sociology

EDITORIAL

Gender and health � aspects of importance for understanding health and illness in the world

This paper is part of the Special Issue: Gender and Health. More papers from this issue can be found here

and here.

I n the call for this cluster of papers in Global Health

Action, we included a variety of perspectives regard-

ing gender and health to be covered, among them

sexual and reproductive health and rights, gender-based

violence, ageing and gender, health systems, climate

change, and globalisation; all with respect to gender.

From the papers that are now included, we draw the

conclusion that some of these aspects are more prevalent

than others. For instance, aspects of sexual and repro-

ductive health and rights, and gender-based violence are

represented by a number of papers, whereas climate

change, ageing, and globalisation are not at all present.

Papers oriented towards gender and health with social

theories on gender are still scarce, despite the fruitful

results, as some of the papers in this cluster show, for

instance in Gibbs et al., Marcos et al., or Torres et al.,

(1�3). We believe that this mirrors the research field of gender and health, and that new aspects are still to be

covered. In this editorial, we briefly summarise and

categorise the included papers and also hint at gaps and

lacking perspectives when it comes to gender and health.

We view gender as a central analytical category in the

studies of health. In health research at large, there is a

tendency to use the concept gender as equivalent to the

concept biological sex, and we can see a rise in this mix of

concepts in the past decade, where the term ‘sex’ is

replaced by ‘gender’ although the focus might not be on

social constructions of sex but rather on biological health

matters. There has for a long time been an urge for

integrating theoretical gender approaches into health

research (4�7). A variety of theoretical approaches are at hand when dealing with research on gender and health

and we agree with other researchers that gender is both

relational and intersectorial (7, 8). When viewing gender

as part of social, institutional, and structural dimensions

of human lives, it also becomes evident that the links and

interconnections between different power structures are

at hand. It matters whether one lives as a woman, a man,

or other sexual identities. All this influences health, not

only at the individual level but also at all levels of human

life. Gender research also problematises other expressions

of sex and gender such as transsexualism, transgender,

and queer perspectives. Therefore, we do not regard

gender as a binary category with men and women only

but also regard it as socially constructed and contextual.

Gender is something we live, perform, and construct.

However, as researchers in health and ill-health, we

cannot disregard that the body is a biological entity

(sex) as well as a socially constructed phenomenon

(gender). Fausto-Sterling has been vital for theorising

sex and gender and how to think about them as integral,

not separate entities (9).

The papers included in this cluster that deal with

sexual and reproductive health and rights come from

different settings and take both quantitative and qualita-

tive approaches. They offer examples of how gender

equality is connected with different sexual and reproduc-

tive health issues, such as condom use, adolescent

pregnancies, maternal-child health, and sexual health.

MacPherson et al. chart the scenario by presenting a

critical overview of gender equity and sexual and

reproductive health in Eastern and Southern Africa.

They conclude that sexual and reproductive health is

central to gender equity in health in the region, and that

interventions to improve it have to be enacted not only

within the health system but also outside the system (10).

In the field of maternal and child health, the paper by

Mason et al. contributes not only to the visibilisation of

the importance of maternal nutrition to improve a

newborns’ health but also that of women’s health (11).

In the field of young people’s sexual and reproductive

health, Mehra et al. explore gender differences in the

association between condom efficacy and condom use

among Uganda university students. They show that

women are at higher risk of inconsistent condom use,

and relate these findings with gender�power relations, proposing that the feminisation of the HIV epidemic in

this setting could be driven by gender inequalities (12).

Christofides et al. present a longitudinal study with

teenage girls in South Africa, exploring the relationship

between gender inequality and gender-based violence

and subsequent unplanned and unwanted pregnancies.

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Citation: Glob Health Action 2015, 8: 26908 - http://dx.doi.org/10.3402/gha.v8.26908 (page number not for citation purpose)

They found that although some of the measures of

gender inequality were not associated with unplanned

and unwanted pregnancies, the role of gender power was

evident in that teenage girls who experienced physical

violence were more likely to have an unwanted pregnancy

(13). Finally, in the field of sexual health, DeMeyer et al.

offer evidence regarding the strong link between gender

equality and sexual health. Their cross-sectional study

with young people in Bolivia and Ecuador reveals that

more egalitarian gender attitudes are related to higher

current use of contraceptives within the couple, more

positive experiences and ideas about sexual intercourse,

and better communication about sexuality with the

partner among sexually active and sexually non-active

adolescents (14).

Violence against women or intimate partner violence

(IPV) is addressed in three articles. Women’s lived experi-

ences of coping with domestic violence in rural Indonesia

is described by Hayati et al. as an ‘elastic band strategy’,

meaning a long-term process of moving between positions

of opposing the violence and accepting it. The interviewed

women faced lack of institutional support (15). Edin and

Nilsson highlight the specific circumstances of living in

violent relations and becoming pregnant. The study is

based in Sweden and they conclude that Swedish health

care institutions and maternal care need to become more

aware of the way pregnant women exposed to IPV express

their situation, which often is indirect and difficult to

understand (16). In a cross-sectional survey, Burgos-Soto

et al. investigated lifetime prevalence of physical and sexual

violence among HIV-infected women in Togo compared to

non-infected women. The prevalence was significantly

higher among infected women (17).

Five articles deal with questions about men, mas-

culinities, and health. They concern traditional masculi-

nities of dominance and power as well as emerging, new

forms of masculinities, of which the former are regarded to

be detrimental to both men’s and women’s health. In the

Nicaraguan context, Torres et al., have investigated young

men’s struggle for more gender-equitable masculinities and

they conclude that the emerging forms of masculinities

found within the study can help improve gender relations

and that they might be labelled ‘health-promoting mascu-

linities’ (3). From the Ecuadorian context, Goicolea et al.

investigate how young men understand IPV. The main

finding is that the young men take a stance in which they

condemn violence whereas at the same time they do not

really reject sexism (18). In a study from southern Spain,

Marcos Marcos et al. provide insights into constructions

of masculinities that are dependent on collective practices

and performative acts which have a bearing on health

behaviour and gender equality (2). In a study on black

South African men’s constructions of respect and mascu-

line identities in regard to violence and HIV, Gibbs et al.

suggest ways of working with men in order to reduce risky

behaviours and prevent violence (1). In a study from

Thailand on men’s experiences of alcohol addiction and

treatment, Hanpatchaiyakul et al. found three clusters of

experiences as ways of describing the development of

addiction. They emphasise the importance of addressing

concepts of masculinity and hegemony in relation to

treatment of alcohol addiction among Thai men (19).

Two papers focus on epidemiological perspectives on

gender and health. Malmusi et al. use data from the

population living conditions survey in Catalonia, Spain,

to explore if unequal gender distribution of resources can

explain women’s poorer self-rated health across social

classes. After adjustment for individual income, they

found that the association between sex and self-rated

health was eliminated, and especially so for the manual

classes. Thus, individual income accounted for the

observed health inequalities by gender and social class.

Malmusi et al. stress the need for policies to close the

gender pay gap and to facilitate women’s labour partici-

pation in order to reduce gender inequalities in health

(20). Bonita and Beaglehole discuss gender bias in the

global discourse on health, which focuses on women’s

reproductive capacity and neglects the influence of non-

communicable diseases (NCDs) on women’s health. This

neglect may result in women receiving fewer examina-

tions and diagnosis tests, despite the fact that the absolute

numbers of NCD deaths in women are similar to that of

men. Bonita and Beaglehole propose that women and

NCDs should be prioritised on the post-2015 sustainable

human development agenda (21).

One article addresses issues of access to health services

from a gender perspective. Otero-Garcı́a et al. explore

rural midwifes’ perceptions on immigrant women’s access

to sexual and reproductive health services. According to

Otero-Garcia et al., midwifes relate underutilisation of

such services by immigrant women to gender inequalities

and access barriers (22).

Health policy is discussed in two of the papers. In their

commentary, Himabindu et al. discuss how the worldwide

attention to the ‘rape crisis’ in India generated widespread

political support for strengthening legal responses towards

violent crimes against women. Despite this, gender-based

violence remains a vast problem in India, due to the deep-

rooted patriarchy of Indian society making laws and

regulations not enough as a solution. According to

Himabindu et al., the portrayal of women in the Indian

cinema plays a significant role in reconstructing prejudicial

attitudes towards women. They call upon health workers

and researchers to take the lead in shaping a social

response towards gender violence by applying a gender

lens to their work and striving for the empowerment of

women (23). Gavriilidis et al. report from an evaluation of

a gender equity integration development plan (GEIPD) in

the city of Malmö, Sweden, aiming to increase gender

equity in all aspects of city life. They applied a policy

Ann Öhman et al.

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Citation: Glob Health Action 2015, 8: 26908 - http://dx.doi.org/10.3402/gha.v8.26908

empowerment index to understand how policy planning

can affect constituent empowerment. Gavriilidis et al.

found that 50�90% of Malmö residents were concerned with gender inequality at home or at work, despite living

in one of the most gender equal countries in the world.

Their evaluation showed that the GEIPD has a strong

potential to empower its constituency, with its strong

emphasis on protection against gender discrimination in

employment, education, and distribution of resources and

agency (24).

To conclude, we argue that there are some important

gaps that need to be addressed in future research dealing

with gender and health. Work-related health is considered

to become one of the leading causes of ill-health in the

world (25). For instance, work is heavily gendered in a

number of ways. There is substantial gender segregation

and discrimination of women in terms of income, career

opportunities, and access to leading positions. In unpaid

work, women usually take a greater responsibility for

reproductive work in child care, care for the elderly, and

household duties. Women report more stress at work and

work-related burnout is common. This calls for health

researchers to address issues of work-related ill-health,

including unpaid work, so that the total work load is

scrutinised. Health problems related to climate change

have up until now not focused much on gender, and the risk

of overlooking gendered outcomes of global warming, car

driving, transportation, and so on, is obvious here (26). We

also welcome a development of postcolonial perspectives

into gender and health research. Postcolonial theory has as

yet mainly been developed in social science and cultural

studies. The need for a theoretical integration of such pers-

pectives is great, and would highlight inequalities, dispa-

rities, and tensions between the Global South and North in

terms of public health policy and international declara-

tions (27). Gendered effects of international migration as

well as the vast demands on societies and individuals in

terms of ageing populations around the world are other

issues of importance for future global health research on

gender and health.

Ann Öhman

Division of Epidemiology and Global Health

Department of Public Health and Clinical Medicine

Umeå Centre for Global Health Research

Umeå University, Umeå, Sweden

Umeå Centre for Gender Studies

Umeå University, Umeå, Sweden

[email protected]

Malin Eriksson

Division of Epidemiology and Global Health

Department of Public Health and Clinical Medicine

Umeå Centre for Global Health Research

Umeå University, Umeå, Sweden

Isabel Goicolea

Division of Epidemiology and Global Health

Department of Public Health and Clinical Medicine

Umeå Centre for Global Health Research

Umeå University, Umeå, Sweden

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Citation: Glob Health Action 2015, 8: 26908 - http://dx.doi.org/10.3402/gha.v8.26908

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