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Paths to social caring: researchers consider their journeys through the ‘mantra’ ‘race’, class and gender.

By Jenny Baker, Margaret Allen, and Maureen Dyer

Activist Intellectual Cluster Group of the Fay Gale Centre

The three of us have been interviewing ourselves, following bell hooks’ example, in order to reflect and consider  the circumstances and social connections that lead to our own social activism, defined here as a form of social caring.

 bell hooks/Gloria Watkins

‘GW: Why remember the pain, that’s how you began?

bh: Because I am sometimes awed, as in finding something terrifying, when I see how many of the people who are writing about domination and oppression are distanced from the pain, the woundedness, the ugliness. That its so much of the time just a subject – a “discourse”. (hooks 1990:215)

Margaret Allen

I grew up in a deeply gender segregated world. But as a white girl in a fairly comfortable family, mine is not a story of personal pain, but rather largely one of learning of the other’s pain and injustice. I was the first from my family to go to University. The Vietnam War was a radicalising experience. I learnt of US imperialism and the military/industrial complex.  Involved with Aboriginal families through the Methodist Mission, I learned about systemic racism. I was active in the academics’ union 1982-1994, working to control casualisation.

The women’s movement changed my life, giving me a political frame for understanding myself and society in general. As Judith Newton wrote,

‘ “The scales fell from my eyes.” … it felt like a moment of empowerment, not of impotence. Dominant and totalising theories were not objectively true; they were informed by male bias. Our identities had been culturally constructed, and we were not alone.’ (Newton 1988:93)

Being part of a cohort of like-minded women made it easy to explore new ideas and to move forward together. My work in introducing and growing gender studies was always a joint effort, carried on with other women.

Maureen Dyer

I grew up working class, on the largest housing commission estate in England. None of my family had been to high school and my father had little belief in girls’ education. At the 11+ examination, no-one at my primary school was completely successful.  I was interviewed, getting in by the skin of my teeth. I later learnt how culturally specific the 11+ was, and that whole forms succeeded in middle class areas. I had so internalised the dominant hegemony of class to see myself as a somewhat inferior girl who did not really fit in.

But I worked hard and with the encouragement of a sympathetic teacher, I applied and succeeded in getting into university. Again I felt completely out of place; especially in the Residence Hall. There were very few working class girls, and none with a cockney accent. The Warden asked if I felt I was in the right place for someone like me.

Becoming an activist involves an awareness and experience of discrimination, and understanding the systematic exercise of power. Through postgraduate studies, I became conscious of the class discrimination I had suffered. My light bulb moments came from reading Sennett and Cobb’s work on class  (Sennet and Cobb 1972) and through the Women’s Movement of the 70s when I put this  together with gender discrimination. Since then I have worked to end such patronising attitudes to working class children.

Jenny Baker

From my earliest memories my family were in a state of disintegration coping with events in their lives: my Mirning Aboriginal mother in her late 30s suddenly with two baby daughters 11 months apart coming ten years after four older children; the family moving to the city in the late 1940s from a farm in a remote country region into a one-room shack and a small caravan, close friends, horses and dogs left behind. These were some of ‘the straws that broke’ the spirit in our family. The death of my seventeen year old brother on a motorcycle four years after moving to the city sealed that sadness that seemed to linger in our lives. My sister and I grew up with our non-Aboriginal father and the four, and then three, older children had difficult lives working out where they should live.

Why remember the pain or is it possible to not remember the pain?  Is it the pain that leads to activism and social caring or is it education and radical analysis that enables that to happen. Unfortunately an analysis that examines the intersection of ‘race, class and gender’ is unavailable for many people trying to battle pain and dislocation in their lives as it has been for my three older siblings. Those moments when’ the scales fall from your eyes’ and you become aware of the relationship between ‘power and knowledge’ (Foucault) are radicalising and they provided me with a new understanding of ‘care’ (Narayan 1995).

Conclusion

People need to care in order for a process of caring to begin (Tronto 1995). It requires ongoing political struggle to keep ‘caring’ as the grounded basis for any society and not simply a discourse within caring professions. Revisiting one’s journey to social caring has involved a re-valuing of our past in the context of today, so thank you bell hooks.

References

Derrida, J. (1998 (1981)). Geopsychoanalysis: “… and the rest of the world”. The Psychoanalysis of Race. C. Lane. New York, Columbia University Press.

Foucault, M. (1972). The Archaeology of Knowledge. London, Tavistock.

hooks, b. (1990). An interview with bell hooks by Gloria Watkins: No not talking back, just talking to myself. Yearning: race, gender and cultural politics. b. hooks. Boston MA, South End Press.

Narayan, U. (1995). “Colonialism and its Other: Considerations on Rights and Care Discourses.” Hypatia 10(2): 133-140.

Newton, J. (1988). “History as Usual? Feminisms and the New Historicism.” Cultural Critique 9(Spring).

Sennet, R. and J. Cobb (1972). The hidden injuries of class. New York, Vintage Books.

Tronto, J. (1995). “Care as a Basis for Radical Political Judgments.” Hypatia 10(2):

 

 

‘Childless-by-circumstance: Is it different for men?’ by Robin Hadley

The grief, and stereotypes, that childless-by-circumstance women experience were movingly described by Jody Day on BBC Radio 4’s Woman’s Hour on the 1st of October, this year. During the programme, I tweeted that men are also childless-by-circumstance, and this was acknowledged by the host, who went on to suggest that, ‘The stereotypes don’t so easily attach themselves to men do they?’ Jody, to her credit, speculated that although men had a similar emotional journey as women it was a different one. The problem identified here relates to the heteronormative pronatalist view that ‘mothering’ and ‘nurturing’ are the ‘ideal’ default positions for women, while ‘virility’ and ‘providing’ are those for men. Women who do not conform, such as the voluntarily* and involuntarily* childless, are subject to a range of reactions from sympathy to antipathy. Moreover, the former tend to be viewed with less sympathy than the latter (Brescoll and Uhlman, 2005).

What then for men?

There is a paucity of research into male childlessness compared to the cannon of material on women (Throsby and Gill, 2004). Infertility studies report that men, diagnosed as infertile, are subject to negative behaviours, including: suspicion, exclusion, discrimination, and isolation, from both females and males, as are house-husbands and fathers who are widowers (Smith, 1998, Throsby and Gill, 2004, Hadley and Hanley, 2011). Men, who do not conform to fatherhood mandate – the patriarchal construct of ‘virility-proved-by-fertility‘ (Lloyd, 1996) – may behave in more extreme masculine ways or reduce their voice, and visibility, thus becoming ‘liminal’ (Hudson & Morgan, 2000; Ribbens & Edwards, 1998). Moreover, the male gender socialization is associated i.e. the ideal of hegemonic masculinity with symbolic roles of dominance, power, and control. These include masculine traits of machismo, virility, and objectivity and displayed through such behaviours as being emotionally distant, rational, and controlling. Wong and Rochlen’s (2005) study demonstrated that although men have the same emotional experience as women, their wherewithal to access, process, and verbalise their feelings were limited. In addition, research has indicated that childless men have a similar level of yearning for parenthood as childless women and, furthermore, childless men had higher levels of anger, depression, jealousy, and isolation than women (Hadley, 2009, 2012).

The distribution of stereotypes that the Woman’s Hour presenter alluded to reflected the dominant pronatalist positioning of women as nurturing/caring and men as aggressive/rational. As a researcher studying older childless-by-circumstance men, and as an involuntarily childless man who was very broody in his thirties (Hadley, 2013), challenging those stereotypes is not easy. Research in the field of older men who are involuntarily childless is important, not only because of actual and projected demographic change but also because of the lack of material reporting the effects of involuntary childlessness on men as they age (Dykstra and Keizer, 2009). For example, there are implications for the childless at national levels with much political rhetoric advancing the future centrality of family in the care of older relatives, with the demand for familial care in England projected to grow by about 90% by 2041 and exceed supply (Pickard et al., 2009). Gerontological research has shown that relationships and social support are as important as physical health for personal development and wellbeing. In Britain, there are a growing number of households of solo occupancy with an increasing number of older people living in that circumstance, the majority of whom are men. Childless people are clearly absent from policy discussions; for example, they are not referred to in the last Government’s strategy paper ‘Building a society for all ages’ (Department for Work and Pensions, 2009).

Robin Hadley is a PhD candidate at Keele University.

University profile: http://bit.ly/194quoN

Academia.edu profile: http://bit.ly/1a2JKAa

Research webpage: www.wantedtobeadad.com

Twitter: @robinhadley1
Email address:  r.a.hadley@keele.ac.uk

Postal address:
Claus Moser Building
Keele University, ST5 5BG,
United Kingdom

References:

Brescoll, V. L., & Uhlman, E. L. (2005). Attitudes toward traditional and non-traditional parents. Psychology of Women Quarterly, 29, 436–445.

Department for Work and Pensions. (2009). Building a society for all ages. Retrieved from http://www.hmg.gov.uk/media/33830/fullreport.pdf.

Dykstra, P. A. & Keizer, R. (2009). The wellbeing of childless men and fathers in mid-life. Ageing & Society, 29(8), 1227-1242.

Hadley, R. A. (2009). Navigating in an Uncharted World: How does the desire for fatherhood affect men? MSc Dissertation, The University of Manchester, Manchester

Hadley, R. A. (2012). Navigating in an Uncharted World: How does the desire for fatherhood affect men? Journal of Fertility Counselling, 19(01), 12-13.

Hadley, R. A. (2013). Robin Hadley: I know all about broody men who long to be dads. I am one. Telegraph Media Group.  http://www.telegraph.co.uk/men/relationships/fatherhood/9969542/Robin-Hadley-I-know-all-about-broody-men-who-long-to-be-dads.-I-am-one.html

Hadley, R. & Hanley, T. (2011). Involuntarily childless men and the desire for fatherhood.  Journal of Reproductive and Infant Psychology, 29(1), 56-68.

Hudson, B., & Morgan, D. (2000). Introduction: Making men into fathers. In B. Hudson (Ed.), Making men into fathers: Men, masculinities and the social politics of fatherhood (pp. 1–24). Cambridge: Cambridge University Press.

Lloyd, M. (1996). Condemned to be meaningful: Non-response in studies of men and infertility. Sociology of Health & Illness, 18 (4), 433-454

Pickard, L., Wittenberg, R., King, D., Malley, J. & Comas-Herrera, A. (2009). Informal Care for Older People by their Adult Children: Projections of Supply and Demand to 2041 in England. London: The London School of Economics and Political Science. http://www.lse.ac.uk/collections/MAP2030/docs/InfCare_Pickardetal_2009.pdf

Ribbens, J., & Edwards, R. (1998). Public knowledge. In J. Ribbens & R. Edwards (Eds.), Feminist dilemmas in qualitative research: Public knowledge and private lives (pp. 1–23). London: SAGE.

Smith, C. D. (1998). “Men Donʼt do This Sort of Thing”: A Case Study of the Social Isolation of House Husbands. Men and Masculinities, 1 (2), 138–172

Throsby, K., & Gill, R. (2004). ‘It’s different for men’: Masculinity and IVF. Men and Masculinities, 6(4), 330–348.

Revaluing Care Workshop 2: September 2013, University of Adelaide, Australia.

At the beginning of September 2013 our Revaluing Care network had its second workshop, following an earlier workshop at Keele University, UK, in September 2012. This second meeting over two days at the University of Adelaide, in South Australia was marked by its attention to analytical concerns that had been raised in the 2012 session. It was also marked by much convivial discussion over food and wine at the end of each day.

We met in a room with views of the city all around us and, fortunately, the sun shone almost all of the time. What I recall most clearly was the very high standard of the papers, the sense of an extraordinary level of conversation within a group which has now forged a strong identity. The degree of confluence of ideas, of substantive and strongly supportive debate was striking. It is rare to attend such an event and feel constantly engaged by an extremely stimulating exchange of views. The event was both inclusive and demanding in the very best sense.

The workshop looked at a wide variety of existing services around care and their impacts on social interconnection (such as services around HIV/AIDs, young people and dementia care), as well as a range of existing legal and policy frameworks. This international orientation informed extensive discussion around new ways of conceiving care (for instance, in relation to social activism, migration and cross-national mobilities). However, it also enabled us to consider where the term care begins to fall away, or seems insufficiently recognised or activated. Consequently there was a significant interchange over the two days concerning the analytical and practical boundaries of care (for example, in relation to sexualities, diverse families, the notion of the human, marginalised services and public institutions seemingly distant from care including parliaments and courts).

These deliberations led to a range of theoretical and terminological discussions around the continuing usefulness of the notion of care, around what it covers and its limits.

The success of the workshop was not only evident in the strengthening of the network as an active, participatory and supportive research community, but also obvious in the final discussions around building research teams, projects and publications across the world and across disciplinary constraints. We aim as a result to produce articles, books of collected works, and grant applications. Many of these aims are now in process. The group was also firmly of the view that further workshops would be very worthwhile and assist in the development of these aims. So, watch this space.

In sum, I can only say that I, for one, gained immensely from the workshop and now have an even stronger sense of the considerable research capabilities of the group. This is a group with much to gain from our continuing association! It is one of the few research clusters that I have been involved in which shows ongoing promise of generating important intellectual exchanges and innovative new work .

Professor Chris Beasley

Discipline of Politics & International Studies (POLIS)
School of Politics and History
 
Co-Director, The Fay Gale Centre for Research on Gender

‘Transnational families, migration and the circulation of care.’

By Loretta Baldassar & Laura Merla

Every day during his lunch break at around 1pm, Alberto, who lives in Perth, Australia, phones his 85 year old father, Angelo, who lives in Rome, Italy. Angelo, who is not in the best of health, is usually sitting at the kitchen table having his morning coffee and bread roll. “It’ll only be 6am in Italy, but Dad will always be waiting for my call,” Alberto explains. Since Alberto’s mother’s sudden and unexpected death a year ago, Alberto, an only child, has tried to manage his father’s increasing care needs from a distance. He took 6 weeks unpaid leave from work to travel to Italy to arrange the funeral for his mother and put in place care supports for his father. Both Alberto and Angelo see aged care facilities as a last resort option; they are expensive and have a social stigma that reflects badly on families. Angelo wishes to remain living in his own home for as long as he can. Moving to Australia is not an option because of Angelo’s failing health; furthermore, aged migration to Australia is costly with prohibitive requirements. Given the aged care regimes in both countries, father and son adopted the commonest solution and hired a domestic worker, Maria, to work from 9 to 5 each day, preparing lunch and dinner, doing the cleaning and shopping and taking Alberto to his medical visits. Maria has agreed to move into the spare room as a live-in carer if Angelo’s health deteriorates. A long-time family friend, Nadia, the daughter of Angelo’s old friend and neighbour, Nello, sets up a Skype every Sunday when she visits her father (who lives next door). Alberto feels this is the best way to “get a thorough update”.

Every Saturday and Sunday, at around 6am, Maria phones her 10 year old son, Diego, in the Dominican Republic. She arrived in Rome a year ago on a tourist visa. Maria planned to find work as a domestic and raise enough money to bring Diego to Italy. In the meantime, Diego lives with his grandmother Lucia, Maria’s mother. Twelve people currently live in Lucia’s crowded house, including her frail partner Arturo, two of Maria’s brothers, their partners and children, and Maria’s sister Anna’s three children. Anna is a domestic employee in the US. Maria and Anna call Lucia a few times a week to talk with and discuss their children, exchange support with their mother, and talk to other family members present at the time of their call. The two sisters are also in regular contact with their oldest sister, Teresa, who lives in Belgium with her Spanish husband and their three children, and the three women send monthly remittances to their mother. In spite of the distance, Teresa plays a central role in her extended family, and is considered by all as the head of the household that is stretched across thousands of kilometres and several countries. Teresa checks with her brothers and sisters-in-law that Arturo, who suffers from diabetes and has lost his sight, takes his medicines and eats properly, and sends emergency remittances when a specific need arises. She visits her family every year, and during these visits she works with her brothers on the renovation of the family house.

These case studies highlight the way family members from different socio-economic and cultural backgrounds care for each other through a process of asymmetrical reciprocal exchange, across and despite the distance that separates them, and the way that care circulates between them. The idea that care circulates within transnational family networks is indeed central our edited book entitled ‘Transnational families, migration and the circulation of care : understanding mobility and absence in family life’ (Routledge).

With increased mobility and improvements in both travel and communication technologies, more and more people are experiencing transnational family lives. The chapters that make up this volume cover a rich array of case studies including analyses of the inequalities between transnational families who circulate care between developing nations in Africa, Latin America and Asia to wealthier nations in North America, Europe and Australia. There are also examples of intra- and extra- European, Australian and North American migration and care circulation, which involve the mobility of both the unskilled and working class as well as the skilled middle and aspirational classes.

Whether pushed or pulled out of homelands in search of safe asylum, better economic futures or improved lifestyles, increasing numbers of people are separated from their family by distance and national borders. Those family members who ‘stay behind’ or ‘stay put’ (as it were) in their place of birth or ancestral homeland, also become part of social relationships stretched across time and place, even though they might never actually relocate or even move at all. We believe a focus on the disparate trajectories of care circulation helps us to better understand mobility and absence in family life, so that we might theorise transnational families as contemporary family forms in their own right. This book highlights, in particular, how the sense of belonging in transnational families is sustained by the reciprocal, though uneven, exchange of caregiving, in the form of financial, emotional and practical support, ‘hands on’ care as well as accommodation. By doing so, this volume challenges narrow definitions of care to consider the portability of care, a fundamental topic for our contemporary lives.

Sources:

Baldassar L. & Merla L. (Eds) (2013) Transnational Families, Migration and the Circulation of Care: Understanding mobility and absence in family life. Routledge, Transnationalism Series

Baldassar L., Kilkey M., Merla L. and Wilding R. (Forthcoming) ‘Transnational Families’. Revised Wiley-Blackwell Companion to the Sociology of Families.

c/o Professor Loretta Baldassar

Anthropology and Sociology
The University of Western Australia (M255)
35 Stirling Highway
CRAWLEY WA 6009
Australia

WeAreOne by Ambreena Manji

Who Cares?

And behind me I hear the footfalls of countless generations and ancestors. And around me the living community of my people, whose woes are my woes; whose moments of joy are mine.

Kofi Awoonor, Ghanaian poet murdered at Westgate, Nairobi on 21st September 2013

On 19th September 2013, at the Annual Lecture of the British Institute in Eastern Africa in Nairobi, Dr Ann Stewart delivered a lecture entitled ‘Caring about care: Recognising and regulating body work in a global market’. Based on her recently published book, Ann gave a compelling and wide ranging talk about forms of care and asked the question ‘who do we care about and how’? The discussions that followed the lecture were vibrant and engaged, the sorts of critical conversations about labour and about gender that I had hoped would come about in my time at the Institute.

On 21st September, at lunchtime, a terrorist siege began of an upmarket shopping mall in Nairobi, Westgate, a mile or two from the Institute. Everyone reading this will have seen the terrifying images. For well-off Kenyans who have become used to hearing the occasional distant grenade explode in the east of the city, in a crowded church or bar or bus station, the events mark a sea change. Here Kenya’s wealthy elite and the international community are the target and terror is at the heart of our lives. I’ve heard it said countless times this week that, looking at photographs of the attack taken in the mall, many of us recognised shop fronts, escalators, sweet stalls, even marble tiles on which we have trodden. As elsewhere, the mall is at once a response to, and a perpetuation of, a city segregated between the wealthy and the destitute. Reborn each day, sparkling clean, its shelves restocked with international branded goods, the Nairobi mall succeeds in making invisible the messy reality of life in a third world city. It would be deeply dishonest to deny that those who clean the mall, serve its meals, guard it – in short, those who provide us with our accustomed care and comfort – go unseen, unknown, unheeded.

Yet in the past three days we have heard stories of supermarket staff, faced with terrified customers running into the shop when the grenades and gunfire began, shepherding people into store rooms, barricading them in to conceal them from the attackers, hiding them behind boxes in stock rooms. Despite our own bleak assessment of ourselves as deeply divided along ethnic lines, as a society riven by long running racial divisions, in the terrifying and traumatic siege of Westgate mall many have commented on the intersecting unities we have discovered this week. An elderly Indian lady, recently returned home from England to care for her elderly mother in Nairobi, and desperate to do something to help, went down to the perimeters of the mall to serve tea and food to the police and media who have worked without a break for days. There she met an African woman who for many years has come to the mall everyday to sell tea and food to its cleaners, waitresses, guards. For the past three days, these two women have teamed up to cook and bring food to those working outside, plastic bags on the ground, car boot full of supplies wide open and elderly mother, still needing to be cared for, in the front seat watching them work.

But the events of the past three days have also made visible that which the well-off and the comfortable work so very hard not to see. The private security guard paid the minimum wage carried our children to safety through a pool of blood; the waitress whom we never greeted in three years of coffee drinking hid us in the cafe kitchen; the cleaner whom we never knew of ushered us to safety through a back exit.

This past three days, Ann’s question at the BIEA lecture – who do we care about – has been constantly in my mind. And as we slip back into our mutual distrust and distance, perhaps we might remember to ask, who cares about (and for) us?

Ambreena Manji

http://www.biea.ac.uk/director-professor-ambreena-manji/

 

 

Caring in Kenya, by Ann Stewart

While young men and possibly young women were laying siege to a shopping mall in Nairobi, killing young and old indiscriminately despite press reports to the contrary, I was spending the day with Maasai families experiencing care at first hand.  While they were forcing their way into this space where love and care was being bought in the same way as elsewhere in the global market place, through children’s cooking parties, coffee and tea drinking and the body work of hairdressers and cosmetic sales persons, I was sitting outside a one roomed home, made with corrugated iron sheets, drinking smoky milk tea from a pot on the open fire, with 4 generations of women from one family, the eldest 100 years old, the youngest 2 years.  The great grandmother was given her food by her grand- daughter.  She was sitting on her goat skin leaning against her hut wall eating her lunch from a bowl with a spoon.  The food had been provided by her last surviving child of 12, her youngest daughter in her 60s now living with her mother, having moved from the local ‘town’, some 8 kilometres away on a deeply pitted dirt road.  The ugali and goat meat with vegetables had been made into a stew on an open fire.  She spooned out all the liquid on to the earth in front of her because she wanted it dry.  Her daughter and grand- daughter looked on while she did this, ensuring that the food did not tip out.  When we had arrived in the sort of SUV which is ubiquitous in ‘developing’ world contexts with her grand- daughter and two great grand-daughters, she had come out to greet them but immediately went back inside the hut and come out again carrying all her belongings in a cloth bundle, secured on her head and back, which was almost her size, and her long stick.  She was intent on getting back to the town to visit her grand-daughter.  She was persuaded gently to put the bundle down and to have her food and to share tea and talk.   She was not going to be able to go back with us.  She and her widowed daughter had moved here because a grandson had taken responsibility for them.  Sons are important.  They provide this economic protection although widowed women are socially powerful within families.    We debated how we would leave when the time came.  The answer was for the men in the party to drive off in the vehicle and wait further off and for the women to stay behind.  Then at a moment when we hoped she was distracted we ran towards the vehicle.  She was not fooled and proceeded to follow us with remarkable swiftness for her age.  We clambered in and left her with her daughter to return to their home.

We were there because my Kenyan research student had studied the interaction between gender and ethnicity in matters relating to land in 3 different communities in Kenya.  The grand daughter was the sister of her interpreter for the Maasai field work.  Agnes had spent time much time and many experiences with this group of women who in Maasai terms are a wealthy and influential family, owning much land.  She was paying a visit to reminisce and to catch up on events.  I was sharing this visit as her teacher.  I also had a ‘husband’ my male partner with me.  Agnes had her husband and we had two male drivers, one for the Maasai area, an influential young man who had assisted Agnes with her fieldwork in this area, and a driver whom Agnes had used generally for all her fieldwork who drove for her family.  Undertaking fieldwork in rural Kenya is not easy.  It involves many challenges which I was only now learning about as we met up with those who had been involved.  Everyone was enjoying the stories. The interpreter’s sister, who set up many of the interviews, had been 8 months pregnant at one stage.  Her mother made it clear that Agnes must be prepared to attend the birth if this should occur on one trip which involved very bumpy terrain.   On one occasion the interpreter had had to climb a tree to try to get a mobile signal to enable someone to come and tow the vehicle out of the ditch.   The Maasai driver had been able to clear the road of a large herd of goats while the Kisii driver had not.  When the great grand- mother had been interviewed she had wanted Agnes to write down her entitlement to land on a piece of paper.  She still had this piece of paper.

I am deeply uneasy about the potential voyeurism involved in this type of narrative but it was not that sort of day.  The men in the party wandered off somewhere and the women chatted to each other lined up along the hut wall for a number of hours.  They spoke Swahili and the Maasai language and English when necessary.  I was made to feel completely welcome but not special.  I shared photos from my newly bought flash smart phone of my two small grandchildren.  They were struck by their very blue eyes.

A few days before I had delivered a public lecture entitled ‘caring about care; recognising and regulating body work in a global market’ at the British Institute in Eastern Africa.  It was based upon my book Gender, Law and Justice in a Global Market (CUP 2011).  As part of the presentation I had shown some photos of the elderly in institutional settings in the UK: older women lined up against walls in wheel chairs, heads down.  I had shown pictures of migrant care workers tending to these elderly frail people.  In the discussion which followed the presentation, we had had a very interesting discussion of the tensions and dilemmas that urban middle class/professional women face in coping with paid work and caring responsibilities in urban Nairobi where use of paid assistance in the home – domestic workers, nannies, care workers generally –are the norm.  We discussed the consequences of privatising social responsibilities with no welfare state safety net  – individual women feel responsible for the lot of other women who have left children and other family members behind to undertake these roles.  The women are not paid enough to replace their care and they may be far from their own homes in the informal settlements in Nairobi.  The Kenyan state has provided some legal protections and minimum wage requirements.  But how are these to be met by individual women with no support from the state?  Women are pitted against each other.

I looked after my mother and father in our home for the last two years of their lives.  My mum was by then very frail and needed constant care.  They both died aged over 90 in our home.  I recognised the care that the women around me were giving on Saturday.  I recognised its quality.  I recognised the power relationships, the negotiations, the vulnerabilities, the love.  I saw the dignity and worth of this very elderly woman’s life – her clean clothes, her neat hair, her alertness, her sense of being part of this community, her frustration at not being able to out run us to the vehicle.

Ann Stewart

School of Law University of Warwick

 

‘Gender Identity and Health Care Experiences in Australia’ by Dr Damien Riggs

In 2012 and 2013 Dr Clemence Due and I conducted two surveys, the first focusing on the health care experiences of Australian people who were female assigned at birth (FAAB) but who now identify with a different gender identity, and the second focusing on the healthcare experiences of Australian transgender women. Our analyses so far have adopted a comparative approach, primarily because most previous studies of transgender, transsexual or genderqueer people’s experiences of healthcare have not disaggregated findings by assigned sex. We thought that a comparative approach might thus be useful given that research suggests that transphobia is highly correlated with both homophobia and sexism amongst heterosexual, cisgender people (see Riggs, Webber & Fell 2009). These three forms of discrimination are related by the fact that the first two are about attitudes towards gender non-conformity, and the third measures how much an individual subscribes to social norms about (nominally cisgender) gender role conformity. Previous research suggests that transphobia (and cisgenderism more broadly) is gendered, not only in the sense that cisgender men are more likely to be transphobic than are cisgender women, but that people FAAB will experience transphobia or cisgenderism differently than will people male assigned at birth (MAAB). In undertaking a comparative approach, then, our hypothesis was that such differential discrimination would result in different experiences with healthcare providers between the two surveys.

In order to test if it was appropriate to group all responses from people MAAB together as one group, and to compare this with all responses from people FAAB, we first checked to see if there were any significant differences within each group in terms of current gender identity. In each study participants were asked to name their current gender identity. The three main categories used by participants within both of the studies were:

1. Affirmed gender (i.e., simply ‘male’ – used by people FAAB – or ‘female’ – used by people MAAB)
2. Transgender (this included terms such as trans woman, trans girl, trans boi, transgender man)
3. Genderqueer

Statistical testing indicated that both within the surveys, as well as when combining the two samples into a whole, there were no significant differences in between those people who identified themselves using either their affirmed gender, the term ‘transgender’, or the term ‘genderqueer’.

In order to further ensure that focusing on differences between people MAAB and people FAAB was a valid approach, we also looked at whether there were other notable differences across the two samples. We found that:

1. Participants who were older were more likely to have undertaken sex-affirming surgery than participants who were younger,
2. Participants who were older reported more positive levels of mental health than did participants who were younger, and
3. Participants who had undertaken sex-affirming surgery reported more positive levels of mental health than did participants who had not undertaken surgery (as we had already found when looking solely at the first study, see Riggs & Due, 2013).

These initial findings suggested to us that it was possible that the main issue at stake across the samples was age. What we did, then, was control for age in our subsequent statistical testing. This enabled us to examine whether assigned sex (MAAB or FAAB) was a significant predictor of experiences. The answer was yes:

• Participants who were MAAB were more satisfied overall with the support they received from counselors, psychologists and psychiatrists than were participants who were FAAB,
• Participants who were FAAB reported more positive levels of mental health than did participants who were MAAB,
• Participants who were MAAB reported more positive experiences of gender-affirming surgery than did participants who were FAAB,

In addition to differences between participants MAAB and participants FAAB, there were other interesting findings. Some of these highlight areas in need of improvement by (nominally, though not in all cases) cisgender mental and physical health care professionals:

• Participants who reported higher levels of discrimination from health care professionals reported less positive levels of mental health,
• Participants who reported feeling that they frequently had to educate health care professionals about issues related to their current gender identity reported higher levels of discrimination,
• Participants who reported feeling that they frequently had to educate health care professionals about issues related to their current gender identity reported that they felt less respected by the professionals.

So what do all of these findings suggest to us? We of course acknowledge that this was a modest sample (78 people FAAB and 100 people MAAB), though these numbers are similar to those of the pioneering TranZnation report (2007), and they include participants from all Australian states and territories. The findings suggest the importance of taking into account both age and natally assigned sex. These demographics may impact upon people’s experiences due to differing:

• Diagnosis rates of ‘gender dsyphoria’ between people MAAB (0.005% to 0.014% of the population) and people FAAB (0.002% to 0.003% of the population),
• Societal gender norms and expectations of people FAAB and people MAAB, such that experiences of discrimination from the general population, from transgender communities, and from health care professionals will likely differ according to cisgender (and transgender) people’s assumptions about gender norms,
• Degrees of availability and successful outcomes of surgery as perceived by people MAAB when compared to people FAAB (though this is slowly changing, see Cotten, 2012),
• Understandings of gender identity within non-gender normative communities.

The report documenting the full findings is available at: http://www.genderidentityaustralia.com/?p=262

References

Cotten, T.T. (Ed.). (2012). Hung jury: Testimonies of genital surgery by transsexual men. Transgress Press.
Couch, M., Pitts, M., Mulcare, H., Croy, S., Mitchell, A., & Patel, S. (2007). TranZnation: A report on the health and wellbeing of transgender people in Australia and New Zealand. Melbourne: Australian Research Centre in Sex Health and Society.
Riggs, D.W. & Due, C. (2013). Mapping the health experiences of Australians who were female assigned at birth but who now identify with a different gender identity. Lambda Nordica, 5.
Riggs, D.W., Webber, K., & Fell, G.R. (2012). Australian undergraduate psychology students’ attitudes towards trans people. Gay and Lesbian Issues and Psychology Review, 8, 52-62.

Dr Damien Riggs
Senior Lecturer
Flinders University
GPO Box 2100
Adelaide 5001
South Australia

 

 

‘Older carers: invisible but invaluable’ by Antony Smith

  • There are 2.8 million people aged 50 and over providing unpaid care in the UK, including 5% of people aged 85 and over.
  • A quarter of all carers aged 75 and over provide 50 or more hours of informal care each week.
  • Carers save the UK economy an estimated £87 billion a year.

At Age UK we hear from many people in later life who are caring for a spouse, partner, relative or friend. Although many find caring rewarding and an expression of their relationship, carers also tell us that they feel invisible and undervalued. Many are stressed and exhausted. Here is an excerpt from one of those personal stories.

Jenny and James

“James and myself were both looking forward to spending our retirement together, but four months after I retired, James became ill and was diagnosed with memory loss caused by depression. Five months later he became ill again, almost overnight, and was hospitalised. He was 71.

“Eventually I was told, because James had Lewy Body dementia, I’d never be able to look after him and that he had to go into residential care. With a nursing background, I thought I could care for James at our home and believed this would be better for his mental wellbeing, but no one listened.

“Once a social worker was assigned to our case, he said he would try and enable a care package where James could live at home with me. However once our financial assessment was done, and we weren’t eligible for funding support, we were left to get on with things ourselves. I set about arranging a care package, but it was a complicated task to do with no guidance. Luckily, I’m able to use the internet, but I dread to think how I would have sorted anything without it.

“After nearly three months in hospital, James finally came home in Feb 2011.

“Being a carer is exhausting – from the moment James wakes up he needs help with everything from moving and getting dressed to washing and going to the toilet. When I don’t have night cover I’m up about four times a night and can’t sleep during the day as James needs someone with him all the time. Because we hired support workers independently we have the same ones nearly every time. I think that’s really beneficial to James, as changing faces can be particularly disorientating for someone with dementia and they perform very personal tasks.

“I take James to a day centre twice a week and this is welcome relief for me. Unfortunately we’ve just been informed that because of local authority funding cuts the centre will close next year. There are about 20 of us who use the centre, and James really enjoys his time there.

“Every six weeks I also put James in respite care for a week, to give me a complete break. Unfortunately on his most recent trip when I went to collect him he had no shoes on, his glasses were missing and he was wearing someone else’s clothes. I could tell he was frightened and he had bruises on his body. When I got him home I discovered he’d lost 8lbs in seven days. I’ve made a formal complaint and am waiting to discover the outcome, but things like that shouldn’t be acceptable and obviously I haven’t felt like I could put him in that respite home since.

“I feel I have managed to come to terms with my feelings of loss and bereavement concerning James, which were overwhelming at the start, and I just have to get on with things. I try not to think about the future. James is getting weaker, and I’m getting older so I don’t know how long I’ll be able to manage and I don’t know what will happen when our money runs out.”

Age UK Is calling for more support for older carers – from government, local authorities and health professionals – such as a Carer’s Allowance for pensioners, a choice of appropriate services and regular carers’ health checks. You can find out more about our work to highlight the support older carers need, as well as the recognition they richly deserve, on Age UK’s website.

Antony Smith is Development Officer for Equalities and Human Rights at Age UK Antony.Smith@ageuk.org.uk

‘Defining and exploring “care practices”‘ by Kathryn Almack

With my colleague Andrew King (University of Surrey), I’m starting work on a paper which aims to explore informal care practices within the lives of older lesbian, gay and bisexual (LGB) people. This will problematize the framing of ‘informal care’ within policy that most often assumes that these forms of care take place either within assumed heteronormative familial relationships and/or within a dyadic relationship, with one person the ‘carer’ and one the ‘cared for’. We are drawing on ‘case stories’ which we’ve developed from our research with older LGB respondents, selected to represent wider issues within LGB communities and illustrative of a range of care practices, including care provided by friends and strangers, reciprocal care and other expressions of care within LGB communities. We anticipate our paper will also contribute to wider debates about the increasingly diverse range of family forms and social relationships that are not easy to name or recognize.

In developing this paper, we are also searching for our theoretical framework within which to situate this; the thoughts on this below are my own, although it will be something that I work on in collaboration and further feedback from members of the networks are welcome.

I’m leaning towards defining and exploring ‘care practices’ –  akin to Morgan’s (1999, 2011) concept of family practices – as a way to investigate and interrogate care and caring relationship and practices and in particular, unpack the meanings of such practices – emotional, relational, moral, and symbolic. The concept of family practices seeks to shifts the focus towards what families do rather than a focus on family structures; but nevertheless also recognising that at everyday levels the ‘family’ is still a term used by individuals to describe their most meaningful relationships. Morgan suggests that this perspective offers the possibility to see the family as ‘less of a noun and more of an adjective or, possibly, a verb’ (1999:16).

Care practices could encompass a whole range of practices that bind people together, that may include conflicts, tensions and ambivalence as well as affection and love. Thus addressing some of the complexities of care – interdependence, reciprocity, conflicts (workings of power/imbalance), resources, identities, moral deliberations, emotions, labour, working across time and space, involving networks as well as individuals and dyadic relationships.

There are of course other ways of theorising care, including carescapes and an ethics of care framework. Carescapes (Mckie et al 2002) seeks to add a dimension to thinking about care across time and space – the concept developed out of concerns focused on the changing yet gendered nature of caring for children and time-space relations implicit in combining caring and working and shifting roles as children grow (but that may have wider application to other relationships of care):

Mapping routes through the shifting and changing multi-dimensional terrain that comprises their vision of caring possibilities and obligations: routes that are influenced by everyday scheduling and by combining caring work through paid work and the paid work of carers (McKie et al 2002: 904)

And of course, an ethics of care framework has been developed and drawn upon to theorise values of care (key references include Tronto, 1993 and more recently Barnes, 2012) – involving both thought and action and placing value on notions of responsibilities of providing good care; valuing connectedness, incorporating values of dignity and respect. It seems to suggest and encompass a moral framework – though not prescriptive – about the delivery of care and how it is delivered. Is that distinct from or similar to the meanings ascribed to relationships through the doing of care?

I’m left with questions that I don’t yet have answers to. Are there overlaps between the three – care practices, carescapes and ethics of care? Is it that they have developed within different spheres and that they do say the same things in different ways or do they offer distinct contributions to debates on care?  All thoughts and ideas most welcome in taking these reflections forward.

 

Name, address, contact details.

Dr Kathryn Almack

Senior Research Fellow

B Floor, QMC

School of Health Sciences

University of Nottingham

Nottingham

NG7 2HA

 

Tel: +44 (0)115 8231204

Email: k.almack@nottingham.ac.uk

 

References:

Barnes, M. (2012) Care in Everyday Life: an ethic of care in practice. Bristol: Policy Press

McKie, L., Gregory, S. and Bowlby, S. (2002) Shadow Times: The temporal and spatial frameworks and experiences of caring and working. Sociology, 36,4:  897-924

Morgan, D. H. J. (1999) “Risk and family practices ” in Silva, Elisabeth B. and Smart, Carol (Eds.) The New Family? London: Sage Publications, pp. 13-30

Morgan, D. H.J. (2011) Rethinking Family Practices. London: Palgrave Macmillan

Tronto, J. (1993) Moral Boundaries: a political argument for an ethic of care. London: Routledge

Trans Mental Health, Transition and Gender Identity Clinics – By Dr Louis Bailey

The Trans Mental Health Study 2012)[1] is the largest survey of its kind within Europe and the first to explore mental health and well-being within the UK trans population.  The survey examined rates of life and body satisfaction within the trans population as well as trans people’s experiences of accessing a range of health and support services (including gender identity services and mental health services), current and past mental health issues, and experiences of daily life.  The full report can be found here.

Impact of Transition on Mental Health

The key finding to emerge from this study was the significance of gender transition in improving mental health and well-being.  74% of the respondents felt that their mental health had improved since transitioning.  85% were more satisfied with their bodies since undertaking hormone therapy, 87% were more satisfied after non-genital surgery and 90% after genital surgery.  Both social and physical changes of gender were shown to have a substantially positive impact on trans people’s self-esteem, happiness and quality of life.  Crucial here was the importance of being able to socially transition as their felt gender identity and having that identity recognised by others.  Alongside and interacting with this was the positive role played by hormonal and surgical interventions, which enabled necessary physical and psychosocial changes to be made.  Such changes reduced instances of Gender Dysphoria and negative body image and, in turn, served to increase confidence, satisfaction and overall well-being.

Rates of self-harming, suicidal thoughts and suicide attempts were high with 53% of respondents having self-harmed, 84% thinking about suicide and 35% attempting suicide at some point over the life course.  However, gender transition was shown to drastically reduce rates of self-harm and suicidal ideation within this group.  Of those that had completed transition, 63% reported having self-harmed, thought about or attempted suicide more prior to transition compared with 3% after transition.   Whilst transition has been shown to significantly reduce rates of self-harm and suicidal ideation, it consequently follows that those who would like to transition but who are unable to or who are experiencing significant delays or set-backs within the healthcare system will be at risk of increased self-harm and suicidal behaviour.

Impact of NHS Gender Identity Services on Mental Health

Whilst treatment for Gender Dysphoria was shown to have a beneficial impact on mental health, the process endured by respondents in order to gain access to that treatment was decidedly negative.  20% of respondents had wanted to harm themselves in relation to, or because of involvement with a NHS Gender Identity Clinic or health service.  The reasons listed included: Long waiting times and delays to treatment, restrictive protocols, inaccurate and unnecessary assessments, being denied treatment, being given the wrong information or advice, receiving negative or inappropriate treatment from psychiatrists, experiencing outmoded attitudes or questions/tests:

  • ‘…some things said to me at my last appointment (specifically that I should accept that my wife and daughters would be better off if I left them) upset me greatly. I left the Gender Identity Clinic on that day and sat in the car crying for over an hour. I decided there and then never to go back.’
  • ‘The Gender Identity Clinic…seemed to have very rigid ideas of masculinity and femininity and seemed to be adhering to a now outmoded medical model…with one my assessors asking me about sex positions, and how this ‘differed from heterosexual sex”‘
  • ‘The GIC expected me to be some stereotypical image of a woman rather than being myself’
  • ‘I experience the NHS GIC service as largely a paternalistic gatekeeping exercise where psychiatrists exercise inappropriate levels of control over the lives and choices of patients. They ensure compliance by withholding or threatening to withhold access to treatment… Having to negotiate the GIC system seriously hindered my transition. At many times, it has left me feeling angry, disappointed, manipulated, controlled and despairing. The system is deeply flawed.’

Summary of Findings

 Protective Factors:

-          Timely access to hormones and surgery

-          Social recognition of their gender

-          Professional understanding and support

 Risk Factors:

-          Untreated Gender Dysphoria (delays, refusals)

-          Minority stress (discrimination, harassment)

-          Unnecessary and intrusive questioning/tests

-          Prejudicial attitudes from service providers

-          Restrictive treatment pathways

Key Recommendations

Exploration of Alternative Health Care Models

There should be a shift towards models of trans healthcare incorporating informed consent and patient flexibility. This could be within the context of Gender Identity Clinics, however there are substantial issues within this system as it currently stands in terms of patient experience and outcomes. Many other models of trans healthcare are used globally and should be explored as alternatives. For example, the THInC model from Chicago (Trans Hormones Informed Consent) has very positive outcomes with the communities being fully engaged and involved in decisions around their healthcare. Informed Consent models are easily adapted to the UK health system (for example the T-PIC model; Traverse Research). These alternatives should be developed and researched to provide a valuable resource for informing true evidence-based practice focussed on enhancing outcomes, and in the process reducing costs.

 

 



[1] The Trans Mental Health Study 2012 – Jay McNeil, Louis Bailey, Sonja Ellis, James Morton and Maeve Regan (Equality Network; September 2012).