At Household level

At Community level

Influence of States/markets international relations

How does the ENVIRONMENT influence who becomes ill?

·              Many rural families have ill ventilated small kitchens. Women while cooking are exposed to smoke for long periods. As a result they may suffer more often from respiratory problems and eye infections.

·              Homes of poor families may be poorly ventilated and have little sun light entering. Women spending long hours in such homes may suffer from TB and general ill health, more often than men.

·              Many liquor shops have opened up in Village X. Drunk men keep harassing women passing by. This generates considerable anxiety among women working outside home.

·              In view of the large revenue received from tobacco trade, state government does not put ban on this and related industry (Gutka etc). Men often fall pray to aggressive advertising and smoke. This gives rise to men suffering more often from lung cancers. Poor women too are known to smoke / chew tobacco.

How do the ACTIVITIES of men and women influence their health?

·              Women’s hand (and feet) remain wet most of the time due to their water related chores / activities like washing, cooking, caring for children etc. So they suffer from fungal infections of skin and nails more often than men.

·              Men work outside home and hence are exposed more to mosquito bite, than women in kitchen.

·              Men work outside home and therefore are more exposed to certain kind of accidents or dangers like road traffic accidents.

·              State promotes recruitment of young men from Hills in to armed forces. This career exposes young men to alcohol, STD/HIV, injuries and premature death.

·              Harvesting herbs & other produce from the hills is ‘illegal’ and therefore men do it in a risky fashion.

·              In absence of strict regulations in rural areas, young men get driving license, without adequate skills or experience. This leads to frequent accidents.

How do the BARGAINING POSITIONS of men and women influence their health?

·              Women cant insist on having a labor saving or healthier device to use at home even when easily available - like kerosene oil stove, smokeless stove, water filter, pressure cooker etc. This would mean that they have to keep on working for long hours and or continue with unhealthy conditions or postures, leading to backache, tiredness and general ill health.

·              Women cant insist on safe sex and therefore is exposed to unwanted pregnancy and STDs.

·              Maintenance, repair, renewal of water resources in a village receives less priority than other issues of interest for men. Women in Panchayat are not able to bargain for these issues. As a result women may have to continue with unhealthy workloads, chores.

·              Commercial sex worker can not bargain effectively with client to protect their own health through use of condoms.

·              Women legislators are not able to bargain with state / their own parties to review ineffective laws dealing with women’s issues (dowry, violence, inheritance, maintenance after divorce etc)

·              ‘Women and Adolescents should not be employed in dangerous trades’ is poorly implemented in rural areas by the state. So women workers are often exploited by the employer, exposing their health and well being to risks.

How does access to and control over RESOURCES influence the health of men and women?

·              Women have less access to channels of information (radio, TV, News paper) and therefore may not be able to protect their well being through preventive steps.

·              In case of poor families with few mosquito nets, women’s access to nets may be limited and her exposure to mosquito bite may be higher.

·              Women’s access to torch, footwear and nutrition (milk, meat) could be less than that of men, giving rise to related problems or vulnerability (snake bite, accidents, worms, malnutrition)

·              Information/ Communication resources (TV, Phone) available to panchayat are often limited to use by men. This reduces women’s capacity to effectively care for their health.

·              State provides more information on family planning, safe delivery, ante natal care etc. Access to health information fulfilling needs of adolescent girls, boys, men, old women and men is limited in rural areas. These groups are less able to maintain their well being in absence of such information. Rural women may not know about self breast examination and therefore report breast cancers late.

How do GENDER NORMS influence health?

·              Wife is not supposed to ask husband to use condom or opt for sterilization.

·              Women supposed to eat last which affects her nutrition.

·              Wife supposed to fast often for the well being of husband.

·              Wife must serve husband and others even when they are suffering from Infectious disease like TB. She can pick up infection easily.

·              Women are not supposed to report violence by husband (or in laws). Much violence goes unreported therefore.

·              Son preference in community forces women to opt for many pregnancies.

·              Only son can care for parents, not daughter. Daughters are therefore less cared for.

·              Men can work bare body, women not. More chances of mosquito bite to men.

·              State follows the unstated norms and will not provide contraceptive info & services to single women. This gives rise to risky / septic abortions.

·              Media / Market promote a macho image of men to sell cigarettes, alcohol etc. Men feel they must fit in to that image and thus fall prey to these unhealthy life styles.

Household

Communities

Available health services

How do the ACTIVITIES of men and women influence responses to illness

·              Unlike men’s work, women’s chores never seem to end. Have no fixed routine. Seeking care for her health problems receives last priority.

·              Women with dermatitis are often asked by the doctor to keep away from water. This is impractical for her. So, cure takes long time.

·              Men in Army, hesitate to report certain health problems (eg. poor eye sight), for fear of losing promotion.

·              Men, being men, go for risky / dangerous occupations (like mining) even at the risk of their health.

·              Hospitals don’t open at the time of rural women’s (and men’s) convenience. Rural women are free in the evening, when hospital OPD is closed.

How do the relative BARGAINING POSITIONS of men and women influence responses to illness?

·              Husband can go for treatment of chronic ailments (TB, Leprosy) and STDs, but wife will have to get husbands consent in most cases.

·              If wife has TB, husband might leave her at her parent’s place; may even desert her and remarry. Community doesn’t object. So women don’t easily accept that they have TB. This interferes with their treatment and follow up.

·              Health department prefers male doctors for chasing national ‘targets’. Women being in the weak bargaining position are not able to demand and get lady doctors, ANMs in the required numbers. This limits their chances of early diagnosis and proper treatment.

How does access to and control over RESOURCES influence how men and women respond to ill health?

·              Women don’t have access to cash. So they go for treatment to faith healers.

·              Large spending on health from MMD savings, can not be made without consulting men / husband. This can delay appropriate health care to women in emergencies.

·              Men often fight at PHC and are therefore given better care than women get.

·              Men get emergency evacuation more easily organized in community, since they move around and have a network of favors given and received.

·              Health department offers no control to rural women where ANM, her work and posting etc are concerned. So whatever ANM does, rural women can do little about it. This often results in poor services to women needing them.

·              Indigenous healers in rural area often accept fee in kind (grain, oil etc). Other service providers would not or can not accept fee in kind. This forces women into accepting services from the former.

How do GENDER NORMS affect responses to illness

·              Women are not supposed to discuss sexual symptoms. This delays correct diagnosis of STDs, Breast / cervical cancer etc.

·              Men, playing the stereotypes, refuse to accept that they are unwell. This delays diagnosis of their problems like High blood pressure etc.

·              Sexual dysfunction (eg. Impotence) in men is a difficult topic to be shared with wife or doctor. Men suffer for long before owning these problems.

·              Unescorted women’s mobility is supposed to be restricted to home. This prevents her from seeking health care at an early stage.

·              Women health professionals are supposed to be good only as ‘gynecologist’ and never given senior administrative posts. Thus, health services never get the chance to become women friendly.

·              Consent form for operation and other medical procedures request for husband’s signature. This sometimes delays the treatment.