Jennifer Block

Hey folks! Today we're going to set aside coronavirus for a moment and panic about a different health issue!

This got pushed up my to-read list by a single conversation in which I found out that several women I know have had hysterectomies--this major organ removal dropped casually into conversation as though it was even less of a deal than an appendectomy! In a matter of seconds, something that I'd assume was a last resort, primarily for women with malignant cancer, was something routine. How the heck is this acceptable?

Block went a good way to helping me understand the arguments made in favor of removing the womb and, of course, the lesser-known reasons NOT to remove it as well as alternative corrective surgeries and treatments. But the book covers way more than just hysterectomies. There's birth control, fertility, pelvic care, gynecology, pregnancy and delivery, abortion, and astroturfing of advocacy organizations, as well as an epilogue that touches on modern motherhood and the "fourth trimester."

Probably the most terrifying section, for me, was the one about pregnancy, given that I am starting to think about that in my future. Of course, Block has probably compiled all the worst possible scenarios and horror stories, and that's one of my two main critiques of this book: that there doesn't seem quite as much attention paid to the strides that we have made in women's health care. This was especially true in the chapter on birth control. Despite the under-reported negative side effects and lack of ongoing testing and refinement that we see in most medicines, the existence of birth control has transformed womens' lives. There is also a lot of emphasis on going natural, which Block does address at points, but we've already seen how, for example, that app that supposedly advises women on when they are and aren't fertile based on their temperatures is flawed. So it's important to remember that Block is making a persuasive argument and may be downplaying the number of average or even positive cases. Of course, it's also very possible (no sarcasm here) that I'm just raising this point because the patriarchy has pounded absolute respect for the medical establishment into me.

And that's one good thing that this book has already done for me: I had my annual barrage of doctor/dentist/OB-GYN appointments and I made sure to ask more questions than usual. Granted, I'm pretty healthy, so I didn't have to interrogate treatment plans much. But that's going to become a bigger issue for me in the near future, so I hope this feeling of wanting power over my own body continues to push me to question and hear all sides. That's why I think this book is immensely valuable for pretty much any women. Yes, there's a lot in here that's frankly terrifying--but this is our lives, and we shouldn't just settle if there's any chance of an alternative.

My second critique is related to this, and it's that the ethnicities of the women discussed is not always clear. I'm of two minds on this. Not mentioning ethnicity might make the discussion seem more universal. Though Block does emphasize, repeatedly, that black women and other women of color receive far worse abuses in health care than white women do, many white women who are probably the main audience for this book--and, potentially, the ones who are more likely to have the time, resources, and clout to push for change--might not feel the same urgency to interrogate what we know about health care if the impression is that none of this happens to white women (which, ugh, I hate that I need to say). But downplaying ethnicity 1) reinforces the tendency to think that white is the norm (at least, for white readers); 2) downplays the horror that so many women of color are being subjected to beyond-unacceptable care; and 3) makes it sound a bit as though all the alternatives and wide-ranging second opinions Block describes are available to all women when they might easily be out of reach.

It's hard to know whether _________.
[Well, will you look at that! Goodreads has a place where it saves unfinished drafts. When my review disappeared halfway through the writing, I thought it was gone forever. Now that I'm seeing this ages after I finished the book, I forget everything else I was going to say. Probable huzzah for any reader... Still, may as well put up what I'd thought I would.]

[Final note: I think the subtitle should have been "Why *Women's* Health Care Needs a Feminist Revolution." I guess that's implied by the bright pink arrow (and equally bright pink cover under the jacket), but I did actually expect a bit more intersectionality--and, since the title phrase is one I've only really heard applied to men before, I expected a few more comparisons of women's care to men's care. But I suppose that might have required a male coauthor.]

Quote Roundup

Yeah, no way is that happening. That amount of quoting is plagiarism, no question.

Disclaimer: I am an employee of the company that owns the publisher of this book, but my thoughts and comments are entirely my own.… (mere)

currently, I would not recommend this book to first time moms, because it paints kind of an awful picture of OB/maternity care. My first child came into the world in a typically "managed" manner, and I was and still am perfectly happy with the result. I'm interested to see how the rest of the book develops, but I don't expect the tone to be anymore positive toward the current healthcare norms. It's not that she doesn't present a good argument or have a lot of good information and research to back up her claims, but I do tend to be wary of anyone who is this extremely biased on any subject.

I'm fully admitting that I started reading the book while pregnant with my 2nd child and decided to stop reading it as a result of the anxiety I began to feel about my upcoming labor/delivery. I had begun projecting the stories and statistics from the book onto my wonderful OB and clinic staff who have been nothing but caring and supportive to me. I'd like to finish the book one day.… (mere)

***NO SPOILERS***

It's been reported that doctors dismiss female patients while taking seriously male patients. For instance, doctors are more likely to miss symptoms of heart disease or heart attack in women than in men. Jennifer Block’s argument is that a feminist revolution in medicine is very needed, but that’ll only happen when the medical establishment genuinely values women; when women are more empowered; and when they're allowed to have a larger say in their care. Doctors need to check their egos at the door and not just allow women to be proactive in their care but welcome and respect it. As this title suggests, Block focused specifically on care of the female reproductive system, a focus that allowed her to illustrate her point--that the medical field is sexist--most effectively.

The female reproductive system covers a range of sub-topics, and Block laid out the facts thoroughly and specifically, with generous citing of studies from numerous reputable medical journals. Covered here is routine gynecologic care, hormonal birth control, infertility treatment, abortion, pregnancy, and childbirth. Her presentation is especially good. This topic has the potential to be complex and dry, but Block wrote engagingly, smoothly transitioning from one related topic to the next. I was gripped from the first page. It’s hard to believe medical care for women is really that dysfunctional until seeing the problems articulated in stark black and white--and this is only pertaining to the reproductive system. The reality is grim, and the real-life profiles illustrate that well.

Errors in female reproductive care can be catastrophic. The trans-vaginal mesh (used to treat incontinence) and permanent birth control Essure have destroyed the quality of life of countless women and should never have been released. The more serious side effects of hormonal contraception are shamefully downplayed. A surgical instrument called a morcellator is convenient for surgeons but can be lethal if the tissue mass it's used on is cancerous. Far too many unneeded cesarian sections are performed each year. In some hospitals, 50% of babies are born via C-section. C-section is a major surgery with serious risks, but it’s fast for busy and impatient obstetricians. The phenomena of unneeded C-section has made it into news media, but Block deftly broke this down to get to the heart of why.

Also overdone are complete hysterectomies as a cure for painful endometriosis, Polycystic Ovary Syndrome, and fibroids. Hysterectomy is the second most common surgery in the U.S. after C-section when it should be a last resort. Right after the loss of a uterus and ovaries, women are sent into full-blown menopause, and often their sexual function is forever damaged. Relating to this, Block pointed out that a female equivalent to Viagra doesn’t exist. Women’s sexual enjoyment isn’t prioritized the way men’s is.

On the topic of abortion, Block advocates for something radical: self-administering abortion. She detailed how the abortion procedure is fairly simple, and women can actually do it safely themselves if they’re taught. Additionally, midwives traditionally provided a full range of gynecologic care, not just pregnancy monitoring and delivering of babies. They’re qualified to perform abortions, just not licensed. Block believes that midwives, with their concern for the emotional well-being of their patients, are a more attractive option than the usually stoic and impersonal abortion clinic.

I would have liked to hear more about racism in medicine. Block addressed the issue, but it looks like it warrants a chapter of its own. Black women and women in the southeast of America are more likely to get hysterectomies--and not because they have more risk factors. They also are more likely to get C-sections. In every aspect they’re especially poorly served or under-served; however, most interesting, and disturbing, are gynecology’s roots. Pioneering gynecologists in the South experimented, without anesthesia, on slave women, giving the field roots in the institution of slavery. Physicians in the North were reliant on poor immigrant women, mostly Irish, for their unanesthetized experimental surgeries.

I’d improve this book in one small way: adding illustrations. I was particularly curious about the morcellator. I really wanted to see this device while reading about the disasters it can cause. I needed a visual of the device for self-administering abortion even more. Block explained that in detail, but I didn’t trust the image in my head. The same is true of Essure and the trans-vaginal mesh--what they look like and how they malfunction to cause irreparable damage.

What I’ve reviewed here is but a tiny fraction of what’s in these pages. With Everything Below the Waist, Block has made a significant, and especially well-timed, contribution to the subject. While right now much-needed attention is directed at sexual harassment and sexual assault, sexism in medical care doesn’t get all the attention it deserves.

Because Everything Below the Waist includes statistics, reading it now, while those are up-to-date, is ideal. Additionally, women are the obvious audience, but I urge men not to dismiss this book assuming it’s information they don’t need; on the contrary, there’s no reason men shouldn’t be just as informed and fight for equality in medical care. It goes without saying that medical professionals must read this.

Complementary documentaries: "At Your Cervix," "The Bleeding Edge," “Orgasm Inc.,” “In Our Control,” and "Eggsploitation."

Complementary articles: “Women Tend to Receive Disease Diagnoses Years Later Than Men Do, New Study Says” https://people.com/health/women-receive-diagnoses-years-later-than-men/

“Inside the Quietly Lucrative Business of Donating Human Eggs” https://www.wired.com/story/inside-lucrative-business-donating-human-eggs/

NOTE: I received this as an Advanced Reader Copy from Goodreads in March 2019.… (mere)