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Dr Alpana SagarCentre of Social Medicine and Community Health
Jawaharlal Nehru University New Delhi, India
Gender Concepts
Using Gender to Examine
Ill-Health
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Multifactorial nature of ill-health
Amongst various factors two that are being considered:
1. Sex: Determined by biology
2. Gender: A social and cultural construct that prescribes norms of behaviour for men and women - masculinity for men and femininity for women, and therefrom assigns them social roles
These norms define: dress, attributes behaviour and roles
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Women
Emotional
Gentle
Caring
Nurturing
Obedient
Self-sacrificing
Tolerant
Men
Rational
Strong
Competitive
Aggressive
Self confident
1 Gender concepts
Attributes and Behaviour
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Roles
Women
Homemakers Mothers
Wives
Daughters
Daughters-in -law
Nurturers
Subordinate to men
Men
Heads of households
Breadwinners
Professional achievers
Carry on bloodline
1 Gender concepts
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2. Gender and Health - Mortality Differentials
While gender is responsible for attributes and norms of behaviour as well as for defining social roles can we say it has any implications for health?
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1 Gender concepts
The Implications of Gender for Health
1. Differences in mortality patterns
2. Differences in health seeking behaviour
3. Women’s Reproductive /Maternal Health emphasized more than their overall health
Policy Implications
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Mortality Differentials Between Males and Female
Cause of Mortality Males Females
Biological
Infectious and Parasitic Diseases 6% 4%
Congenital Malformations 0.3% 0.2%
Genito Urinary System 0.8% 0.4%
Pregnancy, Childbirth andPuerperium
NIL 0.6%
IHD and MI 8% 5%
Social
Burns 0.3% 0.7%
Accidents, Falls, Suicide, DrowningHomicide
4.8% 1.3%
Mental Diseases 0.6% 0.3%
Source: Causes of Survey of Death 1998
2. Gender and Health - Mortality Differentials
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2. Gender and Health - Mortality Differentials
While women are known to be the biologically stronger sex can biological causes of mortality be overridden by social causes for mortality?
What does a closer look at data on mortality of males and females by infectious and parasitic diseases reveal?
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2. Gender and Health - Mortality Differentials
Often biological causes are overridden by social causes
Percentage Proportion of Male and Female Mortalitydue to Parasitic and Infectious Diseases 1998
Age Male FemaleOverall Mortality 59% 41%0-1 years 53% 47%1-4 years 44% 56%5-9 years 44% 56%10-14 years 47% 53%15-19 years 56% 44%20-24 years 50% 50%25-29 years 53% 47%>30 years >60% <40%Source: GOI Survey of causes of Death 1998
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Percentage Distribution of Reported Deaths by Age and Sex1998
Age in Years Male Female
0-14 years 22% 27%
15-44 years 20% 20%
>45 years 58% 53%
Source : GOI Survey of Causes of Death 1998
2. Gender and Health - Mortality Differentials
Often biological causes are overridden by social causes ct.
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3. Gender and Health - Health Seeking Behaviour
Not only do social causes affect mortality,
gender socialization also affects morbidity reporting and health seeking behaviour
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3. Gender and Health - Health Seeking Behaviour
Reported ailments during last 15 days/1000 persons by age and sex
Age in Years 0-14 15-39 40-59 >60Male 50 35 64 178
Female 45 45 75 161
Reported medical treatment during last 15 days /1000 persons by age and sex (urban)
Age in Years 0-14 15-39 40-59 >60Male 934 903 897 891
Female 919 905 915 855Source: NSSO data 1996-1997 GOI
While mortality is highest for girls under 14 years of age morbidity reporting and medical care is lowest for this group
For women in the reproductive age group while reported morbidity is more than males of same age, commensurate medical care is not sought
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3. Gender and Health - Health Seeking Behaviour
It is also worth noting that morbidity reporting is not the same for all women but differs by income groups
Reported ailments during last 15 days/1000 persons by MPCE* and sex
MPCE 0-10 10-20 20-40 40-60 60-80 80-90 90-100
Male 44 40 45 50 56 66 83
Female 40 39 49 55 62 72 91
Source: NSSO data GOI 1996-1997 *MPCE Monthly per Capita Expenditure
While mortality is known to decrease with increasing income, the reporting of morbidity has increased with increasing income
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3. Gender and Health - Health Seeking Behaviour
What is explanation for this disjunction between women’s morbidity and health seeking behaviour
•Women’s own acceptance of illness due to their socialization
•Social definitions of women’s health by their social figures of authority - husbands and mothers-in -law
•Medical definitions of women’s health by doctors
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3. Gender and Health - Health Seeking Behaviour
So what is the result of women’s ill health not being legitimized
Women’s morbidity is thus underreported
Treatment seeking behaviour is affected
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4. Social understanding of women’s health
Not only does women’s state of health get defined socially, a gendered understanding of women also impacts the way in which their problems of ill health are viewed
Most health programs tend to emphasize women’s reproductive or maternal health rather than their over all health
Is this in consonance with the data on women’s health?
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4. Social understanding of women’s health
Causes of Death in Women 1998
Maternalcauses
CommunicableDiseases
Anemia Suicide Burns
All Ages 1.4% 17.4% 4.9% 2.4% 1.6%
ReproductiveAge
8.5% 29.7% 4.3% 11.3% 6.5%
Source: Survey of Causes of Death 1998 GOI
What is the distribution of causes of mortality in women?
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4. Social understanding of women’s health
Percentage Distribution of Reported Deaths by Age and Sex1998
Age in Years Male Female
0-14 years 22% 27%
15-44 years 20% 20%
>45 years 58% 53%
Source : GOI Survey of Causes of Death 1998
Additionally percentage of deaths for women is not highest in reproductive age group
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4. Social understanding of women’s health
Then why despite evidence to the contrary, is women’s health linked so strongly to their reproductive health?
There are many reasons one of which is the historical understanding of reproduction being woman’s most important function
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Policy Implications
AN UNDERSTANDING OF THE IMPORTANCE OF THE IMPACT OF LARGER SOCIAL STRUCTURES ON THE HEALTH OF BOTH MEN AND WOMEN.
THIS LEADS TO THE RECOGNITION FOR EMPHASIZING INTERSECTORAL LINKAGES FOR PUBLIC HEALTH
A CHANGE OF EMPHASIS FROM REPRODUCTIVE TO GENERAL HEALTH IN HEALTH PROGRAMS WOULD HELP IMPROVE WOMEN’S OVER ALL HEALTH
THE NEED FOR LARGER SOCIAL CHANGES TO IMPROVE THE POSITION OF WOMEN
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THANK YOU