sociology research

Gender policies and advertising and marketing practices that affect women’s health

Belén Cambronero-Saiz*

Department of Public Health, University of Alicante, Alicante, Spain

Background: The three papers of this doctoral thesis are based on the social construction of reality through the analysis of communication relating to health issues. We have analysed the contents of parliamentary,

institutional, and mass media to uncover whether their communications create, transmit, and perpetuate

gender biases and/or stereotypes, which may have an impact on peoples’ health, with a particular focus on

women.

Objective: To analyse decision making and the creation of gender awareness policies and actions affecting women’s health: (1) political debates about abortion, (2) gender awareness communication campaigns and

educational actions, and (3) pharmaceutical advertising strategies.

Design: Quantitative and qualitative methods were employed, and the research included observational studies and systematic reviews. To apply a gender perspective, we used the level of gender observation proposed by

S. Harding, which states that: (1) gender is the basis of social norms and (2) gender is one of the organisers of

the social structure.

Results: Sixty percentage of the bills concerning abortion introduced in the Spanish Parliament were initiated and led by pro-choice women’s groups. Seventy-nine percent of institutional initiatives aimed at promoting

equality awareness and were in the form of educational actions, while unconventional advertising accounted

for 6 percent. Both initiatives focused on occupational equality, and very few actions addressed issues such as

shared responsibility or public policy. With regard to pharmaceutical advertising, similar traditional male� female gender roles were used between 1975 and 2005.

Conclusions: Gender sensitivity continues to be essential in changing the established gender system in Spanish institutions, which has a direct and indirect impact on health. Greater participation of women in public policy

and decision-making are critical for women’s health, such as the issue of abortion. The predominance of

women as the target group of institutional gender awareness campaigns proves that the gender perspective

still lacks the promotion of shared responsibilities between men and women. There is a need for institutions

that act as ‘policy watchdogs’ to control the gender biases in mass media and pharmaceutical marketing as

well as to ensure the proper implementation and maintenance of Spanish equality laws.

Keywords: abortion; public policy; work-family reconciliation; pharmaceutical advertising; gender awareness communication

campaigns; gender bias

*Correspondence to: Belén Cambronero-Saiz, C/Princesa Zaida, 5, 58B, 16002 Cuenca, Spain, Tel: (+34) 647 42 78 04, Email: [email protected]

Received: 4 January 2013; Revised: 8 May 2013; Accepted: 4 June 2013; Published: 26 June 2013

I ntegrating a gender perspective in health implies

taking into account relational factors when addres-

sing health problems (1, 2), for example, by exploring

differences in the socialisation between men and women

with regard to family roles, job prospects, and types of

occupation in order to understand patterns of health and

disease (3�7). The WHO Commission on Social Determinants of

Health has warned that health differences become health

inequalities when they stem from unfair and avoidable

situations (8�10). Consequently, gender becomes an indicator of health inequality when gender roles that

involve different levels of exposure to risk are accepted

(8). Assigning the role of family caregiver exclusively to

women has resulted in the feminisation of part-time work

(11�14) and the horizontal segregation (masculinisation of professions) and vertical segregation (the glass ceiling)

of paid work (15). Thus, women are exposed to different

health risks, because they have a lower income (material

risk) (16), a heavier workload (physical risk) (17�22),

(page number not for citation purpose)

�PhD REVIEW

Glob Health Action 2013. # 2013 Belén Cambronero-Saiz. This is an Open Access article distributed under the terms of the Creative Commons Attribution- Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

1

Citation: Glob Health Action 2013, 6: 20372 - http://dx.doi.org/10.3402/gha.v6i0.20372

and less bargaining power, both on a personal and

professional level (behavioural risk) (23).

Gender perspective in the social construction of reality The three papers are based on the social construction

of reality. They analyse the contents of parliamentary,

institutional, and mass media to uncover whether their

communications create, transmit, and perpetuate gender

biases and/or stereotypes, which may have an impact on

people’s health, with a particular focus on women.

R. Braidotti considers gender as ‘the multiple and

complex ways in which social differences between the

sexes acquire meaning and become structural factors in

the organisation of social life’ (24). This reflects the idea

of gender as a social construct that depends on ideolo-

gical, cultural, religious, economic, ethnic, and historical

factors.

P. Luckmann and T. Berger were the first to theorise

that reality is socially constructed through the trans-

formation of a social circumstance into an objective

reality (25). In complex societies, gender roles have been

standardised and institutionalised, and reflect society’s

views about what it means to be a woman or a man

and how they are expected to interact with each another.

This set of concepts forms the symbolic universe (25, 26).

According to social constructionism, the assignment of

gender roles is based on patriarchal social structures

legitimised by repetition, which still persists in Spanish

society today.

In this context, S. Harding provides an analytical

framework consistent with the social construction of

reality theory (27). She states that gender identity can

be changed by social interaction, leading to the creation

of male and female patterns of behaviour associated with

sex, or by the role of gender as the primary organising

force behind the society structure, whereby male and

female roles in that society are assigned based on sex

(27�29). This thesis also employs the feminist communica-

tion theory (30), which states that communication can

be used as a tool for changing or reinforcing the socially

constructed symbolic universe. It also notes the impor-

tance of equal participation in power structures, as this

ensures that the specific needs of women are taken into

account (30�34).

Aim and methodology Based on the theories summarised above, the aim of this

study is to analyse decision-making and the creation of

gender awareness policies and actions affecting women’s

health (political debates about abortion, gender aware-

ness communication campaigns and educational actions)

and pharmaceutical advertising and marketing strategies

(Table 1).

To apply a gender perspective, we used the level of

gender observation proposed by S. Harding, applied in a

previous health study (35), which states that: (1) gender is

the basis of social norms and (2) gender is one of the

organisers of the social structure (36).

Study I. Abortion in democratic Spain: the parliamentary political agenda 1979�2004 Since Spain’s transition to democracy in 1978, arguments

for and against the legalisation of abortion and its

coverage under public health services have taken place

both inside and outside the Spanish Parliament (37, 38).

We thought it would be useful to analyse Parliamentary

debates and voting patterns to identify the positions of

political parties and the agreements and disagreements

within each party, as well as to examine the positions of

male and female Members of Parliament. This will help

to identify the key points of political debate and ways to

encourage the promotion of abortion legislation that

takes into account the needs of women. We also thought

it would be useful to carry out political epidemiological

research on the effects of decisions made by political

institutions on people’s health.

The hypothesis is that gender is the basis of institu-

tional norms created during the Spanish democracy (39).

Thus, greater participation of women in the abortion

debate increases their ability to influence political deci-

sions on reproductive health (37).

Our analysis is based on a retrospective study of the

frequency of legislative initiatives on abortion in demo-

cratic Spain. We also carried out a descriptive content

analysis of different arguments and positions in abortion

debates, found through a systematic search of the parlia-

mentary database between 1979 and 2004. The parlia-

mentary speeches delivered by Members of the Spanish

Parliament were analysed according to the speaker’s sex

and political affiliation.

Study II. Public actions of gender awareness. The efforts of regional and local governments in advertising communication (1999�2007) This study starts from the fact that gender inequalities

in health in Spain are associated with the unequal

distribution of family demands and the lack of active

social policies that facilitate the equal distribution of

unpaid housework (40, 41). The Law on the Reconcilia-

tion of Work and Family Life, enacted in 1999, aims

to facilitate the solution to the problem (42). Amongst

other things, it suggests carrying out institutional cam-

paigns aimed at increasing adequate social solutions for

maintaining, protecting, and promoting health by raising

awareness about the need to share reproductive work

(42, 43).

Feminist Media Studies argue that the gender system

can be changed by intervening in the frequency and way

Belén Cambronero-Saiz

2 (page number not for citation purpose)

Citation: Glob Health Action 2013, 6: 20372 - http://dx.doi.org/10.3402/gha.v6i0.20372

that women are portrayed (44, 45). In accordance with

this line of research, our objective was to examine the

actions of communication aimed at raising gender

awareness as indicators of institutional efforts to promote

equality (1999�2007). We analysed the actions implemented by public insti-

tutions in six Spanish provinces aimed at raising aware-

ness of gender and encouraging shared responsibility

as a means of promoting equality in the distribution of

domestic tasks and care, thus tackling the role of gender

as a determining factor in health inequities (46). Data-

base: (1) City councils of the capitals of the 6 regions,

(2) provincial councils, (3) regional directorates for

women or similar institutions, (4) other council depart-

ments promoting co-responsibility, and (5) Infoadex

Agency. The analytical framework considered the fol-

lowing dimensions: visibility, parity, mainstreaming, and

empowerment.

Study III. Quality of pharmaceutical advertising and gender bias in medical journals (1998�2008): a review of the scientific literature Due to the increasing global and fragmented context in

which they work, physicians are partially dependent on

the flow of information conveyed through advertising,

which acts as a socialising agent and transmits messages

that contribute to the social construction of disease (47).

Marketing strategies target the medical community

and do not always offer neutral information in order to

increase sales (48�50). One of the marketing strategies employed to achieve

greater impact is the incorporation into advertising of

images that segment the consumer according to socio-

demographic characteristics. Furthermore, the potential

population base that could benefit from the medication

is increased through the use of inappropriate frames

that include non-risk groups, to whom the therapeutic

Table 1. Thesis summary

Theoretical

justification

Explanatory theories of health inequities

Theory of the social construction of reality from a gender perspective

Feminist communication theory

Aim

To analyse decision-making and the creation of gender awareness policies and actions affecting women’s health

(political debates about abortion, and gender awareness communication campaigns and educational actions) and

pharmaceutical advertising and marketing strategies.

Observation context:

gender/health Article I: Abortion Article II: Work�life balance Article III: Pharmaceutical advertising

Analysis of

secondary data

Parliamentary speeches Institutional activity reports and

advertising for raising awareness on

gender

Scientific literature

Methodology

Descriptive and exploratory

content analysis

Descriptive and exploratory content

analysis

Descriptive content analysis

Systematic search of the

parliamentary database

Analysis based on institutional

actions for raising awareness on

gender

Systematic review of articles

(published between 1998 and 2008)

which analyse advertising in medical

journals

Analysis based on a retrospective

study of the frequency of legislative

initiatives and the prevalence of

different arguments and positions in

abortion debates

Institutional resources: (1) city

councils, (2) provincial councils,

(3) regional directorates for women,

(4) other council departments

promoting co-responsibility,

with a regional scope of action

Databases: PUBMED, Medline,

Scopus, Sociological Abstract,

Eric and LILACSAdvertising database: Infoadex

(agency which studies the evolution

of investment in advertising in

Spain)

Studies Study I: ‘Abortion in Democratic

Spain: The Parliamentary Political

Agenda (1979�2004)’

Study II: ‘Public actions of gender

awareness. Efforts of regional and

local governments in advertising

communication (1999�2007)’

Study III: ‘Quality of pharmaceutical

advertising and gender bias in

medical journals (1998�2008):

a review of the scientific literature’

Periods of time 1979�2004 1999�2007 1998�2008

Marketing practices that affect women’s health

Citation: Glob Health Action 2013, 6: 20372 - http://dx.doi.org/10.3402/gha.v6i0.20372 3 (page number not for citation purpose)

indications do not apply. This phenomenon is known as

disease mongering (51, 52).

The representation of both sexes in pharmaceutical

advertisements is a point of interest in research on gender

and health issues (46, 53, 54) given that, if such rep-

resentations are inconsistent with reality, they may

reinforce the perception that certain illnesses are asso-

ciated with the most frequently portrayed sex. As an

innovative research field focused on studying the dif-

ferences between men and women and how such differ-

ences affect diseases and their diagnoses and treatments,

gender-based medicine and evidence-based medicine

share the hypothesis that there are inaccuracies in the

production and dissemination of knowledge, as well as

in medical practice, with regard to rigour, transparency,

and subjective judgement (55�57). The aim of this study was to determine whether

gender bias has decreased and whether the quality of

information in pharmaceutical advertising targeted at

health professionals has improved over time. We carried

out a descriptive review of the scientific literature

available on pharmaceutical advertising between 1998

and 2008. The articles’ findings were considered accord-

ing to the following quality criteria: 1) the number,

validity, and accessibility of bibliographic references

provided in pharmaceutical advertisements, and 2) the

relationship between the sexes portrayed in the adver-

tisements and the sex prevalence of the diseases treated

by the drugs advertised.

Main results and discussion

Article I We analysed a total of 229 legislative initiatives in which

abortion was mentioned in the period between 1979

and 2004. A total of 215 parliamentarians (143 women,

72 men) intervened in abortion issues during this period.

Despite the fact that women were a minority in all

8 Parliaments, they dominated the abortion debate and

introduced most of the legislative initiatives (60%).

The inclusion of socio-economic grounds for legal

abortion (64%) and making abortion on request legal in

the first 12 weeks of pregnancy (60%) were the most

frequent proposals for law reform, mostly based on pro-

women’s rights arguments. In contrast, male and female

members of anti-abortion parties and most male mem-

bers of other parties supported foetal rights significantly

more often (p �0.001). Unsafe abortion and interna- tional agreements on women’s rights as well as women’s

health received very little attention.

The debate was led by the Justice Commission rather

than the Health or Social Affairs Commission, meaning

that legal aspects prevailed over women’s health issues.

Female parliamentarians not only spoke more often, but

they also advocated pro-choice reforms of current laws

significantly more often than men (p �0.001). While female Members of Parliament belonging to left-wing

parties led the political debate on abortion, they were not

responsible for many decisions. This was probably due to

the fact that most Members of Parliament were men and

that, contrary to right-wing parties, male and female

members of left-wing parties were not in agreement.

The social construction of unsafe abortion as a public

health problem, promoted by Parliamentarians and non-

Governmental women and media, may have influenced

the enactment of the Spanish Sexual and Reproductive

Health and Abortion Law in March 2010, which legalised

abortion on request in the first 12 weeks of pregnancy.

This law is being discussed again by the Conservative

Party currently in Government.

Article II We analysed 5,697 educational and communication

actions. Seventy-nine percentage of institutional initia-

tives aimed at promoting equality awareness were in the

form of educational actions, while unconventional adver-

tising accounted for 6%. We also identified 136 adver-

tisements linked to the aim of the study.

The predominance of women as the target group of

institutional gender awareness campaigns proves that

the gender perspective still lacks the promotion of shared

responsibilities between men and women.

When it comes to investment in mass media, Madrid

was responsible for 56.17% of the total number of

campaigns aimed at promoting gender awareness, fol-

lowed by the Spanish regions with the highest gender-

related development: Catalonia (19.62%) and the Basque

Country (12.73%). However, public funding has not

been used to promote gender equality. This is because

the gender awareness actions carried out to date have

prioritised women’s training and employability. Differ-

ences between regions suggest that, in addition to

developing a certain number of public policies, there is

a need for institutions that act as ‘policy watchdogs’

to ensure the proper implementation and maintenance

of national equality laws.

Article III The scientific literature review focused on 31 articles � published between 1998 and 2008 � which analyse advertising in medical journals from 1975 to 2005. Nine

articles provided information on the sex of the people

who appeared in the advertisements and the gender

dimension used as categories of analysis (22, 23, 30, 31,

33, 36, 41, 43, 44). No improvement was observed when

the quality criteria were examined from a gender per-

spective, because they all confirmed that there was a

tendency to depict men in paid productive roles, while

women appeared inside the home or in non-occupational

social contexts. Advertisements for psychotropic and

Belén Cambronero-Saiz

4 (page number not for citation purpose)

Citation: Glob Health Action 2013, 6: 20372 - http://dx.doi.org/10.3402/gha.v6i0.20372

cardiovascular drugs over-represented women and men,

respectively. In addition, we found that the number of

references used to support pharmaceutical advertising

claims increased from 1975 onwards but that 50% of

these references were not valid.

Despite the social changes experienced by men and

women since 1970s, medicine is still viewed as a gendered

organisation with a male-dominated culture, which

has had a powerful effect on gender imagery for women.

This perspective has defined medicine as a cultural

system with a tendency to reinforce gender identity

based on the traditional gender roles of women in

society (52). The accuracy of knowledge transfer through

pharmaceutical advertising is essential in order to

avoid gender bias in medical practice and to achieve

quality drug prescriptions according to knowledge-based

evidence (56).

Gender awareness actions carried out to date have

prioritised women’s training and employability, and

public funding has not been used to promote gender

equality or the development of public policies. Thus,

the false assumptions internalised by both health workers

and consumers connect the economic interests of phar-

maceutical companies with the gender system. Advertis-

ing and gender feed off each other through the process

of social construction that characterises them both.

Insufficient financial investment and the lack of medium-

to long-term communication plans in institutional gender

awareness actions do not contribute to social change.

There is a need to strengthen the mainstreaming of

public policies and to increase the gender sensitivity of

equality policies. In the meantime, pharmaceutical com-

panies are devoting large budgets to developing advertis-

ing and marketing strategies in order to increase sales

and become one of the most important filters of medical

knowledge. However, our studies have demonstrated

the presence of gender bias in advertising (discrepancy

between prevalence and representations by sex and

consistency with the gender stereotype). This has resulted

in an increase in the number of diagnoses and treatments,

thereby increasing gender inequities and primarily affect-

ing women’s health.

Conclusions Each of the three articles draws their own conclusions.

However, the global conclusions are as follows:

Gender sensitivity implies intervening in the social

construction of reality and is a key factor for changing

the established gender system. This becomes even more

important when the lack of gender sensitivity impacts

on women’s health. Greater gender sensitivity could

be achieved through greater participation of women

in public policy and decision-making and in the control

of information released by the media. This would

empower women and increase their ability to establish

the necessary measures for raising awareness and thus

achieving social change.

According to the feminist standpoint epistemology,

an increase in the number of women in Parliament

(i.e. greater equality) would result in discussions that

are closer to women’s needs and the implementation of

health policies aimed at solving women’s specific pro-

blems. It could also increase the willingness to change,

providing financial resources for carrying out institu-

tional media campaigns to raise awareness of health

problems derived from a lack of equality and introducing

more equal social models.

This willingness to change could also be expressed

through the creation of a binding code of ethics for the

pharmaceutical industry, which would contribute to the

elimination of gender biases in advertising. First, these

biases are detrimental to women’s health given that

they reinforce the concept of gender as an organising

principle of social structures, through which male and

female activities in society are segregated according to

their sex. Second, gender biases allow the industry to

take advantage of the gender system in order to define

a market niche in situations in which male and female

stereotypes are redefined (motherhood, menopause,

sexuality, or old age).

Acknowledgements

The author expresses her most sincere gratitude to Dr. M. Teresa

Ruiz Cantero for her invaluable contributions in the field of health

and gender ([email protected]) and to Dr. Natalia Papı́ Gálvez for

sharing her knowledge about communication and gender (Natalia.-

[email protected]). Both supervised this doctoral thesis, and are the authors

of the articles submitted as part of the same.

Conflict of interest and funding

This study was funded by the Spanish Institute for

Women through the award of two R&D&i project grants

and by the Women’s Studies Centre at the University of

Alicante.

References

1. World Health Organization (2007). A conceptual framework for

action on the social determinants of health. Geneva: WHO.

2. Dahlgren G, Whitehead M. Policies and strategies to promote

social equity in health. Stockholm: Institute for Future Studies;

1991.

3. Doyal L. Sex, gender, and health: the need for a new approach.

BMJ 2001; 323: 1061�3. 4. Krieger N. Genders, sexes and health: what are the connec-

tions � and why does it matter? J Epidemiol Community Health 2003; 32: 652�7.

5. Velasco S. Recommendations for the practice of gender in health

programs. Madrid: Ministry of Health and Social Policy;

2009.

Marketing practices that affect women’s health

Citation: Glob Health Action 2013, 6: 20372 - http://dx.doi.org/10.3402/gha.v6i0.20372 5 (page number not for citation purpose)

6. Peiró R, Ramón N, .Álvarez-Dardet C, Colomer C, Moya C,

Borrell C, et al. Gender sensitivity in the formulation of Spanish

health plans: what it could have been but wasn’t. Gac Sanit

2004; 18(Suppl 2): 36�46. 7. World Health Organization (2009). Women and health: today’s

evidence tomorrow’s agenda. Geneva: WHO.

8. Annandale E, Hunt K. Gender inequalities in health. Filadelfia:

Open University Press; 2000.

9. Whitehead M. The concepts and principles of equity and health.

Copenhagen: WHO Regional Office for Europe; 1990.

10. Marmot M, Friel S, Bell R, Houweling T, Taylor S. Closing the

gap in a generation: health equity through action on the social

determinants of health. Lancet 2008; 372: 1661�9. 11. Carrasco-Portiño M, Ruiz-Cantero MT, Gil-González D,

Alvarez-Dardet C, Torrubiano-Dominguez J. Gender develop-

ment inequalities epidemiology in Spain (1990�2000). Rev Esp Salud Pública 2008; 82: 283�99.

12. Carrasco-Portiño M, Ruiz-Cantero MT, Fernández-Sáez J,

Clemente-Gómez V, Roca V. Geopolitical development inequal-

ities in gender in Spain 1980�2005: a structural determinant of health. Rev Esp Salud Pública 2010; 84: 13�28.

13. Papı́-Gálvez N, Cambronero-Saiz B, Frau-Linares MJ. Gender

Equality on institutional communication. Making aware in co-

responsability. Madrid: Women’s Institute; 2011.

14. Artazcoz L, Borrell C, Benach J. Gender inequalities in health

among workers: the relation with family demands. J Epidemiol

Community Health 2001; 55: 639�47. 15. Martı́n-Llaguno M. Women in the advertising industry. Vertical

segregation in commercial communication: glass ceiling and

tacky floor. Zer 2007; 22: 429�52. 16. Peiró R, Vives C, Alvarez-Dardet C, Mas R. Policy analysis

from gender and health perspective. In: Borrell C, Artazcoz L,

eds. SEE Monograph: Research on gender and health. Barce-

lona: Spanish Society of Epidemiology; 2007.

17. Papı́-Gálvez N. Conciliation of work and family life as a quality

of life project from equality. RES 2005; 5: 91�107. 18. Artazcoz L, Artieda L, Borrell C, Cortés I, Benach J, Garcı́a V.

Combining job and family demands and being healthy. What are

the differences between men and women? Eur J Public Health

2004; 14: 43�8. 19. Artazcoz L, Garcı́a-Calvente MM, Esnaola S, Borrell C,

Sánchez-Cruz JJ, Ramos JL, et al. Gender inequalities in health:

the reconciliation of work and family life. In: Cabasés JM,

Villalbı́ JR, Aibar C, eds. Health Investment. Priorities in Public

Health. SESPAS Report 2002. Valencia: SESPAS; 2002.

20. Artazcoz L, Cortès I, Moncada S, Rolhlfs I, Borrell C. Gender

differences in the influence of housework on health. Gac Sanit

1999; 13: 201�7. 21. Garcı́a-Calvente M, Mateo-Rodrı́guez I, Eguiguren A. The

system of informal caregiving as inequality. Gac Sanit 2004; 18:

132�9. 22. Messing K, ed. The work of women. Understanding to trans-

form. Institute of Work, Environment and Health. Madrid:

Editorial Catarata; 2002.

23. Backhans M. Gender policy and gender equality in a public

health perspective. Stockholm: Karolinska Institutet; 2011.

24. Braidotti R. Sex/gender terminology and its implications. In:

Griffind G, Braidotti R, eds. Thinking differently. A reader in

European women’s studies. London: Zed-Books; 2002.

25. Berger P, Luckmann T. The social construction of reality.

New York: Anchor Books; 1966.

26. McQuail D. Mass communication theory: an introduction.

London: Sage; 1987.

27. Harding S. The science question in feminism. New York:

Cornell University Press; 1993.

28. Carrasco-Portiño M. Gender perspective of human develop-

ment as structural determinant of women’s health: maternal

mortality and intimate partner violence. Alicante: University of

Alicante; 2011.

29. Papı́ N. Gender through wings. The case of women journalists

in the Valencian Community. Alicante: University of Alicante;

2008.

30. Rakow L, Wackwitz L. Feminist communication theory: selec-

tions in context. Thousand Oaks, CA: Sage; 2004.

31. Villaplana V. Feminist identities, visual culture and narratives.

Asparkia 2008; 19: 73�88. 32. Ramos M. Women’s history and feminist thought: a plural

history to debate. Vasconia 2006; 35: 515�26. 33. Hartsock N. The feminist standpoint revisited and other essays.

Colorado: Westview Press; 1998.

34. Sánchez L, Reigada A. Revisiting communication from the

feminist criticism. Introductory notes. In: Leyva MJ, Olaizola R,

editors. Feminist Criticism and Communication. Sevilla: Social

Communication; 2007.

35. Ruiz-Cantero MT, Papı́-Gálvez N, Carbrera-Ruiz V,

Ruiz-Martı́nez A, .Álvarez-Dardet C. Gender systems and/in

the Spanish National Health Interview Survey. Gac Sanit 2006;

20: 427�34. 36. Harding S. Whose science? Whose knowledge? Thinking from

women’s lives. New York: Cornell University Press; 1991.

37. Cambronero-Saiz B, Ruiz-Cantero MT, Vives-Cases C,

Carrasco-Portiño M. Abortion in democratic Spain: the parlia-

mentary political agenda 1979�2004. Reprod Health Matters 2007; 15: 85�96.

38. McBride Stetson D. Abortion politics, women’s movements, and

the democratic state. New York: Oxford University Press; 2001.

39. Peiro R, Colomer C, Alvarez-Dardet C, Ashton JR. Does the

liberalisation of abortion laws increase the number of abortions?

The case of Spain. Eur J Public Health 2001; 11: 190�4. 40. Papı́-Gálvez N, Cambronero-Saiz B. Public actions of gender

awareness. The efforts of regional and local government in

advertising communication (1999�2007). PLP 2011; 5: 181�203. 41. Larrañaga I, Arregui B, Arpal J. Reproductive or domestic

work. Gac Sanit 2004; 18: 31�7. 42. Law on reconciliation of work and family life (Law 39/1999),

BOE 266 (1999/11/06), 38934-38942. Spain, Head of State, 1999.

43. Martinez E, Vizvaı́no-Laorga J, Gavilán R. Government

advertising: an integrative element. The legal framework in

Spain. Rev Lat Comun Soc 2008; 63: 22�31. 44. Mauro W. The Social Effects of Media. Barcelona: Paidos; 1994.

45. Van Zoonen L. Feminist media studies. London: Sage; 1994.

46. Lorber J. Gender and the social construction of illness.

California: Sage; 1997.

47. Cambronero Saiz B, Ruiz Cantero MT, Papı́-Gálvez N. Quality

of pharmaceutical advertising and gender bias in medical

journals (1998�2008): a review of the scientific literature. Gac Sanit 2012; 26: 469�76.

48. Moynihan R, Heath I, Henry D. Selling sickness: the

pharmaceutical industry and disease mongering. BMJ 2002;

324: 886�91. 49. Grier S, Bryant C. Social marketing in public health. Annu Rev

Public Health 2005; 26: 319�39. 50. FughBerman A, Alladin K, Chow J. Advertising in medical

journals: should current practices change? PLoS Med 2006; 3:

e130.

51. Doran E, Henry D. Disease mongering: expanding the bound-

aries of treatable disease. Intern Med J 2008; 38: 858�61. 52. Ruiz-Cantero MT, Cambronero-Saiz B. Health metamorphosis:

disease mongering and communication strategies. Gac Sanit

2011; 25: 179�81.

Belén Cambronero-Saiz

6 (page number not for citation purpose)

Citation: Glob Health Action 2013, 6: 20372 - http://dx.doi.org/10.3402/gha.v6i0.20372

53. Riska E. Gendering the medicalization thesis. In: Texler Segal

M, Demos V, eds. Gender perspectives on health and medicine.

Adv Gend Res 2003; 7: 59�87. 54. Hawkins J. Women in advertisements in medical journals. Sex

Roles 1993; 28: 233�42. 55. Manderbacka K. Exploring gender and socioeconomic differ-

ences in treatment of coronary heart disease. Eur J Public

Health 2005; 15: 634�9.

56. Ruiz-Cantero MT, Vives-Cases C, Artazcoz L, et al. A frame-

work to analyse gender bias in epidemiological research.

J Epidemiol Community Health 2007; 61: 46�53. 57. Johnson JL, Greaves L, Repta R. Better science with sex and

gender: facilitating the use of a sex and gender-based analysis in

health research. Int J Equity Health 6: 14.

Marketing practices that affect women’s health

Citation: Glob Health Action 2013, 6: 20372 - http://dx.doi.org/10.3402/gha.v6i0.20372 7 (page number not for citation purpose)

Copyright of Global Health Action is the property of Co-Action Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.