Embracing a Feminist Approach to Women’s Reproductive Health

It is with great pleasure that that I take over the reins as Editor of Women’s Reproductive Health, the journal of the Society for Menstrual Cycle Research, continuing the pioneering work of our founding editor, and now editor emerita, Professor Joan Chrisler. Joan and I share a passion for menstrual cycle research, which includes biopsychosocial understandings of menstruation, premenstrual change, and menopause (Chrisler, 2008; Ussher, 2006); the developing field of critical menstrual studies (Bobel et al., 2020); and research on women’s reproductive and sexual health across the life cycle (Ussher et al., 2020). Our new editorial team, consisting of Associate Editors Professor Janette Perz, Dr. Alexandra Hawkey, Dr. Rosalie Power, and Dr. Samantha Ryan, will work alongside me in ensuring that this journal continues to publish high-quality research, commentaries, and reviews that represent the rich diversity and interdisciplinary nature of the field of women’s reproductive health, with a preference for research that adopts a feminist perspective.

The term “women” in our journal title does not assume that reproductive bodies are cisgender, heterosexual, White, and able-bodied. Women’s Reproductive Health is dedicated to the understanding and improvement of reproductive health and well-being across the life-span for all women. We encourage submissions on marginalized populations, including those who are sexuality- and gender-diverse (e.g., lesbian, bisexual, transgender, nonbinary), those living with a disability, or those who are culturally and linguistically diverse (e.g., migrant and refugee women, women of color, indigenous women). The range of appropriate topics we cover is broad, including menarche, menstruation, menopause, pregnancy, birthing, breastfeeding, miscarriage, stillbirth, infertility, assisted reproductive technologies, contraception and abortion, reproductive cancers, sexually transmitted infections, and disorders related to reproductive events (e.g., osteoporosis, fistulas, migraines, postpartum depression, endometriosis, polycystic ovary syndrome).

Women’s reproductive health is central to women’s human rights (Ussher et al., 2020). The United Nations (UN) and its partner agencies, including the World Health Organization (WHO), have long recognized the importance of women’s reproductive health, neglect of which has resulted in high rates of morbidity and mortality for women and girls around the world (Chrisler et al., 2020). The United Nations International Conference on Population and Development Programme of Action states that “reproductive health … implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so” (United Nations Population Fund, 2019). The WHO position statement is unequivocal:

Improved sexual and reproductive health is a key pillar of the overall health, empowerment, and human rights of individuals and of the sustainable and equitable development of societies. Ill-health from causes related to sexual and reproductive health, including too many, too early and too frequent pregnancies, remains a major cause of death and disability among women and girls, particularly among the most vulnerable, marginalized and underserved. Poor sexual and reproductive health contributes significantly to poverty, thereby limiting socio-economic development. Conversely, achieving sexual and reproductive health empowers individuals and communities to participate in economic development.

World Health Organization, United Nations Fiftieth Commission on Population and Development, New York, USA 3-7 April 2017

Women’s reproductive health begins with menarche and continues throughout the life cycle. Women’s experiences of the reproductive body during adolescence and early adulthood sets the stage for health beyond the reproductive years and affects the health of the next generation, as the health of infants is largely a function of their parents’ health and access to reproductive health care (Chrisler, et al., 2020). Reproductive health cannot be understood solely as a biological phenomenon—it is entwined with social, cultural, and political practices and with socially and culturally prescribed meanings and experiences (Braun et al., 2003; Ussher, 2006).

As we outline in our introduction to the Routledge International Handbook of Women’s Reproductive Health (Ussher et al., 2020), a complex array of socioeconomic, cultural, political, personal, and interpersonal factors is implicated in women’s reproductive health. The place of women in society, women’s rights, and gender equality are central to the ability to exercise control over reproductive choices and lifestyles, including the ability to choose sexual partners, access to contraception and abortion, and the number of children born (Chrisler et al., 2020). Systemic and structural issues, such as access to quality health services (WHO, 2014), privacy and confidentiality, and representations of girls and women in the media, also influence reproductive health (American Psychological Association Task Force on the Sexualization of Girls, 2007). Finally, women’s reproductive health is influenced by psychosocial factors, such as beliefs and expectations associated with embodiment, our experiences of our bodies, and our self-confidence and self-esteem. The discursive meanings ascribed to reproductive bodies, which vary across history and culture, also influence women’s experience and ability to have agency and control (Ussher, 2006).

Feminist approaches to research are at the core of this journal—and at the core of the mission of Society for Menstrual Cycle Research. There are many different feminist theories, each with different priorities and practices, resulting in a range of feminist epistemological and methodological standpoints (see Hawkey & Ussher, 2022). These feminist approaches can broadly be distinguished as feminist empiricist, social constructionist, standpoint, and intersectionality approaches (Taylor, 2013). In the journal Women’s Reproductive Health, we welcome them all. Informed by the broader societal feminist movement, these different approaches share a critique of andocentric biases in research design and practice; agreement about the centrality of the critical analysis of gender in research and theory; an appreciation of the moral and political dimensions of research; the view that women are worthy of study in their own right; and the recognition of the need for social change to improve the lives of women and other marginalized groups (Harding, 2018; Hawkey & Ussher, 2022). As Cosgrove and McHugh argue,

Feminist research examines the gendered context of women’s lives, exposes gender inequalities, empowers women, advocates for social change, and/or improves the status or material reality of women’s lives (Cosgrove & McHugh, 2000).

Feminist research is inherently critical. Its starting point is the assumption that mainstream or traditional approaches to research have historically excluded or distorted the experiences of women and used male norms to define normality (Gavey, 1989; Grady, 1981). This includes the fact that differences between men and women have been historically construed as inferiorities on the part of women, such as women’s distress being inappropriately attributed to the reproductive body, positioning the woman and her body as the epitome of the monstrous feminine (Chrisler & Caplan, 2002; Ussher, 2006). The impact of social and cultural factors on women’s lives is negated in androcentric research, as is the impact of gendered power relations, which are central to social life (Calder-Dawe & Gavey, 2019).

Within feminist research, the phallocentric or patriarchal nature of research is criticized, with androcentric researchers accused of maintaining and reinforcing gendered power structures that negate the interests and needs of women and other marginalized groups (Stanley & Wise, 2013). This is ardently evident in distorted anatomical representations and understandings of women’s bodies (e.g., the depiction of the clitoris as a diminutive penis) (Tuana, 2004) and through the development and testing of pharmaceutical treatment protocols that are skewed toward middle-aged, White males—seen as the “universal standard” (Merkatz, 1998). The testing of SSRIs (selective serotonin reuptake inhibitors) on men, even though women are the predominant group prescribed SSRIs (Liebert & Gavey, 2009), including for severe premenstrual distress (Cosgrove et al., 2006; Ussher, 2006), is one example.

In recent decades, feminist researchers have turned attention to the fact that “woman” is often conceptualized as a unitary category, negating differences between women and the intersection of identities (Crenshaw, 1991). Since its inception, intersectionality theory has made a significant contribution to feminist scholarship, becoming a “buzzword” that almost defines feminist research today (Davis, 2008). The theory of intersectionality has built on this early work and emerged as a consequence of the Black feminist movement in the United States in the 1980s (Collins, 1999). The term, originally coined by Kimberlé Crenshaw, challenged the notion of a universal gendered experience for Black women, critiquing mainstream feminist and race scholarship for not accounting for lived experiences of women of color (Crenshaw, 1989). More recent developments of intersectionality focus on the interaction and mutually constitutive nature of gender, race, religion, sexuality, age, and other categories of difference in women’s lives and social practices. At the core of intersectionality is understanding how these social categories interact to form and perpetuate social justice issues (e.g., poverty, social exclusion, marginalization) (Hankivsky et al., 2009).

Debates about what constitutes feminist methodology and feminist methods are ongoing. Methodology refers to the rationale, analysis lens, or research strategy to address a specific issue of phenomena (e.g., action research, phenomenology, narrative inquiry). Methods describe the research tools to collect and analyze data (e.g., interviews, focus groups, surveys, observation) (Mills & Birks, 2014). Feminist researchers work across all disciplines and use the whole gamut of methods used by non-feminist researchers, including quantitative methods (Else-Quest & Hyde, 2016). However, criticisms of positivist research in the 1970s led some feminist researchers to explore the potential of qualitative methods (e.g., Reinharz, 1979). The trend among feminist researchers to embrace qualitative methods continues today because there is an emphasis within feminist theory on giving voice to the subjective views of women and valuing women’s voices in their own right (Gilligan, 1982; McClelland, 2017). Increasingly, feminist researchers are also using arts-based methods, including photo-voice (Triandafilidis et al., 2017, 2018) and body-mapping (Malecki et al., 2022; Ryan et al., 2022), to explore women’s subjectivity. Women’s Reproductive Health welcomes research and commentaries across the whole range of methodologies and methods, across disciplines, including researchers and scholars in public health, nursing, medicine, psychology, sociology, anthropology, women’s studies, queer studies, and the humanities.