Hello and welcome to FAB Gab. This is the podcast for the International Journal of feminist approaches to bioethics brought to you by fab Network. My name is Kathryn MacKay, and today I'm joined by Shehani Jayawickrama and Georgia Loutrianakis to discuss their paper entitled 'air ball: missing the net on female elite athletes reproductive health', which was also co authored with Kathleen Vincent and Lisa Campo-Engelstein. Hi, Shehani. Hi, Georgia.
Hi
Thanks for joining me today.
Thank you for having us.
It's my pleasure. Let's get right into it. I wonder if you can provide the listeners with just a sort of elevator pitch of what the air ball is all about?
Yeah, absolutely. So this project was kind of born from the recognition that although there has been a rapid growth in the field of assisted reproductive technology, it continues to be accessible to only a very few number of people. We noticed that among those, it tends to be elite athletes or elite athletes are included in that. So we kind of start the article by detailing the possible reasons why elite athletes actually might be more likely to require assisted reproductive technology. So namely, kind of from a physiologic or medical standpoint, these athletes, you know, just in their lifestyle, expend an excessive amount of energy throughout the day. And this leads through a low energy reserves, which can kind of slow or even stop the hormonal regulation of menstruation. And that can in turn, kind of affect their their fertility. So that's one reason another one is the overlap in the ages in which they're kind of at the peak of their athletic career and also the peak of their fertility. So after kind of establishing that, they have a very, you know, several reasons to need assisted reproductive technology, we kind of explore the reasons why the reproductive health needs in general of these women are often neglected. And we kind of go into two specific reasons, one being kind of their deviation from what we consider normative femininity, as well as their deviation from normative motherhood, wherever they are, whenever they do become mothers.
That's really interesting. And I think it's, I think I'm kind of aware of some elite, female athletes who became others later in life. I mean, I feel like very famously, Serena Williams, like kind of restarted her tennis career and like, smashed it post becoming a mother. And I was thinking about her a little bit while I was reading this and just like, kind of thinking about, I mean, I didn't hear too many criticisms of her as a mother. But then I also realized that I'm not really in touch, and I just thought that she was like, badass. So I guess I was curious to know more about, you know, what kind of backlash to elite female athletes get when they're when they become mothers, like, later or continue their careers?
Um, yeah, so that was one of the big motivations for this article for this paper, is that we noticed a lot of kind of media stories around athletes and their kind of struggles balancing their, their in desire to have children with their, their sport in their career. Serena Williams being one of them. I know, she kind of recently very publicly announced that she's stepping away from tennis, and helps to focus more on her personal goals of being a mom and and so that was, you know, one thing that we've heard in the media as well as a track star Alyssa muntanya, a few years ago, she very famously ran while she was like eight months pregnant or something like that, like very, very close to her due date. And that was very popular in the media. And while everyone was kind of publicly celebrating, like, Oh, look at her juggling these two goals of her like her career goals, as well as her personal goals. Behind the scenes, there was like, an issue with her contract. I believe that was like, kind of requiring her to for her own livelihood to do this, and Allyson Felix is another one. chok Starr who has also come out about her issues with her Nike contract, and things like this. So it's, it's not always, I would say the backlash is not always in the public eye, I would actually say, generally the public's public is very well receiving of these women, you know, wanting to pursue these other goals. But I think what the backlash they do face tends to be on kind of behind closed doors, it tends to be with their sponsorships, and sports organizations and things like that.
Yeah, that's fascinating, super interesting to hear that it's more like the kind of sponsorships contracts, sporting organizations that are enforcing these things on women, rather than the kind of court of public opinion, because often, I might have assumed that it would be the other way around. So that's really interesting. So what are some of the main points of argument that you make in the paper? What are you trying to, to establish here?
So essentially, we're trying to establish how like what you just mentioned, happens, like when there's so much public support, but yet, there's still so much pushback from like the institutions and the organizations that hold all of these all this power. And the paper split up into two parts, the first one being normative femininity arguments, and the second one normative motherhood arguments. So the normative femininity, is talking about the qualities that are required by sports, historically, aren't the skills that are attributed to women by social norms. So like strength, or power and aggression, ability to strategize, versus something more graceful or delicate and accommodating. And that's why many times female athletes can be seen as breaking of the social norms. We can see that in the Olympics with uniforms, for example, that a lot of sports like a beach volleyball, the prefer the more feminized uniforms, but when the female athletes argue for to wear longer shorts, and there's pushback against that by the organization's when really there, there shouldn't be because it doesn't affect the actual ability to play at all. Are for example, in bodybuilding, bodybuilding, there's a femininity judging criteria, or even in professional magazines like Sports Illustrated, if you compare covers of male athletes versus covers of female athletes, the male athletes are seeing and doing their sport usually, but the female athletes are dressed up in some sort of formal outfit rather than doing what they're they have been doing to be on the cover in the first place. And with normative motherhood, it's a bit of an extension of that, that when athletes do become mothers, their career what their career necessitates, deviates from what society thinks of as traditional motherhood. So the continuation of being in the sport can often be seen as self serving, because it's a commonly held belief that a wrongly held belief that physical exertion is harmful to a growing fetus, but also with athletes commonly with athletes that are elite, but not at the financial level of stardom. So they are dependent on the money that they make from actively doing their sport when their baby is born. They are required to return to sport and then travel as a means of earning for livelihood for their families, and have to leave their baby at home and people think that quote unquote, good mothers should it on to prioritize their career for that they should stay at home with their children
Yeah, absolutely. It's super interesting. I was thinking while you were talking about that, I'm very curious to know if the to you like kind of what what were the so you mentioned one of the motivations of getting into this and undertaking this work, but I'm curious to know if there were other motivations like Do you have experience with sport? Are you guys athletes?
Yeah, I can start off by answering this one. I can't say that I was a huge athlete or anything growing up I played tennis and I did dance. But the way this project kind of began was one of our one of co writers on the, on the paper, Dr. Kathleen Vincent. She is an OB GYN at the University of Texas Medical Branch. And one of her colleagues had come to her kind of explaining about how she's had these struggles with fertility. And she is also a bodybuilder. And Dr. Vincent being the person she is, is always, you know, thinking, what's the, what's the physiology behind this? What's the cause of this. And so she wanted to start a project to look into our athletes, more likely to have fertility struggles. And also, given the possible kind of advocacy work that could be done in this area, she decided to team up with Dr. Lisa Campo-Engelstein, who, you know, has, from like a bio ethical standpoint, she has a lot of, she does a lot of work and kind of gender norms, and things like that. And so she reached out and they formed a collaboration. And me, I got involved just by kind of being interested in getting into the field of bioethics a little bit, I am a medical student. But that is one field that I had, you know, done some work in college and wanted to continue. So that's why I decided to continue working with or that's why I decided to start working with Dr. Campo-Engelstein and got involved with this project. I will say Dr. Vincent has several ties to people who are in the athletic community in you know, various ways. Dr. Campo-Engelstein is a very big soccer fan. And then Giorgia and I both have a little bit of all that Georgia speak about her her background. But one thing we talk about kind of in our subsequent work is the difference between some of these more like aesthetic sports. So dance, ice, skating, diving, gymnastics, things like that. And I think both of us have have a background in some of those more aesthetic sports. And we're able to kind of bring a personal there our personal experience to that.
Yes, very much echoing that. I have a PhD student and my one of my research focuses is reproductive health care, ethics and justice. And I was invited to work with Dr. Campo-Engelstein on this and then with Dr. Vincent and Shehani, for that reason, but also as a personal background that I was an ice dancer and I did ballet for many years and exactly what Shehani was pointing out that there were a lot of deviations in the studio and in the changing room of in the world of ballet, and as an athletic aesthetic sport, certain things were expected and required for you, especially as far as bodyweight goes. And there are definitely people that I knew, and I'm still close with that. We're aware that certain decisions that they could be making would not be good for their future, fertility wise or health wise, but still did it anyways because of those institutional expectations.
Yeah, that's super interesting. And there are so many examples that come to mind even thinking about you talking about that, thinking about the Women's World Cup that just happened and you know, some of the things you mentioned in your paper, which is like, Well, you mentioned bodybuilding, how there's a kind of femininity requirement for it and basically, like women's tennis outfits still involving skirts or field hockey wearing having to wear skirts for field hockey. And yeah, I have a friend who's a competitive bodybuilder and she the requirements of like makeup, and just you know, having your eyelashes done and having your hair done and all of like the spray tan it's just kind of stunning in a way and nails too - like what did that what did they have to do with bodybuilding? But it's a it's a very interesting I feel like there's so much to unpack and uncover in this topic, which is this paper is like an introduction almost to this vast field. could be explored. So with that, like, what's the next thing that you're going to do with this research? Do you think? What's the next point that this project goes along to?
Yeah, I definitely do agree with you like, as far as the uniforms that we're talking about, and the just this creation of like an apologetic defense of, oh, if I'm going to exhibit strength, and, you know, aggression, and some of these other like, more masculine traits, I have to make up for it. With the way that I look, is, you know, something we find as a theme and multiple sports. But yes, as far as where we are going, we've actually done quite a bit of research, and have a few projects going, you know, subsequent to this paper. So, as I mentioned, I'm a medical student and Dr. Kathleen Vincent is an OB GYN. So kind of more on the medical side, we have written a paper, a literature review, that's kind of outline all the ways in which the lifestyle of elite female athletes can affect their reproductive health. It's kind of meant to be a guide for providers being primary care givers, or sorry, primary care providers or OBGYN to kind of help them better provide for their, their patients who could be elite female athletes. So it kind of goes beyond just assisted reproductive technology kind of goes back all the way to, you know, menarche, onset of menstruation, through menstruation, and its effects on or energies, energy expenditures effects on that hormonal regulation that I was speaking to earlier. It also goes into pregnancy and how that can affect someone's ability to perform at their athletic best. And it talks about assisted reproductive technology as well as oral contraceptives. So kind of like really spans a wide range of reproductive health topics. And it's kind of meant to be a general guide. For for providers. So that is one project that we have going that we're hoping to publish soon. And I'll let Georgia kind of speak on kind of the more bioethics focused, practical way of going.
So using this paper in this work as a basis, we've expanded to doing qualitative interviews with a leader with the elite athletes themselves, both college elite athletes, and professional elite athletes, for some for primary data collection. And we will be presenting it at the American Society for bioethics and humanities soon. But we've done 17 interviews so far, and several themes emerged from all of the interviews than being a lack of reproductive information, both access or encouragement to use it, penalties for pregnancy or planning for pregnancy, regulating reproductive health symptoms in order to enhance performance, concerns about fertility, both current and future and a mental health impact because of all of these impacts on reproductive health. And it's been both heartbreaking talking to some of these women, but also very eye opening, that each of the themes the majority of the athletes met. And 82% of the women that we talked to felt that they weren't given access to reproductive health information, even when they asked for it. Like 76% were concerned about their fertility because of the decision that they felt that they had made in order to stay competitive. 59% had experienced penalties for being pregnant. It's all so crazy.
Yeah, that's really, really interesting. And it will be fascinating to see that work that you're both continuing to do. It sounds really exciting. So from Yeah, I don't know from this. From this paper. What do you feel like you want to be the main kind of like headline thing that people take away from it.
I think that first and foremost that the reproductive health needs of elite athletes have been largely neglected because of this deviation from ideas of normative femininity and motherhood. But as well that especially in the United States, black women are disproportionately affected by this because of a low prevalence in the sport community, but be the already existent morbidity and mortality rates we have with black woman in the States. And that outreach, I think, would be the second large message that we're trying to reach a lot of different types of people, first, the academics, that more research needs to be done, but also the sports organizations that can be the ones to make changes in the more immediate, as well as the athletes themselves and the medical community. So they know how to best serve them.
Yeah, and I just want to echo that kind of going back to the original motivation for for Dr. Vincent. It's, yes, educating providers about this and educating the academic community. But it also needs to go beyond that. And we are very conscious of the fact that, you know, this paper and a lot of the work that we do, do are is largely inaccessible to the actual community that needs to be hearing this information. So we are kind of actively working and thinking of ways to disseminate this information to the athletic community in a way that's kind of not behind this academic paywall, that, you know, tends to happen whenever you you publish any, any work in the academic journal. And I just want to thank you for this opportunity. And just because it does help in that, in that goal. I found this podcast on Spotify. And you know, it's very accessible. Anybody can listen. So, you know, kind of like one way we can, we can do that. So thank you so much.
Oh, that's awesome to hear. I'm super glad that I can help you somehow with this. This is very important and super interesting work. Thank you so much for speaking with me, Giorgia and Shehani, that's been really great. And thank you for listening to this episode of FAB Gab. You can find the paper that we've discussed in this episode's notes along with the transcript for gab is hosted and produced by me Kathryn MacKay. You can find our other episodes on Spotify, Apple podcasts, or wherever you get your podcasts of quality, and you can subscribe to our gab so that you'll never miss an episode. Thanks again for listening. Bye
