Salud y patriarcado, por Melissa Sepúlveda

Salud y patriarcado

por Melissa Sepúlveda Alvarado – Militante de Solidaridad, Federación Comunista Libertaria.

Últimamente me ha sorprendido gratamente, después de varios años de majadería feminista, la existencia de cierta intención dentro del movimiento popular de incorporar una perspectiva feminista en su análisis y praxis. Ya es habitual la utilización de lenguaje inclusivo en asambleas y reuniones, y hasta pareciera incomodar la palabra de quien no lo incorpora. Sin embargo, a la hora de plasmar esta intención en los programas de lucha de los diversos movimientos sociales que se están desarrollando en el territorio chileno y Wallmapu, la falta de herramientas para el análisis feminista de la realidad es evidente.

El objetivo de este artículo es aportar al desarrollo de una construcción feminista en el ámbito de la salud y particularmente al fortalecimiento del proceso de construcción programática que está viviendo el Movimiento Salud para Todas y Todos (MSpT). Para esto es fundamental poder identificar las formas en que opera y se reproduce el patriarcado dentro de las prácticas de salud, ya sean las administradas por los servicios de salud del Estado como las que proveen otros actores sociales a los que acuden particularmente mujeres y niños/as.

A mi juicio, un primer punto central es reconocer el patriarcado como un sistema de dominación, diferente y anterior al capitalismo, del que este último se nutre para ejercer explotación a mujeres y niñas en todo el mundo. El modelo de salud está directamente relacionado con los sistemas de dominación imperantes, articulan la cosmovisión y relaciones sociales determinando la economía, política y cultura de las sociedades. El sistema de salud, por su parte, es la materialización de este modelo y se expresa como una serie de conocimientos, saberes y prácticas ejercidas desde la institucionalidad del Estado o fuera de esta para el control sanitario de la población. Este entremado, particularmente en las sociedades capitalistas, fue concebido con el objetivo de garantizar una masa “sana” de trabajadores y trabajadoras que pueda cumplir con las necesidades de producción y en el caso de las mujeres asegurar la reproducción de esa clase trabajadora. Coherente con esto, el sistema biomédico, centrado en las patologías del individuo y que ignora los determinantes sociales de la salud, edifica el sistema de salud que existe en Chile, que se mantiene a pesar de los intentos académicos que han mostrado su ineficiencia para lograr una población más sana, pues logra cumplir con sus objetivos productivos y reproductivos.

Por otra parte, es necesario reconocer que la hegemonía de este modelo de salud está directamente relacionado con la colonización y el genocidio occidental, afianzándose mediante la lucha contra otras y anteriores formas de ejercer la práctica médica: machis, comadronas, curanderas, y parteras fueron excluidas del saber técnico médico y desplazadas todas las formas de conocimiento que no provengan de los estándares institucionales de evidencia científica. Por lo tanto, la primera gran tarea es reconocer, dentro del análisis del modelo de salud que vivimos, que este corresponde a un modelo patriarcal, capitalista y colonial.

Propongo identificar al menos cuatro niveles en los que opera el patriarcado en el modelo y sistema de salud hegemónico. Estos están relacionados entre sí y se expresan cotidianamente en las prácticas de atención de salud.

¡) Androcentrismo. Históricamente, el modelo biomédico ha tenido un carácter androcéntrico, esto es, identifica al hombre como centro de la realidad y desde él construye el entorno, sistema o cosmovisión. El sujeto al que atiende el sistema de salud es masculino y en base a eso establece la universalidad, siendo incapaz de observar el género como determinante de las condiciones de salud y enfermedad. Por ejemplo se afirma que ser mujer es factor de riesgo para desarrollar patología mental, sin considerar las condiciones sociales que implican la mayor prevalencia de patologías psicoafectivas en mujeres. Por otra parte, la aproximación del sistema sanitario a la especificidad de las mujeres ha sido principalmente a través de su función reproductiva, relegándolas socialmente a los roles de madre y esposa, de modo tal que su salud ha estado principalmente vinculada, en la medicina occidental, a su fisiología reproductiva, es decir, a la gestación, anticoncepción, planificación familiar, y recientemente, la menopausia.

ii) Vínculo patriarcal con el sistema de atención en salud. Afirmamos fehacientemente que en nuestra sociedad existe una relación clientelar con el sistema de atención sanitaria, propio del modelo de mercado. Lo que obviamos es que ese vínculo es posible gracias a las relaciones patriarcales, que esconde mucho más que la compra-venta de salud y que es incorporado tempranamente en nuestro primer espacio de socialización: la familia. En la estructura familiar quien condensa todos los poderes es el “pater”, incluidos el de la vida y la muerte sobre hijos, esposa(s) y esclavos. La estabilidad de este modelo que muy bien conocemos se basa en la dependencia. La condición de vulnerabilidad que supone un cuerpo enfermo nos hace buscar protección, y si bien este vínculo se refleja en hombres y mujeres, estas últimas son particularmente dependientes del sistema de atención de salud, quienes son las que más consultan, ya sea como protagonistas o cuidadoras.

iii) Violencia médica contra las mujeres y otras identidades no masculinas. Diariamente observamos vulneración de derechos básicos en las prácticas de atención de salud, los prejuicios y falta de perspectiva de género de las y los profesionales de la salud se traduce en violencia, donde la falta de conocimiento sobre nuestros cuerpos se transforma en terreno fértil para el autoritarismo médico. El maltrato a mujeres y transexuales con patología mental, necesidades especiales u obesidad, como también la violencia obstétrica y ginecológica, son algunos ejemplos que develan la incapacidad de reconocer a las mujeres y otras identidades dentro del sistema sanitario dado por el modelo androcéntrico de salud.

iv) Subjetividad femenina sobre los procesos de salud-enfermedad. Directamente relacionado con el vínculo patriarcal con el sistema de atención, las mujeres no nos percibimos ni se nos identifica socialmente como sujetos con capacidad de autodeterminación, por lo que la incorporación de cambios favorables a nuestra salud está continuamente bajo boicot. Así por ejemplo, podemos asegurar que existe un proceso de feminización de la obesidad en las sociedades occidentalizadas, particularmente en las mujeres pobres, relacionadas con baja autoestima y percepción de autoeficacia a la hora de incorporar cambios en los hábitos alimentarios.

Necesitamos construir un nuevo modelo y sistema de salud que dignifique a nuestros pueblos, quite la centralidad en la producción y reproducción del capital, fortaleciendo una mirada de conservación de la salud por sobre la administración de las patologías y que contribuya activamente a desmantelar las relaciones patriarcales. Este será un largo camino de reflexión, autocrítica, generación de conocimientos nuevos y recuperación de saberes ancestrales. Afortunadamente hemos dado los primeros pasos. La invitación a ser parte de este proceso está hecha.

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