In this chapter I explore the impact of cultural constructions of gender and sexuality on women's and men's health. Drawing on work conducted in subsistence, industrialising and industrialised societies, particularly with women, I illustrate the ways in which sexual, reproductive and other health problems are influenced by ideas about and relations of gender and sexuality. Despite differences in social, cultural and economic contexts, women everywhere are subordinate to men to some degree. Their sexuality is controlled and their social value is tied to their reproductive abilities, both in terms of having children and maintaining the household. These factors influence women's abilities to care for their bodies and to control their fertility. The sexual meanings ascribed to women's bodies influence popular interpretations of the signs and symptoms of health and illness and affect help-seeking behaviour and access to health services and treatment, especially for ailments which might be construed as sexual. Gender also affects men's access to and use of health services in relation to sexual and urinary tract infections in many communities and for that reason, I include some discussion of men's as well as women's health in this chapter.

The social context of health and illness

While this chapter focuses on the social experiences of illness, care and outcome, at the outset it is important to note that the risk of infection and disease occurs through a combination of biological, social and structural factors. Changes to local ecologies by development programmes, patterns of population movement and settlement, water and sanitation, all affect the prevalence of vectors and microbes and, hence, influence the potential distribution of infectious disease for both women and men.

Defining maternity

Over the past decade, the literature on maternity and motherhood has expanded dramatically. This has occurred not as a consequence or reflection of medical professional and state concern for maternal (and infant) health, but rather in the context of social, economic and ideological changes within industrialized societies, resulting in changes in the institutional settings of motherhood, in government policies towards reproduction and in the social meanings ascribed to it (Crouch and Manderson 1993). Concurrently, feminist scholarship has turned from the initial problem of the role of maternity in denning femaleness to interrogating its place in the social relations between men and women and among women, the meanings with which maternity as experience and status are imbued, and the tensions and accommodations of reproduction and production institutionally and personally in different places and under different systems of production. A driving concern has been to understand the macro-processes involved in maternity and motherhood, and the links between biology, psychology and culture, as addressed and problematized by writers such as Martin (1987) and Butler (1990).

This has resulted in numerous studies into the behaviours, practices and values of maternity (childbearing) and motherhood – child spacing, experiences of pregnancy, childbirth, confinement, breast-feeding, sexual practice and abstinence during pregnancy and lactation, child care, the medicalization of childbirth and mothering, foetal diagnosis and monitoring, in-vitro fertilization, infertility, ‘late’ or older motherhood, single motherhood, surrogacy, the choice not to have children, miscarriage, abortion, fertility control, postnatal depression- a list that might be endless, as reproduction and motherhood are documented, scrutinized and analysed (see e.g. Davis-Floyd 1992; Hull and Simpson 1985; Martin 1987; Michaelson 1988; Mitford 1992; Oakley 1980; Stanworth 1987).

Introduction

The Eastern Bureau of the League of Nations Health Section was established in 1925 to collect and disseminate epidemiological information. Until February 1942, when Singapore was invaded by Japanese troops, the Bureau served a variety of functions; the receipt, compilation and dissemination of health statistics, quarantine procedures and other information related to the control of disease were only part of its wider role. Its functions included the co-ordination and review of scientific research; the provision of in-service training of sanitation, public health and medical officers through staff interchanges, study tours and from 1934 annual short-course training programmes for malariologists; and sponsorship of and participation in scientific conferences and symposia. Through these various activities, the Bureau helped to identify the primary public health concerns of the region, facilitate co-operation between individual researchers and research institutions, and develop public health expertise. Less easily documented, the Bureau also played a role in fostering a sense of common purpose among countries in the region. Its primary function and central activity, however, as noted, was the collection and dissemination of epidemiological information; this is the focus of this chapter.

The Commission of Enquiry in the Far East

Epidemic disease in East Asia was first brought before the Health Committee of the League of Nations (LN) at its second session in October 1921, when the Japanese delegate, Dr Miyajima, drew attention to the incidence of pneumonic plague in Manchuria and Siberia.