Transcript: The complex world of women's health: with guest Kris Teow

Onya: Hi folks Onya here, Happy International Women’s Day. This is a special episode to celebrate women all over the world. And today’s topic touches on an issue that many women can relate to. Imagine yourself at work, and you have a number of tasks to complete before the end of the day. 

Speaker 1: I’ve got so many things on my plate right now. I have to submit this report to my boss as soon as I can. I have to help my child who is struggling in his math class. I have to organise my father’s 80th birthday party because my siblings are all busy. 

And at the same time, I have such intense period pains every month. 

I don’t know if this is normal or not. And I don’t know what to do about it. Who should I talk to about this? Will doctors believe my pain? Who can support me through this? After all, every other woman goes through this. I must be strong. I mustn’t let it take over my life. I have a meeting soon. I must control this pain. And I must do well in my presentation. What would the people in the office think about me? 

Ready for the meeting. What’s happening? Numerous factors shaped the approach societies take towards women’s health. With cultural norms, gender roles and stigmas standing out as particularly influential aspects. 

Manolo: Join Onya and Kris in this episode, in which they discuss the significance of unique circumstances and cultural aspects regarding woman’s health. This conversation is based on Kris’ recent research, prosperity in women’s health, a qualitative study of the experience of Malaysian corporate women. 

Onya: Hi, everyone Onya here. Welcome to another episode of Life of PIE. My guest today is Kris Thiele. Kris is an MSc PIE alumni from the 2022 23 cohort. She is passionate about women’s health as well as equality, diversity and inclusion issues. Kris works at the Ford Institute, an organisation focused on strengthening leadership for positive impact. And she is a part of the partnerships team. You can find out more about Kris in our show notes. Hi, Kris it’s so lovely to see you again. Post dissertation. How do you feel? Hi, Onya, definitely great to see you in person post dissertation. I feel great. I’m happy to have completed my dissertation. It’s a beautiful sunny Friday today. Working in London, so no complaints. Great. Great. So for your dissertation, you did a really interesting study on how women’s social roles, impact on our health practices and the outcomes. I want to start with this question. When we think of women’s bodies, what comes to mind? 

Kris: That’s a great question. And I think that’s something that would be good for us both to dialogue on. So for me personally, when I think about women’s bodies. And through the dissertation as well, I realise that people almost always go to weight, they think about oh, this person looks light this person looks heavy. So when we think in those kinds of frameworks and perspectives, we’re thinking that women don’t get to take up a lot of space. Women should be small women should be petite women should be, you know, tiny. So that’s immediately when I think about when I think about women’s bodies. And beyond that is through my dissertation I learned as well through this researcher called Marsha Inhorne is the cultural construction of women’s bodies, right. And that will be different in different contexts, different countries. So for example, in the UK, when it comes to women’s bodies, we think about it in a more empowering way. But whereas where I come from in Malaysia, where we are a Muslim country, we think about how we can cover up our bodies, how we shouldn’t show, you know, specific areas of our bodies. And that becomes this relationship you have with your body becomes sort of a way for you to contort yourself into this system within which you sit. Right. So today, how can I show up as a woman in the UK I feel more empowered, do I feel equally empowered in Malaysia, for example. So that’s, it sounds quite nuanced and complex, and I feel it’s quite different when it comes to sort of different contexts that we think about when we think about women’s bodies. And I’d like to actually throw that back to you on how you think about that in your own context, as well as your context of research. 

Onya: That’s a great question, Kris. And I didn’t see that one coming. But here we are. So what comes to mind? When I think of women’s bodies? It’s backgrounded for me, in that it’s not, I don’t want to say it’s not a priority. But what I would say is, it doesn’t come to the forefront until your period comes right? Do you see what I mean? Because now, now it gets your attention. Perhaps when you’re in if you’re in pain, if you’re experienced pain, or if you experience some of the other symptoms, like acne, bloating, and it really stands out, when you have a meeting, you have to be at work, but at the same time, you’re experiencing intense pain, which you have to power through, or you take some medication, which I tend to do to help minimise the pain. So there, it stands out significantly. But once that, once that goes, once you get to the end of your period, then it’s almost like back to autopilot, or not really thinking about my body. The other thing that comes to mind when I think about the body is how you present yourself how you present the body in public, this feeds into the huge industry. And all of the products that are, you know, that we’re told to buy to look good, you know, you need this to look good, your teeth should be whiter. But coming back to the feminine, you know, you need that mascara or that foundation or that lipstick. So this is what I think about when I think about the body. So this is quite different from what you described, in your home in Malaysia. And also, I’m from Nigeria, and in Nigeria, I have really close friends that are Muslims, of course friends that actually wear hijab. So the thing is, it’s not necessarily even just the country. So if I asked my friend right now, what does she think? When you think about your body? For her beauty? Completely different answer from mine, it might overlap, because we all have our periods. But it might not. And another dimension is from the health perspective, which is what your work is about?  

Kris: Yes.  

Onya: So if I have a friend who has endometriosis says when she thinks of the body, when she talks about her period, that experience will be very different from my experience, just because he impacts on the period, then that has implications for your whole day that your whole experience of your body basically,  

Kris: Completely. If I just quickly respond to that as well. I’m glad you brought up all the examples that you did. Thank you so much. It’s interesting. Firstly, you brought up the example of period pain, which is quite a common experience for many women. And it’s interesting also how you said that brings your body to the forefront, because I think what we’ll explore throughout the rest of this podcast is the idea of prosperity, right? And prosperity shouldn’t be this global North defined or one organisation defined definition of women’s health. So when you talk about your period pain, and if I go through sort of something similar, we are having different experiences, but relatable experiences. And I bring that up in this podcast because the idea of situatedness the word of situatedness is very important to women’s health. One woman’s health is not another woman’s health, and we must be able to define for each of ourselves what that means and what prosperity looks like. To your other points about health and beauty standards. I echo that, and I hope we can continue diving deeper in to this podcast about that. 

Onya: Thank you for that, Kris. I know a significant part of your hesitation was to define prosperity within the context of women’s health. What does prosperity mean in the context of health? And what were your findings? 

Kris: Thank you for that question, Onya. As we grapple with the idea of prosperity at the IGP. What I felt that I resonated the most with when it comes to prosperity is this idea that it’s not only intersectional, but it’s also contextualised to everyone’s different lives. So earlier on you talked about Nigeria and I talked about Malaysia and that’s what contextualization means on a day-to-day reality right. So when it comes to prosperity in the context of health. I realised also on my journey with this dissertation that we hadn’t really, as in the, in academia, or in the collective of sort of policymakers as well as business people, we’ve not really properly defined women’s health, we’ve almost always assumed that women’s health is this idea of just specific conditions that are unique to women. But gender is a fluid idea, as well. So we have a range or a spectrum of gender. And, and when it comes to the discussion of women’s health, does that mean that women’s health conditions and solutions only apply to people who identify as women or people who are born as female, that’s something that we’re still contending with. And that’s something that, for example, the lancet review, which is an academic organisation, still grappling with as well the idea of linking gender, how to be inclusive with health, how to be inclusive with policy, to this idea of women’s health, right, so when we talk about women’s health and prosperity, what does it comprise of us on you? And that’s when I sort of created a prosperity flower for my dissertation, which I can’t show you. But I’ll try and illustrate verbally. Right, and it, it has different intersections to the flower. So what does the prosperity flower consist of? I think what I sort of looked at were different petals, if you can imagine now in your mind different multicoloured petals of different strands of society or the systems we live in, right. So the legal side the laws that we live with them, agency, meaning you as a woman, are you as a human or a person, how much autonomy do you have over your life? How much choice do you have over the health decisions? You get to make education? You know, what do you know and not know about your body earlier on your you mentioned endometriosis. It’s being talked about so much more in the UK, but it’s relatively new in countries like Malaysia. So where do we go and learn about all of this. The fourth pedal would be environment, you know, nature, the built environment around us the buildings we live around, climate change, and the safety of all of that is so relevant to women’s health as well. And then sort of the last remaining pedals would be culture, which is a big piece that we almost always forget, when it comes to health. You think of health, you go to the doctor, you go to the hospital, but you don’t think about, you know, your race and ethnicity when it comes to how the doctors treat you your religion what you can and cannot do your relationships, right, your gender and your personal history. Last two pedals the socio-economic pedal your income level, what can you afford? You know, can you afford to go to the doctor’s today? Do you need insurance? Do you have, you know, a national health service in your country? Lastly, the health care system? Do you have private and public health care systems? What is the access? Like how long do you have to wait to, you know, get your health solutions and medical services? Right. So these are sort of the key components of prosperity that I looked at. And I’m happy to dive a little bit deeper, depending on where you want to go. 

Onya: Thanks for that, Kris. I know that the work so at the beginning, I sort of mentioned the title of your dissertation, which is it’s a study on how women’s social roles impact on our health practices and the outcomes. What social roles do we have? How do women’s social roles and identities shape our health practices? 

Kris: That’s a really great question, right. And I love talking about this, because it’s not something we often get to think about and talk about. So when it comes to social roles, let’s sort of pare back and think about it in simple ways. I was born, I became someone’s daughter, I Am someone’s daughter. My siblings are born on someone’s sister, I get married someone’s wife, and then someone’s daughter in law. So then these roles around your life, whether or not they take precedence over your own identity, is how it affects health. Right? And I’ll dive a little bit deeper here. So earlier on, you touched on how we put ourselves on the back burner. So through my research and talking to over 21 We’re about 21 Women in Malaysia in the corporate realm of Malaysia, I realised that no matter your rank, no matter your age, race background, that everyone almost always talks about others first. So for all of these women, their priorities are my in laws fed? Are my parents that are my kids fed? Are my you know is my husband fed? Is everyone Okay, is their health Okay? academically speaking, this is what we call our Marcia in horn also calls the household production of health. So in the context of that, it’s when then does the woman put herself first, you know, when this her health comes come first? And that is inherently linked with self awareness, right? Because you also mentioned that, you know, I think about my body when I feel the pain. But what about before all of that pain? Are you looking at for symptoms as well? Are you listening to your body on a day to day basis? Do you know how you feel on a day to day basis? Or is there no space for that? So it was interesting to dive in an X exploration way, too, with all of these women and hear their stories and learn about, you know, their roles. And how are other interviews that they were gradually realising that they also deserve to put their health risks to take care of themselves to understand their symptoms. So if I can give a practical example, for women who are about to go through menopause, or have gone through menopause, they actually, at least with the interviewees that I spoke to, they actually don’t know where to go to. They’re not allowed sources in Malaysia, it’s not widely talked about, it’s almost always like stigma periods, there is a stigma with menopause. And I think UCL is actually doing quite a lot of pioneering research in this space. But we don’t talk about it enough. It’s just It happens to your body. And that’s it’s because he said social roles to play. Okay, it’s like, you know, you have to be a mother, you have to be a grandmother, auntie, and everything else. So that’s sort of what we what I explored in my dissertation, 

Onya: What you touched on in your dissertation, Chris is really powerful, just because I think every woman can relate to what you’ve described, whether, you know, whether they’re the ones experiencing it, or they remember their mothers experiencing it, or the grandmother or a sibling, you sort of touch on something fundamental, something core. And there was something, a question came to my mind when you talked about women put others above themselves, not only in healthcare, but in many ways. And that then touches on the whole idea of these informal instant, these sort of cultural norms, that shape almost everything that we do our identities, the roles, etc. And I know that the colleagues even within the IGP that are doing work around this area, looking at how these cultural norms shape, not specifically, our identities, and therefore and our health practices. But I just, I wondered if we think back to the situatedness point, yes. And we think back to how you talked about what the body means for you is, what the body means for me, specifically, and the prosperity flower. What does that mean for healthcare providers? Because to me, it sort of seems as still we need something more bespoke. Big 

Kris: Question on yeah, really great question. And I’m getting very excited and also a little bit nervous about trying to. So okay, so you mentioned the intersection of situatedness. Culture, and prosperity and how healthcare providers can maybe work around these parameters or interact with these factors to help better serve patients, right? When it comes to women’s health and female patients in general think there’s so much research being done on this. A lot of the times, it’s just in a very simple and profound way, women are not being heard for their symptoms. They’re not being seen for their symptoms, because we are under researched were less understood compared to male bodies, because the male body has been the standard for the research standard for a long time. So in the context of that, how healthcare providers can begin to engage with women’s health in a more meaningful way. I think just by just starting with listening and starting with understanding the person as a whole as opposed to the person as a collection of symptoms. I think that’s a big part of it. When it comes to different contexts of situatedness of culture, may be reflecting as a doctor or as a health care provider. So how you are helping this person is very important. And I say this point, I’ll give you a practical example as well. In Malaysia, for example, it’s quite an interesting country, we have many different races. I personally am raised the Buddhists, a lot of my friends are raised Muslim and other friends are raised Christian, Hindu and so on. Whereas, it’s quite strict for the Muslim population that premarital premarital sex is not allowed. It’s not so strict for the other religions, and race and religion is quite inextricably linked in Malaysia. So in the context of that, then for Malay Muslim women, and through this dissertation research as well, I found that some of them actually found it quite a difficult barrier or a cultural barrier to go for their smears. Because there’s this whole, you know, misconception that says, Oh, if you go for your smear, you lose your virginity, you know, or you shouldn’t go for your smear, if you’re not sexually active, there’s really not much wrong with you, you don’t have to get it checked out. So there’s this whole misconception and the whole movement of getting your HPV vaccines as well. It’s all tailored towards women. So for healthcare providers, number one, understanding sort of these kinds of boundaries in the context of your patients, and seeing what they can and cannot do, and then supporting them in that decision is quite important. And then finally, I want to bring in this idea of gender, a gender transformative approach, which has been used by the UN, in recent times, which is this idea of instead of just, you know, including women in the conversation, go beyond that and challenge the gender norms challenge the patriarchy that we live in. And in a practical way, what that also means is, if there’s a wife and a husband in the room, and the husband is dominating all the conversation, do you give the wife a voice? You know, so for example, in Malaysia, for some of us, for some women who are married, actually, you have to ask your husband’s permission before you undergo surgery. So as as a health care provider, what then is the responsibility? Are you responsible to the husband, or the patient in this case, and it’s such a good opportunity for you to challenge the system of having your husband decide for you, and maybe empowering the woman and telling her that look, it’s okay for you then to to make a decision for your own body and placing that power back into her own hands. 

Onya: Thank you for the Kris. So what sort of dialogues can we continue to have around women’s health in a way that can be just going back to what we’ve touched on already, that is unique and contextualised to our different needs? What sort of conversations should we be having? And who, who are some of the actors? whose voices because when you think about prosperity, we talk about, well, whose voice has been included in the conversation and whose voices are being excluded that need to be part of that conversation? Yes. 

Kris: So this is, this is also another difficult question, sorry. But it’s also a very, it’s a very important reflection, right? Because the less we talk about women’s health taboos, the more the louder the silence is, and the less we can move forward with things. So again, contrasting the UK against Malaysia, in the UK, we have actually now a national women’s health strategy set out by the government. I think that’s a great starting point for people to start dialoguing about their symptoms. Whereas in Malaysia, I feel that peers and friends and people who know each other women who know each other are only beginning to have these conversations. And so early on, you asked about who should be having these conversations, I think it’s just all women themselves. And then including allies, including sort of your male counterparts, people from other genders, as well, as you know, slowly, including policymakers, health care providers, as well will be important, but just having that first conversation with your friend about what you’re going through and what works for you, what’s not working for you. I feel that’s how you start to build a community and a collective around sort of removing the silence the shroud of silence around this topic. 

Onya: I also want to just touch a little bit back on that stigma. I feel like healthcare professionals, they want the women to come in for these, if we stick with the smears example, to come in for the screening of the survival for cervical cancer, they want them to come in. But when you have these stigmas that are associated or you have these two I call them folk tale or sort of two keeping women from actually getting the health care that they need. So taking responsibility to the healthcare provider might have my offering you the the screening opportunity, it’s up to you to come and actually take that test. Right, and ensure that you don’t actually have that HPV. I think that’s the Yes. Yeah. So my question here is, how do we deal with those two statements, two stories, 

Kris: yeah, very important to reflect on, because the stigmas are not going anywhere. And if we continue to empower women, without changing the systems around us, nothing is really going to move forward as well. So in that case, to your point, it goes back to actually agency and education, and our bring back this whole gender transformative approach, right? Because when it comes to policymakers give you an example, again, who sets out obviously policies for sexual and reproductive health? When you say sexual and reproductive health, you think of actually women? So it’s almost always lumped together with women and families? Where’s the Father? In this equation? How do we include them? It’s the same approach with the maternity leave, you know, how do we include the fathers in the emotional and the physical labour of childcare, as well. And I think being more inclusive and challenging your own biases, when it comes to policies is very important. So coming back to sort of women empowerment as well, it’s important that we continue to do that. But if we continue doing that, and we keep putting the onus on women to fix this and fix everything for themselves, without changing what’s around us, without including the fathers, without including the men, how, then are we supposed to solve this collectively, right. So then if I had a call to action for some of these policymakers and healthcare providers, is to really do the hard work of beginning to change the system around them to change the culture around them, of you know, Diversity, and Inclusion doesn’t just mean, we need to empower the women? Well, everyone is included under the umbrella or the rainbow of diversity and inclusion. Everyone has different set of needs. And if we have people who want to be parents, people who want to adopt children, they should they deserve time off from work as well. What regardless of gender, regardless of you know, background age, ranking, and, and so on. So in addressing the stigma, education is important. It puts agency back in women’s hands. And it’s not always in women’s control, to be able to educate people. And it’s also not our responsibility, to be honest. So I would, I would Yeah, I would ask allies, I would ask sort of, you know, people in positions of power, to educate themselves to raise the awareness for people that they’re working with people that they manage as well, and do that, that we’re in dialogue with women, right, don’t just think that this is just women’s responsibilities and men toss them aside. 

Onya: I think one point just touching on what you just said, usually when there’s a campaign, yeah, usually targeted primarily at the woman. You’re right. But then, if in Malaysia, a woman needs permission from her husband, to do anything with her body in terms of maybe undergo surgery, and actually studies, studies that have looked at cervical cancer screening. Some papers found some scholars found that some women don’t go for those screenings, or do tests, because they don’t believe their husbands want them to do so. Yeah. So what I’m getting at here is where you have helped professionals, designing campaigns, perhaps the campaign, perhaps your target audience, isn’t just a woman, if you think about it from a systems point of view, what else is happening around her? Should her employees be having those conversations with her employers? Or have those conversations start to have conversations around some of these issues? But should the family also be thinking about these issues? Perhaps you talked about education? Yes. So I know that a lot of initiatives start early. So going into primary schools or secondary schools or high school, wherever you’re based, and educating usually, you’re educating the girls. Yes. About their bodies. Yes. Well, what about exposing even the boys to? I don’t know, I’m just throwing out some ideas here. You know, bringing together all that you’ve talked about and thinking, perhaps one thing and that sort of call to action could be considering campaigns that are targeted at the people that are around the women.  

Kris: Yes.  

Onya: And educating them. Okay. For example, if someone has endometriosis, their experience of a period is not the same, at least from what I’ve heard, their experience is not the same as my experience, my experience, I can still function, I can still sort of move around. I mean, really, I’m in pain, but I can mask that pain. I can sit in the meeting and just keep quiet.  

Kris: But the point is that you shouldn’t have to mask it. 

Onya: Of course. Of course. So what I’m saying is conceptualisation of our bodies is quite like you can do the forty hours straight. 

Kris: Yeah. 

Onya: Men don’t have periods. On a monthly basis. But we do. You know. They don’t go through some things that our body has to go through but we have to power through this and sit in a meeting. I’m just sticking with your corporate settings. Sit in a meeting. Function at 100 per cent. So for me it’s really interesting, the work that you did Kris and I loved this conversation. 

Kris: Thank you so much, Onya .  

Onya: I want to finish off with this question which you already touched on in your last point. So what are the implications of your findings. What’s the call to action? 

Kris: So, my findings are interesting because it’s not a quantitative study. It’s me spending 20 hours talking to women of various backgrounds, ages, ethnicities. It’s so interesting. And I sense this  hunger from everyone to be heard about this, to talk about this and to learn about this. So people were asking do you know where I can go and learn more about menopause. Do you know where I can find more support? And other people also said Facebook is a great community. Google obviously is your first port of call. So I think the implications of this are that it just goes to show that even at that local level for me. In Malaysia in such a small microcosm of corporiate  women, there is a need to talk about this and to not just put the onus on the individual but to start talking about systemic solutions. So we need to move in a circle and cut across from the individual to the system, again, so when I say this I mean not just the women who are learning about their bodies and health and trying to find solutions to their issues, their symptoms but also the people around them which is why I love that bit that you brought in about how there is a village around the women too and that village needs to start stepping up and being her ally because she is a core part for the economy, for the community around her. From a systemic level having policy makers and politicians and your leaders in the work place as well need to see if you need to incorporate any positive changes into your work place. Maybe more dialogue around menopause and mensuration and how that effects your employees and not just their productivity and seeing what solutions can come from that. So much power lies in the hands of making health care more collective and inclusive. When I see a doctor I don’t want to float from specialist to specialist. Maybe just having a more holistic approach to understanding women and being able to research our bodies. What does it look like when we have a heart attack and a stroke which can look different for men and women. Start at the individual but don’t stop until we reach a systemic level. That’s what I would end with.  

Onya: Thank you so much Kris. This was such a great conversation. I could talk about this forever but of course we have to go. Thank you so much for joining us in this conversation, thank you Kris for coming. Hopefully there will be a sequel to this, who knows. 
 

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