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Sexism is the failure to give equal weight to women’s interests. It is the antithesis of feminism, a moral, political, and social movement that seeks justice for women. Sexism is important because it undermines the welfare of one-half of the human population and is a major source of women’s oppression.
Each of these terms—interests, justice, welfare, oppression—is theory-laden, suggesting a particular way of understanding the origins and remedies for wrongful sex- and gender-based distinctions. This research paper is eclectic but relies primarily on the liberal language of rights and interests.
Women have two kinds of rights, the ones shared with men by virtue of their common humanity, and the ones required by virtue of their differences from men. Sexism fails to recognize these rights by assuming, on the basis of inadequate evidence, that there are morally relevant differences between women and men, or by overlooking morally relevant differences that call for different treatment.
Medical treatment of heart disease in women is an example of both kinds of sexism. On the one hand, ignoring contrary evidence, practitioners have assumed that heart disease is not a women’s problem. On the other, they have refused to take seriously the possibility that heart disease might manifest itself differently in women than in men. Consequently, heart disease in women is underdiagnosed, treatments are geared toward men’s needs, and women needlessly suffer and die more often than men.
Although sexism can be a result of inattention, or a deliberate policy of subordinating women’s interests to those of men or children, it may also result from historically embedded social institutions that naturalize assumptions about gender. A key assumption is that biology determines women’s nature, whereas men construct themselves. Woman’s inherent function is to nurture children and men. Women therefore do not elicit the respect due to rational persons with legitimate life-plans of their own; their interests are relatively unimportant, and may be subordinated to others with which they come in conflict. The consequences range from abortion, infanticide, and starvation for female Indian children, to more subtle but still significant losses for Western women. Among these are lack of representation in positions of public power and prestige, longer hours of work for less pay, lack of sexual or reproductive freedom, less advanced healthcare, and less leisure, pleasure, and financial and physical security.
No thoughtful person wants to be seen as sexist. But because of widespread negativism about feminism, many people believe that there is neutral territory between the two. However, where women’s interests are affected there is either a (feminist) commitment to count them equally or there is a (sexist) discounting of those interests. Neutrality can exist where gender is not at issue or where it is difficult to determine whether sexism is at work.
Oppression, Discrimination, Sexism
Oppression is the systematic and unjust subordination of some people by others. Sexism is a major source of women’s oppression. Oppression may be based on superior power, without any attempt at justification. However, it is usually predicated on the alleged inferiority of a class of people, such as women, the poor, people of color, the elderly, homosexuals, or adherents of certain religions. In principle, recognizing the wrong of one kind of oppression implies recognizing the wrong of other types, but in practice these connections are often ignored.
Because many mainstream thinkers (consciously or unconsciously) accept sexist assumptions, they are unconvinced of women’s oppression, and they doubt evidence alleged to support the claim that such oppression exists. Even when the facts (e.g., women’s lesser wealth) are undisputed, they are attributed to the consequences of women’s inferiority, their autonomous choices, or to social necessity.
Feminists respond by arguing that these defenses are mere rationalizations, and that there are systematic and interlocking patterns of sex and gender relationships that disadvantage women. Sexism leads to the high valuation of qualities associated with men but not women. Also, pervasive patterns of gender socialization affect women’s capacities (such as strength or mathematical achievement) and mean that women’s choices may not be as autonomous as they seem. Moreover, many of women’s disadvantages are rooted in the sexist failure to recognize the special rights that need to be granted because of the differences between women and men. Social and political arrangements allegedly based on necessity are essential only for men’s convenience. Relegating women to inferior positions is therefore unjustified, and constitutes oppression.
Discrimination is an effective tool for creating and maintaining oppression. Discrimination can be used descriptively or normatively. Descriptive discrimination among concepts and entities is essential for thought and language. Such distinctions are usually considered to reflect the world, and are thus natural. However, categories may depend on choices about what characteristics count for inclusion and so morally significant groupings may instead be constructed (e.g., race). Normatively, discrimination always implies wrongful treatment of members of a group. The constructed nature of some descriptive groupings may facilitate the creation of normative ones. Thus, for example, conceptualizing the class of potentially pregnant women may make it easier to discriminate against them in the workplace or in medical research.
Sometimes it can be difficult to determine whether a decision or policy is sexist or feminist. For example, selective abortion of female fetuses is often cited as a paradigm case of sexism. But different contexts can render the same act sexist or feminist. Aborting a female because of the belief that boys are superior to girls is sexist; aborting a female to prevent a girl’s suffering can be feminist.
In addition, it is important to distinguish between legal and moral contexts. Because motivation is difficult to determine in legal contexts, sexism in law is most successfully rooted out by a focus on disparate impact. Moral investigation, however, can and must delve further into motivation and intention.
Is it sexist to abort female fetuses to ensure that there are both male and female children in a family? If “balance” is a pretext for ensuring the birth of a boy to secure the alleged social benefits only he can provide (e.g., continuation of the family name), then it promotes and maintains a sexist world. But what if the decision to abort is based on the reasonable belief that social pressures generally lead girls and boys to develop somewhat differently (no matter what the family environment), and that raising them is likely to be an equally desirable, but different, experience?
Evaluating whether assumptions that underlie decisions are sexist can be challenging. For example, it would be sexist to exclude women from drug trials because they are different from men in relevant ways, but not because they are alike in those ways. But which assumption is it reasonable to start with in the absence of knowledge? Assuming that the sexes are alike could be just another instance of taking males as the norm, without paying attention to ways that females might be different. Assuming they are different could be just another instance of the belief that females have more in common with the females of other species than with male humans. A similar quandary arises for race.
Inquiry suggests that women are harmed by their exclusion from clinical trials because such exclusion can result in poorer healthcare. Do cholesterol-lowering drugs or aspirin prevent heart disease in women? Nobody knows because the original research was done in men, and only at the very end of the twentieth century did the relevant studies begin for women.
Digging into the history and culture of medicine reinforces this conclusion. In the past, women were not admitted to most medical schools because they were considered fit only for nursing or midwifery. Harvard University began accepting women only in 1945, when World War II had reduced the number of male applicants; women could not exceed 6 percent of each class until the 1970s. Sue Rosser and Eileen Nechas and Denise Foley were pioneers in documenting obstacles facing women in medicine in the twentieth century. Adriane Fugh-Berman describes a dispiriting range of problems she encountered at a leading medical school. Among them were medical disinterest in women’s bodies (breasts were discarded on the first day of anatomy class) and welfare (students were taught that women can have a satisfactory sex life without orgasms). Some professors did not see women students as equals and refused to teach them certain procedures or topics (sexually transmitted diseases). Male students compounded the hostile environment by harassing and threatening with rape the members of a women’s study group. A survey of recent literature on problems women encounter in medicine shows that there is still much room for progress.
In 2003 women still experience substantial sexism as consumers of healthcare, as the aforementioned example of heart disease shows. Stereotypes about women’s nature (irrational, focused on reproduction) may continue to lead healthcare researchers and providers to sometimes dismiss what women say about their symptoms (e.g., in women with AIDS, or menstrual pain). It may also encourage the development of procedures that put women disproportionately at risk in what should be joint ventures with men (contraception, infertility treatment). More generally, until the end of the twentieth century, researchers emphasized conditions that affect men, ignoring such complaints as dysmenorrhea, incontinence in the elderly, and nutrition in postmenopausal women. At the same time, medicine has also tended to inappropriately medicalize the bodily experiences connected with reproduction: menstruation, pregnancy, childbirth, and menopause. Medicine has also promoted and reinforced the assumption that only women —not men or society at large—are responsible for babies’s health.
Is there any evidence to suggest that women’s exclusion from research (and the failure to analyze studies they did participate in by sex) is a result of concern for women? No. It appears that women have been excluded either for researchers’s convenience or due to concern about harm to possible offspring (or concern about liability for such harm). Men have been assumed to lack hormonal cycles that would confound study results; women however, engender the opposite assumption. But men appear to have their own hormonal cycles, and if women’s cycles affect outcomes, being excluded harms the latter. Also, some researchers have had easier access to male populations (the military, prisons). But ease of access does not justify ignorance about the medical care of women. Excluding women because of possible pregnancy accepts the stereotypes that women are ignorant about their bodies, and careless about the welfare of fetuses; the exclusion of women also ignores the evidence that sperm are affected by exposure to toxins. Non-sexist drug trials would thus regard women and men as equally likely to risk harm to offspring. Both would therefore need to be warned against reproduction, and both sexes ought to be trusted to heed those warnings to the same degree. Abandoning women for such sexist reasons is especially unjust when research is publicly funded. It follows that women should be included in experimentation, and that results should be analyzed by sex. Excluding women from health studies could be seen as a feminist position only when there are excellent reasons for believing that to include women would create more harm than good for women as a class.
In conclusion, the concept of sexism points to the ways that women’s interests are systematically discounted in comparison with those of men. Sexism is a kind of discrimination that oppresses women as a class. Groundless stereotyped assumptions about women and the unjust failure to take seriously both the ways that women resemble men and the ways that the two sexes differ play a central role in sexism. Women have been seriously harmed by sexism in medicine, and only in the last decades of the twentieth century have the women’s health movement and practitioners in the field of women’s health begun to rectify this wrong. Bioethics, which, among other tasks, critiques the healthcare system, was itself quite blind to sexism in healthcare until the 1990s; sexism in bioethics remains a serious problem, as overtly feminist bioethics literature is marginal.
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