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Black migrant women and health
Pergamon
Women’s StudiesInternationalForum, Vol. 18, No. 2, pp. 153-158.1995 Copyright 0 1995 Else&r Science Ltd Printedinthe USA.Allrigh&re.served
0211-5395195$9.50+.00
(1277-5395(95)00007-O
BLACK MIGRANT WOMEN AND HEALTH NTOMBENHIJZ PROTASIA KBOTI TORKLBGTON Liverpool Institute of Higher Education, Sociology Departmenf Woolton Road, Liverpool L16 8ND. UK
SynpnaLeThis article, which focuses on the health of Black migrant women in Europe, argues that health issues cannot be analysed in a vacuum without the interconnections among health, environmental/social factors, and daily life experiences, rooted in the wider social, political, and economic structures of Europe, within which exist the inequalities which determine the health status of individuals. For Black migrant women, their present health status and the ways in which they am treated within the health service is structured primarily by the historical global inequalities embodied in slavery, colonialism, and imperialism. The legacy from these phenomena which Black women brought with them to Europe ensures their vulnerability to poverty, which is at the core of ill health. It also ensures that they receive poor service from health professionals who are influenced by a variety of stereotypes in the portrayal of Black women. The article ends with a plea for Black women in Europe to seek each other out and work together against their oppression. In that fight they must forge links with all women so that we can free ourselves from the clutches of racism, capitalism, and patriarchy.
The most poignant statement about the oppressive position occupied by Black women was made by Margaret Walker when she wrote:
done in the context of wider structural issues of which health is a part. In Europe today there is still a tendency to see health as something which is of concern to individuals particularly when they fall ill with a particular sickness or disease for which they need medical or health care. That perception invariably leads to an analysis of health issues in a vacuum without the interconnections between health, daily life experiences, and the wider social political and economic structure within which exist the inequalities which determine the health status of individuals. Unless we see health issues in the context of that framework we cannot begin to understand the health experience of Black migrant women in Europe. For Black people the effects of that wider structure began to be felt in the days of global inequalities embodied in slavery, colonialism, and imperialism, phenomena which combined to lay the grounds for our migration to Europe. Europe, in search of profits and prosperity, has consistently adhered to an exploitative relationship with her colonies. That exploitation in its varied forms left many of our countries impoverished, necessitating our migration to Europe in search of a new life and better opportunities. In
We have an ongoing struggle for the rights of Black people, and we have never lost sight of the fact that we are women, exploited as much as because of our sex as because of our race and poverty. (Sterling, 1988, p. xi) That triple oppression to which Margaret alludes has continued to face Black women wherever they are and in every aspect of their lives. Its origins are to be found in capitalism, racism, and patriarchy. Although a discussion of how these three phenomena interlink and interact to disadvantage Black women would provide a useful and enlightening discourse, it is not the aim of this article to engage in that analysis, nor is it my intention to compare the fate of Black women in Third World countries to that of their Diasporan sisters. These are no doubt interesting areas to explore, but I do not think that this can be done without deviating and therefore undermining the central purpose which is to look at the health of Black migrant women in Europe. This examination will be 153
154
NTOMBENHLE F’ROTASIA KHOTITORKING~ON
thatseamhtoday,weatetegardedbymanypeo ple as a problem in the metropolitan centres of Europe. We need to awaken such people from this convenient historical amnesia by reminding them that if we are a problem, and I don’t think we are, that problem is primarily of Europe’s own making. We are here because you were there, and, what’s more, some of us are hem to stay. When we arrived in Europe we became part of societies which were and are marked by gross inequalities on the basis of class, gender, and race. Those divisions have given rise to economic injustices, sexism, and racism. The structural framework which brings together these wider issues together with the historical factors in the analysis is essential in the understanding of our health situation. That framework enables us to see clearly that: What happens to us as Black migrant women in the field of health is not only determined in that field but also in the wider social, political, and economic structure of which health is a part. In some countries this link has been made more explicitly. In England for example, the Black Report stated clearly that the inequalities in health reflect the inequalities in the social, political, and economic structure (Black, 1980). Second, the framework enables us to see that to a certain extent what happens to us in the field of health is also experienced by other groups which are disadvantaged-groups, such as White women and working-class people. It is important that we do not dismiss or belittle other people’s experiences. But it is equally important to map out and analyse how our experiences as Black migrant women differ from those other experiences. Third, if as women we have this framework we can perhaps see our situation more clearly and continue to work actively and collectively to change it despite the weight of the triple oppression that many of us experience as a result of racism, sexism, and economic injustices. The issue of our health can be approached from two different but related perspectives. The first is the question of what makes us ill, and the second is how we are treated when we are ill. To understand the first we need to look at how health has been defined. The World Health Organisation has defined health as: a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (Soddy, 1961, p. 70)
In England the Brent Community Health Council has taken this definition further and has spelt out in detail the criteria which we can use to determine whether or not a person is enjoying good health: good health is possible if you are able to choose to do a job you enjoy, in a pleasant and safe environment, to live in a warm house with enough space so that people do not get on top of one another, and with a safe place for your children to play, to be able to have your children looked after during the day, eat the food you like best, to have a garden, to live in the country or be able to get away to the country at weekends. It is having time with people you love and time on your own. (Torkington, 1983, p. 9) Many people in seminar groups where these issues have been raised have dismissed these criteria as idealistic and Utopian and have argued that they are unattainable in real life. On the contrary, from my observation in England I would argue that these criteria paint the reality of life. They map out a continuum on which some people come very close to the attainment of good health, when judged on those social factors, and others who are far removed from the possibility of attaining good health. At the extreme end of the latter group are Black migrant women. Perhaps we can best illustrate this by looking at some of these criteria in relation to their health consequences. Let us look at employment for example. In the area of employment migrant labour is not about people choosing to do jobs they enjoy. The whole migrant labour system was specifically set up in order to provide workers for those areas of work which were shunned by the indigenous workforce. These areas shared a number of characteristics - low pay, low status, poor working conditions, long exhausting working hours, accident prone and poor union support. Whilst this applies to both men and women, the situation for Black women is considerably harder than that of men because of sexism within the work situation. Black women generally get the lowest wages. The London Food Commission’s Report of 1988 stated that of the 8 million people whose wages were below the poverty line two thirds
Black Migrant Women and Health
were women, with British Asian women receiving the lowest wages (Storkey, 1991). Not only are Black migrant women less well paid, they are also subject to a lot of discrimination by employers, male employees, and White women workers. In times of recession, Black migrant women are the first to be made redundant as they are less well protected by unions and yet may often need jobs far more than White women do because our husbands or partners are also trapped in low paid jobs. Our wages therefore are crucial for the survival of our families. Low wages and unemployment places many of our families in a poverty trap, and many studies do suggest that there is a considerable link between poverty and poor health in all the phases of the life cycle. Blane, for example, argues that the health consequences of poverty: start before birth, with poor maternal nutrition contributing to prematurely and low birth weight. During childhood, poor nutrition inhibits normal growth and development, lack of hygienic facilities predisposes to infestations with scabies, head lice and intestinal worms, damp housing increases the incidence of upper-respiratory-tract infections which may lead to chronic ear disease, partial deafness and a poor educational record, and lack of play facilities hinders psychological development and increases the risk of accidents. (Blane, 1991, pp. 109-129) Poverty also has direct health consequences for women. Malnutrition leads not only to food deficiency diseases, but it also makes us more susceptible to all forms of illnesses. As caters and housewives we constantly struggle to make ends meet, juggling with very little money at our disposal - do we cut down on food in order to pay the gas bill or electricity bill? Do we pay the hire purchase installments to stop the shop repossessing the furniture, or do we buy clothes for the children? That unending struggle very often predisposes many of us to depression and sometimes to hopelessness. All of this shows very clearly the link between the jobs people do, the amount of money they earn, and the level of health they enjoy. Housing is another area which has a direct impact on the health of Black migrant women in
155
Europe. There is enough evidence to show that bad housing is a contributor to a variety of diseases and illnesses. The attempt to clear slum areas in European cities was prompted by this realisation, and yet in many centres of Europe there are still many migrant families living in transit centres, shanty towns, and old substandard dwellings fit for demolition (Guyot et al., 1978). Again as carers, women tend to spend much of their time at home with young childten, and the impact of these poor living conditions affect them and the children more than it does men. A study by the Commission for Racial Equality (CRE, 1984) revealed that if allocated council property, Black people tend to be given small inferior houses or flats on higher floors with no access to a garden or safe playing area for children. Black women on low pay or unemployed and single parents don’t only face the problem of finding good housing, but they also face the threat of having their children taken into care. The dilapidated areas in which we find ourselves in European cities also provide a fertile ground for violence against Black women. Many women have been subjected to rape and racial attacks. In England the incidence of racial attacks per 1000 of the population is 50 times higher for Asian and 37 times higher for all Black people than for White people (Storkey, 1991). Fear of these racial attacks have made many Black women prisoners in their homes in poor housing conditions. It is the combination of all these factors which determine the health status of Black migrant women in Europe. Faced with these environmental factors it is inconceivable that Black women can have “a state of complete physical, mental and social well-being.” Let us now look at how we are treated by the health service when we become ill and need health care provision. In this area the experience we have centres around our interaction with health professionals. In that interaction the power is always weighted in favour of professionals. We as women, both Black and White, experience that power more often than men because, for the following reasons, we interact constantly with health workers: 1. We consult them when we suffer from specific women’s health problems such as breast cancer, cervical cancer, salpingitis, and many others.
156
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hKYCWA
2. When we go through natural processes of pregnancy and childbirth, we find that these have been now heavily medicalised, forcing us to consult health professionals. 3. Even if we don’t want to have children, if we engage in heterosexual intercourse we are encouraged generally to use “effective contraceptives,” and for those we have to consult health workers. 4. A lot of us suffer from premenstrual tension, period pains, and stressful menopause. For relief we consult health professionals. 5. As carers for children and elderly relatives we are the ones who take these dependents to health workers when they fall ill. It is true that sometimes our husbands and male partners try to help in this area. But many women with whom I have worked say that their male partners or husbands come back with such garbled information about what the doctor said or prescribed that they feel it would have been better to do the job themselves. 6. Worse still, when our male partners are ill some of them are fairly reluctant to go and consult a doctor during the early stages of the illness. Any advice from the women is dismissed as nagging. When the illness gets worse, we have to accompany them to the doctor or risk the accusation by in-laws and neighbours of being uncaring and unloving. The extent to which health professionals will exercise power in all these interactions will be determined by the class and colour of the woman. So, for example, working-class White women are more likely to be treated worse than middle-class White women. For Black women, however, the situation is different. Their middle-class status does not necessarily protect them from the negative attitudes of many health workers. It really does not matter much whether you are middle-class or not., whether you are born here or not; to some health professionals color is the trigger to a multitude of stereotypes held about Black women, stereotypes whose roots are grounded in the history of slavery, colonialism, and imperialism. But these stereotypes are kept alive by current discriminatory practices in contemporary Europe. Migrant workers in Europe are here to fulfill a clearly defined economic function. Beyond that they have no legitimate claim to legal, political, or social provision in the countries
KHOTI
TORKINGTON
where they work That view of migrant workers certainly shapes the attitude of health workers and the level of health provisions. For example, many migrant workers have problems in communication because of the language barrier. But very few organisations within European countries provide effective translation and interpreting services. In the field of health this affects women more because of the constant interaction we have with health professionals for the reasons stated earlier. In some instances the problem is lack of sensitivity to and consideration for our cultural and religious norms and values. This makes what is provided unacceptable. Many hospitals, for example, still fail to provide relevant diets to various groups. Similarly in the area of childbirth, until recently in England, some hospitals have been insisting that only the husband, who is seen as the nearest relative in a nuclear family, can be present during childbirth and not female relatives. This took no account of the fact that in many Black societies the presence of men, in particular husbands, is not acceptable during childbirth. Another popular view held about Black women is that they are promiscuous and are generally of low moral fibre. Maya Angelou put it in a nut-shell when she said that the popular view is that “black women have sex, but white women make love” (Angelou, 1991). But Black women are not only perceived to be sex-mad; they are also believed to be extremely fertile, and the thousands of children we produce will lead to the swamping of European cities with Black people and the sapping of Europe’s resources. Many Black women in England believe that the eagerness of some doctors to force Black women to have abortions, to prescribe Depo provera for contraception, and to impose sterilisation is linked to this stereotype: There are a lot of doctors who don’t even bother to make a secret of the fact that they go along with the idea that we are sapping this country’s resources, and see it as their professional duty to keep our numbers down. They say things like “well, you’ve already got two children, so why do you need to have any more? You might as well get your tubes tied when you come in for that D & C.” It’s about racism, they don’t want us here anymore, so it’s easier just to
Black Migrant Women and Health
quietly kill us off. (Bryan, Dodzie, & Safe, 1985, pp. 104-105) It is this realisation that caused Black women to reject the White feminist demand for “the right to abortions” and to ask for the “right to choose” because for us abortions have always been imposed in an attempt to curb our numbers. With regard to abortions and Black women, some health workers hold a different view. They believe that most, if not all of us, have had backstreet abortions to cope with the consequences of our promiscuity. This assumption was made very clear to Juanita Cole when she needed health care. After migrating to London from Jamaica, Juanita Cole developed various symptoms of illness (Cottle, 1978, pp. 29-35). On many occasions she visited her local clinic where she was never given an examination, and more often than not was subjected to unacceptable humiliation. The doctor she saw was more interested in her reproductive capacity than in her illness. He said: The record says you got a boy first, then two girls . . . you got a boy, then a girl, so why did you go ahead and have another one, you had one of each? When Juanita started passing blood with her urine she went back to the clinic despite the humiliating treatment. Even at this stage there was no positive response from the health professionals in the clinic. She was told to go home and not to worry. But when she became very ill the clinic sent her to the hospital to be examined by a consultant. On examining her the consultant said “whoever did your abortions for you was a butcher.” When Juanita told him that she had never had an abortion, his retort was: Mrs. Cole, if you haven’t had an abortion, you’re the first woman of your kind who I’ve ever treated who hasn’t. On further examination, the consultant discovered that Juanita had cancer and that she was a very sick woman: If you felt this way, then how come you never went to see a local doctor, someone in
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the clinic where you live? You must know about the health program, you’ve been here almost 20 years. When Juanita told him of the many visits she made to the clinic the doctor consulted the records: According to the information I was given, your complaints have been strictly psychological. When Juanita was operated on they discovered that her ovaries, fallopian tubes, and cervix were filled with cancerous tissue. As Cottle points out, Mrs. Cole’s death would be a wasteful one: wasted because her illness could have been treated as soon as she had detected it, and wasted because it would not change the attitude and approach of the doctors and nurses . . . there would be no lesson learned by anyone . . . and that would be the biggest waste of all. (Come, 1978, pp. 29-35) That for me summa&es the predicament we are in The social, economic, and political conditions we live in make Black migrant women ill. When we look for health care we are humiliated and refused effective treatment. When we die we are blamed for failing to look after our health. What I hope I have done is to outline the health of Black migrant women in Europe. I have done this in the context of a social, political, and economic framework, and I hope this has enabled us to see that our experience in health cannot be divorced from the dynamics of that structure. We know what those dynamics are, and that should enable us to work together as well as with other disadvantaged groups and find ways of bringing about change. Our priority as migrants is to challenge the whole migrant system as practised in Europe today. We must seek each other out in the countries/cities we find ourselves in Europe and work together on this common issue. We have to exchange views and information on how to tackle local, national, and international issues that affect us. There are those issues which specifically affect Black migrant women, but we must remember that both race and gender are specific social con-
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structs and they must in turn be related to another social construct-class. In our fight we must meet head-on the inequalities and discriminations which arise from racism, sexism, and classicism, in other words, our triple oppression. We must also remember that the bulk of Black women live not in Europe but in the so called “Third World Countries.” Our fight for liberation from oppression will never be achieved unless we link up with these women. We must work closely with Black women all over the world. We must also forge links with all women because our fight for liberation will never be achieved unless women all over the world are liberated from the clutches of patriarchy and capitalism. In our solidarity shall be our strength to contribute to the liberation of women and the world in general. As Sojourner Truth reminds us, we are famous for our strength even when we work individually, how much more when we work as a group: If the first woman God ever made was strong enough to turn the world upside down (we) ought to be able to turn it back and get it right side up again. (Campbell, 1989, p. 101)
REFERJZNCES Aogelou, Maya (1991). Live performancein the Liverpool PhilharmonicThea&e. Black, Douglas. (1980). Inequalifies in health. London: Departmentof Health and Social Services. Blanc, David. (1991). Inequalities and social class. In Scambler Graham(Ed.), Sociology as applied to medicine (pp. 109-129). London: Bailliere ‘II&l. Bryan, Beverley, Dodzie. Stella, & Scafe, Suzanne. (1985). The heart of race - Block women’s lives in Britain (pp. 104-105). London:Viio. Campbell, Karlyn Kohrs. (1989). Man cannot speak for her: Key texts of the early feminists (Vol. 11. p. 101). Westport:Greenwood Press. Commission for Racial Equality. (1984). Race and housing in Liverpool:A research report. London: CRC. Cottle, Thomas. (1978). Black testimony (pp. 29-35). London:Wildwood House, London. Guyot, Jean, Padrun, Ruth, Dauphinet, Evelyne, Jospa, Yvonne, Fischli, Elena, deMestral, Marianne, Giudici, Doriana, & Scheidecker, Chantal. (1978). Migrant women speak. London: Geneva Search Press Limited and World Council of Churches. Soddy, Kenneth (Ed.). (1961). Cross culrural studies in mental healrh (p. 70). London: Tavistock. Sterling, Dorothy. (1988). Black foremothers. New York: The Feminist Press. Storkey, Elaine. (1991). Society and social scirnce founda-
tion course. Milton Keynes: Open UniversityPress. Torkington,Ntombenhle Pmtasia Khoti. (1983). 77temcial politics of health - A Liverpool pm@? ( p. 9). Livexpool: University of Liverpool.
Women’s StudiesInternationalForum, Vol. 18, No. 2, pp. 153-158.1995 Copyright 0 1995 Else&r Science Ltd Printedinthe USA.Allrigh&re.served
0211-5395195$9.50+.00
(1277-5395(95)00007-O
BLACK MIGRANT WOMEN AND HEALTH NTOMBENHIJZ PROTASIA KBOTI TORKLBGTON Liverpool Institute of Higher Education, Sociology Departmenf Woolton Road, Liverpool L16 8ND. UK
SynpnaLeThis article, which focuses on the health of Black migrant women in Europe, argues that health issues cannot be analysed in a vacuum without the interconnections among health, environmental/social factors, and daily life experiences, rooted in the wider social, political, and economic structures of Europe, within which exist the inequalities which determine the health status of individuals. For Black migrant women, their present health status and the ways in which they am treated within the health service is structured primarily by the historical global inequalities embodied in slavery, colonialism, and imperialism. The legacy from these phenomena which Black women brought with them to Europe ensures their vulnerability to poverty, which is at the core of ill health. It also ensures that they receive poor service from health professionals who are influenced by a variety of stereotypes in the portrayal of Black women. The article ends with a plea for Black women in Europe to seek each other out and work together against their oppression. In that fight they must forge links with all women so that we can free ourselves from the clutches of racism, capitalism, and patriarchy.
The most poignant statement about the oppressive position occupied by Black women was made by Margaret Walker when she wrote:
done in the context of wider structural issues of which health is a part. In Europe today there is still a tendency to see health as something which is of concern to individuals particularly when they fall ill with a particular sickness or disease for which they need medical or health care. That perception invariably leads to an analysis of health issues in a vacuum without the interconnections between health, daily life experiences, and the wider social political and economic structure within which exist the inequalities which determine the health status of individuals. Unless we see health issues in the context of that framework we cannot begin to understand the health experience of Black migrant women in Europe. For Black people the effects of that wider structure began to be felt in the days of global inequalities embodied in slavery, colonialism, and imperialism, phenomena which combined to lay the grounds for our migration to Europe. Europe, in search of profits and prosperity, has consistently adhered to an exploitative relationship with her colonies. That exploitation in its varied forms left many of our countries impoverished, necessitating our migration to Europe in search of a new life and better opportunities. In
We have an ongoing struggle for the rights of Black people, and we have never lost sight of the fact that we are women, exploited as much as because of our sex as because of our race and poverty. (Sterling, 1988, p. xi) That triple oppression to which Margaret alludes has continued to face Black women wherever they are and in every aspect of their lives. Its origins are to be found in capitalism, racism, and patriarchy. Although a discussion of how these three phenomena interlink and interact to disadvantage Black women would provide a useful and enlightening discourse, it is not the aim of this article to engage in that analysis, nor is it my intention to compare the fate of Black women in Third World countries to that of their Diasporan sisters. These are no doubt interesting areas to explore, but I do not think that this can be done without deviating and therefore undermining the central purpose which is to look at the health of Black migrant women in Europe. This examination will be 153
154
NTOMBENHLE F’ROTASIA KHOTITORKING~ON
thatseamhtoday,weatetegardedbymanypeo ple as a problem in the metropolitan centres of Europe. We need to awaken such people from this convenient historical amnesia by reminding them that if we are a problem, and I don’t think we are, that problem is primarily of Europe’s own making. We are here because you were there, and, what’s more, some of us are hem to stay. When we arrived in Europe we became part of societies which were and are marked by gross inequalities on the basis of class, gender, and race. Those divisions have given rise to economic injustices, sexism, and racism. The structural framework which brings together these wider issues together with the historical factors in the analysis is essential in the understanding of our health situation. That framework enables us to see clearly that: What happens to us as Black migrant women in the field of health is not only determined in that field but also in the wider social, political, and economic structure of which health is a part. In some countries this link has been made more explicitly. In England for example, the Black Report stated clearly that the inequalities in health reflect the inequalities in the social, political, and economic structure (Black, 1980). Second, the framework enables us to see that to a certain extent what happens to us in the field of health is also experienced by other groups which are disadvantaged-groups, such as White women and working-class people. It is important that we do not dismiss or belittle other people’s experiences. But it is equally important to map out and analyse how our experiences as Black migrant women differ from those other experiences. Third, if as women we have this framework we can perhaps see our situation more clearly and continue to work actively and collectively to change it despite the weight of the triple oppression that many of us experience as a result of racism, sexism, and economic injustices. The issue of our health can be approached from two different but related perspectives. The first is the question of what makes us ill, and the second is how we are treated when we are ill. To understand the first we need to look at how health has been defined. The World Health Organisation has defined health as: a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (Soddy, 1961, p. 70)
In England the Brent Community Health Council has taken this definition further and has spelt out in detail the criteria which we can use to determine whether or not a person is enjoying good health: good health is possible if you are able to choose to do a job you enjoy, in a pleasant and safe environment, to live in a warm house with enough space so that people do not get on top of one another, and with a safe place for your children to play, to be able to have your children looked after during the day, eat the food you like best, to have a garden, to live in the country or be able to get away to the country at weekends. It is having time with people you love and time on your own. (Torkington, 1983, p. 9) Many people in seminar groups where these issues have been raised have dismissed these criteria as idealistic and Utopian and have argued that they are unattainable in real life. On the contrary, from my observation in England I would argue that these criteria paint the reality of life. They map out a continuum on which some people come very close to the attainment of good health, when judged on those social factors, and others who are far removed from the possibility of attaining good health. At the extreme end of the latter group are Black migrant women. Perhaps we can best illustrate this by looking at some of these criteria in relation to their health consequences. Let us look at employment for example. In the area of employment migrant labour is not about people choosing to do jobs they enjoy. The whole migrant labour system was specifically set up in order to provide workers for those areas of work which were shunned by the indigenous workforce. These areas shared a number of characteristics - low pay, low status, poor working conditions, long exhausting working hours, accident prone and poor union support. Whilst this applies to both men and women, the situation for Black women is considerably harder than that of men because of sexism within the work situation. Black women generally get the lowest wages. The London Food Commission’s Report of 1988 stated that of the 8 million people whose wages were below the poverty line two thirds
Black Migrant Women and Health
were women, with British Asian women receiving the lowest wages (Storkey, 1991). Not only are Black migrant women less well paid, they are also subject to a lot of discrimination by employers, male employees, and White women workers. In times of recession, Black migrant women are the first to be made redundant as they are less well protected by unions and yet may often need jobs far more than White women do because our husbands or partners are also trapped in low paid jobs. Our wages therefore are crucial for the survival of our families. Low wages and unemployment places many of our families in a poverty trap, and many studies do suggest that there is a considerable link between poverty and poor health in all the phases of the life cycle. Blane, for example, argues that the health consequences of poverty: start before birth, with poor maternal nutrition contributing to prematurely and low birth weight. During childhood, poor nutrition inhibits normal growth and development, lack of hygienic facilities predisposes to infestations with scabies, head lice and intestinal worms, damp housing increases the incidence of upper-respiratory-tract infections which may lead to chronic ear disease, partial deafness and a poor educational record, and lack of play facilities hinders psychological development and increases the risk of accidents. (Blane, 1991, pp. 109-129) Poverty also has direct health consequences for women. Malnutrition leads not only to food deficiency diseases, but it also makes us more susceptible to all forms of illnesses. As caters and housewives we constantly struggle to make ends meet, juggling with very little money at our disposal - do we cut down on food in order to pay the gas bill or electricity bill? Do we pay the hire purchase installments to stop the shop repossessing the furniture, or do we buy clothes for the children? That unending struggle very often predisposes many of us to depression and sometimes to hopelessness. All of this shows very clearly the link between the jobs people do, the amount of money they earn, and the level of health they enjoy. Housing is another area which has a direct impact on the health of Black migrant women in
155
Europe. There is enough evidence to show that bad housing is a contributor to a variety of diseases and illnesses. The attempt to clear slum areas in European cities was prompted by this realisation, and yet in many centres of Europe there are still many migrant families living in transit centres, shanty towns, and old substandard dwellings fit for demolition (Guyot et al., 1978). Again as carers, women tend to spend much of their time at home with young childten, and the impact of these poor living conditions affect them and the children more than it does men. A study by the Commission for Racial Equality (CRE, 1984) revealed that if allocated council property, Black people tend to be given small inferior houses or flats on higher floors with no access to a garden or safe playing area for children. Black women on low pay or unemployed and single parents don’t only face the problem of finding good housing, but they also face the threat of having their children taken into care. The dilapidated areas in which we find ourselves in European cities also provide a fertile ground for violence against Black women. Many women have been subjected to rape and racial attacks. In England the incidence of racial attacks per 1000 of the population is 50 times higher for Asian and 37 times higher for all Black people than for White people (Storkey, 1991). Fear of these racial attacks have made many Black women prisoners in their homes in poor housing conditions. It is the combination of all these factors which determine the health status of Black migrant women in Europe. Faced with these environmental factors it is inconceivable that Black women can have “a state of complete physical, mental and social well-being.” Let us now look at how we are treated by the health service when we become ill and need health care provision. In this area the experience we have centres around our interaction with health professionals. In that interaction the power is always weighted in favour of professionals. We as women, both Black and White, experience that power more often than men because, for the following reasons, we interact constantly with health workers: 1. We consult them when we suffer from specific women’s health problems such as breast cancer, cervical cancer, salpingitis, and many others.
156
NToMBENHLR
hKYCWA
2. When we go through natural processes of pregnancy and childbirth, we find that these have been now heavily medicalised, forcing us to consult health professionals. 3. Even if we don’t want to have children, if we engage in heterosexual intercourse we are encouraged generally to use “effective contraceptives,” and for those we have to consult health workers. 4. A lot of us suffer from premenstrual tension, period pains, and stressful menopause. For relief we consult health professionals. 5. As carers for children and elderly relatives we are the ones who take these dependents to health workers when they fall ill. It is true that sometimes our husbands and male partners try to help in this area. But many women with whom I have worked say that their male partners or husbands come back with such garbled information about what the doctor said or prescribed that they feel it would have been better to do the job themselves. 6. Worse still, when our male partners are ill some of them are fairly reluctant to go and consult a doctor during the early stages of the illness. Any advice from the women is dismissed as nagging. When the illness gets worse, we have to accompany them to the doctor or risk the accusation by in-laws and neighbours of being uncaring and unloving. The extent to which health professionals will exercise power in all these interactions will be determined by the class and colour of the woman. So, for example, working-class White women are more likely to be treated worse than middle-class White women. For Black women, however, the situation is different. Their middle-class status does not necessarily protect them from the negative attitudes of many health workers. It really does not matter much whether you are middle-class or not., whether you are born here or not; to some health professionals color is the trigger to a multitude of stereotypes held about Black women, stereotypes whose roots are grounded in the history of slavery, colonialism, and imperialism. But these stereotypes are kept alive by current discriminatory practices in contemporary Europe. Migrant workers in Europe are here to fulfill a clearly defined economic function. Beyond that they have no legitimate claim to legal, political, or social provision in the countries
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where they work That view of migrant workers certainly shapes the attitude of health workers and the level of health provisions. For example, many migrant workers have problems in communication because of the language barrier. But very few organisations within European countries provide effective translation and interpreting services. In the field of health this affects women more because of the constant interaction we have with health professionals for the reasons stated earlier. In some instances the problem is lack of sensitivity to and consideration for our cultural and religious norms and values. This makes what is provided unacceptable. Many hospitals, for example, still fail to provide relevant diets to various groups. Similarly in the area of childbirth, until recently in England, some hospitals have been insisting that only the husband, who is seen as the nearest relative in a nuclear family, can be present during childbirth and not female relatives. This took no account of the fact that in many Black societies the presence of men, in particular husbands, is not acceptable during childbirth. Another popular view held about Black women is that they are promiscuous and are generally of low moral fibre. Maya Angelou put it in a nut-shell when she said that the popular view is that “black women have sex, but white women make love” (Angelou, 1991). But Black women are not only perceived to be sex-mad; they are also believed to be extremely fertile, and the thousands of children we produce will lead to the swamping of European cities with Black people and the sapping of Europe’s resources. Many Black women in England believe that the eagerness of some doctors to force Black women to have abortions, to prescribe Depo provera for contraception, and to impose sterilisation is linked to this stereotype: There are a lot of doctors who don’t even bother to make a secret of the fact that they go along with the idea that we are sapping this country’s resources, and see it as their professional duty to keep our numbers down. They say things like “well, you’ve already got two children, so why do you need to have any more? You might as well get your tubes tied when you come in for that D & C.” It’s about racism, they don’t want us here anymore, so it’s easier just to
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quietly kill us off. (Bryan, Dodzie, & Safe, 1985, pp. 104-105) It is this realisation that caused Black women to reject the White feminist demand for “the right to abortions” and to ask for the “right to choose” because for us abortions have always been imposed in an attempt to curb our numbers. With regard to abortions and Black women, some health workers hold a different view. They believe that most, if not all of us, have had backstreet abortions to cope with the consequences of our promiscuity. This assumption was made very clear to Juanita Cole when she needed health care. After migrating to London from Jamaica, Juanita Cole developed various symptoms of illness (Cottle, 1978, pp. 29-35). On many occasions she visited her local clinic where she was never given an examination, and more often than not was subjected to unacceptable humiliation. The doctor she saw was more interested in her reproductive capacity than in her illness. He said: The record says you got a boy first, then two girls . . . you got a boy, then a girl, so why did you go ahead and have another one, you had one of each? When Juanita started passing blood with her urine she went back to the clinic despite the humiliating treatment. Even at this stage there was no positive response from the health professionals in the clinic. She was told to go home and not to worry. But when she became very ill the clinic sent her to the hospital to be examined by a consultant. On examining her the consultant said “whoever did your abortions for you was a butcher.” When Juanita told him that she had never had an abortion, his retort was: Mrs. Cole, if you haven’t had an abortion, you’re the first woman of your kind who I’ve ever treated who hasn’t. On further examination, the consultant discovered that Juanita had cancer and that she was a very sick woman: If you felt this way, then how come you never went to see a local doctor, someone in
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the clinic where you live? You must know about the health program, you’ve been here almost 20 years. When Juanita told him of the many visits she made to the clinic the doctor consulted the records: According to the information I was given, your complaints have been strictly psychological. When Juanita was operated on they discovered that her ovaries, fallopian tubes, and cervix were filled with cancerous tissue. As Cottle points out, Mrs. Cole’s death would be a wasteful one: wasted because her illness could have been treated as soon as she had detected it, and wasted because it would not change the attitude and approach of the doctors and nurses . . . there would be no lesson learned by anyone . . . and that would be the biggest waste of all. (Come, 1978, pp. 29-35) That for me summa&es the predicament we are in The social, economic, and political conditions we live in make Black migrant women ill. When we look for health care we are humiliated and refused effective treatment. When we die we are blamed for failing to look after our health. What I hope I have done is to outline the health of Black migrant women in Europe. I have done this in the context of a social, political, and economic framework, and I hope this has enabled us to see that our experience in health cannot be divorced from the dynamics of that structure. We know what those dynamics are, and that should enable us to work together as well as with other disadvantaged groups and find ways of bringing about change. Our priority as migrants is to challenge the whole migrant system as practised in Europe today. We must seek each other out in the countries/cities we find ourselves in Europe and work together on this common issue. We have to exchange views and information on how to tackle local, national, and international issues that affect us. There are those issues which specifically affect Black migrant women, but we must remember that both race and gender are specific social con-
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structs and they must in turn be related to another social construct-class. In our fight we must meet head-on the inequalities and discriminations which arise from racism, sexism, and classicism, in other words, our triple oppression. We must also remember that the bulk of Black women live not in Europe but in the so called “Third World Countries.” Our fight for liberation from oppression will never be achieved unless we link up with these women. We must work closely with Black women all over the world. We must also forge links with all women because our fight for liberation will never be achieved unless women all over the world are liberated from the clutches of patriarchy and capitalism. In our solidarity shall be our strength to contribute to the liberation of women and the world in general. As Sojourner Truth reminds us, we are famous for our strength even when we work individually, how much more when we work as a group: If the first woman God ever made was strong enough to turn the world upside down (we) ought to be able to turn it back and get it right side up again. (Campbell, 1989, p. 101)
REFERJZNCES Aogelou, Maya (1991). Live performancein the Liverpool PhilharmonicThea&e. Black, Douglas. (1980). Inequalifies in health. London: Departmentof Health and Social Services. Blanc, David. (1991). Inequalities and social class. In Scambler Graham(Ed.), Sociology as applied to medicine (pp. 109-129). London: Bailliere ‘II&l. Bryan, Beverley, Dodzie. Stella, & Scafe, Suzanne. (1985). The heart of race - Block women’s lives in Britain (pp. 104-105). London:Viio. Campbell, Karlyn Kohrs. (1989). Man cannot speak for her: Key texts of the early feminists (Vol. 11. p. 101). Westport:Greenwood Press. Commission for Racial Equality. (1984). Race and housing in Liverpool:A research report. London: CRC. Cottle, Thomas. (1978). Black testimony (pp. 29-35). London:Wildwood House, London. Guyot, Jean, Padrun, Ruth, Dauphinet, Evelyne, Jospa, Yvonne, Fischli, Elena, deMestral, Marianne, Giudici, Doriana, & Scheidecker, Chantal. (1978). Migrant women speak. London: Geneva Search Press Limited and World Council of Churches. Soddy, Kenneth (Ed.). (1961). Cross culrural studies in mental healrh (p. 70). London: Tavistock. Sterling, Dorothy. (1988). Black foremothers. New York: The Feminist Press. Storkey, Elaine. (1991). Society and social scirnce founda-
tion course. Milton Keynes: Open UniversityPress. Torkington,Ntombenhle Pmtasia Khoti. (1983). 77temcial politics of health - A Liverpool pm@? ( p. 9). Livexpool: University of Liverpool.