Stratified reproduction

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Stratified reproduction is a widely used [1] social scientific concept, created by Shellee Colen, that describes imbalances in the ability of people of different races, ethnicities, nationalities, classes, and genders to reproduce and nurture their children. [2] Researchers use the concept to describe the "power relations by which some categories of people are empowered to nurture and reproduce, while others are disempowered," as Rayna Rapp and Faye D. Ginsburg defined the term in 1995. [3]

Contents

Concept

Globally, women are confined to different societal standards on reproduction. The ability to choose whether women want to become pregnant is not available to all women. Contraception and abortions can be illegal or difficult to obtain depending on location or socioeconomic status. Women's experience of child birth has varied from required minimum number of children a mother must birth and honors for overachieving the set minimums to a restricted the number of children per household. In a broader sense, stratified reproduction asserts that certain categories of people are encouraged and coerced to reproduced while others are systematically discouraged to do so. The capacity to control one's reproductive choices is unequally distributed among race, sexual orientation, gender, class and socioeconomic status. [4] Stratified reproduction also extends beyond the aspect of reproduction to the extent of conception, contraception, prenatal medical care, childcare, and the mother's role in their child's life. [5]

In 1984, Shellee Colen coined the term "stratified reproduction" when studying West Indian childcare workers in New York City, who typically worked for wealthier white families. Colen highlighted differences between white and West Indian mothers’ ability to choose how they each care for their children. The white mothers hire a nanny to carry out the routine tasks of childcare while the West Indian mothers forgo the ability to raise their children so that they can financially support them. Colen drew the conclusion that child birth and childcare is experienced, valued, and rewarded differently depending on a mother's socioeconomic status and availability of resources. [2]

Studies using the concept

Since the emergence of the term stratified reproduction, researchers have applied its concepts to analyze the different effects of varying social factors on reproduction and childcare. Rayna Rapp and Faye D. Ginsburg pioneered the application of stratified reproduction to different societies to emphasize the variation to which women experienced reproduction and childcare. In Rapp and Ginsburg's book, Conceivingthe New World Order: The Global politics of Reproduction, they discuss several societies that limited women's choice on reproduction and childcare due to socioeconomic factors. [3] They touch on Shellee Colen's research on West Indian nannies in New York and how they are unable to participate in their own child's childcare, because they must immigrate to America to find work to support their family. [3] They also include Gail Kligman's research on abortion bans in Romania under Ceausescu’s rule. [6] State policy required the Romanian women to birth at least four children in hopes of increasing the population for a more efficient socialist country. They also discuss China’s limit on the maximum number of children per household, and low-income African American women’s struggle to obtain proper contraceptives and abortions. [3] Rapp and Ginsburg concluded that “global and local socioeconomic relations that form the context for stratified reproduction, whereby ‘some categories of people are empowered to nurture and reproduce, while others are disempowered’”, and that cultural ideologies and state policies reinforce the stratified reproduction implanted by socioeconomic factors.

The scope of use of the stratified reproduction framework is not limited to women’s access to contraceptives or lack thereof. Researchers are applying stratified reproduction to the health of the mothers and children. Infertility has also been linked to the effects of stratified reproduction. Scarce financial resources deters mothers from being able to reach effective medical services to help prevent infertility. [7]

Infertility options and stratification

Medical infertility treatments

Infertility is just one aspect of stratified reproduction. Although it is estimated that 186 million people worldwide are affected by infertility, technology can be able to assist those who are infertile. [8] In-Vitro-Fertilization (IVF) is one assisted reproductive technique (ART) that is used. IVF was developed over 30 years ago to help women with blocked or damaged fallopian tubes. IVF has helped many couples achieve their dreams of having a child. However, IVF is extremely expensive and/or inaccessible to many globally. In Central and Southern Africa "two-thirds of infertile women have diagnoses of tubal blockage attributable to sterilizing RTIs [Reproductive Tract Infections]" which is exactly what IVF was developed for. [9] The high costs and inaccessibility keep infertility as a major aspect of stratified reproduction. According to a study done by Marcia C. Inhorn and Pasquale Patrizio, regions such as South Asia, sub-Saharan Africa, the Middle East and North Africa, Central and Eastern Europe and Central Asia have high infertility rates. [8] While infertility is a global phenomenon, other issues within those regions play a role in their high infertility rates. Secondary infertility, being unable to conceive after a previous pregnancy, is the most common form of infertility in women. [8] Typically secondary infertility comes from RTIs. In countries where abortions are illegal, women will choose to have unsafe abortions. These unsafe abortions can lead to RTIs and secondary infertility if left untreated. Studies show that in places where laws are lifting the ban on abortions, secondary infertility rates are decreasing. [9]

Racial disparities and socioeconomic status also play a role in infertility as well as the reported use of medical services for infertility. Data from the National Survey of Fertility Growth (NSFG) showed that infertility rates for black (19.8 percent) and Hispanic women (18.2) were much higher than those rates for white women (6.9 percent).The same study revealed that although women of color experience higher infertility rates, they reported having not received medical services for infertility at higher rates than their white counterparts. [10] Socioeconomic status also provides barriers for women who do not have the flexibility to take off work and schedule appointments that higher socioeconomic status women do. [10] Without public or even insurance company funding for these ARTs, this suggest that those in a higher socioeconomic standing should be able to reproduce, while those who cannot afford these treatments should not have the same ability to do so. This notion is furthered by policies such as the welfare reform act of 1996 which denies benefits to children who are born to mothers on welfare. [4] However, race and class disparities in infertility treatment remain even in states that have mandated infertility insurance coverage suggesting that the issue of stratified infertility options go beyond political policies.

Adoption

Adoption is another infertility option that hosts many barriers to underrepresented populations. Cost is one factor that is a barrier for people with a low SES status. There is also a devaluation of children of color within the adoption system. The demand for white children is higher than that for children of color, thus leading some adoption agencies to charge more to adopt white children. This practice suggests that white children are of higher value than children of color. [4]

Reproductive technologies and stratification

As there is a continual expansion of reproductive technologies, there is also increasing deficits in the access and utilization of these technologies due to stratified reproduction. Barriers achieving equal access to these reproductive technologies include high costs, lack of adequate healthcare or no healthcare, restrictive policies, lack of transportation and the lack of autonomy given to women to make their own reproductive decisions. [4]

"Stratified Contraception"

Sheoran uses Shellee Colen's 'stratified reproduction' conceptual framing to propose that contraception is experienced hierarchically in places like India. Sheoran, when writing of Emergency Contraceptive Pills in India writes, 'ECPs in India thus make visible the reality of ‘stratified contraception,’ even as these technologies make inviting claims of eradicating stratification by providing all women with access to these pills at the local pharmacy'(pg. 250). [11]

Sterilization

Sterilization is a relatively permanent form of contraception that can be used to give women reproductive control; however, this form of contraception has a history of blatant misuse. Sterilization was used to reinforce the social hierarchy where wealthy, white families were genetically superior to other groups of people. In this hierarchy, people of color, people with mental illnesses, criminals, those on welfare, single mothers and addicts were all seen as genetically inferiors; therefore justifying forced sterilization for the common good. The main target of forced sterilization were poor women of color. [12]

In more recent history, there is still subtle and covert forms of coercion for certain groups to undergo sterilization. Sterilization rates still remain unequal between poor women of color and their white counterparts with Black and Native American women being twice as likely to have received a tubal sterilization. This data is found to be surprising taking into consideration that women of color are less likely to receive reproductive care or have health insurance to cover the costs of this procedure. A few explanations of this discrepancy is negative stereotypes of women of color as poor mothers and assuming women of color cannot afford children without being on welfare. These assumptions often lead to coercion and more invasive surgeries for reproductive issues that lead to sterilization. [12] With women of color still at the forefront of this misuse of sterilization, the prison system has become a large target for coerced sterilizations. It was discovered that over 150 women were forcibly sterilized in prison between 2006 and 2010 because these women were deemed likely to return to prison. Even though sterilization was a costly procedure, physicians claimed that it would be better to pay for the procedure than pay for the welfare of these women's children. [13]

Racial implications

Ethnicity and race also play a role in stratified reproduction. Western media often focuses on the infertility of middle-class white women, to the detriment of poor and nonwhite women. [14] Race and ethnicity are common tools used to justify reproductive injustices and health disparities seen throughout the United States.[ citation needed ]

Latino populations and stratified reproduction

Recent scholarship has investigated the history of conflict around Latinas and fertility in the United States. These stories provided evidence that the United States had funded forced sterilization of Latino people and other ethnic groups.[ citation needed ] In their article, Elena R. Gutiérrez and Liza Fuentes study two communities, Puerto Rican women in Puerto Rico and New York and Mexican-origin women in Los Angeles. [15] Once Puerto Rico became an American colony in 1898, people[ who? ] began to talk about Puerto Rico being overpopulated. By 1965, over 34% of mothers aged 20–49 had been sterilized. [15] Not all women chose to be sterilized. [15] Many of these women were used for contraceptive testing without their knowledge. [15] Mexican-origin women were another community that experienced forced sterilization. Some women were forced into nonconsensual sterilizations, including as they were giving birth. [15] Scholar Leo Chavez argues that these sterilizations came from the idea that Latinos are over-populating the U.S. [16]

In his article, Leo Chavez discusses Latino fertility in the United States. He writes that their presence promoted anti-immigration sentiment and advertising suggesting that they should leave the United States and that their fertility was not welcome in the country. [16] Puerto Ricans, such as those discussed in the article by Gutiérrez and Fuentes, were a part of this larger Latino community that was being targeted. In Chavez's article, he collects data to discuss fertility rates among Latinas, showing that, though Latina women were more fertile than their non-Hispanic white counterparts, they had fewer lifetime sexual partners. [16]

Black women experiencing stratified reproduction

Nearly one in four African-American women live below the poverty line, which greatly increases the risks associated with bearing children. [17] Black women are two and a half times more likely to die during pregnancy, and their children are two times more likely to die as infants. [18] Many[ who? ] attempt to view this issue as a biological issue of African-American women; however, black women residing in other countries have less reproductive complication than their American counterparts.[ citation needed ] Black women are less likely to be given medical advice, to be warned of possible medical complications, and to receive helpful prenatal therapies. [19] This differential treatment from medical health professional leads to more birth complications, adverse birth outcomes and fetal death thus contributing to the system of stratified reproduction. [19]

Residential segregation may indirectly harm health through harmful living environments and limited access to resources. Segregated communities often are characterized by more crime, greater pollution, higher population densities, more poverty, and fewer and lower-quality services, leading to infant mortality. [19] This includes forms of environmental injustice, which incorporates the unfair plotting of landfill facilities and the deliberate targeting of minority and low-income communities as repositories for hazardous waste sites. [20] Even though residential segregation affects various minority groups, in the United States there are stark health discrepancies between black woman and their white counterparts. Flint, Michigan is a predominately black area that exemplifies the harmful impact low environmental quality can have on healthy reproduction: The Flint water crisis decreased fertility rates by 12 percent and raised infant mortality by 58 percent among Flint residents. [21]

Queer stratified reproduction

More recently, there has been a closer look into how the system of stratified reproduction impacts the LGBTQ+ community. Stratified reproduction within the reproductive field of medicine feeds into a political economy that does not include a right to health, but a right to purchase health care if one can afford it and is deemed worthy of these biomedicines.[ citation needed ] States such as Arizona and Mississippi have recently seen legislative attempts to allow health care services to deny care to LGBTQ people; these stratifications of access to care also deny LGBTQ people the same possibilities for family planning and formation. [22]

Related Research Articles

Sterilization is any of a number of medical methods of permanent birth control that intentionally leaves a person unable to reproduce. Sterilization methods include both surgical and non-surgical options for both males and females. Sterilization procedures are intended to be permanent; reversal is generally difficult.

Reproductive technology encompasses all current and anticipated uses of technology in human and animal reproduction, including assisted reproductive technology (ART), contraception and others. It is also termed Assisted Reproductive Technology, where it entails an array of appliances and procedures that enable the realization of safe, improved and healthier reproduction. While this is not true of all people, for an array of married couples, the ability to have children is vital. But through the technology, infertile couples have been provided with options that would allow them to conceive children.

<span class="mw-page-title-main">Family planning</span> Planning when to have children

Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marital situation, career or work considerations, financial situations. If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction.

Fertility in colloquial terms refers the ability to have offspring. In demographic contexts, fertility refers to the actual production of offspring, rather than the physical capability to reproduce, which is termed fecundity. The fertility rate is the average number of children born during an individual's lifetime. In medicine, fertility refers to the ability to have children, and infertility refers to difficulty in reproducing naturally. In general, infertility or subfertility in humans is defined as not being able to conceive a child after one year of unprotected sex. The antithesis of fertility is infertility, while the antithesis of fecundity is sterility.

Reproductive rights are legal rights and freedoms relating to reproduction and reproductive health that vary amongst countries around the world. The World Health Organization defines reproductive rights as follows:

Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. They also include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence.

Male contraceptives, also known as male birth control, are methods of preventing pregnancy by interrupting the function of sperm. The main forms of male contraception available today are condoms, vasectomy, and withdrawal, which together represented 20% of global contraceptive use in 2019. New forms of male contraception are in clinical and preclinical stages of research and development, but as of 2024, none have reached regulatory approval for widespread use.

<span class="mw-page-title-main">Sexual and reproductive health</span> State of the reproductive system without evidence of disease, disorders, or deficiencies

Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's reproductive system and sexual well-being during all stages of their life. Sexual and reproductive health is more commonly defined as sexual and reproductive health and rights, to encompass individual agency to make choices about their sexual and reproductive lives.

<span class="mw-page-title-main">Reproductive justice</span> Social justice movement

Reproductive justice is a critical feminist framework that was invented as a response to United States reproductive politics. The three core values of reproductive justice are the right to have a child, the right to not have a child, and the right to parent a child or children in safe and healthy environments. The framework moves women's reproductive rights past a legal and political debate to incorporate the economic, social, and health factors that impact women's reproductive choices and decision-making ability.

<span class="mw-page-title-main">Birth control</span> Method of preventing human pregnancy

Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unintended pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th century. Planning, making available, and using human birth control is called family planning. Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable.

The following outline is provided as an overview of and topical guide to obstetrics:

<span class="mw-page-title-main">Family planning in India</span> Efforts to curb unintended pregnancies in India

Family planning in India is based on efforts largely sponsored by the Indian government. From 1965 to 2009, contraceptive usage has more than tripled and the fertility rate has more than halved, but the national fertility rate in absolute numbers remains high, causing concern for long-term population growth. India adds up to 1,000,000 people to its population every 20 days. Extensive family planning has become a priority in an effort to curb the projected population of two billion by the end of the twenty-first century.

<span class="mw-page-title-main">Birth control in the United States</span> History of birth control in the United States

Birth control in the United States is available in many forms. Some of the forms available at drugstores and some retail stores are male condoms, female condoms, sponges, spermicides, over-the-counter progestin-only contraceptive pills, and over-the-counter emergency contraception. Forms available at pharmacies with a doctor's prescription or at doctor's offices are oral contraceptive pills, patches, vaginal rings, diaphragms, shots/injections, cervical caps, implantable rods, and intrauterine devices (IUDs). Sterilization procedures, including tubal ligations and vasectomies, are also performed.

Abraham Albert "Al" Yuzpe is a Canadian obstetrician-gynecologist known for his work on human fertility and emergency contraception. The Yuzpe regimen, named after him, is a method of reducing potential unwanted pregnancies, including pregnancy from rape. He published the first studies demonstrating the method's safety and efficacy in 1974.

<span class="mw-page-title-main">Prevalence of birth control</span> Overview article

Globally approximately 45% of those who are married and able to have children use contraception. As of 2007, IUDs were used by about 17% of women of child bearing age in developing countries and 9% in developed countries or more than 180 million women worldwide. Avoiding sex when fertile is used by about 3.6% of women of childbearing age, with usage as high as 20% in areas of South America. As of 2005, 12% of couples are using a male form of contraception with rates of up to 30% in the developed world.

Women's reproductive health in the United States refers to the set of physical, mental, and social issues related to the health of women in the United States. It includes the rights of women in the United States to adequate sexual health, available contraception methods, and treatment for sexually transmitted diseases. The prevalence of women's health issues in American culture is inspired by second-wave feminism in the United States. As a result of this movement, women of the United States began to question the largely male-dominated health care system and demanded a right to information on issues regarding their physiology and anatomy. The U.S. government has made significant strides to propose solutions, like creating the Women's Health Initiative through the Office of Research on Women's Health in 1991. However, many issues still exist related to the accessibility of reproductive healthcare as well as the stigma and controversy attached to sexual health, contraception, and sexually transmitted diseases.

Abortion in Uganda is illegal unless performed by a licensed medical doctor in a situation where the woman's life is deemed to be at risk.

African Americans', or Black Americans', access and use of birth control are central to many social, political, cultural and economic issues in the United States. Birth control policies in place during American slavery and the Jim Crow era highly influenced Black attitudes toward reproductive management methods. Other factors include African-American attitudes towards family, sex and reproduction, religious views, social support structures, black culture, and movements towards bodily autonomy.

Rayna Rapp is a professor and associate chair of anthropology at New York University, specializing in gender and health; the politics of reproduction; science, technology, and genetics; and disability in the United States and Europe. She has contributed over 80 published works to the field of anthropology, independently, as a co-author, editor, and foreword-writing, including Robbie Davis-Floyd and Carolyn Sargent's Childbirth and Authoritative Knowledge. Her 1999 book, Testing Women, Testing the Fetus: the Social Impact of Amniocentesis in America, received multiple awards upon release and has been praised for providing "invaluable insights into the first generation of women who had to decide whether or not to terminate their pregnancies on the basis of amniocentesis result". She co-authored many articles with Faye Ginsburg, including Enabling Disability: Rewriting Kinship, Reimagining Citizenship, a topic the pair has continued to research.

<span class="mw-page-title-main">Lisa Campo-Engelstein</span> American bioethicist

Lisa Campo-Engelstein is an American bioethicist and fertility/contraceptive researcher. She currently works at the University of Texas Medical Branch as the Harris L. Kempner Chair in the Humanities in Medicine Professor, the Director of the Institute for Bioethics & Health Humanities, and an Associate Professor in Preventive Medicine and Population Health. She is also a feminist bioethicist specializing in reproductive ethics and sexual ethics. She has been recognized in the BBC's list of 100 inspiring and influential women from around the world for 2019.

<i>Killing the Black Body</i> 1997 book by Dorothy Roberts

In Killing the Black Body: Race, Reproduction, and the Meaning of Liberty, Dorothy Roberts analyzes the reproductive rights of black women in the United States throughout history. Published in 1997 by Pantheon Books, this book details a history of reproductive oppression that spans from the commodification of enslaved women's fertility to forced sterilizations of African American and Latina women in the 20th century. Through these accounts, Roberts makes the case that reproductive justice is a necessary part of the greater struggle for racial equality.

References

  1. ↑ Casper, Monica; Currah, Paisley (2011). Corpus: An Interdisciplinary Reader on Bodies and Knowledge. Basingstoke: Palgrave Macmillan. p. 26. ISBN   9780230342569. Shellee Colen's influential notion of 'stratified reproduction' has aptly named how 'kinship' is hierarchically rearranged by structures of race, sex, and class in transnational political economies.
  2. 1 2 Colen, Shellee (1986). ""With Respect and Feelings": Voices of West Indian Child Care Workers in New York City". All American Women: Lines That Divide, Ties That Bind: 46–70.
  3. 1 2 3 4 Conceiving the new world order : the global politics of reproduction. Ginsburg, Faye D., Reiter, Rayna R. Berkeley: University of California Press. 1995. ISBN   9780520089143. OCLC   30896173.{{cite book}}: CS1 maint: others (link)
  4. 1 2 3 4 Reid, M., Dirks, D. & Aseltine, E. (2009). Stratified reproduction. In J. O'Brien (Ed.), Encyclopedia of gender and society (pp. 812-814). Thousand Oaks, CA: SAGE Publications, Inc. doi: 10.4135/9781412964517.n406
  5. ↑ Ginsburg, Faye D. and Rayna Rapp, ed. 1995 Conceiving the New World Order. London, England: University of California Press
  6. ↑ Gender in cross-cultural perspective. Brettell, Caroline., Sargent, Carolyn F., 1947-. Boston: Pearson. 2012. pp. 374–384. ISBN   9780205247288. OCLC   789661646.{{cite book}}: CS1 maint: others (link)
  7. ↑ Greil, Arthur L.; McQuillan, Julia; Shreffler, Karina M.; Johnson, Katherine M.; Slauson-Blevins, Kathleen S. (2011). "Race-Ethnicity and Medical Services for Infertility". Journal of Health and Social Behavior. 52 (4): 493–509. doi:10.1177/0022146511418236. PMID   22031500. S2CID   14925772.
  8. 1 2 3 Inhorn, M. C.; Patrizio, P. (2015-03-22). "Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century". Human Reproduction Update. 21 (4): 411–426. doi: 10.1093/humupd/dmv016 . ISSN   1355-4786. PMID   25801630.
  9. 1 2 Inhorn, Marcia C. (2009-06-18). "Right to assisted reproductive technology: Overcoming infertility in low-resource countries". International Journal of Gynecology & Obstetrics. 106 (2): 172–174. doi:10.1016/j.ijgo.2009.03.034. ISSN   0020-7292. PMID   19539927.
  10. 1 2 Greil, A. L., McQuillan, J., Shreffler, K. M., Johnson, K. M., & Slauson-Blevins, K. S. (2011). Race-ethnicity and medical services for infertility: Stratified reproduction in a population-based sample of u.s. women. Journal of Health and Social Behavior, 52(4), 493-509. https://doi.org/10.1177/0022146511418236
  11. ↑ Sheoran, Nayantara (2015). "'Stratified Contraception': Emergency Contraceptive Pills and Women's Differential Experiences in Contemporary India". Medical Anthropology. 34 (3): 243–258. doi:10.1080/01459740.2014.922081. PMID   24901232. S2CID   23468080.
  12. 1 2 Shreffler, K. M., McQuillan, J., Greil, A. L., & Johnson, D. R. (2015). Surgical sterilization, regret, and race: Contemporary patterns. Social Science Research, 50, 31-45. https://doi.org/10.1016/j.ssresearch.2014.10.010
  13. ↑ Nti-Asare, A. (2015). We Will Not Be Erased: Confronting the History of Black Women and Forced Sterilization.
  14. ↑ Bell, Ann V. 2010. “Beyond (Financial) Accessibility: Inequalities within the Medicalisation of Infertility.” Sociology of Health & Illness 32:631–46.
  15. 1 2 3 4 5 Gutiérrez, Elena R.; Fuentes, Liza. "Population Control by Sterilization" (PDF). Latino (A) Research Review. 7 (3): 85–100 – via Google Scholar.
  16. 1 2 3 Chavez, Leo (Summer 2004). "A Glass Half Empty: Latina Reproduction and Public Discourse". Human Organization. 63 (2): 173–188. doi:10.17730/humo.63.2.hmk4m0mfey10n51k. JSTOR   44127294. S2CID   145666405.
  17. ↑ Tucker, J., & Lowell, C. (2016). National Snapshot: Poverty Among Women & Families, 2015.
  18. ↑ BLKHLTH. (2017). Why Black Health Matters: An Introduction to BLKHLTH.
  19. 1 2 3 Dominguez, T. P. (2011). Adverse Birth Outcomes in African American Women: The Social Context of Persistent Reproductive Disadvantage. Social Work In Public Health, 26(1), 3-16.
  20. ↑ Harris, M. L. (2016). Ecowomanism: Black Women, Religion, and the Environment. Black Scholar, 46(3), 27-39.
  21. ↑ West Virginia University. (2017). Flint's water crisis led to fewer babies and higher fetal death rates, researchers find. ScienceDaily.
  22. ↑ Greil, A. L., McQuillan, J., Shreffler, K. M., Johnson, K. M., & Slauson-Blevins, K. S. (2011). Race-Ethnicity and Medical Services for Infertility: Stratified Reproduction in a Population-based Sample of U.S. Women. Journal of Health and Social Behavior, 52(4), 493–509. https://doi.org/10.1177/0022146511418236
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