Studies from developing countries of gender differences in nutrition in adulthood argue that household power relations are closely linked to nutritional outcomes. In Zimbabwe, for example, when husbands had complete control over all decisions, women had significantly lower nutritional status than men (24). Similarly, female household heads had significantly better nutritional status, suggesting that decision-making power is strongly associated with access to and control over food resources. Access of women to cash-income was a positive determinant of their nutritional status. In rural Haiti, the differences in nutritional status for male and female caregivers were examined for children whose mothers were absent from home during the day. Those who were looked after by males, such as fathers, uncles, or older brothers, had poorer nutritional status than children who were cared for by females, such as grandmothers or sisters (25). Ethnographic research conducted by the authors revealed, however, that, while mothers told the interviewers that the father stayed home with the children, it is probable that the father was, in fact, absent most of the day working and that the children were cared for by the oldest child, sometimes as young as five years of age.
Gender and Power in Rural North China
In most cultures, productive and reproductive activities are valued differently. Generally, earning an income brings greater autonomy, decision-making power, and respect in society. Given the greater involvement of men in the paid labour force and their higher earnings even when domestic and other activities of women are costed, they generally enjoy more autonomy and higher social status. The gender differences in economic status and purchasing power affect the health-seeking behaviour and health outcomes of men and women. Recent schools of thought have recognized that many types of non-market or reproductive labour are also productive. For example, gender-aware economics includes unpaid caring work in the home in the concept of productive labour and informal paid work, such as home-based income-generating activities and work in non-profit or non-governmental organizations.
Results of research in industrialized countries consistently indicate that women have higher rates of anxiety and depression than men, independently of race, time, age, and rural-urban residence. The fact that men have greater control over resources, and decision-making power is one explanation, but there is considerable evidence that even when women have control over resources and income through employment anxiety and depression is not necessarily reduced (45). A national cross-sectional survey of British adults found that people in the most disadvantaged socioeconomic positions reported higher rates of affective disorders and minor physical illnesses than those in higher positions. The gender differences were found in the other socioeconomic classes. Among healthy older women, for example, those in the skilled occupational class reported the highest rates of affective disorders, whereas among men, the highest rates were found in the clerical class. Generally, in positions occupied by both the sexes, and among men and women with similar income levels, women reported higher rates of both affective disorders and minor physical morbidity (46). The authors concluded that the experience of a particular social or occupational position might be different for men and women, explaining why women consistently experience more affective disorders and minor physical morbidity.
One typical imagination of gender roles in coping with electricity use is reflected in the enlightenment booklets in the early phase of electrification: a woman conventionally uses water to clean wires and light bulb. The way of coping with electricity means a serious risk of life. Source: Nongcun yongdian changshi wenda (Questions and answers concerning electricity use in rural), edited by the Electricity Bureau of Harbin. Harbin: Heilongjiang renmin chubanshe, 1964. Figure 37
One typical imagination of gender roles in coping with electricity use is reflected in the enlightenment booklets in the early phase of electrification: a man repairs lighting appliance with scissors. The way of coping with electricity means a serious risk of life. Source: Nongcun yongdian changshi wenda (Questions and answers concerning electricity use in rural), edited by the Electricity Bureau of Harbin. Harbin: Heilongjiang renmin chubanshe, 1964. Figure 41
But it was not only food production and available opportunities for work that could not keep up with the population surge. The machinery of government had been reasonably well-suited for a smaller population, yet a proportionate increase in administrative personnel was not made to keep pace with the population. By the 19th century, it is estimated that a direct magistrate, the lowest level official responsible for all local administration, might be responsible for as many as 250,000 people. Small wonder that when real crises came, officials in government were powerless to avoid them, and people had nothing to fall back on except for some meager donations and national and international relief efforts, which reached few people. To get an idea of the extent of the suffering in the late nineteenth century look closely at the woodblock prints from the China Famine Relief Fund distributed in Europe. As you view them, keep in mind that they were produced during one of the most disastrous famines in recent Chinese history, which took place between 1876-1879. It affected all five provinces of north China and claimed at least 9.5 million lives. The immediate cause was a three year drought which withered crops from 1873-6.
Female figurines representing either goddesses or fertility symbols have been found at several sites of the Hongshan culture in Liaoning province, as well as the Xinglongwa culture in eastern Inner Mongolia. These figures are posed with their hands resting on their large bellies and, as the Niuheliang figure was found inside a temple, this supports the idea that they were worshipped.[15] The division between female and male was also likely less rigid in the Neolithic than in later periods, as demonstrated by a vessel from the Majiayao culture site of Liupingtai (Chinese: 六平台) in Qinghai. The figure on the pot has both male and female genitalia, leading archaeologists to argue that the genders combined were considered to be powerful, perhaps as a precursor to later yin and yang philosophy.[16]
Women's status varied between regions during the Shang dynasty. While Shang dynasty women are thought to have been considered lower in status to men,[22] archaeological excavations of burials have shown that women not only could reach high status but that they also exercised political power. The tomb of Fu Hao, consort of King Wu Ding, contained precious jade objects and ritual bronze vessels, demonstrating her wealth. In addition, texts from the Shang dynasty have been excavated that record Fu Hao leading troops into battle to the north of Shang territories, conquering states, leading services to worship ancestors, and assisting in political affairs at court.[23] After her death, Fu Hao was honored by later rulers as Ancestor Xin and given sacrifices to ensure she remained benevolent.[24]
Gender is often neglected in health systems, yet health systems are not gender neutral. Within health systems research, gender analysis seeks to understand how gender power relations create inequities in access to resources, the distribution of labour and roles, social norms and values, and decision-making. This paper synthesises findings from nine studies focusing on four health systems domains, namely human resources, service delivery, governance and financing. It provides examples of how a gendered and/or intersectional gender approach can be applied by researchers in a range of low- and middle-income settings (Cambodia, Zimbabwe, Uganda, India, China, Nigeria and Tanzania) to issues across the health system and demonstrates that these types of analysis can uncover new and novel ways of viewing seemingly intractable problems.
Gender is often neglected in health systems, yet health systems are not gender neutral. Gender is a key social stratifier, affecting health system needs, experiences and outcomes at all levels [1,2,3]. Within health systems research, gender analysis seeks to understand how gender power relations create inequities in access to resources, the distribution of labour and roles, social norms and values, and decision-making [1, 3,4,5]. An intersectional gender analysis [6], which aims to promote researcher and activist engagement to bring about positive transformation in the structures and institutions of power, explores how gender intersects with other determinants of social stratification, such as race, class, age, (dis)ability, education, etc., to create different experiences of privilege and/or marginalisation within the health system [7]. Intersectionality offers an analysis that augments our understanding of gender, and how gender and other social stratifiers are mutually constituted and intersect in dynamic and interactive ways [8, 9].
Within the health system, gender power relations affect, for example, the health workforce (whether informal care provided at home is recognised and supported; whether recruitment, retention, promotion and harassment policies take gender bias into consideration), health financing (the extent of financial protection availability to different groups, out-of-pocket expenditures) and governance (the systems of daily management, leadership, accountability and the extent to which policies incorporate gender considerations) [1, 4, 11,12,13,14].
The research used a combination of mixed, quantitative, qualitative and participatory methods, demonstrating the applicability of diverse research methods for gender and intersectional analysis. Within each study, the researchers adapted and applied a variety of gender and intersectional tools to assist with data collection and analysis, including different gender frameworks. Some researchers used participatory tools, such as photovoice and life histories, to prompt deeper and more personal reflections on gender norms from respondents. Others used conventional qualitative methods (in-depth interviews, focus group discussion (FGDs)). Care was also taken to think about multiple power relations that guide interactions within the particular communities of interest throughout the research process, for example, within sampling techniques (i.e. who is included and excluded from the research process), the positionality of the researcher and how this affects the data collection process, separating different categories of people during FGDs (i.e. conducting separate FGDs with older and younger women or with health managers and community health workers), and considering where participants, such as health workers and community members, would feel most comfortable for interviews (e.g. health workers at health facility and community members at community offices like village offices), as well as bringing gender and intersectionality lenses to the analysis process (e.g. exploring how gender, age and location shape progression opportunities within the realities of post-conflict contexts). 2ff7e9595c
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