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  • 學位論文

子宮頸抹片檢查的身體政治:婦女與公衛護士的經驗

Body Politics of Pap Smear:The Experience of Women and Public Health Nurses

指導教授 : 王秀雲

摘要


本文旨在探討與解構醫療論述中,不(定期)接受子宮頸抹片檢查的婦女,她們通常被形容為認知不足、觀念錯誤、性格保守、害羞。其次,本文亦探討第一線公衛護士在推廣子宮頸抹片過程中,如何看待不(定期)接受子宮頸抹片檢查的女性;為了提升並達到中央衛生主管機關所訂定的子宮頸抹片篩檢率及目標數,她們提出了哪些政策,實際推動過程中運用了哪些策略和方法。本研究以質性研究的方法進行,訪談不(定期)接受子宮頸抹片檢查的婦女,並參與高雄市衛生局召開3場次的「婦女友善醫療環境推動及改善會議」,瞭解公衛護士實際在第一線推動子宮頸抹片檢查的情形,並對照相關子宮頸抹片檢查的醫療論述及公衛研究等加以分析。   描繪不(定期)接受子宮頸抹片檢查的婦女是因害羞、保守而不就男醫的子宮頸抹片檢查的醫療論述,把女性的身體看成是上婦產科求診的困境,限縮了女人在醫療場域的協商空間,但事實上,醫師的性別並非主要影響某些婦女接受子宮頸抹片檢查的意願及原因,她們反而去性化自己的身體及生殖器,以此訴說就男醫的經驗及觀點。有的婦女接受子宮頸抹片檢查之所以找女醫師,是因認為容易溝通,但也有不少受訪者提到就女醫的負面經驗,不認為就女醫較好。另外,認為自己「身體好好的」,不需(定期)接受子宮頸抹片檢查者,並非無預防醫療的保健概念,她們實際上會利用報章雜誌等通俗醫療知識瞭解自己的身體,並依此自我管理與觀察,以避免接受子宮頸抹片檢查。   雖然西方醫學為台灣的主流醫學,子宮頸抹片檢查被視為「早發現、早治療」的醫療技術,以及國家衛生政策用以規訓、監控女性罹患風險的方法,但由於中醫或民俗醫學本身有完備的知識體系,加上婦女個人的隱微知識,使得她們得以充權,甚至質疑西方醫學。此外,在抹片的醫療論述裡,雖然子宮頸癌的高危險群與性複雜和多重性伴侶相連結,但本研究中50~69歲不(定期)接受子宮頸抹片的婦女,以及未婚或單身的女性,因理解自己性是安全的,罹癌的風險較低,認為不(需)定期受檢。   由於過往對於婦女之所以不(定期)接受子宮頸抹片檢查的論述,多半由公衛界及醫界發聲,少見第一線推動子宮頸抹片檢查的公衛護士有發言的機會,或瞭解她們在抹片推動上使用的策略及方法,本研究第三章以此為題。為了提升子宮頸抹片篩檢率,公衛護士們極盡所能,對於在衛生所辦理社區篩檢的子宮頸抹片空間,除了著重隱私性、可近性,更塑造不同於診間的候診空間,讓婦女得以在社區設站,或衛生所抹片時享有友善的醫療環境。不過,女性除了著重隱私外,也意識到抹片檢驗過程中各不確定性,例如:子宮頸抹片檢查採樣細胞的保存問題,或診察台等檢查設備處理與消毒是否妥適,但此在於女性把醫院與衛生所的社區篩檢環境比較,她們認為醫院才是設備完善、先進、專業等正規、乾淨的醫療環境;但也有部份的女性認為,衛生所或社區篩檢的方便、可近性,以及無繁複醫療流程才是較佳的抹片空間。

並列摘要


The thesis examines medical discourses on women who avoided doing Pap smear in which they were portrayed as ignorant of correct knowledge, irresponsible of their own health, and conservative regarding their body being examined by male physicians. By interviewing women themselves, the medical discourses were limited in that many women were not ignorant nor irresponsible. Instead, they paid considerable attention to their own bodies and health. In addition, I also explore how public health nurses carried out the various projects to promote Pap smear, how they understood women who did not do Pap test (annually), and the policies and procedures they developed to improve the screening rate. This research is based on qualitative methods, including several interviews with women who did not do Pap test, and participation observations on several focus group discussions organized by the Women Friendly Health Care project run by the Health of Department of the Kaohsiung City Government. Women who did not do Pap test, according to the existing medical discourses, were prevented by their concerns of modesty and were reluctant to see a male physician. However, the gender of the physician was not the only reason why women did not do Pap test, if not irrelevant. Some older women even desexualized their body and genitals and made the point that a male phtysician did not matter as much as people assumed. They saw that communicatons with female gynecologists are easier than with male gynecologists. In addition, some women mentioned their bad experience with a female gynecologist. Furthermore, the women who believed that they were healthy were very well-informed in health information.They made rational choices, had control over their own bodies, and paid attention to their body to avoid having Pap smear. Despite the fact that the major health care system in Taiwan is dominated by western medicine and Pap smear is an effective measure for cervical cancer prevention, traditional Chinese medicine and other alternative care of the body co-exist in Taiwan. Many women are equipped with these resources, and, with a certain degree of tactic knowledge of their own bodies, they were able to question the mainstream and empower themselves to do otherwise. In addition, in response to the much popularized notion of risk groups for cervical cancer ( i.e. multiple sex partners) in this study, women who were above 50 or single who don’t take Pap test (annually) believed that because they practiced safe sex or did not have conventional sex they were at low risk of cervical cancer. Little has been done on women don’t take Pap test (annually) from the viewpoints of the public nurses. In order to promote the screening rate of Pap smear, public nurses worked hard to meet the policy’s demand. They did so by ensuring the privacy of the exam room (supplying free tea, coffee and cookies for the waiting room), offering gifts and other tests. But in fact privacy was not the only issue, many women were concerned about the accuracy of Pap smear. Some women believed that tests done in the hospital would be more professional, modern, and well-equipped than those in the health stations, despite the fact that others believed that doing Pap test in at the health stations is more convenient.

參考文獻


中文書目
毛樹仁、吳坤霖(2004),〈臺灣非政府組織於政府外交事務的角色與功能〉,《國際政策季刊》3(1):175~200。
王本仁、黃心苑、周穎政、李丞華、張鴻仁(2005),〈全民健保子宮頸抹片檢查受檢情形影響因子分析—個體時間序列資料之實證研究,1997~2000〉,《台灣衛誌》24(1):33~42。
王秀紅(2001),〈婦產科就診婦女接受子宮頸抹片檢查之意願及其影響因素-高屏地區城鄉之比較〉,「行政院衛生署九十年度委託研究計畫-委託研究成果報告」。
王秀雲(2008),〈不就男醫,清末民初的傳道醫學中的性別身體政治〉,《中央研 究院近代史研究所集刊》59:29~66 。

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