The purpose of this course was to analyze how gender intersects with cultural models of sickness and health within the human body. Through the content of this course, I have learned how to analyze different aspects of women’s health that play a role in different societies. We have seen that the health issues discussed in this class aren’t always just societal issues, but are commonly deeply rooted in a cultures environment, religion and politics, along with their specific cultural practices. For this final project, I have spent the last eight weeks researching how post-traumatic stress disorder (PTSD) plays a role in Peruvian women’s overall health. Through my research, I found that Peruvian women experience high prevalence rates of PTSD, or have the characteristics for developing PTSD, that stem from numerous life events that they will encounter. For this project, I will be looking at this issue through a critical medical anthropological perspective.
As I stated, women in Peru often experience high rates of PTSD. A study conducted by Levey et al. (2017) studies pregnant women in Peru, specifically to estimate the prevalence of antepartum PTSD symptoms, as this is just one factor that is known to bring about PTSD in Peruvian women. This study also examines how the women’s past traumatic experiences play a role in their onset of PTSD after pregnancy. From this article, we see that PTSD symptoms are higher during pregnancy, which often lead to negative maternal and infant health outcomes (Levey et al. 2017). From their study, they found that out of the 3,372 pregnant women interviewed, 2,920 reported they had experienced one or more traumatic events prior to pregnancy. 41.8% of these women had met criteria for PTSD, and a quarter of participants had reported experience with four or more traumatic events, and 60.5% of these women had PTSD (Levey et al. 2017). Often, this traumatic event(s) are sexual assault or rape. If the women were sexually abused, the body changes and sensations that is a result of pregnancy can trigger flashbacks of the abuse, as does obstetrical and gynecological care during pregnancy (Levey et al. 2017). My interpretation of this was that having someone inside of them and having their reproductive organs constantly examined throughout pregnancy puts these women into a state of stress, and reminds them of the time that they were sexually abused. While only 3,372 pregnant women were assessed in this study, more than 75% of these women had been through a traumatic event, which is an extremely high amount- and these findings are generalizable to the pregnant Peruvian population, not to all women in general, so I can imagine the overall rate of traumatic events and PTSD symptoms/diagnoses for the entire women population would be very high. The prevalence of PTSD symptomology in this study population was 36.2%- more than four times the lifetime prevalence that has been reported not just in the United States, but globally (Levey et al. 2017).
Another study I examined looked at a different cause of PTSD, which sent the prevalence of PTSD even higher after an 8.0 magnitude earthquake struck the city of Pisco, Peru. In this study, 298 adult earthquake survivors were interviewed and found that 75 of these survivors had PTSD, which is a prevalence of 25.2% (Cairo et al. 2013). In their analysis, they found that female sex, food and water shortages from the earthquake, loss of church, injuries to themselves or loved ones, and low levels of support from loved ones were associated with PTSD, and found that PTSD affected a quarter of Pisco’s population overall (Cairo et al. 2013). Again, this article doesn’t directly examine all Peruvian women exclusively, but the idea that PTSD effects 25% of a city of Peru is major, and women are definitely included in that percentage.
Marta B. Rondon (2009) wrote an article discussing the mental health issues and disorders that we see in a lot of Peruvian women. Most women report feelings of unhappiness and pessimism, and she includes that interpersonal violence plays a huge role in the production of psychiatric morbidity (Rondon 2009). It is noted that gender-based violence is widely tolerated, and most of that violence is toward women. According to a study done by the World Health Organization, women in the Andean region of Cusco, Peru are the most physically abused women in the world, with women in Lima, Peru, not too far behind. While these feelings and abuse don’t automatically give women a diagnosis of PTSD, not getting mental health help for their feelings or to overcome the abuse, contributes to a diagnosis of PTSD. Peruvian women don’t have very good access to mental health help. There are some psychiatric hospitals located in Lima, which make up 75% of psychiatric hospitals, but there are other hospitals with beds for psychological help in Piura, Arequipa and Iquitos (Rondon 2009). There is no mental health care at the primary level. Those needing mental health care have to travel far distances to these cities that have psychiatric hospitals, which stops a lot of people from seeking mental health services. The unavailability and inaccessibility of mental healthcare is the most important human rights and public health issue in Peru, Rondon (2009) argues. Not receiving help or support for the issues these women have experienced let their experiences and thoughts linger with them, let them potentially develop PTSD.
Levey et al. puts another perspective into why there is a such high prevalence of PTSD in Peruvian women. For decades, Peru has been a country affected by numerous acts of terrorism and violence by a communist group which is seeking to over through the existing Peruvian government, which led to internal conflict between the country. Between 1980 and 2000, 69,280 victims were killed due to this internal conflict, which only contributes to their culture of violence and trauma (Levey et al. 2017). PTSD is an outcome of all of this trauma and terrorism, which is deeply rooted in their culture and their political affiliations within the country.
Critical medical anthropologists ask questions looking at the inequalities and political, economic and social power leading to a better or worse outcome for specific people. They also believe that politics and social issues are important factors of human health. I chose this theory to look at PTSD among women in Peru because I believe Peru’s culture is full of inequalities towards women that there are huge political, social and culture factors that come into play when looking at the prevalence of PTSD.
Education is also a very important key that plays a role into PTSD diagnoses. Findings from numerous studies show a positive association between maternal education and child survival in developing countries. If a woman is educated, she can better understand the use of modern health-care services, and alters their beliefs about disease causation and the cure for these diseases. Schooling is seen as an enhancement in the mother’s ability to communicate with health-care providers and increases the value she places on good health, which results in a higher demand for good modern health-care services within the country (Elo). This is definitely important because if women do seek help, they may not even be able to comprehend what is being told to them. Educating women would alter the way they see the violence they endure, and would know what this is doing to their health. This is yet another economical and societal problem, because women should have the same access to education that men do. If women were educated, perhaps the lack of mental health care wouldn’t exist, because they would demand access to these resources to promote the quality of overall health.
One factor is that women in Peru don’t get the same access to schooling, jobs or any kind of resources outside of the human like the men do. Because of this, women often report feeling unhappy and less-than compared to the males. On top of these already existing feelings, women who live in Cusco, Peru are the most physically abused women in the world, with Lima, Peru being a very close second. This abuse is widely tolerated in society. This societal and cultural view of women being less than and having restricted access to learn that the abuse isn’t okay, how to defend themselves, and how to cope with these abuses when compared to men, also account for a lot of their PTSD diagnoses. This is definitely an important social issue, because clearly women are thought to be less than in comparison to men.I could also argue that social exclusion plays a role in their determinants of health. Women are so socially excluded from education and employment opportunities compared to men. The community would rather give an educational opportunity to a male than a female, and women aren’t really allowed a social life, since they mostly sit at home and take care of the children, clean the house, and prepare meals. They’re expected to endure abuse, they’re expected to receive educational or career opportunities as a second choice, they’re not meant to travel outside of the home or take advantage of the little resources Peru has to offer them. There is no mental health care at a primary level, so women in Peru often have to travel very far distances into different cities to seek mental health care at a psychiatric hospital. Even if they are aware of the help out there for them, and are willing to take advantage of it, many of them still can’t have access to it because of the distance. These women are suffering because of lack of access, and that is something that is an economic factor that plays a role in such high PTSD rates in Peru. The economy doesn’t allow more available resources. If women had easier access to mental health care, they may be able to cope with or overcome their issue before it becomes a full-blown PTSD diagnosis. According to the article by Bonnefoy et al., the unequal distribution of the social determinants of health produce inequalities in health (Bonnefoy et al. 2007). I think that the lack of access of mental health clinics is definitely an unequal distribution of social determinants of health, since we see that social and emotional support is a determinant of health. If they can’t turn to their peers or government because they condone the behavior that they are experiencing, then they should at least be able to have the access to talk to someone who is able to give them the social and emotional support they need.According to the World Health Organization, those that lack social and emotional support from others are more likely to experience a lesser well-being feeling, along with higher rates of depression (WHO 2003). The WHO also mentions that it’s suggested that good social relations can reduce the physiological response to stress (WHO 2003). All of these articles make it clear that PTSD is a social problem in Peru, but it is not just a social problem.
Peru is also a country with very high amounts of terrorism acts and inner-city violence. A communist group is trying to over through the current Peruvian government, and by doing so, is often causing a civil war within the country. Due to this, the citizens of Peru are often exposed to severe amounts of violence and they get to not only live in a war filled country, but they get to see first-hand some of the effects of war. This type of violence causes a lot of women to develop PTSD. This PTSD prevalence is due to the social power and political power making it worse for all citizens in Peru. Peru is also prone to natural disaster’s due to its location in the world. After an 8.0 magnitude earthquake struck Peru, a lot of the Peruvian citizens were left with PTSD after losing fresh water, food, shelter, being separated from family members, and even the death of close friends or family. This PTSD stemmed from not having enough structural support as a country to be able to survive without serious struggle after a disaster such as this one. This is impacted by structural and political power, because the government should have planned for instances like this and had some kind of plan instead of letting all of these people struggle without fresh food, water and shelter.
We see that PTSD effects the women’s mental health, emotional health, psychological health, and has effects on the infants’ health during pregnancy. In terms of the earthquake, these people were left with food and water shortages too, which can also effect a person’s physical health- only adding more stress to the current PTSD diagnosis or symptomology. They are also regions in Peru with the most abused females in the world, and they have no mental health services available to them, making this a serious public health issue. Women in Peru’s society are constantly seen as less than the men in society. All of these are components of societal structures, cultural structures political structures and environmental structures. I can definitely see that in Peru, cultural, political and social structures are deeply embedded with inequality towards women, not giving them the same support, access, education or health treatment that men would be able to easily acquire, which is why I chose the critical medical anthropological approach. “Critical medical anthropology advocates took a materialist approach – one that prioritized the examination of power structures that underlay dominant cultural constructions and questioned the ways in which power” (Singer & Erickson 2013.) I think this quote is perfect, because the issues in Peru that lead to these PTSD diagnoses are power structures. Whether that ‘power’ be literal like the government or figurative, as in the men who hold all of the power socially, it definitely makes you question the way in which ‘power’ is playing against the women in Peru. PTSD is absolutely a social, political and cultural problem that plays an outstanding role in the health of women in Peru.
Bonnefoy, Josiane, et al. “Constructing the Evidence Base on the Social Determinants of Health: A Guide.” National Institute for Health and Clinical Excellence, Nov. 2007
Cairo, Javier B., et al. “The Prevalence of Posttraumatic Stress Disorder Among Adult Earthquake Survivors in Peru.” Cambridge University Press, Disaster Medicine and Public Health Preparedness , 1 Apr. 2013, www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/prevalence-of-posttraumatic-stress-disorder-among-adult-earthquake-survivors-in-peru/07E3858207AB8B9F596D6DD93CE0DE21.
Elo, Irma T. “Utilization of Maternal Health-Care Services in Peru: the Role of Women’s Education.” Health Transition Review, vol. 2, no. 1, 1992, pp. 49–69. JSTOR, JSTOR, www.jstor.org/stable/40652032.
Levey, Elizabeth J., et al. “Trauma Exposure and Post-Traumatic Stress Disorder in a Cohort of Pregnant Peruvian Women.” The National Center for Biotechnology Information, U.S. National Library of Medicine, 13 Sept. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5849493/.
Rondon, Marta B. “Peru: Mental Health in a Complex Country.” International Psychiatry , vol. 6, no. 1, Jan. 2009.
Singer, M., & Erickson, P. I. (2013). A companion to medical anthropology. Chichester [England: Wiley-Blackwell.
Wilkinson, Richard, and Michael Marmot. “Social Determinants of Health: The Solid Facts.” Anthropology MSU, World Health Organization, 2003, anthropology.msu.edu/anp270-us18/files/2015/05/Soc-Determs-of-Hlth-the-solid-facts-WHO-2003.pdf.