The Effect of Popular Culture on the Medicalization of Women’s Health

1. Context

Many factors, such as the development of modern medicine, progress in health technologies, and changes in the body perception of individuals, have led to the emergence of the concept of medicalization. Medicalization is defined as explaining and understanding a non-medical condition or problem in the context of medical terms, leading to responding via medical interventions. Historically, medicalization is assumed to play a more important in women’s life cycles (1). Especially throughout Western history, in societies dominated by patriarchy, women’s natural life processes had been presumed different and inferior to men’s, and this situation was thought to be related to differences in male and female reproductive processes, sexuality, and endocrine functions. In this situation, the concept of the manipulation of a female body as a control area emerged (2). In studies on women’s and men’s health, women are defined as patients, and this has contributed to the emergence of the sexist ideology of medicalization. Conditions such as menstruation, premenstrual syndrome, pregnancy depression, childbirth, motherhood, postpartum period, sexuality, menopause, and eating disorders are medicalized because they are positioned as diseases that need to be treated. These situations show that medicalization is mostly entangled with women’s health. Parameters such as more commonly attributing the concept of disease to women, feminizing diseases, and tending to execute more control on the female body than the male body has caused women to have a more active role in the medicalization process. However, in recent years, it has been observed that factors such as reaching the ideal body, old age, and andropause have increased the rate of medicalization in men. It is an undeniable fact that the media, which is increasingly used today, and popular culture can have a role in the tendency toward medicalization in both women and men (3).

Regarding the definition of popular culture, one can not emphasize only a single concept. According to one definition, popular culture is defined as “the whole cultural items that are validated, produced, and consumed quickly in a certain period of time” (4). In another definition, popular culture is defined as “the culture adopted by broad masses of people”. The common point in these definitions is that they can appeal to everyone regardless of their social class; they do not require special education or etiquette and are ordinary. In short, popular culture emerges as a phenomenon that is imposed on populations and individuals, provides short-term pleasures, and is consumed by society (5). Although the history of popular culture dates back to ancient times, it has gained importance today as a result of an increase in the use of media, especially in the context of advanced technologies. Today, media is considered an important concept interacting with culture. The media reflects popular culture in terms of content and form and also plays an important role in the formation of popular culture. Social media is considered one of the most important communication tools of popular culture due to its wide accessibility and interactions (6).

With the spread of popular culture, in which the media plays an important role, there has been an increase in different perceptions towards women’s bodies, causing some situations related to women’s life cycles to be regarded as diseases, pushing women to seek medical help, which promotes medicalization. We found no review on this matter in the literature, and in this review, we aimed to discuss the effect of popular culture on medicalization in women’s health. This review is considered to contribute to the future studies.

2. Evidence Acquisition

2.1. Medicalization and Popular Culture in Different Life Stages of Women

The medicalization of women’s health can emerge in a wide range of dimensions, such as menstruation, premenstrual syndrome, pregnancy, birth, plastic surgery, abortion, family planning, psychological conditions, menopause, and obesity, throughout their lives. The natural life processes of women have been medicalized throughout history (7), which has been associated with the propagation of various medical problems. Today, the “medicalization of women’s health" has turned into a popular trend. In fact, even normal life experiences of women have begun to be merged into the medicalization process. Women are becoming extremely important buyers of a wide range of health products with the perception of being responsible for their own and their families’ health, leading to the medicalization of their bodies and normal life processes. Women’s bodily issues and normal life processes have been brought to the agenda of the medicalization process, and this has led to the reproduction of gender stereotypes (8). In fact, the medicalization process may engulf not only the conditions that are not regarded as a disease but also the events that occur in daily life as a disease. Under the influence of popular culture and transforming perceptions toward women’s bodies, health and beauty elements have also begun to be medicalized. One of the best examples that can be given in this field is cosmetics and aesthetics (9).

Popular culture is one of the most important elements, making the body a consumable object and nurturing different meanings to women’s health. In the context of popular culture, the image of femininity is integrated with family, love, and sexuality, while money, occupation, and travel are defined as distant areas. In today’s popular culture, beauty is assumed to be the most important necessity for women. According to this perception, a woman is accepted and thought to be liked when she has long legs, bronze skin, thin, vigorous looks, a healthy body, and fashionable hair and clothing. These necessities demanded by the popular culture cause women to use aesthetics, cosmetics, and drugs during their lifetimes, pushing them into medicalization (3).

2.2. The Effect of Medicalization and Popular Culture on Menstruation

Menstruation, which is one of the natural life processes of women, is perceived as a nuisance, embarrassment, or something to be suppressed or hidden due to sociocultural factors. Among the reasons for women to hide their menstruation are to ensure femininity, the perception of menstruation as dirty, and the patriarchal perception of women’s bodies as being clean, sexually attractive, and not disturbing (10). A medicalized perception is created when menstruation is presented with a medicalized perspective, especially for girls before puberty, leading to the gradual medicalization of the menstrual cycle (11). The fact that with the assistance of technological developments, women can now suppress the menstrual period using birth control pills has shifted the appearance of menstruation from a natural process to a pathological condition (12). With the medicalization of menstruation, women may perceive themselves as inadequate, sick, or ill, who need medical treatment. Therefore, menstruation is adopted as a “health" problem in the context of medicalization.

The concept of menstruation has been discussed in the media and popular culture. Especially in the media, re-menstruation is described as cyclical and regular, warning against certain behaviors that can upset the balance of this cycle. Thus, women are encouraged to take the necessary measures to prevent any condition leading to menstruation from being perceived as a medical disease requiring interventional actions (11). In addition, media-assisted propagation of the idea that women’s concealment of their menstruation will provide them with freedom has created a new consumption area and reinforced the idea that menstruation is an unhealthy condition that girls and women need to protect themselves and others against which by referring to “female hygiene" and “sanitary protection". Menstrual product advertising and direct-to-consumer (product) education reinforce (bio) medicalization and embody women’s need to hide their menses. These products are marketed to girls and women as convenience and “freedom” from their bodies, reflecting how successful they are in hiding their menses. By using an approach that encourages women to hate their bodies during their menstrual periods, women are prepared to feel guilty (Wood, 2020) (10). All these perceptions and factors favored by popular culture and media can push women toward medicalization during menstruation.

2.3. The Effect of Medicalization and Popular Culture on Childbearing

With regard to women’s health, childbirth is one of the most medicalized areas. After the first use of forceps and chloroform, many interventions, equipment, and methods have been used to facilitate childbirth. Over time, birth has been defined as a risky process, so medical interventions started to be assimilated into obstetrics as a necessity (7). Today, birth is seen as a more risky event than it used to be, so medical interventions are considered normal. Some women who see childbirth as a risky event do not have sufficient education and knowledge on this subject and believe that cesarean deliveries are safer than vaginal deliveries. In the current literature, medicalization of labor may be regarded as the use of forceps, vacuum, blood transfusion, episiotomy, and cesarean section, but it is recommended that the use of these interventions should not become routine, sparing them only for necessary situations when maternal or neonatal health is compromised (13). The World Health Organization (WHO) has recommended that labor induction should not be performed without a clear medical indication because of the risk of uterine hyperstimulation, rupture, and fetal distress. In addition, the routine use of electronic fetal monitoring, routine active care management, and episiotomy without indication is not recommended (14). With an increase in the medicalization of childbirth and technological advances, pregnancies are increasingly monitored, managed, and often terminated using medical interventions. The medicalization of childbirth undermines the mother’s ability to give birth naturally and adversely affects the labor experience for her. The use of fewer interventions improves the quality of care during pregnancy and childbirth, increasing women’s satisfaction and making childbirth a safer experience (15). The use of cesarean section has been reported to increase globally, which currently accounts for more than 1 in 5 (21%) of all births, in a study by the WHO. In addition, this rate is expected to continue to increase in the next decade, reaching approximately one-third (29%) of all births by 2030 (16). In Turkey, the rate of cesarean section has been reported to be influenced by various factors, including the preferences of and referrals by physicians, the desire of mothers, perceiving cesarean delivery a safer, more comfortable, easy, and painless modality, the reluctance of pregnant mothers to experience pain, mothers’ fear of natural labor, anxiety, the desire for tubal ligation, the ability to plan the birth date, the advanced age of the mother, high socioeconomic status, high level of education, history of previous cesarean section, physicians’ concerns over legal issues in case of complications during vaginal delivery, limited availability of painless delivery options other than cesarean section, the increasing rate of preterm and multiple pregnancies due to assisted reproductive techniques, the widespread use of ultrasound and antenatal fetal monitoring leading to the diagnosis of fetal distress, a decrease in parity, the mother’s occupational concerns, the impatience of expectant mothers to accomplish childbirth more quickly, and perceiving the baby as a precious creature. All these factors have partly contributed to the increase in cesarean section deliveries (17, 18). In another study conducted in Turkey, the rate of cesarean section was found to be 51.2% (19). In Sweden, one of the Scandinavian countries, although technological and media coverage is at a higher level than in many countries, a tendency toward cesarean section is lower, which is believed to be related to positive attitudes and beliefs toward natural childbirth and related initiatives. Among these initiatives are the promotion of natural childbirth, management of birth-related anxiety, adaptation of a multidisciplinary approach, and provision of effective care by midwives (20).

In the media, which is one of the most effective means of communication and spreading popular culture, natural childbirth should not be displayed as a risky, dramatic, and painful experience. The media plays an important role in shaping women’s decisions on the method of childbirth, their expectations, and choosing the place for giving birth. The media’s moving in the opposite direction is partially responsible for the increase in the rate of intervened births (21). In popular culture and in a fictional virtual environment, the medicalization of birth is portrayed as normal or even necessary, where women play a passive role in the birth process. Even most physicians and midwives found the media’s portrayals of birth realistic. In many popular cultures, birth is depicted as a sudden event characterized by the leakage of the amniotic fluid. In real life, however, about 85% of pregnant women feel contractions before membrane rupture. The labor generally progresses so fast that mothers barely enter the birth area before they feel the urge to push especially first-time mothers. Women with an upright position feel less pain and, despite being warm, give birth on the back without moving while their knees are raised (the common position in hospitals). However, such scenes still become highly medicalized, causing the birth to be perceived as a non-natural process that requires the support of medicalization, affecting women’s birth experiences in hospitals and the extent to which mothers maintain social control during their labor (22, 23). Popular culture can instill the perception that childbirth is too medicalized and scary, medicalized delivery is normal and safe, and women in labor should use painkillers or undergo a routine cesarean delivery (24).

2.4. The Effect of Medicalization and Popular Culture on Aging and Menopause

Menopause and old age play an important role in a woman’s life cycle. Many diseases become more prevalent with aging. However, aging is not a disease (25). Menopause, on the other hand, is defined as the end of the menstrual cycle of a woman and the cessation of ovulation due to decreased estrogen production in the ovaries. Menopause is socially shaped and comes with a range of bodily changes, and accepting these changes is crucial to having a positive experience of menopause. Indeed, a healthy transition in this phase is key to having a better quality of life and a healthy aging process in the long run. Describing menopause as a hormone deficiency that requires management leads to its medicalization (26), in which menopause and its symptoms are regarded as a disease that needs to be treated with hormone replacement therapy (HRT), pushing women into medicalization. It is believed that the medicalization of menopause reinforces the notion that women’s bodies are inferior to men’s. It should be noted that although medical aids may alleviate some symptoms of menopause, they may also expose women to unknown risks (27, 28).

When aging is subjected to medicalization, the relevant bodily changes also become a target for medicalization. For example, anti-aging cosmetics have started to become a frequently used term among others (botox, laser skin treatments, etc., for aged skin, liposuction, eyelid rejuvenation, facelift, etc., for aging faces) (29).

Less attention is paid to menopause and aging in the popular culture, in which most of the focus is directed toward youth. Much of the talk about menopause in popular culture is negative and often serves as a way of mocking women for fun. Menopausal women are described as old, tired, depressed, and irritable (30). In popular culture, older women are generally held in the background and portrayed as less significant than men. The reason for this is that menopausal women lose their reproductive ability and move away from the role of motherhood. Another reason is the perception that women’s sexuality declines as they get older. The idea that women will become less sexually attractive after menopause-related physical changes is prevalent in popular culture (31). These depictions drawn by popular culture and the focus of the media on beauty can create a negative perception toward menopause among women, leaving them scared of aging and leading them to take anti-aging measures, exaggerating the medicalization of menopause and aging in women.

2.5. The Effect of Popular Culture on the Perception and Medicalization of the Female Body

Today, the female body has become the focal point of consumption culture under connotations such as housewife, businesswoman, beauty, sexy, and aesthetic. The female body, which is juxtaposed with concepts such as youth, beauty, sexiness, delicacy, and aesthetics, has been subjected to medicalization (32). In general, most societies give great importance to the female body and beauty, pressuring women to be beautiful if they want to live a more fulfilling life. Beauty plays an important role in defining the gender role of women and is thought to be a main feminine concept with regard to physical appearance. As a result of aging, wrinkles, sagging, and hair loss gradually appear in the female body, which needs to be resolved from the perspective of medicalization. Today, cosmetic applications are finding their way more and more into medicalization regarding ever-changing technologies (33). According to the data published by the International Society of Plastic Surgery (ISAPS) in 2020 on the rates of cosmetic surgeries performed on women, the first place belongs to breast augmentation with 1.6 million, liposuction with 1.3 million, followed by eyelid surgeries, abdominoplasty, and rhinoplasty (34). Over the years, achieving desired body measurements (“90 - 60 - 90", “38 size", “0 size", “ideal weight", and “55 kilos"), which has an important place in the body perception of women, has started to demand medicalization. However, many individuals with incompatible genetic signatures fail to naturally obtain normalized weight and body measures, forcing them to use the power of medicine to reach these normalized targets (33).

In recent years, popular culture has become more widespread and has increased its influence, imposing negative impacts on body image, especially among women (35). Women’s bodies, attractiveness, and beauty have been the center of feminine discussions over the years, causing the female body to be overviewed and controlled by medicine in order to reshape the female body according to changes in popular culture and in the perception of the female body (36). The mass media has a substantial role in the construction of popular culture, especially through advertisements, press, films, social media, etc., and in propagating the ideal body appearance. In addition, besides continuous body care and the use of cosmetics, women are largely encouraged to seek medical help to nail the ideal body (3). Women are manipulated by the perception of beauty propagating through the media, where popular culture is predominant, so they try to change their bodies accordingly. The misperception that popular culture icons have perfect and proportionate bodies and smooth skin may cause women to dislike their own bodies (35). The ideal body perception created by popular culture can negatively affect women both psychologically and socially, pressuring them to seek medicalization.

3. Conclusions

Today, along with technological advances, great transformations have taken place in the fields of health sciences and information technology, affecting societies mentally, psychologically, and physically. Although advances in health sciences are expected to offer benefits such as prolonging life expectancy and eradicating many diseases, in some cases, these transformations have led to medicalization, especially with regard to women’s life elements (menstruation, childbirth, menopause, etc.), affecting the patriarchal structures they live in during these periods. The perception that women can become weak and easily sick has caused medicalization to focus more on women than on men. Bodily changes that are physiological in women are increasingly perceived as diseases, and they are tried to be medicalized. Popular culture is thought to have an important role in this area. The media and mass media can especially play an effective role in shaping and constructing popular culture and perceptions of women’s health. They can also impose pressure on women and lead them to medicalize their preferences more and more in their lifetimes, which can bring along dangerous outcomes. Therefore, this pressure imposed on women by popular culture should be terminated and replaced with positive perceptions. Women should be enabled to love themselves and their bodies as they are and must avoid medicalization unless necessary.