The Struggle to Be “Fully Human”: Women’s Communicative Disenfranchisement and Ideological Formations in the U.S. Healthcare System

Drawing on the theory of communicative disenfranchisement (TCD) and based on qualitative interviews with 27 women living in the U.S. this study illuminates the enduring and persistent role of deep-seated "ideological formations'' (i.e. essentialized and oversimplified assumptions and worldviews) in medical interactions. Specifically, the analysis uncovers three core ideological formations that shape the communicative disenfranchisement (CD) encountered by women: (a) assumptions around the superiority of biomedicine, (b) assumptions about women's voice, agency, and decision-making capacities, and c) assumptions (and scrutiny) around women's reproductive capacities and physical features. Women experienced CD at the intersection of essentialized worldviews surrounding biomedicine and the "humanness" of women. These ideological assumptions meant that women routinely encountered a masculinist and patriarchal biomedical model of medicine, stereotypes about women's bodies, agency, and reproductive facilities, and in some instances, women endured sexist macroaggressions. Theoretically, the study advances TCD by elaborating upon core ideological formations that create and sustain CD in medical settings. In practical terms, the study calls for refocusing the healthcare system using a women-centered approach that recognizes the limitations of biomedicine and women's agentic struggles to be seen as "fully human."