difference has its own history of associated oppression, power,
privilege, and status, the intersection of race and gender for women of color demonstrates a
unique position in the discourse and practice of Western biomedicine. The discourse and practice
of Western biomedicine perpetuate systems of less valuation for women of color by
dehumanization and societal exclusion through unequal healthcare access, reproductive rights,
and considered appropriateness as a surrogate. Racialized and gendered groups have responded
to discourses and practices dehumanizing and excluding them by demonstrations, aiming for
governmental reform, and individual resistance to systems of power.
Western medical discourse has constructed and perpetuated that women of color are
lower in the hierarchy of racial and gender social valuation. The Sojourner Syndrome is a
framework that speaks of the effects of the intersection of race, class, and gender in the risk of
health disparities for African-American women (Mullings). In the way that the Sojourner
Syndrome framework incorporates and conceptualizes the combined effects of class, race, and
gender on health, biomedical discourse incorporates and conceptualized racial and gender
hierarchies into the formation and dissemination of medical knowledge. This particularly affects
women of color to be excluded from medical studies and iconographically depicted as outside of
the idealized norm, thus viewed as embodying difference in their very bodies. The notion of
difference has manifested in icons and images of the colonial period. The nature of these images
depicted the Hottentot figure as inextricably linked to the essence of the black woman,
conceptualized as possessing bodily differences from the white female (Gilman 225). In the way

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that colonial images of females and sexuality create different classes of qualities, medical
discourse considers and acts on these perceptions to treat certain groups differently. Medicine is a
system that organizes perception of the world through social construction of meaning (Gilman
224). Thus, medicine has immense power because its perceptions infiltrate other segments of
society and its status legitimizes its actions. The failure of medical discourse is to view groups
equally. It is made clear through its role in framing the basis for limiting reproductive rights,
sterilizing women, and enabling transnational surrogacy which predominantly targets and affects
women of color. The framing of medical knowledge affecting its practice is rooted in functions
of conventions. These conventions determine who is a citizen worthy of reproduction and
participation in the surrogacy market exchange as surrogates. The effect of these conventions is
traumatic not solely because medical discourse is a process of social construction that captures
and perpetuates racial and gender hierarchies through discourse, but its perspectives affect other
spheres, specifically through the practice of biomedicine. In other words, medical discourse is
not limited to knowledge formation by its translation into practice affecting women of color with
disproportionate justice by limiting access to healthcare, reproductive rights, and assumed
appropriateness for participation as surrogates. Biomedical discourse has perpetuated the notion
that people of color lack the capacity for rational thought, independence, and self-control
which are essential for self-governance (Roberts 208-209). This discourse affects reproductive
rights and perpetuates racialization of the identity of a proper citizen, affecting immigration
policy. Medical discourse also justifies population control methods of sterilization as a means of
helping society by limiting the number of low-income, minority births. Discourse is framed in a
way to be concerned with the betterment of society by limiting poverty. Of course this
framework provides justifications then for performing sterilization due to its supposed economic

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and social basis. This thinking puts power in the doctors not only to frame medical
understanding, but also to frame solutions to what they perceive as problems (Lawrence 412).
This is inherently calling on solutions to be enacted since medical discourse is perceived with
high regard and as legitimate. The way women view and relate to their bodies is also affected by
medical discourse in teaching Indian women to view their body as a machine made of parts,
separate from the self where parenthood is purely in biology and not who gives birth, and the
surrogates identity is as a provider, not a parent (Vora 271). This taught and embraced
perspective sets the woman up for imagining her womb as surplus that can be used in capital
exchange. Once women are trained to view their bodies as machines and their uterus as empty
space, they can be hired for surrogacy work. Its clear that medical discourse doesnt exist in a
vacuum. Instead, its position of status and elaborate beliefs translate into medical practice.
The discourse of the lesser valuation of women of color translates into medical practices
that affect reproductive rights and the use of transnational surrogacy. Through Proposition 187,
non-verifiable citizens or admitted aliens are prohibited from nonemergency health care,
preventing undocumented pregnant women from prenatal care (Roberts 207). This Proposition
perpetuates racial and gender inequality by the lack of access to prenatal care, presenting the
options of abstaining from reproduction, reproducing with risk of mortality, or moving out of the
country for care. Denying the right to reproduce is denying a basic human right, preserving
hierarchies of inequality and leaving groups of people dehumanized and with a feeling of a lack
of worth (Roberts 214-215). By limiting the right of women to contribute to future generations,
they fail the test of inclusion in society. This reproductive control has also been enacted through
sterilization policies aimed toward minority groups. Sterilization policies toward Native
American women resulted in a 25% sterilization rate for women ages 15-54 (Lawrence 400).

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These women were targeted for their birth rate, resulting in 3,406 sterilizations between 1973
and 1976 (Lawrence 407). Although sterilization might have been framed as a neutral population
control method, it demonstrates the notion of who is unworthy to reproduce, reinforcing
hierarchies of difference, privilege, and power based on race and gender. The use of women as
biocapital in transnational surrogacy also perpetuates these inequalities. Western biomedicine
treats the Indians female body as a machine that can be used for economic valuation. That the
system of surrogacy is occurring mainly by women of color, hierarchies are reinforced where
women are dehumanized through their inability to get emotionally attached to the child and are
excluded through their dormitory-style living as they deliver and nurture the baby (Vora 276).
The role that only women of color can play in this surrogacy exchange imposes the inequality of
valuation on their lives, abilities, and inabilities. Being considered as appropriate surrogates, the
hierarchies of value and privilege and strengthened. However powerless and exploited racialized
and gendered women are, they have responded to the inequality they face.
Racialized and gendered groups have responded to the discourse and practice of Western
biomedicine through demonstrations and other forms of resistance. Native American women held
demonstrations in 1974 in Claremore, Oklahoma against the Indian Health Service for the
sterilization abuse their communities face (Lawrence 413). These women aimed to raise
awareness of the injustice they faced and attempted to threaten those exercising authority over
populations reproductive rights. Further organization took place in September of 1977 by the
National Council of Churchs Interreligious Foundation for Community Organizing (IFCO).
IFCO held a conference in Washington D.C. to strategize for a fight for survival against
sterilization abuse (Lawrence 413). Having a presence at the nations capital brought greater
awareness to the abuse faced, bringing the conversation out of reservations. A year earlier,

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Congress passed the Indian Health Improvement Act, giving tribes the right to manage or control
Indian health service programs. The response was taking over the Indian Health Service facilities
and starting their own health services, particularly in their own healthcare traditions (Lawrence
214). Although some gains were achieved, women of color are far from receiving proper justice
through equality of treatment, access, and status, leaving them with an option of individual
response. Oppressed women deal by self-pitying or resisting institutions of power. Puja was a
surrogate that cries herself to sleep every night after saying goodbye to the child she gave birth to
(Vora 275). Her response to the injustice she feels is this form of self-pity because the power of
the transnational surrogacy is difficult to challenge. She deals by a silent suffering. Four Native
American women who were forcibly or unknowingly sterilized deal with their experiences by
refusing to use the Indian Health Service for any reason or going only for routine checks
(Lawrence 413). This form of resistance does not alter the power structure, but it challenges it on
an individual level. By responding through demonstrations, governmental policy reform, and
resistance, women of color are better able to cope with the unjust hierarchies they face. However
energetic the movements of demonstration and resistance may be, it is unlikely to see
fundamental change soon as the notion of difference and valuation continues to be perpetuated
through Western biomedicine.
Race and gender have intersected in the discourse and practice of Western biomedicine to
perpetuate hierarchies of lesser valuation for women of color through the inequality of
reproductive rights and proper qualification for surrogacy. Western biomedicine is responsible
for further dehumanizing and excluding these women of color in their respective communities.

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Works Cited

Gilman, Sander, Black Bodies, White Bodies, in Race, Writing, and Difference, Henry
Louis Gates, Jr. Ed, University of Chicago Press, 221-261.
Lawrence, Jane, The Indian Health Service and the Sterilization of Native American Women,
American Indian Quarterly. (2000) 24.3: 400-419.
Mullings, Leith, Resistance and Resilience: The Sojourner Syndrome and the
Social Context of Reproduction in Central Harlem, in Gender, Race, Class, and
Health (2006), 345-70.
Roberts, Dorothy, Who May Give Birth To Citizens, in Immigrants Out: The New Nativism
and the Anti-Immigrant Impulse in the United States (NYU Press, 1997), 205-19.
Vora, Kalindi, Indian Transnational Surrogacy and the Commodification of Vital Energy,
Subjectivity (2009) 28, 266278.