The tense debate around Caster Semenya and Dutee Chand demonstrate the intersection between race, gender and medical imperialism
by Anna Kessel
When I was eight years old I visited South Africa, my dad’s homeland, for the first time. I’ll never forget flying into Jo’burg, looking down over the houses in the city and seeing hundreds of turquoise squiggles and dots. “Wow,” I said, excitedly, “everyone has a swimming pool here!”
My dad gave me a stern look. “Not everyone,” he said. It was 1987 and apartheid was in its final throes.
I learned a lot on that trip – my first taste of inequality at its most raw. By the end of the trip I questioned many things I thought I knew. I had thought that it would be wonderful to have a swimming pool. I had thought that everybody started from a level playing field.
In sport, of course, the premise is that they do. Sport’s governing bodies exist to ensure that athletes arrive at the starting line with a fair chance. They seek to enforce fair play with a catalogue of rules. And yet, this role of the enforcer is increasingly problematic, particularly in relation to women and sport. In seeking to define the boundaries of womanhood – our genetics, our apparel, our most intimate parts and experiences – women are being policed. Worryingly, the very rules designed to protect us are becoming our oppressors.
The story of the South African runner Caster Semenya embodies these tensions perhaps more than any other. The multiple world and Olympic 800m champion has been the subject of insults, medically invasive procedures and hysteria since she first competed on the international stage. She has also been claimed as a national hero, an icon, South Africa’s version of Serena Williams.
Semenya’s story divided women in sport too. Sometimes uncomfortably so. Italy’s 800m runner Elisa Cusma Piccione cruelly labelled her “a man” after Semenya was diagnosed with hyperandrogenism, a medical condition characterised by elevated levels of testosterone. One of Great Britain’s national runners, Lynsey Sharp, decreed Semenya’s presence in the sport “unfair”, while marathon world-record holder Paula Radcliffe said, “When we talk about it in terms of fully expecting no other result than Caster Semenya to win that 800m, then it’s no longer sport.” Disturbingly, the female voices of dissent are overwhelmingly white. In contrast, those women most affected by athletics’ stance on what constitutes a female athlete are women of colour from the global south.
“The irony of athletes from Great Britain, which spent £275m on preparations for the Rio games, raising fundamental questions about fairness in a race against an athlete from a country that spent less than £1.9m has somehow been lost,” wrote the South African author and commentator Sisonke Msimang. Msimang’s point is important. The wealth and investment in international sport from the world’s richest countries is the elephant in the room. Ahead of the Rio Olympic Games, just 30 countries were expected to win 80% of all the medals. John Hawksworth, chief economist at PwC, coolly observed that this sporting pattern mirrored the shape of the global economy: a select few powerhouses reaping the greatest rewards.
I was at the Berlin World Championships in 2009, working as an athletics correspondent, when Semenya’s story first broke. She was just 18 when the world began reporting on her genitals. It was the most challenging, heart-wrenching, uncomfortable story I ever worked on. The global sports media didn’t have the language to cope, as journalists lurched awkwardly through a range of terminology from “hermaphrodite” to “intersex” to “hyperandrogenism” and “DSD” (disorders of sex development).
Nine years on and Semenya has received hormone treatment to comply with the International Association of Athletics Federations (IAAF) demands, but continues to be viewed with suspicion. Meanwhile, the court of arbitration for sport (CAS) decreed that the IAAF’s rules on hyperandrogenism should be suspended unless they can provide conclusive evidence to show that elevated testosterone levels lend a significant advantage to athletes like Semenya. Ultimately, we are still clumsily navigating our way through this issue.
Hyperandrogenism, as so many have since argued, is just one genetic variation among many that separates one athlete from another. Eero Mäntyranta, the Finnish cross-country skier who dominated his sport in the 1960s, had a naturally high red blood cell and haemoglobin count; Usain Bolt is almost 2m tall and, combined with lightning fast leg turnover, obliterated the competition through three Olympic cycles. But no one complained that his presence in the competition made for an uneven playing field. So why should gender be singled out for regulation?
I attended a sports conference in 2016 and heard the bioethicist Dr Silvia Camporesi discuss these issues. Since the hyperandrogenism rule came into place, says Camporesi, only women of colour from the global south have been targeted for gender testing. “How could this be?,” I asked.
“There is an intersection of race and gender, and possibly medical imperialism [in sports governing bodies’ approach],” Camporesi says. “This idea is that sex is binary, and if women do not conform they should have surgery or take androgen suppressing therapy – while there is no such requirement on men. In sport there seems to be this idea that to ensure fairness in competition you need to suppress outliers if women perform too well or too close to the male range. There are different genetic and biological variations, plus training, mental capacity and other features that make an athlete a champion. Compare Caster Semenya with Bolt and she’s not such an outlier. Using hyperandrogenism to define fairness is too narrow. Fairness is a much broader concept.”
Katrina Karkazis, a bioethicist at Stanford University, is one of the experts who testified in the Dutee Chand case – the Indian sprinter whose legal action persuaded CAS to suspend the IAAF’s testosterone rule for two years in 2015. Karkazis has been key in redefining the debate around this issue, in particular challenging what she calls the “testosterone myth”. She has frequently called out the socio-cultural context. “The IAAF must show that female athletes with higher total T [testosterone] have a performance difference that approximates what male athletes typically have over female athletes; not that female athletes with higher T have any competitive advantage over their peers. In other words, it has to be a big performance difference, which CAS put in the 10-12% range. What the study found is nothing near this.”
In media reporting of Semenya and Chand’s cases, much has been made of their rural upbringing, as though there is a direct link between their birthplace and their genetic make-up. In fact, Camporesi says, there is no scientific evidence to suggest that hyperandrogenism is any more prevalent in the global south than it is in the UK. “That would be wrong …and I would be very sceptical of any theory that stated it was dependent on race. It can be due to different causes. It can come in mild forms such as polycystic ovary syndrome [affecting one in five women in the UK].”
Camporesi believes that white athletes have not so far been picked up because they do not necessarily conform to the “visual triggers” born out of western ideas about femininity. “My intuition is that of course it is a pressure on women to conform to a certain heteronormative standard of femininity. We can make some extrapolations on the basis of the table that was included in the IAAF hyperandrogenism regulations.”
The scoring table that Camporesi refers to is based on a system originally produced by two doctors working in England in 1961. Currently the regulation is suspended, but before the CAS ruling it formed part of the IAAF’s approach to regulating the women’s competition.
Reading the appendix is like encountering something out of a different era. It is disturbing to consider that this approach was used until 2015. A section on hirsutism (excessive hair growth) includes a “scoring sheet” that covers 11 different areas of the body, with accompanying hand-drawn illustrations. It also endorses a vigorous line of questioning about facial hair removal – which methods? how often? – and included for assessment is “apocrine sweat odour”. This is women’s bodies being measured and categorised, in alarming fashion.
When Semenya’s story first broke I remember being surprised at the certainty with which those around me discussed her gender, based on her appearance. If Semenya was white, with long hair and make-up, would there have been the same amount of outcry?
I ask Sisonke Msimang about that visual checklist from the IAAF, an institution viewing women of colour through an inflexible, white, western lens. “It’s true, I’m sitting here talking to you and I’ve got extremely short hair, almost non-existent, and that’s extremely common for women in South Africa, and it isn’t read as masculine or butch,” Msimang says. “And of course if you look back historically the notion of white femininity has always been constructed vis-a-vis black femininity so what is beautiful in a white woman, if a black woman has features that mimic that then she is considered to be beautiful. If she doesn’t, then she is considered to be ugly.”
White femininity is the default femininity. “Black women are always going to be on the wrong side of that spectrum. And then on top of that you’ve got Caster, who of course has hyperandrogenism, and then it becomes even more dramatic. But the drama is already inbuilt into the way the category is set up.”
Semenya has become South Africa’s cause célèbre. “People are interested in Caster’s story for all kinds of reasons – gender, identity and all that stuff – but I think people are interested in South Africa as a last colonial outpost.” Msimang references the South African writer and academic Njabulo Ndebele on the protections of international whiteness. “There is a sense whereby South Africa is owned by white people everywhere. They can move there, feel comfortable there, there’s a claiming of it. And I feel there’s something going on with this Caster Semenya thing, which is in part about South Africa, the claiming and ownership of South Africa, and she challenges everything about what’s supposed to be. She’s an affront on every single sensibility, in particular a British sensibility.”
I mention the emphasis on the “rural community” origins of Semenya and Dutee Chand, as though this could only happen somewhere out of colonial control, deep in “the bush”. Msimang laughs. “That’s right. That’s also part of why South Africans have owned her so strongly. There’s this bigger tussle that’s going on with Caster Semenya. I mean everybody loves Caster Semenya, the most patriarchal, misogynist, homophobe loves Caster. Search for the hashtag #castersemenya and you’ll see the extent to which she is universally adored by South Africans.”
Msimang says there is yet to be a genuine groundswell of movement towards championing women’s equality in sport. Banyana Banyana for example, South Africa’s national women’s football team, are not paid to play and, despite achievements such as winning the COSAFA Cup in September, receive very little recognition. Semenya’s approval, then, hails from the universality of lived experience. “It’s a recognition about the unfair ways in which Caster is seen and talked about. She stands in for something bigger. Serena is always hyper masculinised, harking back to stereotypes and tropes we’ve had for many years. So when a black woman is doing well, excelling, she becomes a motif for a certain kind of overcoming. It’s about people being able to demonstrate that discrimination is real by pointing to the way in which these exceptional figures are treated. It’s like, ‘They’re so amazing and yet even they are subjected to what we experience – so what are the chances therefore for us?’ So of course we’re going to root for them because they are an emblem for us.”
Where things have gone “wrong” is not in the genetics of these sportswomen, but in the ways they have been treated by major organisations despite their commitment to sporting value, fair play and ethics. At just 18, and having excelled in the national junior championships, Chand says she was hoodwinked into a gender verification test. According to her testimony, at the request of the Athletics Federation of India (AFI), the teenager travelled 1,700km to Delhi for a blood test, only to be told that there was no one available so instead she would undergo an ultrasound. Her clitoris, vagina and labia were examined, as were her breasts and pubic hair. (The AFI disputes Chand’s version of these events.)
Afterwards, the AFI sent a concerned letter to the Sports Authority of India warning that such cases are an “embarrassment” to their international reputation. Chand was promptly banned from competing, unless she agreed to undergo hormone treatment. She refused.
Many fear the ethical implications of forcing athletes to take drugs or undergo interventions when there is no medical reason to do so. Katrina Karkazis, the Stanford bioethicist, warns of an increased risk of osteoporosis following surgeries, while in the Journal of Clinical Endocrinology & Metabolism, Peter Sonksen, a retired professor of endocrinology, notes that the “feminising” procedures of clitoral mutilation and partial gonad removal are “unethical”. Although the IAAF covers the cost of the medical procedures they do not pay for the aftercare of the athlete, he says, potentially negatively impacting athletes from the global south who may not then have access to continued hormone treatment or follow-up health checks. The United Nations special rapporteur on health, Dainius Pūras, has condemned clitoridectomies – a so-called “feminising” treatment performed on four female athletes at the time of the London Olympic Games – as a form of female genital mutilation.
How we understand these stories is largely due to the storytellers. Shireen Ahmed, a Canadian sports journalist, emphasises how dependent we are in the west on a select few to tell globally important stories. As a Muslim woman, passionate about sport and suffering under the hijab ban, Ahmed left her job in social services to become a sportswriter and shake up the hegemony. “One of the reasons I got into this is because I really hated the way that stories of Muslim women in sport were written about,” she explains. “They’re all written by a white guy. There’s very little understanding of the geopolitical context, that Muslim women are not a monolith.”
In the west we assume to have all the answers, but Ahmed points out that in Canada the women’s professional ice hockey league are not paid, despite it being a national sport. They receive a food stipend and their travel expenses, and that’s it. “I was appalled when I found this out. We like to tout ourselves as developed nations, the UK, Canada, Australia. But the struggles of women in sport are universally exactly the same whether that’s the Matildas fighting for equal pay, the Danish women’s team, England’s Lionesses.”
She cites the row about the 2015 FIFA women’s world cup that was played on turf in Canada, despite football’s female stars pursuing legal action against FIFA. “Well, Canada is now bidding for the men’s World Cup in 2028, and they’re not bidding for turf. They’re bidding for grass. It’s really funny because with the women it was like, ‘Well we have winter until April so there’s no way we can keep grass. Well yeah, unless it’s for the men.’” Ahmed laughs as she describes desperately trying to find international women’s sport on TV in Canada. When the women’s European Championships were on in 2017, a TV network was broadcasting “corn hole” championships – literally tossing beanbags into holes in a wooden board – instead of the women’s football. “Can you imagine? For the men’s Euros those matches were on every major network. You can’t build an audience if you don’t show it. It’s ridiculous.”
Over the years, Ahmed has tracked the various developments around sport and the hijab – from the lifting of the ban by FIFA and FIVB Beach Volleyball, to the ongoing battles in women’s boxing and court volleyball.
When she wrote about the 2016 Olympic volleyball match between Egypt and Germany – crassly dubbed “burka versus bikini” – Ahmed uncovered the disturbing dictate on the all-women’s competition kit. “I didn’t realise that the volleyball federation mandated women’s bikinis to the centimetre and width of their band on their bikini bottoms. I was completely mortified. I approached the article thinking this was about controlling what Muslim women wore, but it wasn’t, it was about controlling what all women wore. There’s a woman from the Netherlands who wanted to wear a short-sleeved rash guard. She had to get special permission in order to just wear a T-shirt, instead of a bikini. You don’t see the same level of policing of men’s uniforms.”
The world of sport is being forced to confront its treatment of women. Women’s football globally fights on with Nigeria’s sit-in protest over unpaid wages, and Denmark and Argentina on strike over equal pay and conditions. It is not just a matter for athletes. Second Source, a group for female journalists working in the UK, has recently been established, with cross-party political support, to tackle sexual harassment and abuse in the media. It is much needed. As I write, a female journalist sends me screenshots of messages she’s received for daring to give a sporting opinion on social media; she is invited to kill herself and told to go back to the kitchen. It is a common occurrence for many in her role.
“It’s really not complicated to make sure women are included, it’s just not,” Ahmed says. But sadly, the notion of a level playing field in sport continues to fail women; in 2018, we need to do better.”
- This is an edited extract from the Griffith Review 59: Commonwealth Now