Speech therapy, despite being a profession mostly practiced by women, continues to drag gender inequalities in areas such as research, teaching and clinical practice. In this article, we explore how gender stereotypes, structural biases and female underrepresentation in positions of responsibility affect the profession. From a feminist perspective, tools and reflections are proposed to promote a feminist speech therapy, more conscious, inclusive and equitable with patients and work materials.
[This text was published on the 38th issue (fall-2021) of the journal Logopèdia, under a Creative Commons by-nc-sa-nd license]
Every June, a group of people take the entrance exams and cross their fingers to get the grade needed to enter the speech therapy degree. Of these people, an overwhelming majority are women and, luckily, they are more aware than those in my class of what it means to be one. At that time (I have been twenty for twenty years), feminist activism existed, but it moved through minority circuits, hidden from the general population who, in fact, saw the adjective feminist as ridiculous and obsolete. Feminism was for many an outdated memory of the past, a dream of inflamed activists, of aunties who get heavy when they drink more than they should. Those of my class, to paraphrase Montserrat Roig, did not consider whether we were men or women, it was the others who, little by little, reminded us that we were women.
With the arrival of the so-called fourth wave of feminism ten years ago, we began to open our eyes to oppressions that we were previously unable to see, some of which we were even victims of. We realized that women had indeed occupied public spaces and paid jobs that were previously occupied by men, but that at the same time there had been no counterpart on their part in terms of domestic work and care. Women had not abandoned these jobs, we had extended our hours. With the fourth wave, we realized that we did not have to accept certain behaviors and comments towards us. We learned to value more what we do and what we can do.
Within the field of speech therapy, a profession with a large majority of women, oppressions and violence that are already known for other disciplines with a female predominance, such as nursing or education, are reproduced. As expected, gender discrimination also extends to speech therapy consultations and research on communication and language. This article collects some of the oppressions that unfold on the gender axis and makes some reflections on good practices to avoid the perpetuation of certain stereotypes.
Where are all the women?
One might expect that in a discipline as feminized as speech therapy, for example, the CLC report details that there are 95.4% female members, the proportions would be reflected in positions of greater responsibility and status. However, a study by Rogus-Puglia et al. (2018) showed that this is not the case. They analyzed the gender representation of professionals in communication sciences and disorders in doctoral positions, university positions, and in the awarding of awards and honors. The data showed that men were the majority in these spaces of greater responsibility and remuneration.
This study was conducted in the USA, but these are data that are repeated in other countries, in the academic field in general and also in disciplines comparable to speech therapy in particular. Women are there and they are not there at the same time. They maintain a presence in the profession as basic speech therapists, they support speech therapy, but there is a significant absence in the upper layers, there is a representation that is incongruent with the number of women who make up the profession.
Women are present and absent at the same time: they sustain speech therapy, but devoid of positions of power.
This asymmetry hides a series of gender biases that women suffer throughout their professional careers. First, the very decision to choose speech therapy studies is influenced by a gender stereotype. Disciplines such as speech therapy attract women more due to a cultural gender bias on the female role that traditionally associates women with tasks related to care and assistance to dependent people. This tacit idea in our culture of “women take care of others as they should” would make young women with inclinations towards other disciplines traditionally associated with men end up opting for these more socially acceptable options.
Later, during their professional careers, women suffer various pressures, such as subtle influences to keep them away from doctoral programs. These pressures should be understood not as direct actions of a group or necessarily an individual, but as structural biases, as tendencies embedded in the system. That is, in a given political and cultural system there are rules and expectations about how men and women should act. These expectations are what end up tipping the figures towards an absence of women in these more specialized layers of the study of communication and disorders.
These generally unconscious biases also put men at an advantage in recruitment selection processes. Furthermore, according to the study, unlike men, women in positions of responsibility who adopt behaviors traditionally associated with male leadership (such as personal promotion or negotiation) suffer a negative reaction and anxiety from being judged through stereotypes.
The scientific study of human language and communication also suffers from a gender bias that affects the knowledge that is constructed from academic circles. Unfortunately, this is not new to research either. Multiple gender biases have been documented in research into the biological and social aspects of human beings. From the well-known biases in describing how diseases manifest in men and women to the assumption that Neanderthal females did not hunt, science has been plagued by methodological flaws influenced by gender stereotypes.
One of these methodological flaws in speech therapy studies and other socio-health disciplines is the absence of women in study samples and the generalization of male results to the female population. A clear case is the gender bias in the study and description of the traits of people with ASD, which may be different in men and women. This has necessitated a review of clinical practice guidelines for the diagnosis of ASD, which is underdiagnosed in women.
Authors: Ana Sánchez Palacín “Iru” (@little_iru) and Nima Peyman-Fard (@doctorojete).
What happens inside the consulting room?
At this point, we see that gender oppression is much more difficult to detect at first glance and that it is more widespread than we thought. Could we be perpetuating certain gender stereotypes in our daily lives without realizing it? Obviously, if we see gender as a series of repeated acts (Butler, 1990), as a choreography that we let ourselves be carried away by, it is easy for many of the things we do or say to end up repeating the same dance steps. It is difficult to say “I am not sexist”, because the cultural, religious and economic context in which we live is. In this context, it is practically impossible to have an immaculate record with regard to gender discrimination. For this reason, it is necessary to carry out an act of review of one’s own practice and make conscious decisions.
And how does this translate into the speech therapy field? At the level of materials, sexist practices are still being reiterated, such as making women and their role in the construction of knowledge or in artistic creation invisible; presenting traditional divisions of labor between men and women; showing the male body as the prototype of a human being in anatomy sheets; including illustrations of boys and girls with a traditional gender expression (boys and girls who dress and play in certain ways); etc.
It is difficult to say “I am not sexist”, because the cultural, religious and economic context in which we live is.
This is especially important in the case of audiovisual material (films, music videos, songs, etc.), since the dominant culture is still very sexist. Also when we search for photos or illustrations on the internet to prepare an exercise, it is very likely that the first results that appear in the search engine are sexist.
Standardized assessment tools are made at a specific sociocultural time and by work teams that often do not represent the population equitably. For this reason, they can fall into the use of sensitive images for some groups and that are inappropriate today. For example, in an article published in Asha Leader, researchers Ellen Bernstein-Ellis, Eve Higby and Michelle Gravier highlight the need for socially responsible practice and explain the case of an illustration of the Boston Naming Test-2 that has caused the publisher to receive many requests for change. It is a drawing of a rope, an image with a powerful ideological symbolic charge that transports to the recent past of racist lynchings in the United States. After the murder of George Floyd in 2020, the publisher admitted the need to change this image and began giving away stickers with an alternative image of a boomerang to replace the previous one.
Regarding gender stereotypes, CELF Preschool 2, for example, represents women and men with very traditional roles: women who make soup in a kitchen, who pick flowers and men who work as doctors and wash the car with their child. Obviously, this is not easily changed overnight and most speech therapists do not have that much influence to change a validated and standardized publication. Despite this, there are some reflections that are worth making in relation to our daily practices.
A first conscious action against sexism can be to review the treatment of gender in the materials we use in the consultation. An example of this self-review practice was the analysis carried out by the Espai i Lleure association and the gender commission of the Tàber public school of the collection of their children’s library in 2019. After reviewing this section from a gender perspective, they removed 200 sexist stories, 30% of the collection, because they reproduced gender stereotypes.
It is not only about what we say in practice, also what we show: images, roles and silences speak.
Beyond the materials and examples we use in the session, it is very important to reflect on the attitudes, expressions and behaviours we have with patients and with our male and female colleagues. As for patients, the speech therapy consultation must be a safe space, a place of trust so that the person being treated can express their gender freely. This implies, for example, not taking for granted that the person in front of us has a certain gender identity. We must ensure that we address the person with the grammatical gender with which they want us to address them or with the name they recognize as their own. The person being treated must be able to express their personality without feeling judged (desires, fears, sense of humour, anecdotes, etc.).
When assessing patients’ skills, as has already been said, unconscious gender biases operate a lot. Some ways to mitigate this possible involuntary bias are to use standardized tests, despite the internal biases they may have, and to compare the results with other peers when possible. On the other hand, a self-review exercise should be carried out when considering the prognosis and the skills that the person may achieve. We must bear in mind that if with people outside the consultation there is already an underestimation of what a woman can do, in the case of the people we treat, this bias is likely to remain. To understand how quickly we learn this notion of intelligence or ability associated with gender, it is worth reviewing the study by Bian et al. (2017), which showed that girls as young as 6 years old begin to underestimate the ability of other girls. From this age on, they begin to think that members of their gender are less likely to be very intelligent and stop participating in activities that they say are for children “who are very bright”.
Regarding relationships between professionals, apart from the bias regarding promotion opportunities within an organization, multiple cases of aggression against women in work environments have been described. The way of interacting in meetings, decision-making or the assessment of the professional competence of each member of the team are also crossed by a gender bias. In this sense, several guides to good practices have been published in companies to guarantee a good selection process, development and quality of work life for female workers.
[This text was published on the 38th issue (fall-2021) of the journal Logopèdia, under a Creative Commons by-nc-sa-nd license]
References
Bernstein-Ellis, E., Higby, E., & Gravier, M. (2021). Responding to Culturally Insensitive Test Items. Leader Live.
Bian, L., Leslie, S. J., & Cimpian, A. (2017). Gender stereotypes about intellectual ability emerge early and influence children’s interests. Science, 355(6323), 389-391.
Butler, J. (1990). Gender trouble, feminist theory, and psychoanalytic discourse. Feminism/postmodernism, 327, x.
Rogus-Pulia, N., Humbert, I., Kolehmainen, C., & Carnes, M. (2018). How gender stereotypes may limit female faculty advancement in communication sciences and disorders. American journal of speech-language pathology, 27(4), 1598-1611.