Date of Degree

6-2022

Document Type

Dissertation

Degree Name

Ph.D.

Program

Sociology

Advisor

Susan Markens

Committee Members

Lynn Chancer

Mary Clare Lennon

Stef Shuster

Subject Categories

Gender and Sexuality | Inequality and Stratification | Medicine and Health | Race and Ethnicity

Keywords

hysterectomy, reproductive justice, biomedicalization, chronic illness, trans health, science and technology studies

Abstract

Hysterectomy is the most common gynecological surgery worldwide and approximately one third of people assigned female at birth in the U.S. will have their uterus removed by the age of 65. Despite the high prevalence, sociologists have neglected to examine this procedure amid broader systems of gender, health, and race inequality. Over 90% of hysterectomies are deemed “elective,” including for chronic reproductive illness or as gender affirming care for trans and nonbinary individuals. Given the various reasons for a hysterectomy, and the incidence of this procedure across gender identities, an analysis of hysterectomy experiences allows for a rich investigation into the meaning of medical practices across contexts, as well as the inequalities embedded into medical provision across gender and race. Accordingly, this dissertation asks: how do biological, cultural, and structural factors interact to shape contemporary experiences with elective hysterectomy?

Drawing on medical sociology, reproductive justice, and science and technology studies, I use hysterectomy as a case for understanding the way all reproductive health choices are constrained within interlocking systems of inequality. I draw on 100 in-depth interviews with a racially diverse sample of individuals who had, want, or are considering hysterectomy to treat chronic reproductive health conditions or as gender-affirming care for trans and gender-nonbinary (TGNB) individuals. I begin with a historical chapter that traces the history of medicine vis-à-vis the hysterectomy. More specifically, I use hysterectomy as a reference point through which to examine three major legacies of modern medicine: a) the emergence of medicine to treat “women’s disorders” b) racialized medical abuse and experimentation and c) the development of transgender healthcare. In the process, I show how modern hysterectomy experiences are shaped by the legacies of medical sexism—including hysteria and medical experimentation on women’s bodies, eugenics movements and forced sterilization, and the emergent practice of using common medical treatments to “treat” gender for gender nonconforming individuals since the 20th century.

Drawing on my interview data, I then locate hysterectomy in social scientific debates regarding the role and meaning of medicine—particularly medicalization and biomedicalization frameworks. I first examine the reclaiming of hysterectomy from an “unnecessary,” overperformed instrument of an oppressive healthcare system into a tool individuals can use to “fix” or enhance a broken or erroneous body; in the process I interrogate how refined technology, coupled with shifting cultural norms, alter the boundaries between elective/essential, biological/cultural, and human/technological. I then show how the politics of reproduction shapes contemporary experiences by gender and race, producing divergent medical pathways and v personal reactions to the same procedure. Using these findings, I introduce the concept of the stratified motherhood complex which explains how gender and race—specifically, proximity to white womanhood—impacts healthcare provision and the way we interpret the meanings attached to biological facts, technologies, and our own bodies. I argue that the inequality embedded in hysterectomy is a key point in reproductive injustice that has been overlooked amid a focus on abortion and forced sterilization.

Additionally, I interrogate what hysterectomy narratives can teach us about the modern patient-physician dynamic; specifically, I uncover the ways those seeking medical interventions for chronic reproductive illness or for gender affirming healthcare must rely on alternative sources of knowledge, community networks, as well as social and cultural capital to achieve their health goals. Amid broader cultural narratives like repronormativity, transnormativity, and medical racism, strategies to challenge and customize their healthcare are critical. These findings provide key insights into the study of biomedicalization, by exemplifying the way the ability to “choose” body modification practices such as hysterectomy are stratified.

The findings from this dissertation further debates in sociology about the relationship between culture and biology in shaping personal experiences with medicine and reproduction. Overall, this work makes important contributions not only to hysterectomy, which is highly performed yet understudied, but also to key theoretical puzzles within the sociological study of medicine, science and technology, gender and sexuality, and reproduction.

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