Stereotyping

We were conducting a workshop on ethics and professionalism among community health workers. There was a case study which we discussed in the workshop. A community health worker (CHW) is posted in a village which has many members belonging to a nomadic tribal community. The CHW provided care for a woman who had just delivered her fourth child, a healthy boy. She instilled an intrauterine contraceptive device in this woman without informing her, immediately after the delivery, even when she was still drowsy from the labour. We were discussing the ethics of instilling an intrauterine device in the tribal woman without informing or obtaining consent from her. 

"People belonging to that tribal community never practice contraception. They have many children. They have frequent childbirths without any spacing. It is impossible to convince them to have an intrauterine device. If we do not instill the device now, we will miss the opportunity and she will get pregnant soon. It will be harmful to her health. So we have to instill the contraceptive intrauterine device without her knowledge for her own good." This was the explanation that the CHWs provided during the discussion. While there are several problematic issues in this discussion, especially with respect to the agency of the tribal woman and her autonomy, the point I want to highlight here is slightly different. 

This is a case of stereotyping of the women belonging to a certain community. In this blog I want to discuss stereotyping and its effects. 

What is stereotyping? Why do we stereotype?

Stereotyping is the process where we ascribe certain characteristics to people belonging to a certain group in general, without any proof to support the assumption. Stereotypes can be based on age, gender, religion, caste, socio-economic class and various other social axes. Some of the common age stereotypes are 'GenZ are disrespectful', 'GenZ dont value elders', 'Boomers are not tech savvy', 'Boomers have rigid opinions' etc. What this CHW has done in this case is to stereotype women belonging to a certain tribal community. "Those people" are like that! One typical characteristic of stereotyping is that there is a process of 'othering' in which people of that specific social group are characterised as 'others' who have a certain characteristic that is not common in the 'us'. 

Stereotyping is a cognitive strategy. To reduce the cognitive load, the human brain prefers to put people and situations in clearly labelled boxes. The mind observes people, classifies them into these boxes. These boxes are helpful to quickly respond and relate to these people without having to process a lot of information. It is often an energy conserving mechanism and a protective strategy as well. In Tamil Nadu there is a common stereotype that men from southern Tamil Nadu are angry, sickle toting violent people. The immediate instinct is to get defensive when people encounter such men. Unfortunately this is not true. I have several gentlemen friends from southern Tamil Nadu who are great friends to hang out with. This is the problem with the cognitive process of stereotyping. It leads to prejudice. 

Is prejudice the same as stereotyping? 

Prejudice is a strong unreasonable feeling of not liking or being averse to someone just because they belong to a certain social group. The fear of men from southern Tamil Nadu is such a prejudice. During the COVID 19 pandemic people who had the Asian facial features were attacked and bullied because of the prejudice that the Chinese were responsible for the emergence of the pandemic. While stereotyping is a cognitive process, prejudice is an emotional process. The CHW mentioned that women belonging to that tribal community never practice birth control. That was a cognitive stereotype. But when that becomes hatred and irritation with women from that community, it becomes prejudice. The prejudice is a negative feeling and can have adverse consequences for the CHW-community relationship. When stereotyping leads to prejudice, it flows from there into discrimination. 

What is the association between stereotyping and discrimination? 

When we were discussing the case of the tribal woman who had just given birth and the CHW instilled the intrauterine contraceptive device without her knowledge, one of the CHWs asked, "Would she have had the courage to do that, to an educated woman from an upper class society?" This was a very pertinent question. Stereotyping leads to prejudice and this prejudice gives rise to discrimination. It makes the person having the prejudice treat the person differently compared to others. The 'othering' that happens due to the prejudice leads to discrimination. The discrimination leads to injustice. Thus in many situations stereotyping leads to prejudice and that causes discrimination and injustice. But there are situations where stereotyping can be positive too. 

Can stereotyping be good?

Fiske et al describe two axes across which stereotyping can be studied. These are the axes of perceived competence and an emotional feeling of warmth. When we stereotype people to be highly competent and have an emotionally warm feeling towards them, we admire them. People who appear confident, look attractive and dress well usually land jobs when they go for an interview. This is the stereotype of good looks and manner along with a warm feeling. On the other hand when there is a stereotype of high competence but a lack of warm feeling, it leads to envy and jealousy. A typical example is the stereotyping of Jewish people in Nazi Germany during the Holocaust. They were seen as the highly competent people who came to destroy the commoners. There can be stereotype of low competence with a feeling of warmth and it leads to paternalism. That is the sense that the CHW has expressed when they said "we are instilling the intrauterine device for the poor tribal woman for her own good'. The stereotyping of low competence with a poor feeling of warmth can lead to hatred, prejudice and discrimination. But the very fact that there are so many situations where stereotyping can be negative implies that we should avoid it as much as possible in our everyday life, especially clinical work. 

How should we handle stereotyping? 

It is not always easy to handle stereotyping. Some stereotypes are inherent and subconscious. We are not even aware of them. For example, when a man comes with chest pain to the casualty, he is given attention to rule out heart diseases, but the same chest pain in women is taken less seriously. Similarly, when an older person and a younger person come to the casualty of a hospital with breathlessness, the triage system will prioritise the younger one. Classifying people into high risk and low risk, prioritising them based on their level of risk are all strategies of stereotyping. We may not be able to do much about them. But stereotyping of the type discussed with the CHWs in the case study can be disturbing and conscious efforts can be taken to avoid them. We just have to treat every person as an individual, separating their community identify from their individual identity while evaluating them. Instead of saying all tribal women refuse to practice birth control, it is important to ask - will this woman sitting in front of me practice birth control? How can I help her decide on birth control? This is easy to say, but difficult to practice. But if we make a conscious effort to do this, it will help handle the negative consequences of stereotyping.