dr alpana sagar centre of social medicine and community health jawaharlal nehru university

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Dr Alpana SagarCentre of Social Medicine and Community Health

Jawaharlal Nehru University New Delhi, India

[email protected]

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


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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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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


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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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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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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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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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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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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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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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

dr alpana sagar centre of social medicine and community health jawaharlal nehru university

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