美籍教師蕭玫凱（Malissa Kay Shaw）助理教授於2018年2月加入臺北醫學大學人文暨社會科學院醫學人文研究所，並於2020年2月獲得科技部109年度「愛因斯坦培植計畫」，為期3年550萬元的補助，本刊特邀她分享目前進行的相關研究。（編按）
在生物醫學領域中，女性健康及她們的身體經常被忽略，或與男性標準比較時，被視為是一種變異，身為具有人類學、科學及技術研究背景的醫學社會學者，我的研究旨在彰顯這些知識的鴻溝，包括探討女性對其健康及身體進程的經歷、她們與醫療專業人員及醫療處置間的連結經驗，及其使用生物醫學與身體技術的經驗。
我開始對女性健康產生興趣，尤其生殖議題，緣起於我在阿姆斯特丹大學念碩士班時，跟人類學家特魯迪埃格里茨（Trudie Gerrits）在撒哈拉以南的非洲區，舉辦一場輔助生殖文獻探討時。那個機緣，讓我到愛丁堡大學攻讀社會學博士。由於我在南半球時，已有將高科技不孕症治療技術導入醫療體系內的高度複雜經驗，加上我對拉丁美洲的興趣，遂決定在哥倫比亞的波哥大發起醫院民族志的輔助受孕計畫。這個研究聚焦於促產主義的天主教國家中的女性及醫療人員，在探索毫無規則可循與新自由主義的人工生殖技術市場時，所產生的主體行為。我尤其專注在女性對侵入性醫療處置的動態內建經驗的主觀性，如何形成一種內建行為動能性，排斥一般醫療處置被過度簡化的物化特徵。【左圖：人社院醫文所蕭玫凱老師】
自從2018年加入臺北醫學大學，我的研究仍持續專注於女性健康、體現及醫療介入措施，但至少部分是以臺灣當地的觀點來看這個議題。我目前正在進行臺灣女性內診經驗的質性訪談分析研究，這個研究源自於我比較臺灣與其他地方醫療資源使用差異而產生的興趣。很明顯地，臺灣對懷孕及分娩過程的過度監測，遠勝於其他醫療資源低度使用或不足的地方。雖然我的訪談對象很清楚地表達這個現象及潛在成因，但更有趣的是，這些女性不但嚴謹評估她們對醫療過程的期待，更認為一個好的醫療人員必備的專業要能夠滿足這些期待。醫學專業主義（或稱醫學專業素養）的研究，除了以專業醫療人員執行醫療為中心的觀點，很少考量病人的觀點。
除了這個進行中的分析之外，我最近獲得科技部愛因斯坦培植計畫3年的研究經費，計畫名稱是「污穢的身體，污穢的秘密，污穢的地球：透過不同的月經產品改變對月經和女性生活受限的認知」，這個研究關注月經杯的多重印象與意義，月經杯是近期的新發明，其設計理念在於以更安全、更環保、更經濟的方式收集經血。
在這個二階段的研究中，我正在探討全球80家以上生產月經杯公司（主要由女性經營）對其產品多樣的認知與意識型態，雖然這其中許多家公司以其可重複使用、方便的產品提升更積極的生活模式，得以賦予女性權力為傲，然而，有時他們的產品廣告，卻強化了月經對女性而言是一種髒污且須被隱藏的負面描繪。第二階段會比較兩間生產月經杯公司及其使用者的經驗，一間在臺灣，一間在哥倫比亞。廣義而言，這個研究旨在探討月經杯公司所釋放的不同訊息，以及這些訊息如何引發當地女性對健康更廣泛的關注；進而了解其使用經驗最終如何改變她們對月經的看法。（文/蕭玫凱，醫學人文研究所助理教授）【下圖：蕭玫凱在人社院授課情形】
Within biomedicine women’s health and their bodies have often been neglected, or seen as deviant when compared to the male standard. As a medical sociologist with a background in anthropology and science and technologies studies my research aims to bring light to this gap in our knowledge through exploring women’s experiences of their health and bodily processes, their engagement with medical professionals and medical interventions, as well as their use of biomedical and other bodily technologies.
I initially became interested in women’s health and specifically reproduction during my masters when I conducted a literature review on assisted reproduction in Sub-Saharan Africa with Anthropologist Trudie Gerrits at the University of Amsterdam. From there I went on to study a PhD in Sociology at the University of Edinburgh. Given what I had learned about the complexities of incorporating high-tech infertility treatments into medical systems in the Global South and my interests in Latin America, I decided to conduct a hospital ethnography on assisted conception in Bogota, Colombia. The study focused on the agency of both women and medical staff as they navigate the unregulated, neoliberal market of ARTs in a pronatalist, Catholic country. I specifically focused on the dynamic ways women’s embodied experiences of invasive medical procedures are agentic, forming a type of embodied agency that refutes the commonly oversimplified objectifying character of medical interventions.
Since moving to TMU in 2018, my research has continued to focus on women’s health, embodiment, and medical interventions, but (at least partly) within the local Taiwanese context. I am currently analyzing data from a qualitative interview study on women’s experiences of pelvic examinations in Taiwan. This study was driven by my interest in the contrast between an apparent over-medicalization of pregnancy monitoring and birthing practices in Taiwan compared to an underuse, or under-medicalization, of preventative gynecological screening. Though this phenomenon and potential causes of it were clearly expressed by my interview participants, what may be more interesting is the way women critically assessed not only what they expected from a medical encounter, but also their unwavering expectations of what constitutes a good medical professional. Studies of medical professionalism have rarely considered the perceptions of patients, despite their central role in the medical encounter.
In addition to this ongoing analysis, I recently received a three-year Einstein Grant from MOST. My project, “Dirty Bodies, Dirty Secrets, Dirty Earth: Transforming Restrictive Perceptions of Menstruation and Women’s Lives through Alternative Menstrual Products” concerns the diverse images and meanings surrounding menstrual cups, a relatively new device designed to collect menstrual blood in a healthier, more environmentally friendly, and economical way.
In this two-part study, I am currently exploring the diverse perceptions and ideologies that the more than 80 (primarily women run) companies producing menstrual cups around the globe have of their products. Though many of these companies pride themselves on empowering women through their sustainable, more convenient products that promote an active lifestyle, their advertising at times reinforces the negative portrayals of menstruation that have stigmatized women and this bodily process as dirty and needing to be concealed. The second phase will involve a comparative study of the experiences of two menstrual cup companies, one in Taiwan and another in Colombia, and the women who use their products. Broadly speaking this study aims to explore the various messages menstrual cup companies portray and how these messages are positioned within broader concerns for women’ health in the local context; how women perceive these concerns, how they experience using a menstrual cup, and, ultimately, how this use alters their experience of menstruation. （By Malissa Kay Shaw, Assistant Professor, Graduate Institute of Humanities Medical）
