The relational dynamics of hegemonic masculinity among South African men and women in the context of HIV

In South Africa, the frequent positioning of men's sexual behaviours as a prime driver of the HIV epidemic has generated much interest in men's sexuality. However, the relational nature of dominant male norms that exacerbate the risk of HIV transmission is inadequately understood. This study used sexual biographies to explore how men and women negotiate gendered norms and how this affects their sexual and reproductive health (SRH). A total of 50 sexual-history interviews and 10 focus group discussions were conducted with men, and 25 sexual-history interviews with women, with participants sampled from three age categories (ages 18–24, 25–55 and 55+years), a range of cultural and racial backgrounds and urban and rural sites across five provinces in South Africa. The narratives illustrate that men and women's SRH is largely dependent on the type and quality of their relationships. Men's sexuality was regularly depicted as being detached from intimacy and uncontrollable, which was premised as being opposite from and/or superior to women's sexuality and could justify men's high-risk sexual behaviours. Yet many participants also supported gender equitable relationships and endorsed accountable and healthy SRH behaviours. The narratives reveal that HIV-risky dominant male norms should be addressed relationally for the sake of better SRH outcomes.     

Married men's first time experiences of early childbearing and their role in sexual and reproductive decision making: a qualitative study from rural Vietnam

Male partners' involvement in women's sexual and reproductive health has been increasingly emphasised in international health. A qualitative approach with open-ended qualitative interviews was used to explore young, married men's first time experiences of early childbearing, their sexual and reproductive decision making and the meanings they make of their role as husbands and fathers. The results offer a nuanced picture of the men's vulnerability in becoming young fathers and having to assume their role as family decision-makers, while still being inexperienced in matters related to the health of their wives and newborn child. Constraints to gender equality and traditional norms and values continue to pose barriers to both young men and women making independent decisions in relation to marriage and childbearing. Men's involvement is necessary in healthcare programmes designed to improve women's sexual and reproductive health and the health of the newborn. Young, first-time fathers, in particular, need support and empowerment.     

Fit to father? Online accounts of lifestyle changes and help‐seeking on a male infertility board

The reproductive realm is routinely viewed as a feminised space requiring women's commitment and labour. By contrast, men's procreative contributions and ‘reproductive masculinity’ is represented as unproblematic, with men assumed to be fertile across the lifespan. Recent scientific research has, however, cast doubt over these longstanding assumptions, suggesting that a link does exist between ‘lifestyle’ factors and male fertility. The notion that fertility can be improved with effort (for both women and men) can be located within wider cultural and political shifts which construct individuals as increasingly responsible for acting on health messages and engaging in self‐disciplining body projects. Through an exploration of ‘lifestyle changes’ within a men's online infertility discussion forum board, this paper examines how discourses of individualisation healthism and masculinity are reproduced and interlinked. Our thematic analysis indicates that ‘lifestyle work’ is construed as crucial for achieving conception ‐ and as a means to demonstrate men's commitment to the dyadic goal of parenthood, which in turn may challenge and extend previous notions of ‘reproductive masculinity’.     

Understanding gendered influences on women's reproductive health in Pakistan: Moving beyond the autonomy paradigm

Recent research and policy discourse commonly view the limited autonomy of women in developing countries as a key barrier to improvements in their reproductive health. Rarely, however, is the notion of women's autonomy interrogated for its conceptual adequacy or usefulness for understanding the determinants of women's reproductive health, effective policy formulation or program design. Using ethnographic data from 2001, including social mapping exercises, observation of daily life, interviews, case studies and focus group discussions, this paper draws attention to the incongruities between the concept of women's autonomy and the gendered social, cultural, economic and political realities of women's lives in rural Punjab, Pakistan. These inadequacies include: the concept's undue emphasis on women's independent, autonomous action; a lack of attention to men and masculinities; a disregard for the multi-sited constitution of gender relations and gender inequality; an erroneous assumption that uptake of reproductive health services is an indicator of autonomy; and a failure to explore the interplay of other axes of disadvantage such as caste, class or socio-economic position. This paper calls for alternative, more nuanced, theoretical approaches for conceptualizing gender inequalities in order to enhance our understanding of women's reproductive wellbeing in Pakistan. The extent to which our arguments may be relevant to the wider South Asian context, and women's lives in other parts of the world, is also discussed.     

Beyond “toxic bodies”: Multiplied rationalities of women's reproductive health in a high-risk environmental area (Taranto,Italy)

This study investigates women's reproductive health concerns in Taranto, a steel town and a “high-risk environmental area” in Italy. It draws on participatory ethnographic research (body mapping, interviews and fieldnotes) and analyses political and social aspects of women's reproductive health in relation to pollution. I argue that in highly polluted environments, both political rationalities and women's health concerns over their bodies are multiplied, extending beyond a focus on their bodies as shaped by toxic exposure. Women make sense of knowledge about their reproductive health and questions of responsibility in relation not only to societal norms, but also through reference to the wider polluted environment and the political-economic structures they inhabit. By focusing on women's own experiences, the study contributes to our understanding of women's agency over their environment-health relations and seeks to complicate women's role as environmental subjects beyond “toxic bodies”.     

(Not) talking about sex: couple reports of sexual discussion and expression in Bangalore,India

Adolescent marriage is common in India, placing young women at risk of HIV, early pregnancy and poor birth outcomes. Young women's capacity to express their sexual desires is central to negotiating safe and mutually consensual sexuality. Men, too, play an important role in shaping women's sexual and reproductive health outcomes, but little research has examined how men influence women's sexual expression. Using paired husband and wife data, this paper reports on a preliminary investigation into the patterns of and concurrence between women's sexual expression and their husbands' attitudes about it, as well as the influence of men's approval of their wives' sexual expression on women's actual expression of sexual desire. The results suggest that, among this sample, men are more open to sexual expression than their wives and that, for women, expressing desire not to have sex is far more common than expressing desire to have sex. Further, men's approval of sexual expression from wives appears to positively influence women's actual expression. These findings suggest that men may be resources for women to draw upon as they negotiate sexuality in adolescence and early adulthood.     

Gender Inequities in Health: An Exploratory Qualitative Study of Saudi Women's Perceptions

This study aimed to explore Saudi Arabian women's perceptions of how gendered social structures affect their health by understanding their perceptions of these influences on their health relative to those on men's health. Qualitative methods, including focus group discussions (FGDs) and in-depth individual interviews (IDIs) were conducted with 66 married women in Riyadh, the capital city. Participants were purposively sampled for maximum variation, including consideration of socio-economic status, age, educational level, health status and the use of healthcare. The majority of women perceived their health to be worse than men's and attributed this to their childbearing, domestic and care-giving roles, restrictions on their mobility, poverty and psychological stress related to their responsibilities for children, and marital conflict. A minority of participants felt that men's health was worse than women's and related this to their gendered roles as “breadwinners,” greater mobility and masculine norms and identities. Gender equity should be a health policy priority to improve women's health.     

Peer Reviewed: Cognitive Health Messages in Popular Women’s and Men’s Magazines, 2006-2007

Introduction

Growing evidence suggests that physical activity, healthy diets, and social engagement may promote cognitive health. Popular media helps establish the public health agenda. In this study, we describe articles about cognitive health in top-circulating women''s and men''s magazines.

Methods

To identify articles on cognitive health, we manually searched all pages of 4 top-circulating women''s magazines and 4 top-circulating men''s magazines published in 2006 and 2007 to identify articles on cognitive health. We examined article volume, narrative and illustrative content, information sources, and contact resources.

Results

Women''s magazines had 27 cognitive health articles (5.32/1,000 pages), and men''s magazines had 26 (5.26/1,000 pages). Diet was the primary focus (>75% of content) in 30% of articles in women''s magazines and 27% of men''s magazines. Vitamins/supplements were the focus of 15% of articles in men''s magazines and 11% in women''s magazines. Articles mentioned physical activity, cognitive activity, and social interaction, although these subjects were rarely the focus. Articles focused more on prevention than treatment. Topics were primarily "staying sharp," memory, and Alzheimer''s disease. Colleges/universities were most often cited as sources; contacts for further information were rare. Most articles were illustrated.

Discussion

Although the volume of cognitive health articles was similar in the magazines, content differed. More articles in men''s magazines discussed multiple chronic conditions (eg, Alzheimer''s disease), whereas more in women''s magazines discussed memory. Including more articles that focus on physical activity and direct readers to credible resources could enhance the quality of cognitive health communication in the popular media.     

Letter – Understanding gender equity in the context of men's health policy development

The achievement of gender equity is central to improving health outcomes across the world. Indeed, this will be a foundation principle within the men's and women's health policies currently being developed by the Australian Government. For this to be meaningful and relevant to the 21st Century, it will be important to clearly define what gender equity means in the context of both men's and women's health. This is not just a case of ensuring that one policy does not have a bias over the other, but is about recognising that gender equity is fundamentally about sets of relations. The editorial in the August 2009 issue of the Health Promotion Journal of Australia5 seems somewhat limited in its interpretation of gender equity, failing to recognise the contested nature of the concept6 and collapsing all discussion down to one particular relation – men's propensity toward violence. Men and violence (both in terms of those who perpetrate and those who are victims) is clearly a key public health issue that requires serious and integrated policy action. Yet, it is by no means the only issue of concern for addressing gender inequities to improve men's (and women's) health in Australia in the 21st Century     

“We have to ask and only then do”: Unpacking agency and autonomy in women's reproductive health in urban India

The limited autonomy and agency of women in developing countries is recognized as a key barrier to improving their reproductive health. Using an existing perinatal cohort in urban South India, we interviewed 36 women who had recently been through childbirth, and we carried out observations of family life and clinic encounters. Critical domains involved in women's agency and autonomy were women's participation in employment and group action and their mobility. Household decision making was considered a joint rather than individual responsibility. We call for a more nuanced understanding of these domains and their relationship to women's reproductive health, particularly for urban populations.     

Culturally constructed relationships shape sexual and reproductive health in Bolivia

This paper reports on findings from five studies on the ways in which culturally specific identities and relationships shape women's and men's attitudes towards, and experiences of, sexual and reproductive health and health care in Bolivia. Quantitative and qualitative methods were used to examine knowledge, power and decision‐making in sexual relationships, and between health care providers and clients. Findings indicate that men and women hold different attitudes towards, and knowledge of, certain aspects of sexual and reproductive health. Moreover, health providers and users have dissimilar perceptions of health care encounters. In both arenas, poor communication was identified as a major constraint to improving sexual and reproductive health. Taken as a whole, these studies suggest that a deeper understanding of the relational dynamics and cultural contexts of sexual and reproductive health can contribute to the development of more successful health care programmes. They also suggest that much work needs to be done on developing ways to implement that understanding in policy and practice.     

Re-framing microbicide acceptability: findings from the MDP301 trial

Microbicides are most usually conceptualised within a disease prevention framework and studies usually define acceptability in terms of product characteristics, willingness to use and risk reduction. This starting point has led to assumptions about microbicides which, rather than being challenged by empirical studies, have tended to foreclose the data and subsequent conceptual models. Few studies take an emic (‘insider’) perspective or attempt to understand how microbicides fit into the broader context of women's and men's everyday lives. As part of the integrated social science component of the MDP301 Phase III microbicide trial, in-depth interviews were conducted with female trial participants in South Africa, Zambia, Tanzania and Uganda. Women's experiences of the gel challenge several assumptions that have commonly been reiterated about microbicides. Our analysis suggests that current definitions and conceptual frameworks do not adequately account for the range of meanings that women attribute to gel. Even within the context of a clinical trial, it is possible to obtain a richer, ethnographic and cross-cultural concept of acceptability based on women's practice and emic interpretations. We now need to move beyond limited notions of acceptability and consider how microbicides fit into a more holistic picture of women's and men's sexuality and sexual health.     

A Womb of His Own

Although some feminists formerly saw utopian possibilities in reproductive technology, many now fear that the new technologies are turning women's bodies into test tubes. They feel that these technologies are designed less to help infertile women than to appease men's envy of women's reproductive power. The consequences of the new technologies for the psychology of women and children and the future creation of culture are open questions. Should the technologies succeed in taking reproduction out of the body altogether, it remains to be seen whether women will gain in freedom, or whether this will simply fulfill the age-old misogynistic fantasy of depriving women of their central place in procreation.     

Gender norms in South Africa: implications for HIV and pregnancy prevention among African and Indian women students at a South African tertiary institution

In post‐Apartheid South Africa, women are constitutionally guaranteed protections and freedoms that were previously unknown to them. These freedoms may have positive implications for women's ability to negotiate sexual protection with partners and hence prevent unintended pregnancy and decrease their risk of HIV. Among tertiary institution students, who are a relatively ‘privileged’ group, there is little information on gender norms that might shape responses to HIV‐prevention programmes. To elicit gender norms regarding women's and men's roles, condom and contraceptive use, sexual communication and sexual pleasure, we conducted 10 semi‐structured focus group discussions with African and Indian female tertiary institution students in order to understand how norms might be used to buttress HIV‐ and pregnancy‐prevention. Participants reported dramatic changes in the structure of gender norms and relations with the formal recognition of women's rights in the post‐Apartheid context. These generational shifts in norms are supported by other research in South Africa. At the same time, women recognized the co‐existence of traditional constructions of gender that operate to constrain women's freedom. The perceived changes that have taken place provide an entry point for intervention, particularly for reinforcing emerging gender norms that promote women's protection against unintended pregnancy and HIV/STIs.     

Abortion and Contraception: Attitudes of South African University Students

Despite the availability of contraception, the rates of abortion among young women in South Africa continue to increase. We designed a study to examine young people's attitudes about abortion and contraception. One hundred and eighty-eight South African university students (97 females and 91 males) completed the survey. While we found moral objections to abortion for the sample as a whole, females showed stronger support for availability of abortion and women's autonomy compared with males. The respondents acknowledged the importance of contraception at a personal and general level, but more than 40% of them believed that women who use contraception are promiscuous. Females expressed difficulty with usage more frequently than males and indicated that they would not consider sexual intercourse if contraception were not available. For health care workers involved in counseling young people about their sexual and reproductive choices, the challenge lies in promoting a culture of equal rights and respect for women's reproductive freedom.     

Negotiating Respectability: Migrant Women Workers’ Perceptions of Relationships and Sexuality in Free Trade Zones in Sri Lanka

Migration has implications for women's sexual and reproductive health and rights. Our purpose with this study was to explore unmarried migrant women's perceptions of relationships and sexuality in the context of Sri Lankan Free Trade Zones. Sixteen semi-structured qualitative interviews were analyzed using thematic analysis. We found that the women's perceptions were influenced by gendered hegemonic notions of respectability and virginity. Complex gender relations both worked in favor of and against women's sexual and reproductive health and rights. Programs for improvement of migrant women's health should be informed by contextualized analysis of gender relations with its various dimensions and levels.     

Social and cultural contexts of concurrency in a township in Cape Town,South Africa

Following the 1994 International Conference on Population and Development, the world has seen a shift in paradigm away from focused family planning programmes towards reproductive and sexual health more generally. This paper considers how the traditional emphasis on women's health and family planning can result in men's sexual health needs being overlooked. A biomedical rationale to target men with health services evolved from the rising interest in control programmes for HIV and sexually transmitted infections (STIs). To plan appropriate health interventions more needs to be known about how men perceive their sexual health. Unique data from Orissa (India) and rural Bangladesh illustrate men's perceptions of their sexual health problems and demonstrate that men are willing to seek care. While public sector programmers and health planners may be focusing their attention on the control of STIs, men in both studies indicated that their major concerns relate more to matters of psychosexual disorders. The failure of public sector programmes to take cognisance of male sexual health problems may lead to men continuing to seek care for all their sexual health problems (including STIs) in the unregulated and possibly ineffective private sector. If programmes addressing the sexual health needs of men are to be effective, they will need to be comprehensive in their scope and coverage, just as they are now aiming to be for women.     

Men's contribution to the food and nutritional situation in the Tanzanian household

More is presently known about women's than men's role in food production and nutrition in Africa. The present article is an attempt to remedy this shortcoming. A special focus is put on the influence men exert through their labour and decision‐making on the household food situation. Findings from a study in a subsistence agricultural community in Tanzania give a differentiated picture compared to current literature. Most men put a substantial amount of labour into food production, but not as much as their wives, while a minority did almost nothing. When men worked hard in the fields, their wives worked hard too. Both men's and women's labour input in the field was important for household food availability. However, no direct relationship was found between men's work and child nutrition. In decision‐making women had a subordinate position and men were apt to favour cash above food. However, women usually had their way with men to insure that family food needs were met. The potential for improving women's situation by increasing men's contribution is discussed.     

Pakistan's health policy: Appropriateness and relevance to women's health needs

The interface between national health policy and women's health needs is complex in developing countries like Pakistan. This paper aims to assess if Pakistan's national health policy 2001 is relevant and appropriate to women's health needs.Through review of existing data on women, a profile of women's health needs was developed which was transformed into framework of analysis. This framework indicates that Pakistani women's health needs are determined by gender disparities in health and health-related sectors.Comparison of national health policy with women's health needs framework reveals that although policy focuses on women's health through prioritization of gender equity, it is however addressed as an isolated theme without acknowledging the vital role gender inequalities in health and health-related sectors play in defining women's health needs. Moreover, gender equity is translated as provision of reproductive health services to married mothers, ignoring various critical overarching issues of women's life such as sexual abuse, violence, induced abortion, etc. Health systems strengthening strategies are though suggested but these fails to recognize main obstacles of utilization of healthcare services by women including non-availability of female healthcare providers and gender-based obstacles to healthcare utilization such as illiteracy, lack of empowerment to make decisions related to health, etc.In order to be relevant and appropriate to women's health needs the policy should: (1) use gender equity in health and health-related sectors as an approach to develop a healthy policy (2) expand the focus from reproductive health to life cycle approach to address all issues around women's life (3) strengthen health systems through creation of gender equity among all cadres of health providers (4) tailoring health interventions to counter gender-based obstacles to utilization of healthcare services and (5) dissemination interventions for behavior change.     

The impact of gender and hierarchy on women's reproductive health in a Kam1 village,Guizhou Province,China

This paper explores the power hierarchies that shape the reproductive health of Kam village women with the purpose of identifying key potential causes of reproductive morbidity. The analysis is based on one year's fieldwork undertaken in a minority ethnic village in Guizhou in southwest China. Data from women's narratives reveal the ways in which power hierarchies, including the sex/gender system, shape daily life, dominance and resistance as well as actual health outcomes. Findings demonstrate how the sex/gender system intersects with other aspects of the village hierarchy, and how both affect villagers' reproductive decisions and reproductive health. Suggestions are offered on how to improve women's sexual and reproductive health in Kam areas.