Women, Health and Nation: Canada and the United States since 1945 (review)

In the last decade the history of health and medicine has witnessed a revival, spurred in part by a growing interest in the social history of medicine, health funding for research in the social sciences and humanities, and contemporary concerns with health-care funding and policy making. Women, Health and Nation is a collection of twenty essays, most of them originating from a 1998 conference and research project, the latter funded by the Burroughs Wellcome Fund 40th Anniversary Award for the History of Medicine and Science. Concentrating on post-Second World War Canada and the United States, the essays promise cross-border comparisons, a promise that is partially fulfilled. As in any collection of essays, there are strengths and weaknesses, and in this particular example, the comparisons are more often implicit than explicit.

The editors identify five themes in the volume: the power of the nation-state, the role of biomedicine, the diversity of women's health needs and experiences, women's agency, and the role of reproduction in women's health activism and history (4-9). But the volume does not always follow this thematic organization, providing us instead with one short chapter called 'Why Borders Matter,' and sections on biomedicine, childbirth, patients and providers, and women's activism. While in their introduction the editors emphasize the nation-state theme as 'foremost,' specific comparisons are drawn most clearly in chapter 1 by the editors, chapter 2 by Barbara Clow on thalidomide use, chapter 5 by Alison Li on menopause and the marketing of premarin, and in chapter 17 by Susan Smith and Dawn Nickel on nursing in palliative care. The remaining chapters focus on either Canada or the United States. Nevertheless, a number of excellent essays raise questions and confront previously accepted approaches.

The comparative chapters suggest that borders mattered, but not always and not in every situation. The editors' chapter surveys developments on both sides of the forty-ninth parallel, noting that while Canada moved into insuring health services in the late 1950s and the 1960s, the Americans brought in insurance for targeted populations. Later the differences become more striking, as Canada strengthened provisions for universal care while the United States severely limited or froze access to health care. Similarly, the editors pinpoint clear differences in women's health activism but note that in both countries the pressures of a post-September 11 world put 'unprecedented demands on Medicare' (36). Clow's chapter on thalidomide demonstrates the more cautious approach taken by American regulatory agencies, which refused to permit the sale of the deforming drug; it also insists on the need to consider the social and cultural factors that led women to take the drug, taking the consumer's perspective. Li's article, on the other hand, explores the selling of drug treatments for menopause to younger and younger women and the different policy responses of Canadian and American drug regulators. Smith and Nickel dig into the differences between American hospice care outside the hospital and Canadian palliative care nursing in a hospital setting, the latter influenced by federal-provincial funding arrangements in the context of changing cultural norms about death and dying.

Indeed nursing and midwifery provide another thread in this collection, representing nearly one third of the articles. Both Laura Ettinger and Aline Charles examine the role of nursing sisters. Ettinger analyses the role of the first sisters to practise midwifery in the United States, while Charles focuses on the 'religious labour' of hospital sisters in Quebec, a work role that disappeared by the 1980s as nuns became salaried and unionized too. Judith Zelmanovitz and Kathryn McPherson draw our attention to northern and Aboriginal communities and the regional and cultural tensions experienced at nursing outposts as nurses, often not trained in midwifery, found themselves performing deliveries and importing southern medical practices to the North. Similarly, Karen Flynn's essay underlines...