Social, Cultural and Biomedical Construction of Menopause in Punjab, Pakistan
Menopause is commonly defined as a universal biological phenomenon of permanent cessation of menstruation experienced by all females. Menopause is considered to have different cultural meanings and cultural construction in different cultures. This thesis explores how menopause is socially, culturally, and biomedically constructed in Punjab, Pakistan. In particular, it explores the meaning of menopause as defined by participant women and medical practitioners. Ethnographic fieldwork was carried out in Punjab between March 2019 and October 2019. It involved semi-structured interviews with participant women and practitioners, and participant. A total of 25 interviews were conducted with participant women including 15 women who experienced natural menopause and 10 women who experienced surgically-induced menopause. Data was thematically analyzed using ethnographic principles. A comprehensive literature review was conducted based on empirical studies on the experience and perception of menopause. In these research papers, experience and perception of menopause are described into three main categories including menopause as a distressing time, menopause as a liberating time, and menopause as a neutral time of life. Drawing on Scott’ (2018) conceptual framework of the sociology of nothing and McGoey’s analytical framework on the sociology of ignorance (McGoey, 2012), this research study demonstrates that cultural and social framing of menopause is no-thing, underrepresented and ignored where nothing means non-existence, underrepresented is non-presence of something that actually exists, and ignorance is unawareness of something regardless of its existence. This study's findings show that menopause is culturally non-existent for women of Punjab because it is absent in their everyday conversations and their understanding of health and ageing. Similarly, this study also suggests that menopause is underrepresented because its presence is not acknowledged by health care practitioners which means it is not recognized as a disease. In addition, surgical menopause is ignored because despite its existence and presence healthcare providers and participant women ignore its presence. Moreover, this study suggests that gender is at the core of shaping the absence of menopause interwoven with other cultural aspects such as socioeconomic status, religion, and interpersonal relations in Punjabi society. This study argues that the concepts of health and illness are multidimensional and need to be analyzed through cultural concepts of diseases. The integration of the theoretical framework of the sociology of nothing and the sociology of ignorance in this study offers a novel theoretical underpinning to understand menopause in a culture where its presence is not acknowledged and accepted. Given the burgeoning work on differences in menopause experience across the globe, this thesis is timely and useful in supporting the approach that menopause is a phase of life that people experience differently in different cultural settings and in different time periods of their lives. This study suggests that the meaning of menopause as a universal experience is unstable and needs to be reanalysed through a novel lens.
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