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Colourism and racism in a patriarchal Society- their influence on skin lightening in South African women of colour and the adverse health outcomes

Introduction

Over the years it has been found that society has played an active and prominent role in determining what a population generally perceives as beauty. Skin and its various shades have been no exception to this scrutiny. Various routines and regimens have been prescribed to ensure that the standards of beauty are met. Statistics show that a third of Black and Indian women in South Africa use skin lightening products (Dlova, et al., 2014). Skin lightening can be defined as the act of using substances that the alter the tone of one's skin, making it lighter. Different terms for this are skin lightening, skin whitening, skin brightening, skin dying or skin bleaching. Dlova, et al.(2015,p2)found that “a prevalence of skin lightening of 25–67% has been reported in Sub Saharan African countries “and this practice is considered by Hamann, et al.2014 “a global health hazard.” This goes to illustrate how a vast majority people heavily rely and use these products to change their skin shade and appearance.

The media utilises models as marketing strategies, celebrities and people of influence to pass on messages to associate fairness with beauty and wealth (Jacobs, et al., 2016). Women are the focus of this literature review because the worth of a woman is judged vigorously on the premise of physical appearance (Glenn, 2008). (Agorku, et al., 2016) and (del Giudice and Yves, 2002) have shown that skin bleaching is more common practice among women than men. This is particularly true more for women than it is for men in a patriarchal society much like that of South Africa. Ratele (2008 cited by Cornwall, Corrêa and Jolly, 2013) shows how prominent political figures in South Africa have prevailed with regards to showing gender equity as hostile to African culture, verifiably comparing it with modernity, (white) working class goals, and across the board absence of (male) financial headway. These findings reinforce the patriarchies of the South African Society. Gilbert and Walker (2002) explain how there is generally a lower status for women in the South African society. They further explain how this is manifested in low levels of job availability and income thereafter, education opportunity; the vast lack of political representation and the lack of access to basic services such as health care, transportation, housing and government bureaucracy. This is only compounded by the high levels of ethnic prejudice and low levels of social capital. From this study, it is clear that there is not only a gender inequality in the society but also racial inequalities, these inequalities and their influence on the skin bleaching trends and the subsequent health effects will be the main focus of this literature review.

The term people of colour refers to black Africans, Indians and coloureds (people of biracial ethnicity) because these are the main ethnicity groups within the South African population that are prone to racial marginalisation. Williams, et al., (2008) Finds how people of colour in South Africa were two to four times more probable than whites to report intense encounters of racial micro-aggression. One may conclude that racism is very common and dynamic in the South African culture (Slabbert, 2001), and from that the general idea of what beauty ought to be has been altered to and is inclined towards racist ideas. Golash-Boza (2009 cited by Dlova, et al., 2014) finds how in South Africa where the tone of one's skin predetermines social status and subsequently financial opportunities, skin lightening has become a very common practice, among darker people of colour.

Lewis, et al.,2011) Shows how proscriptive convictions that darker skin is less attractive and connected to lower status produces sentiments of inadequacy and low confidence and are reflected in the act of skin lightening. Discrimination based on woman's skin colour cuts across the board, there is also intra-ethnic and intra-racial discrimination in the form of colourism, which is defined by Glenn, (2008,pp.) as “the social hierarchy based on gradations of skin tone within and between racial and ethnic groups”

Skin lightening products contain mercury, corticosteroids and hydroquinone which are known to cause ill physical health impacts, but it is also important to note that the very social environment inhabited by a dark-skinned woman of colour in which she feels less confident and accepted, will have its own, very adverse mental health effects too. A biopsychosocial approach to this phenomenon of skin bleaching is to highlight the interaction that exists between the three main factors in the process of skin lightening: the reasons why skin lightening is done, the various practices and their mental and physical health consequences, and for future prevention and support processes (Jacobs, et al., 2016).This literature review will look at how racism and colourism in a patriarchal society affect women of colour, the adverse mental health effects of inhabiting a racist and patriarchal society that influence the use of skin lightening products , as well as the physical health effects caused by the use of skin lightening products. The first essay will look briefly at the background of skin lightening then review literature about physical health effects, complications of skin lightening product use, racism, colourism and their mental health effects. Essay two will review literature about the influence of patriachialism on skin lightening, its mental health effects and look at possible recommendations and solutions to this public health crises.

Background

Goldin (1984 cited by Jacobs, et al., 2016) describes how research over the years has shown that skin lighteners have been utilised for a considerable length of time, the earliest records of their utilisation in South Africa among women of colour propose that it started in the 1950s with the introduction of the Coloured Labour Preference Act of 1955. This skin tone segregatory piece of legislation gave a particularly favourable position to coloured individuals over Black Africans in connection to work and property. Meaning that the fairer or lighter one was the better social standing and jobs they had. Dlova, et al., (2015,pp.) states that “during the 1960s and 1970s – at the height of apartheid rule – the country's skin lightener market was robust and highly profitable” This was because the people of colour recognised that to get ahead they needed to have a lighter shade of skin. (Glenn, 2008) People of colour found themselves classified as native or coloured on the basis of skin hue and other phenotypic physical traits. This covert colourism with time became overt skin tone discrimination, which is the very basis of low self-esteem experienced by women of colour in the present day South Africa.

Physical Health Effects and Complications of Skin Lightening Products Use

Over the last twenty years, there have been many active ingredients found in skin bleach products, however the most common have changed from hydroquinone to corticosteroids, mercury (Dlova, Hendricks and Martincgh, 2012) and retinoid (Jacobs, et al., 2016).

There are various health effects incited by hydroquinone amid topical use. These can occur in a short space of time (acute) or after a long period of use (chronic) (DeCaprio, 1999). Studies show that hydroquinone skin lighteners may cause dermatitis (skin inflammation), exogenous ochronosis (blueish-black discoloration) (Burke and Maibach, 1997), cataract (clouding of the eye lens), scleral and nail pigmentation and patchy depigmentation. The exogenous ochronotic blueish black lesions are most commonly marked on exposed areas of the body. Abnormal regimentation of the lightened skin has also been reported on abrupt discontinuing hydroquinone use results in a skin colour much darker than the original skin tone. Because of this, those who use these products find it of paramount importance to continue to use the lightening products in order to maintain the newly acquired skin tone(Olumide, et al., 2008)This creates dependence on the lightening product and also leads to prolonged use which is more detrimental to health.Olumide, et al., (2008) also writes how skin lightening is also often manifested by delay in wound healing, after major surgical procedures wounds do not heal timeously and there may be death from infection. This is a clear indication that skin lightening is harmful to health.

Mercury and its subsidiaries are the most established known skin lighteners (Olumide et al, 2008). Although restricted by the US Food and Drug Administration in 1973 and by the European Union (EU) in 1976, mercurials are still being produced and sent out to Africa and the Caribbean (Jablonski, 2012 in Davids et al., 2016), this demonstrates the advantageous and protective effect of social capital on skin lightening manufacturers. However according to (del Giudice and Yves, 2002) Mercurials were well accepted until the point when they were perceived as dangerous, and their utilization was prohibited in South Africa. This goes to show that the South African government has realized the health urgency of eradicating skin lightening and has actively played a role in trying to combat it by means of legislation. Mercury toxicity may have two main variants, acute which manifests after a short period of mercury exposure and chronic which manifests after long-term mercury exposure. Acute toxicity manifests as a pneumonitis (lung inflammation) and gastric(stomach) discomfort. Chronic toxicity manifests by as nephrotoxicity (kidney toxicity) (Barr et al., 1972). Mercury also accumulates in keratin and leads to discolouration and brittleness of the nails Alexander and Mendel (1923 cited by Olumide, et al., 2008)

Olumide, et al., (2008) highlights that some of the strongest topical corticosteroids, are among the most commonly used skin lightening products mainly Betamethasone dipropionate (Diprosone). This is a topical corticosteroid that should only be obtained by prescription, this is a clear indication that law enforcement is available however it has not been thorough enough. Olumide, et al., (2008) Research shows how long-term users may develop Cushing's syndrome with characteristic “mooning” of the face and obesity, glucose intolerance and hypertension. Steroid addiction syndrome follows daily use of steroid based lighteners for periods of more than a one month to the facial, neck or genital skin. The skin tissues become “addicted” to the corticosteroid, so that without its use, the result is severe burning which can only be relieved by further corticosteroid application. These results for mercury based skin lighteners mainly manifest after long term use.

(Davids, et al., 2016) Research shows that in the present day many skin bleach products contain a form of retinoid. They function to lighten skin by decreasing enzyme production from the pigment producing cells in the skin. Some of the adverse health effects of retinoid according to Kimbrough-Green (1994 cited by Draelos, 2007) is an irritant dermatitis (skin inflammation) manifested as by redness, dryness, and flaking of the skin.

In order to fully appreciate the global health effect of skin lightening one must fully understand the health hazards that skin lightening products expose a woman to. There are numerous physical health effects caused by the use of skin lightening products ranging from minor and easily manageable effects to very severe and life-threatening complications that may result in death.

Racism and colourism

According to Kubota and Lin (2009)” Racial categories are not biologically determined and scientists agree that race is not a concept determined by biological evidence” The definition of race is perceived biological characteristic. Racism is therefore a phenomenon that is perceived superiority or inferiority based on perceived biological characteristics. According to critical race theorists, racism is the norm and is expected, it is the common and usual experience of every person hence making it difficult to address because it is not acknowledged. (Delgado, Stefancic and Harris, 2017).

This same theoretically based concept can be applied to colourism, the roots and origin of colourism stem directly from racism. For as long as colourism remains non-aberrational then it can never be considered a problem. A study by Dlova, et al., (2014) carried out in Durban in South Africa, by means of a questionnaire, tried to gage the perceived benefits of lighter skin and found that “more than a third of women believed that a lighter skin tone increased self-esteem and also implied that a woman belongs to a higher socio-economic class, helped women get better job opportunities, and increased a woman's chances of getting married as it is considered more beautiful by men. “However, the questions used in the survey may have been prone to bias as they were very suggestive and phrased more as statements to which women had to place one of five answers between, “strongly agree, agree, neutral, disagree, and strongly disagree” Dlova, et al., (2014) the results may not have been a true representation of the women's thoughts. However another study was  conducted in Dar es Salaam, with interviews also a part of the methodology and in contrast to the Durban study the “interview format included semi-structured and open-ended questions that assessed five core domains: demographics, perceptions of beauty, knowledge about skin bleaching, participation in skin bleaching, and family background”(Lewis, et al., 2011) the findings of this study were that 38% of the sample used skin lighteners to be lighter in skin complexion, more beautiful and more European looking,14% to please one's  partner as well as be considered more attractive by male mates,  and 22% to please peers. These findings were very similar to those of the Durban study. (Li, et al., 2008) conducted a similar research in Asia, the findings were that good skin should be “smooth, young, pore-less, line-free, bright, transparent, white, full, and fine”, these findings show that extensive research has been done on lighter skin perceptions amongst people of colour, and a correlation between those beliefs and the use lightening products is evident. This similarity in findings in different countries and continents shows a global pattern. Hamed, et al., (2010 cited by Jacobs et al., 2016) allude to how even though apartheid and politically-sanctioned racial segregation have long passed, the trans-generational mental scars still exist.

Darker women of colour consider the discrimination that they face to be non-aberrational and believe by use of skin lightening products they too will be more desirable and have better economic opportunities. This train of thought is detrimental to mental health in that constant feelings of a lack of validation or social assimilation may cause low self-esteem. Research by (Mann, 2004) suggests that an insecure self-idea and poor confidence can assume a vital role in the occurrence and risk of a variety of mental health problems and social issues, for example, depression, anorexia nervosa, bulimia, nervous and anxiety disorders, abuse of addictive substances and high-risk practices. Self-esteem is a very vital aspect of whole and healthy being, as it alters one's perception of the world and of themselves. (Mann, 2004) also shows that low confidence levels as a risk factor and high confidence levels as a defensive factor, confidence is therefore considered as a powerful tool for both physical and psychological well-being, and in this way, ought to be an essential aspect of health promotion; specifically, mental health.

However, the argument still remains that the precolonial African perception of female beauty favoured women with lighter brown, yellowish, or red skin tone. If that were true, the racial hierarchies established in areas that were colonised by Europeans institutionalised and generalised the privilege attached to women of colour having lighter skin Burke (1996) and Ribane (2006 cited by Glenn, 2008). These occurrences only drove the wedge of colourism farther down the figurative societal skin tone gap amongst people of colour.

Another theoretical concept raised by critical race theorists is interest convergence, which states that because racial discrimination and prejudice propels the interests of both white elites and working-class (average)whites, large segments of society have little or no motivation to eradicate it (Delgado, Stefancic and Harris, 2017). In South Africa, this is evident in that even as a minority in terms of population, whites constitute to only 8.4% (Community Survey 2016, Statistical release P0301, 2016) of the population, and people of colour account for the other 91.6% of the population (Community Survey 2016, Statistical release P0301, 2016). According to a study by the Old Mutual investment group South Africa the findings are that “only 23% of the shares traded on the exchange are held – directly and indirectly – by black South Africans “in addition, capital, in its multiple forms such as the land ownership, property and human economic capital, remains heavily in white ownership (Chandler, 2016).This is evidence of income inequality, more so women of colour who were found to have the highest unemployment rates(van Wyk, 2014) in South Africa.

Social capital in context is defined by Adler and Kwon (2002 cited by Claridge, 2004) as “the goodwill available to individuals or groups. Its source lies in the structure and content of the actor's social relations. Its effects flow from the information, influence, and solidarity it makes available to the actor” Women of colour in South Africa have very little if any social capital. This lack of social capital is displayed by their lack of health knowledge,employment and use of bleaching products. However, social capital has played a protective role and has been used to the advantage of the many skin lightening production companies, which are located in Europe being the main mercury containing soap producers. Chadwick 2001; Earth Summit (2002, 13-14 cited by Glenn, 2008) state that the” Distribution of mercury soap has been illegal in the EU since 1989, but its manufacture has remained legal as long as the product is exported.The mercury containing soaps are labelled for use as hygienic and scented; however, they are commonly known to be and are used as skin lighteners”. The practice is more likely to continue to increase as the sphere of influence of capitalism and social capital grow.

Studies show that lighter skinned women of colour with more European like features are more likely to be hired than their darker counterparts. Harrison and Thomas (2009) state that “Lighter skinned Blacks were more likely to have completed more years of schooling, to have higher salaries, and to have more prominent jobs than darker skinned Blacks. Perhaps the most compelling discovery of the study was that they found that the effect of skin colour on educational attainment and socioeconomic status between light- and dark-skinned Blacks is equivalent to the effect of race between Whites and all Blacks on these two domains” This intra-racial socioeconomic disparity between skin tones creates a clear distinction between the opportunities available to a darker skinned woman of colour and that of a lighter skinned woman.(Galobardes, 2006)Generally ,through time and place, countless investigations and studies have demonstrated how financial drawback is identified with poorer health. Women of colour also have the lowest rates of education in the South Africa (van Wyk, 2014). (Dlova, et al., 2015)  shows that women who were exposed to more than a decade of education were less likely to use skin lighteners, however on the contrary women from more urban areas were more likely to use skin bleaching products but they tend to use more expensive and sophisticated bleaching products.

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