Review of Sugar and Tension: Diabetes and Gender in Modern India, Lesley Jo Weaver, New Brunswick, NJ: Rutgers University Press, 2020, 202 pp.

Reviewed Book

Sugar and Tension: Diabetes and Gender in Modern India, Lesley Jo Weaver, New Brunswick, NJ: Rutgers University Press, 2020, 202 pp.

Victoria Sheldon

University of Toronto

Diabetes requires intensive self-care. Faced with constant monitoring, oral medications, and insulin injections, one may never forget that they have the disease. In Sugar and Tension: Diabetes and Gender in Modern India, Lesley Jo Weaver draws on this fact to raise an important question: What does it mean to be an appropriate modern woman with type 2 diabetes in North India, when self-sacrifice—not self-care—is so often elevated as a central index of feminine, familial propriety? More than just about diabetes, then, this book opens a window into the lives of North Indian women in the 21st century, showing how they balance chronic illness, family life, class and caste status, individual and group values, and changing social norms.

A key purpose of this book is to examine how gender, modernity, and health intersect in the context of women’s diabetes care in North India. The title of the book—Sugar and Tension—points to two key colloquial terms: Hindi speakers address diabetes as “sugar,” while employing “tension” to index “the feeling of being stretched between competing priorities” (p. 143). Backed by case studies and quantitative analyses, Weaver engages with such everyday idioms as she analyzes how women make sense of diabetes and its implications for their domestic responsibilities, their health, and their moral standing. In contrast to globally determined models of biomedical self-care, this book productively recognizes diabetes as “a sort of ‘natural experiment’ in cultural change around gender and propriety in North India” (p. 142).

Weaver builds on a long tradition in medical anthropology of examining the social production and structuring of disease, asking how its meanings are shaped by social, historical, and political forces. What sets the book apart is its focus the moral and practical work involved in women’s diabetes management. With attention to variations across age, class, and caste identities, Weaver highlights how self- and other forms of care in North India are morally fraught categories, shaped by pervasive local ideologies of feminine virtue as stemming directly from women’s domestic care of others. Yet, while Weaver draws attention the balancing acts that diabetic women face as they work to be both domestic and modern, she does not frame her interlocutors as passive. Rather, she highlights the creative ways through which they respond to kinship dynamics and accrue symbolic and social capital, all the while managing—or downplaying—the need to care for their health. By juxtaposing women’s illness narratives with interviews from male diabetic specialists, Weaver offers a nuanced and empathetic picture of gendered care and the “habitus of self-sacrifice” constituting domestic modernity in North India (p. 104).

Weaver’s striking analysis is grounded in her mixed-methods approach. At clinics, she coordinated semi-structured interviews of 280 women—184 with diabetes, and 96 without. During these meetings, Weaver collected biomedical measurements: body mass index, body fat percent, and waist-to-hip ratio. In addition, she collected measures of glycated hemoglobin, random blood glucose, C-reactive protein, and Epstein–Barr virus antibodies—all in the aim to assess overall cardiovascular health and immune stress. While the heart of the book is found in women’s illness narratives, these quantitative methods help to substantiate Weaver’s critiques of biomedical models of self-care, including her overarching claim that “an individual’s hard work or lack thereof does not map neatly onto positive or negative (diabetes) outcomes” (p. 62).

Weaver coordinated in-depth interviews with 30 women from the clinics, whose perspectives and dilemmas illuminate the key arguments of each chapter. Across caste identifications, age, and socioeconomic backgrounds, their words showcase how diabetes care intimately implicates families as a whole. Self-sacrificial norms are so pervasive in North India, she argues, that women often prioritize the care of their families, at the expense of their own health. Weaver’s in-depth representations of women’s domestic lives also help ground her final suggestions for improving health-related practice. In the conclusion, she maps out several strategies for developing health care programs in India that work with culturally valued ideals. Publicly reframing women’s diabetes self-management as a “family value”, for instance, may serve as a powerful motivator for supporting consistent management of this epidemic (p. 153).

Taken together, the book’s seven chapters offer an incisive portrayal of gendered roles and expectations in contemporary India. The introduction and following two chapters introduce the key features that define modern India, showing how the structural, social, and personal features of women’s lives shape their diabetes experiences. In grappling with diabetes, many women express being caught between “two Indias”: one that involves fidelity to domestic norms of service and another that prioritizes self-care and freedom in public space (p. 6). The later three chapters and conclusion build on this contextual ground by investigating how women’s diabetes links to personal hardships, kin-based expectations, and mental health. Chapter 6 in particular demonstrates how, despite the social value of gendered self-sacrifice and its implications for potentially not following one’s diabetes-management recommendations, many women draw on social support to generate emotional resilience and live well. Uniting the entire book is the key point that “the concurrent rise in diabetes, sedentary lifestyles, processed foods, and new social roles for women is not coincidental; all are related to economic and political changes in contemporary India” (p. 19).

One of the greatest strengths of this work is Weaver’s ability to clearly intervene in discussions on gender, agency, and biomedical care, while remaining close to the voice of her female interlocutors. Chapter 4 especially provides some much-needed context to discussions on idioms of distress in India. By elaborating the diverse ways that women with diabetes employ narratives of tension, Weaver demonstrates how this idiom serves as a “unifying language for the threads of social life, health, and domesticity that are intertwined in women’s lived realities”—even though these concerns are often excluded from biomedical conceptions of pathological distress (p. 77). By focusing on tension as at once an idiom of distress, (an) explanatory model, and (a) site of resiliency work, Weaver effectively demonstrates how—despite biomedicine’s reductive conceptions of “good diabetes”—patients draw on competing demands and experienced-based traditions of expert medical knowledge in ways that may not translate into “controlled biologies” (p. 56). It is in this shifting context that Weaver demonstrates how socioeconomic status, caste, and kin expectations shape whether and how women frame their diabetes as sources of either depression, tension, or resilience.

Weaver’s emphasis on the conflicts between diabetes self-care and women’s socialization to care for others is a major strength of the book. Her arguments could have been (reinforced) by foregrounding the regional specificity of her analysis. In Chapter 4, for instance, Weaver argues against Murphy Halliburton’s claim that in Kerala, the idiom of tension supports cultural homogenization by supplanting more traditional mediums of distress, including spirit possession. However, Weaver’s critique does not take into account that Halliburton’s analysis is embedded within a unique context of literacy, popular science, and religious pluralism in Kerala, South India. Tightening the regional scope of her analysis to urban North India and emphasizing the role of local class and caste identifications in shaping themes such as domestic modernity would have further supported Weaver’s overall arguments. This is a clear and very compelling ethnography that demonstrates how for women in New Delhi, learning to be diabetic is as much about family and global development as it is about individual well-being. Weaver does not set up self-sacrifice and self-care as mutually exclusive possibilities but considers how acts of control and giving hold profound social meaning in North India. Overall, this highly readable book would be appropriate for undergraduate and graduate courses in medical anthropology, global health, biocultural anthropology, and the anthropology of gender. In addition, health professionals who are unfamiliar with India may find the book engaging, especially as it clearly introduces a gendered perspective to chronic illness care.