Today the New York Times published a very personal and, for many people, unexpected op-ed by actress, director, and humanitarian Angelina Jolie. Ms. Jolie, a carrier of the gene BRAC1 with a mutation that significantly increases breast cancer risk, recounts her decision and experience undergoing a preventive double mastectomy — the surgical removal of both of her breasts. There should be no shame in undergoing such a procedure. Still, Ms. Jolie feels compelled to note: “On a personal note, I do not feel any less of a woman.” This is a real concern for many women.
The more we talk about women’s health and the unique health experiences women face, the better. The same goes for men. Our bodies are often imbued with such greater expectations than their basic purpose, to allow us to live our lives. We make judgments about each other based on shape and size, and spend countless, wasted hours making these judgments about ourselves.
I applaud Ms. Jolie for her contribution to this important conversation. It also raises important issues for women’s health beyond the New York Times readership. Ms. Jolie writes,
For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.
I wish this were more true than it is. For many women around the world, there are not many options. Ms. Jolie is well aware of this, and I believe she will be one among many fighting to change the status quo. In the meantime, there are sobering facts to face at home in Uganda.
Breast cancer is the third most common cause of cancer among women in Uganda, behind cervical cancer and Kaposi’s sarcoma (the latter of which are largely preventable).
The vast majority of Ugandan women present at late stages in the cancer’s progression, at which point there is little chance of survival.
The estimated budget of the Uganda Cancer Institute is approximately Ushs 5.5 billion, just over US$2 millon (Sector Budget Framework Paper). The State House budget is 36 times that, over Ushs 200 billion.
The cost of testing for BRAC1 and BRAC2, as Ms. Jolie notes, is US$3,000 in the United States, and completely inaccessible for almost all women in Uganda.
In comparative terms, Uganda has relatively low rates of breast cancer. But it’s hard to know how accurate these figures are due to poor surveillance and diagnosis in much of the developing world.
Women of my generation have clung to the feminist credo we were raised with, even as our ranks have been steadily thinned by unresolvable tensions between family and career, because we are determined not to drop the flag for the next generation. But when many members of the younger generation have stopped listening, on the grounds that glibly repeating “you can have it all” is simply airbrushing reality, it is time to talk.
I still strongly believe that women can “have it all” (and that men can too). I believe that we can “have it all at the same time.” But not today, not with the way America’s economy and society are currently structured. My experiences over the past three years have forced me to confront a number of uncomfortable facts that need to be widely acknowledged—and quickly changed.
Conventional wisdom and a number of recent papers say yes, but Matthias Doepke and Michèle Tertilt have a paper out that suggests we think twice about this relationship:
“In this paper, we examine the link between female empowerment and economic development from the perspective of economic theories of household decision making. We develop models that are consistent with the empirical observation that an increase in female resources leads to more spending on children. We use these models to address two related questions. First, we focus specifically on programs that target transfers to women and aim to raise female income, and ask whether such policies really make children better off. Second, we consider a wider range of policies, and ask whether alternative forms of female empowerment have similar effects.
While at first sight it may seem that existing empirical evidence is sufficient to answer these questions, our theoretical analysis shows that this is not the case. We demonstrate that the link from the observed empirical patterns to policy implications is far from obvious: the effects of policy interventions are highly sensitive to the details of the underlying economic model, unintended consequences can arise, and different forms of female empowerment can have opposite effects.”