Gender, Health, and Development

Introduction
Academic and practical discourses surrounding feminism, health, and international development have shifted in the past several decades. A literature review of the Women and International Development Working Paper Series of Michigan State University’s Center for Gender in Global Context shows that academic and research foci about issues in women’s health have also changed. I will argue that, though health and development discourses are improving (that is, becoming more focused on women as autonomous agents, regarding women’s health as more than just pregnancy and childbirth, and more fully integrating health with development issues), this change is slower to come than other improvements in feminist development discourse and more progress needs to be made. Understandings of what is “health” must expand to include the social determinants of health and recognize how deeply connected physiological and mental health are with the other aspects and goals of development. Health should be viewed, not as a specific focus of development, but rather as one of many issues that should be integrated into all development work.

Background
Feminism
“Feminism,” referring to the sociopolitical theory focused on the power relations of gender-based inequalities, has gone through dramatic changes since it began in the late nineteenth century. Feminist historians classify feminist movements in three “waves.” American and European women organized for suffrage in the late nineteenth and early twentieth centuries, focusing on women’s rights to vote, own property, and control her body. In the 1960s and ‘70s, feminism’s second wave argued against gender inequalities based upon biological differences in sex and physiology. During this era, the “social construction of gender” became a popular concept, as feminists argued that gender roles were created more through socialization than biology. The current third wave of feminism, which began in the 1990s, is beginning to include post-colonial, post-modern, third world, and developing world feminisms, in an attempt to “democratize” feminism, a movement previously incredibly Euro-American-centric.

International Development
“Development” as “change” has been ongoing since the beginning of time. As used here, “international development” refers to a specific process of “advancement” for countries in the Global South (primarily Africa, Asia, the Caribbean, and Latin America) beginning in the 1940s at the end of the Second World War. Like feminism, the international development movement has experienced shifts in ideologies and priorities. What began with American and European approaches to development as economic growth can be criticized in relation to priorities and cultural relativism. Critics of mainstream development thought argue that economic growth should not be seen as the “true” or “only” form of development. Amartya Sen, perhaps one of the best-known development ethicists and economists, argues that a capability-based approach focused on individual agency is more important than increasing a country’s gross domestic product (GDP). Some anthropologists and other proponents of cultural relativism take issue with a development practice that assumes the Western understanding of development should be imposed in all regions.
Though these criticisms of development have enjoyed increased presence in academic discourses, including theories of post-development (the notion that the West should disengage altogether, as it does more harm than good in its attempts to aid the rest of the world) and alternative development (such as Sen’s capability approach), mainstream development continues to focus on economic growth. Most funding for development comes from international and national organizations such as the International Monetary Fund (IMF) and USAID. These organizations are generally headed by traditionally-trained economists and politically-minded leaders, whose priorities are not necessarily in the best interest of the “developees.” As political priorities and security concerns have shifted, so too has funding, and not necessarily in the direction scholars and justice-seekers would wish. Thus, though academic work has begun to pay attention to grassroots movements and people on the ground, funding (with its stipulations and conditionality greatly affecting the practical work that can be and is done) has not done so as fully.

The Center for Gender in Global Context (GenCen)
One organization that receives such stipulated funding is the Center for Gender in Global Context (GenCen) at Michigan State University (MSU). The Center for Gender holds the Women’s Studies academic department at MSU. Gender-focused majors, minors, and specializations (topical minors) are administered by the GenCen. Additionally, the Center hosts the “Gender, Development, and Globalization” (GDG) Program. GDG explores issues of global change and international development as they affect and are affected by women and gender relations.
Funding for GenCen and the GDG Program comes from Title VI funding, part of the United States Higher Education Act, awarded by the US Department of Education. The GenCen also works on a variety of gender and development projects funded by international organizations and USAID, generally in collaboration with other universities and institutions.

The Working Papers
The Gender, Development, and Globalization Program publishes a triannual resource bulletin on gendered issues in development. Additionally, GDG publishes a Working Papers Series. These article-length manuscripts (up to nine thousand words) come from a variety of disciplinary and regional foci. They address cultural, economic, political, and social change as they impact local and global gender relations. The series’ goals, as stated in GPID’s “Call for Papers,” are
• to promote research that contributes to gendered analysis of social change;
• to highlight the effects of international development policy and globalization on gender roles and gender relations; and
• to encourage new approaches to international development policy and programming.
The GenCen’s Working Paper Series has changed since its beginnings in 1981 just after the Second Wave of feminism and before the beginnings of the Third. The Resource Bulletin and Working Paper Series were originally published under the name “Women and International Development.” In 2008, facing the effects of feminism’s Third Wave, GenCen renamed its publications “Gendered Perspectives on International Development” (GPID).

Methodology
Research Foci
This study sought to explore the complex relationships between gender, development, and health. My primary research questions were:
• What are the relationships between gender, development, and health?
• How are these intersections addressed in academic discourses and how have these frameworks changed as feminism shifted from its second to third wave?
These questions were explored through a literature review of the GenCen’s GPID Working Paper Series. Specifically,
• How has the concept of “health” been present or absent in the Working Papers of the Center for Gender in Global Context?
• How have discussions and understandings of “health” changed since the series’ inception?
While performing a review of what can be found within the Working Paper Series, I engage in discussion about the implications of what development workers see as “health” and its interconnections with “development,” exploring possible ramifications for women, their health, and society as a whole.

Selecting GenCen’s Working Papers Series
I have selected to focus this study on the GPID Working Papers because the Gender, Development, and Globalization Program is the oldest of its kind in the United States. MSU established the program in 1978; the program published its first Working Paper in 1981. Interning for the Center, I have easy access to the Working Papers and have encountered some of the program’s background in my current work. This has been helpful in writing a more comprehensive review exploring not only the literature itself but also its development.
Because the Working Paper Series dates to 1981, the series includes work done during the second wave of feminism (papers written in 1981 discuss research completed in the ‘70s), work from the transition phase of feminism’s waves, and work completed during the third wave.

Review Process
I determined that forty-two of the total two hundred ninety-eight Working Papers dealt with health issues and reviewed these forty-two articles in detail (see section below for selection criteria). I examined the full list of WID/GPID Working Paper titles to contextualize these forty-two “health papers.” To help determine shifting frameworks, I read many of the health papers completely, skimmed others, and performed very basic mathematical analyses (percentage of working papers dealing with health; percentage of health-focused papers dealing with fertility, etc.).

Defining “Health:” Selecting Papers
In seeking to explore how the GPID Working Papers discuss issues of health, I was first obliged to determine what I meant by “health.” The full list of Working Paper titles and abstracts is available online (I also had access to the list and records kept by GenCen). I read the list of titles for health issues, searching for the following keywords and variations: AIDS, birth, breastfeeding, Cesarean, contraception, death, diet, doctor, fertility, genital, health, illness, medical, menopause, midwife, nurse, nutrition, obstetrics, physician, pregnant, prenatal, reproduction, sick, and, survival. When the title left some doubt, I read the abstract to determine if the paper should be included. I then reviewed the selected papers in more detail.
By including words such as “fertility” and “contraception” in the search, I have essentially defined “health” as including all reproductive issues. While this is helpful in expanding the number of papers explored, it also serves to increase the proportion of Working Papers focused on reproduction health relative to other health issues. This can be counter-productive to feminism, as it strengthens the perception of women merely as child-bearers. However, it is reproduction and fertility that has and continues to dominate discussion about women’s health, and I believe it is important to include in this discussion with accompanying critique about the dilemma and concerns raised by naming these issues as women’s health concern.

Limitations of Methodology
This literature review was limited to those Working Papers explicitly focusing on health issues, in which “health issues” were determined by my biased understanding of what constitutes “health.” Arguably, each of these papers deal with health, as development issues such as socioeconomic status and personal agency all greatly affect individual and community health. A more complete review would aid in more fully understanding changing discussions and conceptions of the intersections between health, development, and gender. There may be several papers which incorporate health issues without indicating this in the article’s title. Indeed, it may even be these articles, in which health is seen as one of many issues involved in gender and development, that will best indicate shifting discourses. However, I have completed a previous review of these papers, exploring papers not explicitly dealing with health issues, and found virtually no references to health in these other papers. While I have not read each of the two hundred ninety-eight articles comprising the Working Paper Series, the samples explored in this and a previous literature review clearly indicate that health is explored either centrally or not at all in this development work. I will later discuss the implications of this for women’s health and overall development.

Results, Analysis, and Discussion
Health-Focused Working Papers
The titles of the Working Papers focusing on health issues are given in Table 1, listed in order of publication.
Table 1. Health-Focused WID/GPID Working Papers
# Publication Year Title Author
8 1983 Women’s Reproductive Histories and Demographic Change: A Case from Rural Mexico Millard, Ann V.
20 1983 Toward a New Model of Fertility: The Effects of the World Economic System and the Status of Women on Fertility Behavior Ward, Kathryn B.
22 1983 Genital Mutilation: Every Woman’s Problem Moen, Elizabeth Williams
34 1983 A Social-Evolutionary Investigation of Factors Affecting Female Employment in the Medical Profession Kang, Gay E. and Mary Ellen Heim
40 1983 Determinants of Natural Fertility in Matlab, Bangladesh Becker, Stan and Alauddin Chowdhury
41 1983 The Impact of Expected Child Survival on Husbands’ and Wives’ Desired Fertility in Malaysia: A Log-Linear Probability Model Lehrer, Evelyn and Marc Nerlove
48 1984 Breastfeeding and Demography in Two Mexican Villages Millard, Ann V. and Margaret A. Graham
49 1984 Causes of Death to Women of Reproductive Age in Egypt Fortney, et al.
66 1984 Cesarean Delivery in the Northeast of Brazil Janowitz, et al.
68 1984. Women’s Productive and Reproductive Roles in the Family Wage Economy: A Colombian Example Rosenberg, Terry Jean
76 1984 Women’s Work, Family Formation and Reproduction Among Caribbean Slaves Morrissey, Marietta
95 1985 Development, Women’s Situation and Fertility: The Mexican Case Ireson, Carol J.
96 1985 The “Wild,” the “Lazy,” and the “Matriarchal”: Nutrition and Cultural Survival in the Zairian Copperbelt Schoepf, Brooke Grundfest
101 1985 I’m Sick ... I'm Coming: Illness Among Zairian Elite Women Kornfield, Ruth
103 1985 Birth Planning in Rural China: A Cultural Account Potter, Sulamith Heins
107 1985 Prenatal and Postnatal Sex-Selection in India: The Patriarchal Context, Ethical Questions, and Public Policy Miller, Barbara D.
126 1986 Technology Transfer in Obstetrics: Theory and Practice in Developing Countries Jordan, Brigitte
127 1986 Women and Work in Rural Taiwan: Building a Contextual Model Linking Employment and Health Gallin, Rita S.
130 1986 Health, Women’s Work, and Industrialization: Women Workers in the Semiconductor Industry in Singapore and Malaysia Lin, Vivian
137 1987 Folk Dietary Practices and Ethnophysiology of Pregnant Women in Rural Bangladesh Hossain, Zakir and Ahmed F. H. Choudhury
154 1987 The Selfish Housewife and Menopausal Syndrome in Japan Lock, Margaret
164 1988 Underdevelopment, Women's Work and Fertility in Zimbabwe Mazur, Robert E.
169 Knowing by Doing: Lessons Traditional Midwives Taught Me Jordan, Brigitte
178 1989 Religion and Reproduction in Philippine Society: A New Test of the Minority-Group Status Hypothesis Johnson, Nan E. and Linda M. Burton
191 1989 Women’s Status as a Factor in Male and Female Decision Making About the Use of Contraception: A Case Study From Rural Peru Maynard-Tucker, Gisele
198 1989 Family Planning: More Than Fertility Control? Keysers, Loes and Ines Smyth
203 1990 Sometimes Available But Not Always What the Patient Needs: Gendered Health Policy in Bangladesh Feldman, Shelley
210 1990 Development, Gender Inequality, and Fertility in Iran Aghajanian, Akbar
211 1990 Variations in Reproductive Goals Among Indonesian Spouses Williams, Linda B.
215 1990 Nuer Women in Southern Sudan: Health, Reproduction, and Work Gruenbaum, Ellen
220 1991 Economic Factors of High Fertility in Traditional Households Chojnacka, Helena
232 1992 The Rural-Urban Difference in Contraceptive Use in Pakistan: The Effects of Women’s Literacy and Desired Fertility Zaki, Khalida P. and Nan E. Johnson
234 1992 The Flowers of Spring Garden: A Study of Primary Health Care in Brazil Using Rapid Assessment Procedures Novaes da Mota, Clarice
244 1994 The Mexico City Policy: An Examination of the Conservative Assault on US International Population Policy and Women’s Reproductive Rights Mehra, Malini
248 1994 Men's and Women's Reproductive and Contraceptive Decisions: A Case Study from Highland Peru Maynard-Tucker, Gisele
249 1994 Impacts of AIDS on Women in Uganda Durrant, Valerie
251 1995 Routine Herbal Treatment for Pregnant Women, Neonates, and Postpartum Care Among the Mahafaly of Southwest Madagascar Sussman, Linda K.
258 1996 Women’s Health Status Differentials in China Lin, Vivian
259 1996 Reproductive Imperialism: Population and Labor Control of Underdeveloped World Women Kuumba, M. Bahati
283 2004 Between “Modern Women” and “Woman-Mothers”: Reproduction and Gender Identity among Low-Income Brazilian Women de Bessa, Gina Hunter
284 2005 Some Unexpected Consequences of Implementing Gender “Neutral” Reproductive Programs and Policies Browner, C. H.
286 2006 Health and Development Policies and the Emerging “Smart Woman” in Rural Bangladesh: Local Perceptions Schuler, Sidney Ruth et al.

Numerical Analysis
A basic mathematical “glance” at the Working Papers was helpful in understanding the overall pattern and participation of health discourses in feminist development work from the 1980s to now. Table 2 shows the total number of papers, percentage of the total number of working papers (n=298), and percentage of the health-based working papers (n=42) dealing with several issues. A used here, “reproductive” refers to birthing and reproductive systems as they produce children. Health issues affecting reproductive systems are not included (i.e., Margaret Lock’s 1987 “The Selfish Housewife and Menopausal Syndrome in Japan” is classified as dealing with a non-reproductive issue).

Table 2. Numerical Snapshot of Health-Focused WID/GPID Working Papers
Issue Total # of Papers % of Total Working Papers % of Health-Focused Working Papers
Health-Focused 42 14% 100%
Health-Focused; “Fertility” in the Title 9 3% 21%
Health-Focused; “Fertility” not in the Title 33 11% 79%
Health-Focused; Dealing with Reproductive Issues 30 10% 71%
Health-Focused; Dealing with
Non-Reproductive Issues 12 4% 29%
Health-Focused; African-Focused 6 2% 14%
Health-Focused; Asian-Focused 13 4% 31%
Health-Focused; Latin American-Focused 12 4% 29%
Health-Focused; Middle Eastern-Focused 3 1$ 7%

Reproduction and Fertility
By far, the majority of the Working Papers dealing with issues in women’s health focus on reproduction and fertility. Again, it is debatable whether or not discussions of fertility should automatically be considered to involve “women’s health.” Depending on how the research is conducted, some fertility-based projects have ramifications for women’s health; others do not, instead focusing on child survival or dismissing the influences to an individual’s health that childbirth processes have.
A shift can be seen along the Working Paper Timeline. Though a few of the early papers focus on women’s health while exploring fertility, focusing on women becomes the norm later in the series. This is most marked by presence or absence of the word “fertility” in paper titles. Up to 1992, “fertility” was commonly included in the title of a working paper. Past 1992, though, at the beginning of feminism’s third wave, “fertility” disappears from titles. This is not to say that reproductive issues disappear; rather, the notion of “fertility” is replaced with concepts such as “contraceptive decisions” and “reproductive rights” (Maynard-Tucker, 1994; Mehra, 1994). These later working papers focus more on women’s autonomy and agency in making reproductive choices, as opposed to the earlier articles that looked at overall fertility patterns and institutional change mechanisms.
At the same time, conversations about how the West has imposed fertility control rose to the forefront, as evidenced by titles such as “The Mexico City Policy: An Examination of the Conservative Assault on US International Population Policy and Women's Reproductive Rights” (Mehra, 1994) and “Reproductive Imperialism: Population and Labor Control of Underdeveloped World Women” (Kuumba, 1996).
These shifts reflect the changing discourse in feminism, seeking to address women’s experiences as they intersect with global power relations of class, race, ethnicity, nationality, etc. The critique of Western health and population-control policies mirrors critiques of second-wave feminism as being too American- and Euro-centric and also parallels shifting discourses around development itself.

Non-Reproductive Issues in Health and Development
Of the “non-reproductive” issues, many of them nonetheless focus on issues related to sexual and reproductive systems (genital mutilation, menopause, AIDS). Very few of the papers look at more general health issues. Those that do are generally focused on rural and/or upper-class women in developing countries (women in the medical profession, friend and family healthcare systems (in which women are generally viewed as health providers), intersections of employment and health, etc.). The two most holistic papers, those that look at issues of women’s overall health and how important it is in development, were both written well after the turn of the third wave of feminism (Vivian Lin’s “Women’s Health Status Differentials in China” and Schuler et al.’s “Health and Development Policies and the Emerging ‘Smart Woman’ in Rural Bangladesh: Local Perceptions”).

Mental Health Issues
Issues of mental health are virtually nonexistent in the Working Papers. Though this reflects a greater focus in development work on the biological and “basic” (i.e., issues such as mental health tend to be seen as “luxuries” that should be tackled only after “basic” development has occurred), this does not excuse the Working Papers from their lack. Feminist discourses should seek to push development to incorporate a greater variety of issues important to women and their lives. With the focus on reproductive concerns, issues in post-partum depression would seem a natural starting place for researchers cautious about “rocking the boat.”

Geographic Foci
The Women and International Development/Gender, Development, and Globalization Program concentrates its work in the “global South,” recognizing that “the ‘South’ is a set of relationships rather than a place” (Center for Gender in Global Context, “Gender, Development, and Globalization”). Generally speaking, the global South includes Latin America, Africa, and Asia. The complete Working Papers include research from each of these regions, with country-specific discussion for most countries. There are some countries/regions with more papers; I believe this is caused primarily by funding foci and safety (for example, there are no papers specific to Palestine or Rwanda, though these countries certainly have a strong need).
Health-focused papers have been written on communities in Bangladesh (4), Brazil (3), the Caribbean, China (2), Colombia, Egypt, India, Indonesia, Iran, Japan, Madagascar, Malaysia/Singapore (2), Mexico (4), Pakistan, Peru (2), Philippines, Sudan, Taiwan, Uganda, Zaire (2), and Zimbabwe. Table 3 shows again the numerical analysis of the regionally-focused papers taken from Table 1 with the addition of a column showing the percentage relative only to those working papers that are health-focused and concentrate on a specific geographic region.

Table 3. Numerical Snapshot of Health-Focused and Regionally-Focused WID/GPID Working Papers
Issue Total # of Papers % of Total Working Papers % of Health-Focused Working Papers % of Health-Focused; Regionally-Focused Working Papers
Health-Focused; Regionally-Focused 34 11% 81% 100%
Health-Focused; African-Focused 6 2% 14% 18%
Health-Focused; Asian-Focused 13 4% 31% 38%
Health-Focused; Latin American-Focused 12 4% 29% 35%
Health-Focused; Middle Eastern-Focused 3 1% 7% 9%

Though no clear spatial change can be seen temporally (that is, regional foci have not shifted from one geographic location to another across time in the Working Papers), a disproportionate number of health-focused and regionally-focused working papers look at Asian societies. The non-health-related working papers do not seem so “Asia-heavy.” Though someone might guess this is due to the inclusion of fertility discussions in the health-focused papers, and the large number of studies done on China’s one-child policy; in fact, only two of the thirteen health-focused and Asian-focused papers are about China, and only one of those focused on birth planning. Four of the papers come from Bangladesh; they are temporally spread out. The high proportion of research coming from Bangladesh may be due to its status as a well-functioning Asian democracy that has made good strides in development indices, particularly in educational gender parity and fertility rates, making it an attractive target for gender-based research (World Bank).
Even if the Middle East and Africa are combined as a single geographic region (often done in academic discourses), they contribute eleven percent less to the regionally-focused, health-focused papers than Asia does, and eight percent less than Latin America. This may be in part because Asian and Latin American countries generally have more Westernized economies and healthcare systems, making health and development research easier (or, at least, more obvious when “health” and “development” are defined in Western terms).

Shifting Discourses
The early papers of GenCen’s Working Paper Series, like the mainstream development ideologies of the eighties, are prevalent with paternalistic and patronizing language. Problems arise not only with what the authors say (though oftentimes this is problematic enough), but the way they say it:
“If the extraordinary pronatalism of traditional culture is overcome, then what it means to have a child in China and to be a child in China will change completely, yielding dramatic new cultural and structural forms. There will be the resources to provide decently for those who are born and to care for them so that they can indeed be healthy and superior. If the extraordinary Chinese pronatalism is not modified, future generations of Chinese children will suffer increasingly until they are destroyed by the weight of their own numbers” (Potter, 1985, 23).
Language such as tradition being “overcome” and assumed hopes of being “superior” is both inappropriate and unhelpful.
Authors of the early working papers tend to assume that women have little to no agency or abilities. Fortney, et al. declare a lack of “optimal medical supervision” in contraceptive use in developing countries, assuming that people will be unable use contraceptives appropriately themselves (1984, 10). Moen shares the concern that older women are unable to safely perform female circumcision because the procedure necessary is too “medically advanced” and requires knowledge of anatomy (1983).
The early papers, along with early development ideologies, tend to see women more as the tools of development than as important beneficiaries of progress. The early Women and International Development literature is replete with the notion that women’s education will help to reduce fertility rates rather than the idea that women’s education is important for the women’s sakes and their own health rather than the health of their family members.
Some of the early papers critique this dominant language. For example, Jordan asserts that “technology, because it defines what is authoritative knowledge, in turn establishes a particular regime of power” (1986, 14). These critiques are the minority, however, and those that do not explicitly critique the dominant language often fall into the trap of accidentally furthering the problematic ideologies. Maynard-Tucker expresses greater faith in “modern contraceptives,” devaluing traditional knowledge of practices such as the “rhythm method” (1989). Maynard-Tucker (1989) and Miller and Graham (1984) both address rural women’s preference for these traditional methods rather than “modern” or “medical” contraceptives. The authors assert that women consciously choose this based on a rationality fearing for their health (contraceptives were thought to cause certain types of cancer, birth defects, etc.). Though it is good that authors are giving voice to women’s opinions, often the tone is accusatory (rural women as irrationally susceptible to believing rumors, etc.), sometimes carrying undertones of “silly natives.”
Though the authors of early papers will occasionally point out issues that arise for women and women’s health due to various development practices, they often do so only nominally and without suggesting how policies need to change. Yuan, while discussing the ramifications of China’s minimal reproduction policies, points out that “[b]ecause of son preference, some husbands, frequently with the encouragement of their mothers and other close relatives, have abused and battered their wives following the birth of girl babies; they hope to force their wives to seek divorce” (1984, 8). This he does without fully critiquing these policies, suggesting alternatives, or providing a means by which to care for battered wives.
The later working papers (“later” defined as coming from the 1990s and beyond, written during the third wave of feminism) have made great improvements both in which issues they address in women, health, and development and how they address these issues.
Schuler, et al. discuss the changing gender roles in Bangladesh drawing on data collected through in-depth interviews. This is a clear trend in the Working Papers: with the passage of time, authors are more likely to incorporate significant amounts of qualitative data from community members’ voices rather than theoretical assertions or governmentally-gathered census-like data. With this data, Schuler et al. assert that people in rural Bangladesh have more agency and reasoning capabilities that previous authors and officials have generally assumed. This is evidenced through quotations such as “women were not nearly as dependent on home distribution of contraceptives as many had believed” and “ordinary people in rural Bangladesh have considerable insights into the effects of social policies on norms related to gender, even though they do not label ‘gender’ as such” (2006, 15). Schuler et al. also focus on improvements in health and development as a way to improve gender equality (“health and development policies, along with other factors, have been contributing to an evolution towards gender equality and equity”), asserting that gender equality is intrinsically valuable, rather than seeing gender equality as a mechanism to development, valuing gender equality only instrumentally (16).
Another Working Paper highlights a place where a well-intended policy negatively impacted gender equality and women’s empowerment. Browner explores how policies in reproductive health meant to more fully include male partners in decision making processes end up furthering male dominance (2005). Exploring genetic testing and counseling in “high risk” pregnancy situations in Mexican communities living in California, Browner finds that “[w]hen genetic counselors sensed ambivalence from women, they clearly allied themselves with the male partners to gain consent for procedures” (Abstract). Browner is critiquing a Western policy while raising the voices and concerns of minority women, goals characteristic of the third wave of feminism.
In Sussman’s 1995 paper on the medicinal uses of indigenous plants, she too focuses on listening to the voices of women previously assumed to be disempowered. She asserts that “botanists who exclusively survey plants used by healers, may also miss relevant information on their knowledge and use by the lay population” (Abstract). Though she gives heed to the voices of rural women, then, acknowledging their systems of knowledge and power, she also argues for the importance of determining the “pharmacological properties” of these plants. If this paper were to be written today rather than in 1995, the shifting discourse about indigenous rights and sovereignty might cause a change in how the importance of, and our right to, study and utilize these indigenous plants is discussed.
Sussman’s paper was written in 1995, during the early stages of the third wave of feminism. That her paper assumes a right and value to investigating indigenous persons’ plants without much attention to her rights further demonstrates that these shifting discourses are not discrete changes. Though feminist historians classify the third wave as beginning with the 1990s, this does not mean that on January 1, 1990, suddenly all Westernly-ethnocentric language was eradicated or all feminist theorists automatically considered all the nuances of the intersections with race, class, ethnicity, nationality, gender, socioeconomic status, etc.

Conclusion
As seen in the discussion of “Shifting Discourses,” the changes wrought by feminism’s third wave were not discrete. Nor, I argue, are they complete. More recent papers more directly incorporate native women’s voices in studies and are more likely to give attention to the importance of power structures and intersections between race, class, ethnicity, gender, etc. This shift is reflective of the changing discourses in feminism from the 1970s to today. But we must not become complacent. Too often, ethnocentric language of Western superiority tends to “creep in” when feminist writers are not explicitly trying to heed to the voice of the “other.” We must remain vigilant in order to make this shift not only permanent, but so ingrained that it feels “natural.”
These shifting foci have not equally affected all areas of development. The effects of feminism’s shift are less apparent is in discourses about health. Too often, “women’s health” is still code for “reproductive issues.” The health of women must be seen as important for their sake, not merely for the sake of the children they will bear. And the impacts of women’s lives on their health must be taken into account. The Gendered Perspectives of International Development Working Papers are the perfect venue for discussing the interconnections between development, gender, and health, addressing the social determinants of health and how these are affected (negatively or positively) by attempts at development.
Development and gender work should not view health as a distinct issue, but rather as one of many factors influencing people’s lives, voices, and agency. This is a prime opportunity for medical anthropology to voice its unique contributions. Medical anthropologists have a chance to work towards incorporating themselves more fully in anthropological discourse and in interdisciplinary discussions about issues in gender and development. By doing so, medical anthropologists can show how useful their discipline can be in policy and practice, rather as simply a chance to explore the “curiosities” of “native” medical cultures.
The Women and International Development Working Papers became the Gendered Perspectives on International Development Working Papers in 2008. Since this time, none of the papers published have focused on health. Though the name change of the papers in no way indicates a discrete shift in the foci and discourse of the series, it does indicate institutional moves in work surrounding women and development. It is up to medical anthropologists to ensure that health is incorporated as a part of these changing discourses as we move toward a world that is more just for all.

References
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Becker, Stan and Alauddin Chowdhury. 1983. “Determinants of Natural Fertility in Matlab, Bangladesh.” Michigan State University Women and International Development: Working Paper #40.
Browner, C. H. 2005. “Some Unexpected Consequences of Implementing Gender ‘Neutral’ Reproductive Programs and Policies.” Michigan State University Women and International Development: Working Paper #284.
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Center for Gender in Global Context. 2010. “GPID Call for Papers.” Accessed 8 November 2010 at .
Center for Gender in Global Context. 2010. “Working Papers.” Accessed 15 November 2010 at .
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Durrant, Valerie. 1994. “Impacts of AIDS on Women in Uganda.” Michigan State University Women and International Development: Working Paper #249.
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Fortney, Judith A., Saneya Saleh, Saad Gadalla, and Susan M. Rogers. 1984. “Causes of Death to Women of Reproductive Age in Egypt.” Michigan State University Women and International Development: Working Paper #49.
Gallin, Rita S. 1986. “Women and Work in Rural Taiwan: Building a Contextual Model Linking Employment and Health.” Michigan State University Women and International Development: Working Paper #127.
Gruenbaum, Ellen. 1990. “Nuer Women in Southern Sudan: Health, Reproduction, and Work.” Michigan State University Women and International Development: Working Paper #215.
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Ireson, Carol J. 1985. “Development, Women's Situation and Fertility: The Mexican Case.” Michigan State University Women and International Development: Working Paper #95.
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