Biomedical versus social science understandings of gender

Aoife McKenna and Rosalind Cavaghan

Interdisciplinary and transdisciplinary projects often bring Science Technology Engineering and Medicine (STEM) researchers and social scientists together. This kind of teamwork is very fruitful – but can be very demanding as it often involves communicating across disciplinary boundaries and investing extra effort in understanding the strengths of other approaches. For gender sensitive health research, these disciplinary differences can lead to potentially contradictory methods of tackling health problems.

Practitioners working in international development have long dealt with these challenges using ‘gender sensitive situational analysis’ and collaboration with local communities where relevant, to work out how gender may affect the positive impact, (or not), of their interventions. GenderED’s on-going project on gender sensitive research has translated these kinds of insights into tools specifically for HE researchers, including a toolkit and briefings about several disciplines such as health.

But what kind of competing ways of thinking about gender tend to come up on the study of health?

Biomedical scientists tend to think about and study biological sex differences. In the past, many understood sex as a binary: male and female. Now, sex is understood as a spectrum or bimodal – having two majorities but with many other variations possible. This approach provides crucial information on the hormonal, genetic and epigenetic influences of biological sex on physiology and disease.

Social scientists studying gender on the other hand, are interested in socially and culturally produced expectations projected onto bodies, and their impact. This stems from many years of social research that has shown cultural variation in understandings of gender and the ways that gender structures political and economic hierarchies, and culture. Gender norms and roles are thus intricately intertwined into all social power dynamics, reflecting and reinforcing wider social inequalities. This approach to gender also includes the understanding that gender is a multiple, non-binary category and that gender attributes can be fluid.

So, what happens when these two ways of thinking meet?

Teaching

Medical and public health students often start out thinking about sex and its relationship to health. This means students would be highly aware, for example, that Covid-19 has a higher male mortality rate. When they begin to understand the social science approach, they start to appreciate the influence of gender on health at both at the individual patient level and wider systemic or structural level. They find it easier to see how gender identityimpacts upon an individual’s experience of illness, for example, how masculinity and ideals of stoicism can discourage help-seeking behaviour. At the wider structural level, students can also understand why, despite men’s higher mortality from Covid-19, the pandemic is having such severe consequences for women.

A social science approach to gender helps students to understand more clearly how health promotion interventions need to effectively target ‘upstream’ determinants of health (the systemic roots of health problems, e.g. policy), as well as ‘downstream’ determinants of health (the individual behavioural level, e.g. exercise). This approach thus enables students to see whether interventions can more easily achieve their aims according to public health principles such as equity and empowerment.

Research

Different understandings of gender and the role it can play in health research can lead to tension in research teams. This is evident from the recent debate in the Lancet on ‘Gender norms and the wellbeing of girls and boys. Failure to include a comprehensive social science approach to gender from an initial research design stage can, however, lead to the failure of sustainable health intervention programmes. This is true even for projects that include a focus on gender empowerment for certain aspects of a programme. These potential problems are particularly important in projects involving Official Development Assistance (ODA) funding because, beyond the ‘science’ goals, they aim for research to follow principles such as fair and equitable partnership, do no harm, and ‘leave no one behind’ etc. This means that biomedical researchers may be asked to get more deeply involved in the mechanisms mediating the local social impacts of their research. Designing an app to deliver a well-designed, evidenced-based health rehabilitation programme for children may in fact fail to have an impact,  if it turns out that mothers responsible for children’s care don’t have regular access to mobile phones because having one would render them vulnerable to harassment, gossip and/or surveillance.

Thinking these kinds of issues through will enhances research from an ethical standpoint, because it increases equality of impact. It also increasing the chances of receiving support from funders increasingly supportive of gender sensitive research, such as GCRF, NIMH and the Bill and Melinda Gates Foundation.

For relevant tips and tools check GenderED’s resources on how to do gender sensitive research.


Author’s bios

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Aoife McKenna is a postdoctoral researcher and teacher at the University of Edinburgh who works in the field of medical sociology and public health. Aoife’s research focuses in particular on the social determinants of health, intersectionality, and policy aspects of healthcare.

 


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Rosalind Cavaghan is an independent scholar and consultant whose work focuses on the intersectional gender impacts of public policy, particularly economic, and science and technology policy. Over the last 18 months she has worked closely with genderED to build capacity across the university in gender sensitive research practices, responding to the legal gender equality requirements incorporated into interdisciplinary funding schemes such as the Newton Fund and the Global Challenges Research Fund. She is an active member of the Scottish Women’s Budget Group and her most recent publications include ‘The Possibilities and Constraints for Intersectional Practice in Gender Budgeting Activism‘ in Social Politics, ‘Feminist Political Economy and its Explanatory Promise’ in the Routledge Handbook of Gender and EU Politics. and Dead Ends and Blind Spots in the European Semester: the epistemological foundation of the crisis in social reproduction, forthcoming soon in the Journal of Common Market Studies.