Medical Sexism: Contraception Access, Reproductive Medicine, and Health Care

As argued by Delston (Univ. of Missouri–St. Louis), wherever women seek contraception, systemic roadblocks and pervasive social barriers abound. This text examines the ways paternalistic values, and physicians holding them, block access to contraception by requiring costly and unnecessary pelvic exams, Pap smears, and other tests. Forced pregnancy care, policing of pregnancy, and obstetric violence are also considered. Although limiting contraceptive access is not standard practice in medicine, practitioners may not know or follow guidelines. To respect patient autonomy, ethical practice recommends providing free, universal access to reversible, long-lasting contraception. Delston provides vignettes to illustrate how systemic denial of contraception and abortion impose medical and moral harm on patients and the moral concerns that arise when pelvic exams are conducted, sometimes on unconscious patients, without informed consent. She further maintains that medical sexism is behind limiting access of trans patients to contraception and blocking women from participating in research trials, and that it also explains why clinical guidelines for mammography are ignored. Delston warns that such treatment infantilizes and violates women. As she acknowledges, screening has benefits, but if used to deny or delay access to contraception, it can harm women. This is an essential handbook for providers, historians, patient advocates, and health care faculty. Summing Up: Essential. All readers.

In her book Medical Sexism: Contraception Access, Reproductive Medicine, and Health Care, Jill B. Delston explicates the phenomenon of medical sexism and argues that it is uniquely capable of explaining current practices in reproductive medicine that would, in other contexts and for other patients, be deemed unconscionable. Perhaps the greatest contribution of this book, however, is the role it plays in consciousness raising for those of us most vulnerable to the effects of medical sexism.

Jill B. Delston’s Medical Sexism: Contraception Access, Reproductive Medicine, and Health Care offers an empirically and philosophically formidable affirmation of what many patients have long known or suspected: a hierarchy of maleness or masculinity over femaleness or femininity is regularly reinforced in US medical contexts. … This meticulously argued monograph shows that medical sexism is a serious systemic problem which entails harms and rights violations specific to patients who are (or have attributes associated with) women. Certainly, this text will appeal to readers with an interest in feminist philosophy, especially feminist bioethics. Delston’s book could do considerable good if put in the hands of health care providers, medical policy makers, and those who aspire to become either. This would be a profoundly eye-opening read for people who have never and will never themselves be under the care of an OB/GYN. This book can help equip patients and patient advocates to push back rather than capitulate when met with such reactions. For those who have experienced medical sexism firsthand, a reading of this outstanding book ought to underscore one fact above all: you deserve better. We all deserve better.

Delston’s book would be of interest to those in the field of feminist bioethics because she powerfully demonstrates how sexism underpins women’s health­care, including seemingly minor and well-intentioned practices like linking contraception to Pap smears. Delston brings to light yet another example of the pervasive, systemic nature of medical sexism.

Doctors routinely deny patients access to hormonal birth control prescription refills, and this issue has broad interest for feminism, biomedical ethics, and applied ethics in general. Medical Sexism argues that such practices violate a variety of legal and moral standards, including medical malpractice, informed consent, and human rights. Jill B. Delston makes the case that medical sexism serves as a major underlying cause of these systemic and persistent violations. Delston also considers other common abuses in the medical field, such as policy on abortion access and treatment in childbirth. Delston argues that sexism is a better explanation for the widespread abuse of patient autonomy in reproductive health and health care generally. Identifying, addressing, and rooting out medical sexism is necessary to successfully protect medical and moral values.

Jill B. Delston is associate teaching professor of philosophy at the University of Missouri-St. Louis.