WOMEN'S HEALTH
How can your gender affect your health?
The most obvious effects of course are in terms of life expectancy. Girl babies are more robust at birth and more boy babies die in the neonatal period (0-28 days old). Data from Palestine, amongst other countries (seepcbs.gov.ps ) has demonstrated the effects on mortality rates of the differential health-care provided to boys and girls. Immediately after birth more boy children died…a global phenomenon… but after several months of nurture the rate of girl child mortality became higher. A dramatic illustration of one society’s preference for sons.
Globally however, women live longer than men but tend to experience more chronic and debilitating diseases. Men who survive the first twenty-eight days tend to live shorter but healthier lives!
Whilst some of these differences relate to biological makeup there are many cultural or societal factors
which affect women’s & men’s health differently. This is a field where the impacts of sex and gender are often most difficult to disentangle. Gender (as well as sex) can affect the kind of illnesses one is prone to as well as the services one can access.
In societies organised on typical patrilineal principles, where high value is placed on a women's ability to bear children and particularly sons - i.e. for her correct performance of her reproductive role - marriages are often arranged to consolidate family and kin groups. Typically girls are married at a young age to avoid their being a cause of family dishonour by an unauthorized dalliance. This can lead inevitably to early child-bearing, and a long a period of frequent child- bearing detrimental to women's health.
The primacy placed on women's reproductive role, to ensure family solidarity and continuity, is also reflected in such practices as polygamy, sati, and widows being inherited by a brother of the deceased (Read more on our page on Gender and Violence). Marriage between closely related individuals is also common where marriages are about clan and property rather than about love and companionship (although of course these are not excluded!). Generations of close kin marriages lead to health problems for everyone in such a system.
In societies with a strong preference for sons, women may not only continue child-bearing in the hope of having a son, and may get divorced for not producing one, though as we saw on other pages (Sex & Gender) it is the Y chromosome carried by men which determines the sex of the child so a man who insists on discarding wives who do not bear him sons is actually on the wrong track.
Women are unlikely in traditional patrilineal/patriarchal systems to have much if any power of negotiating sexual or reproductive behaviour which can make them particularly vulnerable to sexually transmitted diseases, HIV/AIDS and domestic violence.
In some societies (Egypt, Ethiopia, Sudan, parts of West Africa) women's sexual and reproductive behaviour is subject to the extreme form of control known as FGM - Female Genital Mutilation - which in addition to the immediate pain and danger of the procedure, results in life-long health risks. It is currently estimated that some 135 million women and girls in the world have experienced FGM (amnesty.org) (See entry on FGM on this site under Gender & Violence).
HIV/AIDS which has now become a major health problem all over the world was initially considered a disease of male homosexuals and injecting drug users, heterosexual transmission now accounts for 70% of infections (unaids.org)
Women are biologically more susceptible and some evidence suggests that the rate of male to female transmission is five times higher than from female to male.
The so-called Triple Jeopardy of women in relation to the AIDS pandemic, refers to their greater biological vulnerability to the virus, (in addition to being socially and economically powerless and therefore unable to negotiate safe sex); their having primary responsibility for taking care of the sick at home; and the fact that they may also transmit the AIDS virus to their children.
Where jobs and occupations are segregated along gender lines then women and men may be exposed to very different occupational health hazards. For example women are more often exposed to water-borne diseases from collecting water. Men as drivers and truckers are more likely to be involved in road accidents or to suffer injuries from construction-related accidents. (see www.who.int).
It can be argued also that where women work longer hours, combining reproductive and productive roles, and where women are the bottom of the occupational pecking order, then not only are they much more vulnerable to stress and exhaustion but they are likely to be far from negotiating special conditions of work such as maternity leave, child-care in the work place, family allowances etc.
How does gender affect access to health care?
A primary obstacle in some developing countries to equal access is women's lack of decision-making power over not only her own body but the use of the family budget for health and other expenses.
A second major obstacle in developing countries lies in the fact that there may be fewer educated women and therefore fewer female doctors for women to visit.
Gender disparities also pervade the structures for provision of services, if we look at gendered division of labour in the health care systems, with the hierarchy of predominantly male doctors and predominantly female nurses the gendered occupational segregation is clear - with the mother at home as carer at the bottom of the pyramid. Timing, location and physical facilities of health services are often less than woman-friendly.
This de-personalization of the patient has been subject of a number of interesting studies of the type of communication which takes place between doctors and patients which analyze the ways in which the former controls the language, the information, the spatial and time encounter with patients, and how doctors' evaluation of a patient's social, economic, ethnic, and of course gender, identity affects their medical judgements and the cures that they prescribe.
Most studies show (perhaps not surprisingly) that the more socially superior the doctor felt he was to the patient, the less he felt the need to inform the patient about the diagnosis or the treatment, but expected simple compliance. In societies with stark gender disparities - which imply of course that women are less educated and that most doctors are therefore men - we may imagine the tender loving care given to female patients.
The point is also often made that the new reproductive technology ( where available) is a double-edged sword as it has increased the (presumably) male-dominated medical profession's hold over women and hence facilitated such practices as female infanticide in countries where male children are much preferred, and/or in countries where a one-child family is the (legal) norm. It is imperative in such societies to make sure that that ONE is the RIGHT ONE.
And a small quiz to close this page!
As noted earlier the effects of Sex & Gender tend to be particularly intertwined when it comes to health status & health care. Can you distinguish the effects of sex and gender in the following statements….which may be either True or False of course!
The majority of hospital managers in most countries are men and most of the ward managers are women.
Doctors are men; nurses are women.
Boys and men suffer from haemophilia, whereas girls and women are usually only carriers.
Women suffer from the menopause, men do not.
More health research funds go to research on illness and disease associated with men than those associated with women.
More women are raped as compared to men.
Women are more susceptible to sexually transmitted diseases than are men.
The rate of behaviour disorder and hyperactivity for boys is 2-3 times the rates of girls.
Women undergo tubal ligation, men do not.
In societies where boy children are preferred, men may divorce and remarry in order to have a son.
Son preference is a factor in large families.
References for further reading!
The Birth of the Clinic: an Archaeology of Medical Perception
Michel Foucault, Vintage Books 1973.
The Wisdom of Whores: bureaucrats, brothels & the business of AIDS
Elizabeth Pisani Granta Books, London, 2008
www.wisdomofwhores.com
(*) The photo depicts three "Machis" on the outskirts of the city of Temuco, Chile, participating in a "nguillatun" a religious ceremony of the Mapuche. The Mapuche are a strongly matriarchal ethnic group native to southern Chile. Machi is the name used to designate the person who has the role of religious authority, advisor and protector of the Mapuche people. This role is mainly occupied by women. The role of the machi is to direct the healing ceremonies of h er/his people (Machitún), spiritual ceremonies (Nguillatun) . The Machi also participates as a counsel of peace or war.