Women's socio-economic status and self assessed health: identifying some disadvantaged groups

This paper uses data from the British Health and Lifestyle Survey to explore the relationship between women's overall assessment of their health and their occupation, employment status, household composition and household income. Logistic regression was used to predict the odds of assessing health as either ‘good’ or ‘less-than-good’. These findings suggest that after controlling for age and the presence of a long-standing illness or disability, women's occupational group has the strongest influence on self-assessed health. The re-classification of certain occupational groups, in particular retail occupations, from their conventional socio-economic categories is also vindicated in terms of their assessed health adding in line with the suggestion that, with respect to their income and terms of employment, retail workers are ‘misclassified’ as non-manual. This analysis shows also that women who were economically inactive were more likely to evaluate their health as ‘less-than good’ than women in paid work, after controlling for the presence of a long-standing illness or disability. This is interpreted as evidence that not all of the poor health usually attached to the role of ‘housewife’ can be explained in terms of health selection out of the labour market.     

The work-relatedness of disease: workers' own assessment

In the routine compilation of statistics on the relation between occupation and ill-health it is usually possible to demonstrate links to certain physically demanding occupations. However, studies of the causal links between work and ill-health present problems. Besides the difficulties that often occur in collecting information on present and previous occupations, exposure periods, latency, duration, etc, the analysis and interpretations themselves are complicated. The aim of this paper is to study the interviewees' own views on whether or not any ill-health they may suffer could be caused by any particular job they may hold or have held in the past. Does one get the same picture of the relationship between occupation and ill-health as when routinely compiling statistics? The study population comprised 12,664 men and 12,942 women between 25 and 75 years of age. For all respondents, detailed occupational histories were recorded The results indicated that health problems are more common among persons who have or have had physically demanding work. On the other hand, in certain heavy jobs with high numbers of persons reporting long-term illnesses it is rare for individuals to blame their health problems on working conditions. Conversely, other occupations have relatively low numbers of persons with long-term illnesses, yet high proportions of these attribute their health problems to their work.     

Just the job? Is the relationship between health and domestic and paid work gender-specific?

Gendered assumptions about working lives are inherent in explanatory models and empirical analysis of the relationship between work and health. Although some of these assumptions reflect the reality of gender divisions of labour, they are rarely empirically tested and male and female samples are too often considered separately. Here we take a broader definition of work which includes aspects of paid work and domestic work, treating both domains as being relevant in principle to both men and women. Using multivariate analysis and two measures of current health (malaise and physical symptoms), it was found that the association between domestic work (at least as measured here) and health is relatively small, and restricted to women's health. Paid work, in contrast, has much stronger associations with malaise for both men and women, and some indicators of specific aspects of work suggest that effects are not gender- specific. Taking account of both paid and domestic work together has an enhanced effect for women though not men, especially when indicators of conflict between paid work and other areas of life are taken into account. However, reports of work conflict are associated with more malaise in both men and women. Although the model is successful in explaining the variance in malaise symptoms this was not true for physical symptoms.     

Employment and ill-health among women in Israel

Recent studies carried out in the United States consistently showed employed women to enjoy better health than non-employed women. Various measures were used and a number of explanatory approaches have been advanced. The present study follows previous research and its purpose is two-fold: first, to identify several dimensions of ill-health and examine the role of employment in each; and second, to provide comparative data from Israel and thus assess the generalizability of previous findings. The analyses reported are based on a sample of 416 married women between the ages of 25 and 65 residing in urban communities south of Tel Aviv. While employment status generally had a positive effect on all measures of health, it accountes for variable portions of the differences between employed and non-employed women. Employment accounted for most of the gap in illness behavior, but only for a small portion of the difference in perceived sickness. Employment increased somewhat the likelihood of mild symptoms. These patterns are discussed in light of theoretical approaches that address the relationship between employment and health.     

Do changes in spousal employment status lead to domestic violence? Insights from a prospective study in Bangalore,India

The prevalence of physical domestic violence – violence against women perpetrated by husbands – is staggeringly high across the Indian subcontinent. Although gender-based power dynamics are thought to underlie women's vulnerability, relatively little is known about risk and protective factors. This prospective study in southern India examined the association between key economic aspects of gender-based power, namely spousal employment status, and physical domestic violence. In 2005–2006, 744 married women, aged 16–25, residing in low-income communities in Bangalore, India were enrolled in the study. Data were collected at enrollment, 12 and 24 months. Multivariable logistic regression models were used to examine the prospective association between women's employment status, their perceptions of their husband's employment stability, and domestic violence. Women who were unemployed at one visit and began employment by the next visit had an 80% higher odds of violence, as compared to women who maintained their unemployed status. Similarly, women whose husbands had stable employment at one visit and newly had difficulty with employment had 1.7 times the odds of violence, as compared to women whose husbands maintained their stable employment. To our knowledge, this study is the first from a developing country to confirm that changes in spousal employment status are associated with subsequent changes in violence risk. It points to the complex challenges of violence prevention, including the need for interventions among men and gender-transformative approaches to promote gender-equitable attitudes, practices and norms among men and women.     

Women's Status and Health of Two Ethnic Groups Inhabiting a Periurban Habitat of Kolkata City,India: A Micro-Level Study

Abstract

We studied the interrelationship of women's status in terms of socioeconomic inequality and its effect on women's health at micro level between two ethnic groups in a periurban area of Kolkata City, India. One-hundred twenty-seven women who belong to a tribal population (Munda) and 174 women who belonged to a caste population (Poundrakshatriya) participated in this study. We found significant differences between various (socioeconomic, demographic, diet intake, and body mass index [BMI]) factors among the two ethnic groups that indicated a better situation for the Pod women. The number of live births, dietary intake and BMI of the women of the two ethnic groups varied differentially among socioeconomic factors, such as women's education and working pattern and poverty level of the household, which are the most recognized measures of women's status.

Thus, the diverse socioeconomic status in various cultural groups in traditional Indian societies reflects a more complex situation of women's status and their health. Different factors were responsible for the differential health status of women, which is culture and location specific. Women who are more educated and employed are not necessarily more healthy, since poverty remains an integral factor, based on which literacy and employment status of women in India is determined. Furthermore, suppression of women is rooted in the very fabric of the Indian society, in tradition, in religious doctrine and practices, within the educational systems, and within the families. Along with education, therefore, income-generating schemes for the women of the economically deprived population should be strengthened to bring equality in overall health status of a region that consists of diverse cultural populations with vast economic disparity.     

Health professionals’ beliefs about domestic abuse and the issue of disclosure: a critical incident technique study

Domestic abuse is increasingly recognised as a serious, worldwide public health concern. There is a significant body of literature regarding domestic abuse, but little is known about health professionals’ beliefs about domestic abuse disclosure. In addition, the intersection between health professionals’ beliefs and abused women's views remains uninvestigated. We report on a two‐phase, qualitative study using Critical Incident Technique (CIT) that aimed to explore community health professionals’ beliefs about domestic abuse and the issue of disclosure. We investigated this from the perspectives of both health professionals and abused women. The study took place in Scotland during 2011. The study was informed theoretically by the Common Sense Model of Self‐Regulation of Health and Illness (CSM). This model is typically used in disease‐orientated research. In our innovative use, however, CSM was used to study the social phenomenon, domestic abuse. The study involved semi‐structured, individual CIT interviews with health professionals and focus groups with women who had experienced domestic abuse. Twenty‐nine health professionals (Midwives, Health Visitors and General Practitioners) participated in the first phase of the study. In the second phase, three focus groups were conducted with a total of 14 women. Data were analysed using a combination of an inductive classification and framework analysis. Findings highlight the points of convergence and divergence between abused women's and health professionals’ beliefs about abuse. Although there was some agreement, they do not always share the same views. For example, women want to be asked about abuse, but many health professionals do not feel confident or comfortable discussing the issue. Overall, the study shows the dynamic interaction between women's and health professionals’ beliefs about domestic abuse and readiness to discuss and respond to it. Understanding these complex dynamics assists in the employment of appropriate strategies to support women post‐disclosure.     

“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.     

Attitude toward and use of induced abortion among Taiwanese women

While the debate over abortion rages in Western societies, it is regarded as natural and treated as a way of life in other societies. The relationship between couple's education, occupation, income, wife's employment status, wife's age at first marriage, and religion and the use of abortion as a birth control method was examined among 742 married Chinese women in Taipei, Taiwan.

The findings show that members of all social groups—differentiated by the couple's education, occupation, wife's employment status, wife's age at first marriage, and religion—practice abortion. For those in Taiwan who try to regulate their family size, abortion is as popular a measure for birth control as any other, despite being technically illegal.     

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.     

Domestic labour, paid employment and women's health: analysis of life course data

The relationship between the amount of domestic labour performed by a woman during her lifetime and a variety of self-reported and objective measures of her health in early old age was examined in the female members (n = 155) of a data set containing considerable life course information, including full household, residential and occupational histories. Domestic labour, on its own, proved a weak predictor of health. The relationship strengthened when domestic labour was combined with the hazards of the formal paid employment which the woman had performed. This suggests that it is the combination of domestic labour plus paid employment which influences women's health. The robustness of this conclusion is indicated by its agreement with other studies which reached the same conclusion through an analysis of data with markedly different characteristics.     

Women with HIV and their burden of caring

It is argued that the survival time of women with AIDS is connected to these women's values and beliefs about health and AIDS, which in turn affect how they care for themselves and others. Moreover, their values and beliefs result from the interrelationship between economic conditions and cultural and social norms. Consequently, women's experience of HIV infection is affected by both their inferior role and status in society and the lack of acknowledgment of HIV and AIDS as women's health issues. This situation has the fatal consequence that women with AIDS have a shorter survival time than do men with AIDS.     

Associations between strain in domestic work and self-rated health: a study of employed women in Sweden

AIM: The aim of this study was to analyse the association between strain in domestic work and self-rated health among employed women in Sweden, using two different methods of measuring strain in domestic work. METHODS: Questionnaire data were collected on health and living conditions in paid and unpaid work for employed women (n=1,417), aged 17-64 years. "Domestic job strain' was an application of the demand-control model developed by Karasek and Theorell, and "Domestic work equity and marital satisfaction' was measured by questions on the division of and responsibility for domestic work and relationship with spouse/cohabiter. Self-rated health was measured using the SF-36 Health Survey. Associations were analysed by bivariate and multivariate linear regression analyses, and reported as standardized regression coefficients. RESULTS: Higher strain in domestic work was associated with lower self-rated health, also after controlling for potential confounders and according to both strain measures. "Domestic work equity and marital satisfaction' showed for example negative associations with mental health beta -0.211 (p<0.001), vitality beta -0.195 (p<0.001), social function -0.132 (p<0.01) and physical role beta -0.115 (p<0.01). The highest associations between "Domestic job strain' and SF-36 were found for vitality beta -0.156 (p<0.001), mental health beta -0.123 (p<0.001). CONCLUSIONS: Strain in domestic work, including perceived inequity in the relationship and lack of a satisfactory relationship with a spouse/cohabiter, was associated with lower self-rated health in this cross-sectional study. Future research needs to address the specific importance of strain in domestic work as a contributory factor to women's ill-health.     

Women's Health Bridges and Barriers: A Qualitative Study

The authors aimed to understand the social bridges and social barriers to women's health in Iran. We used a qualitative content analysis method and interviewed 22 women. The participants identified appropriate employment, physical exercise, and cultural and educational development as social bridges to women's health. Social barriers to women's health included gender inequalities, burden of responsibility, and financial difficulties. Based on the results of this study, we suggest an interdisciplinary approach to plan social-based health programs in order to improve women's health outcomes in the developing countries such as Iran.     

ILLUMINATING SOCIAL DETERMINANTS OF WOMEN'S HEALTH USING GROUNDED THEORY

Emphasis in health policy has shifted from curative intervention to prevention and health promotion through personal responsibility for lifestyle choices and, most recently, to the social determination of health. These shifts draw attention to and legitimize women's health research that moves beyond biomedical, epidemiological, and subjective knowledge to question previously unquestioned societal norms and structures that influence women's health. The challenge is to avoid relying solely on population-based studies that support relationships between social determinants and indicators of women's health and to find ways to illuminate the processes by which social determinants interact with the health of specific groups of women. Without such research, our knowledge of how social factors that underpin women's health interact will be faceless and will not address the interplay of health and social policy within women's lives. One research method that may be useful for exploring the interplay between such policies and women's health is grounded theory. Grounded theory is a widely used approach in women's health research. The goal of grounded theory is the discovery of dominant social and structural processes that account for most of the variation in behavior in a particular situation. Despite the usefulness of this method for capturing the interaction between social conditions and women's health experiences, many grounded theory researchers restrict themselves to women's subjective experiences as a source of data for theory development. Consequently, the resultant theory's capacity to illuminate the effects of the social determinants of health is limited. The purpose of this article is to discuss how the grounded theory method can be used in a participatory way to theoretically sample structural conditions at many levels. Using examples from completed and ongoing women's health research where data have and have not been collected primarily from women themselves, we outline the benefits and process for using grounded theory to influence health and public policy in women's health.     

Women's empowerment and its differential impact on health in low-income communities in Mumbai,India

This paper examines the relationship of empowerment to women's self-reported general health status and women's self-reported health during pregnancy in low-income communities in Mumbai. The data on which this paper is based were collected in three study communities located in a marginalised area of Mumbai. We draw on two data sources: in-depth qualitative interviews conducted with 66 married women and a survey sample of 260 married women. Our analysis shows that empowerment functions differently in relation to women's reproductive status. Non-pregnant women with higher levels of empowerment experience greater general health problems, while pregnant women with higher levels of empowerment are less likely to experience pregnancy-related health problems. We explain this non-intuitive finding and suggest that a globally defined empowerment measure for women may be less useful that one that is contextually and situationally defined.     

Prevalence and correlates of physical,psychological, and sexual intimate partner violence in Bolivia

Despite increasing awareness that domestic violence is a major public health problem, existing studies focus on physical and sexual violence and give little attention to psychological violence. This study uses data from the 2008 Bolivia Demographic and Health Surveys (BDHS) to examine the prevalence and correlates of physical, sexual, and psychological intimate partner violence in Bolivia. The results show that psychological intimate partner violence is extremely common (affecting nearly one in two women) and often occurs in addition to physical violence. While physical, psychological and sexual intimate partner violence have several common predictors, there are factors that only affect some types of violence. Common risk factors include urban residence, respondent's employment status and having witnessed interparental violence in childhood. Although marital status is not a risk factor for physical violence, unmarried cohabitation is a strong risk factor for psychological intimate partner violence. Our findings highlight the need for research to assess the potential consequences of psychological intimate partner violence, particularly for women's mental health.     

Gender bias in health research: implications for women's health in Kerala (India) and Sri Lanka

Indian state of Kerala, and Sri Lanka have a special place in global health discourses, although there has been a relatively little systematic analysis of women's health in these societies. Moreover, there are a number of dimensions of women's health that have been underappreciated by public health researchers and development experts due to systematic gender biases in health research. This article seeks to provide a more complete picture of women's health in Kerala and Sri Lanka by explicitly addressing three key gender biases: inattention to health issues that particularly affect women, incomplete approaches to understanding the health of women and insufficient attention paid to the interactions between gender and other social stratification, such as class, ethnicity or caste.