|
 
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| EDITORIAL |
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| Year : 2023 | Volume
: 11
| Issue : 1 | Page : 5-8 |
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Improving the health of women through building resilience: A way forward
Ranjan Solanki, Arvindsingh Kushwaha, PR Deshmukh
Department of Community Medicine, AIIMS, Nagpur, Maharashtra, India
| Date of Submission | 03-Sep-2022 |
| Date of Decision | 09-Nov-2022 |
| Date of Acceptance | 11-Nov-2022 |
| Date of Web Publication | 02-Feb-2023 |
Correspondence Address:
Ranjan Solanki
Department of Community Medicine, AIIMS, Nagpur, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/mjhs.mjhs_96_22
How to cite this article:
Solanki R, Kushwaha A, Deshmukh P R. Improving the health of women through building resilience: A way forward. MRIMS J Health Sci 2023;11:5-8 |
| Introduction | |  |
Human Society is divided along many lines, including caste, religion, country, and gender. Gender has been known as an important determinant of health. There are many studies that have proven how gender dynamics and discrimination cause poor mental and physical outcomes for women all over the world. Despite the improved educational and financial status of women in India in the last three decades, India remains one of the most gender-unequal countries in the world.[1] With India ranks 140th rank among 156 nations as per the World Economic Forum's Global Gender Gap Report 2021. India remains the third worst performer in south Asia as per World Economic Forum's Global Gender Gap Report 2021. Women are more likely to be socially and economically vulnerable than men.[2],[3] Women are more vulnerable to mental illnesses due to the lower status accorded to them in the social hierarchy.[4]
As per a meta-analysis done on gender differences in depression in the USA using nationally representative samples, women were found to be twice as depressed as men. Merikangas et al., in 2010, reported the lifetime prevalence of depression for girls and women to be 15.9% and 7.7% for boys and men.[5] Women also seem to have poorer self-esteem and less sense of entitlement to high pay than men. The common mental disorders are the leading cause of health-related burdens across the world.[6] The situation gets further aggravated by socioeconomic adversity, physical and sexual abuse, poverty, lower education status, and gender disparity.[5],[7] Across the world, about 30% of women over age 15 come across intimate partner violence.[8]
WHO commission on social determinants of health considers gender equity as an important aspect in determining health. Gender being a complex cultural and social phenomenon, is difficult to intervene. Empowering females in the domain of education and finance have caused a major shift in gender dynamics. However, at times these intervention does not seem to be enough, as gender-based violence has not reduced in proportion of the rise in the educational and financial status of women. This gap indicates the need for some specific intervention in the domain.
Resilience is defined as the capacity for successful adaptation to situations despite challenging or threatening circumstances.[9] The skills such as empathy, self-efficacy, negotiation, and communication can help women sail through negative life experience with dignity and positivity. These psychosocial skills could be imparted to women with proper training and sensitization.[10] The Nascent evidence indicates that biopsychosocial factors are closely related to health. There are few evaluations of the effectiveness of interventions of building resilience programs on women's health. It has been consistently indicated that improved resilience has an impact on positive mental, physical, educational, and livelihood outcomes. However, very few programs in India and other developing countries have viewed resilience as a key determinant of improving the mental and physical well-being of women.
| Review of Literature | | |
Gender and mental health
Women are more predisposed to develop symptoms of common mental disorders than men. This has consistently been indicated in many studies across the world. Women present with higher levels of anxiety and depression than men at all stages of life. In developed countries, women are more likely to receive treatment for these conditions. However, men are more likely to suffer from schizophrenia and other serious psychoses. They are even more likely to commit suicide. Women are more likely to attempt suicide.[11]
The higher prevalence of anxiety and depression among women worldwide is attributed to different socialization and power imbalance between the two genders. It is also attributed to lower self-esteem and self-worth experienced by women.[11]
| Self-Esteem and Health-Seeking of Females | | |
Women across the world have accepted suffering to be an inevitable part of life. The health issues such as backache, body ache, or vaginal discharge are so prevalent that they are accepted as normal, and solutions are not sought for the same.[12] Women have a lower sense of entitlement when it comes to making a demand. This puts them in a vulnerable position when it comes to thwart the physical and sexual violent advances from intimate partners or seeking health care from the system. Their lower social, economic, and cultural status also creates the hurdle to health seeking. Lack of education not only leads to low self-worth but also limits their understanding of their own bodies and assessing their own health needs.[13]
| Occupational Hazards of Domestic Workers | | |
The unpaid work contributed by women as homemakers may lead to poor mental health outcomes of women. A substantial number of evidence from developed countries indicates that depression is an occupational hazard of women who serve as primary caretakers of young children.[14] The domestic work done by women takes toll of their mental health. In many community surveys, it has been found that these full-time “housewives” go through feelings of emptiness, sorrow, and worthlessness. In many cultures across the world, it has become increasingly evident that the domestic lives of women are the breeding ground of considerable anxiety and depression.[11] The unpaid and thankless nature of the domestic job, low status accorded to domestic work could be cited as the cause behind this phenomenon. The social isolation and lack of engagement in any recreational and financially fruitful activity could further aggravate the situation.[11],[12]
| Gender and Violence | | |
The perpetrators of violence are usually males. The acts of violence in the domestic sphere are usually a reflection of the power imbalance between the two genders.[15] Although both sexes could be on the receiving end of the violence, the experience and the harm inflicted could be distinctly different for both sexes. The violence against women could be a way to express the power and control of men over them. The perpetrators are motivated by the desire to demonstrate their own masculinity. Many academicians choose to use the term as gender-based violence.
| Health Consequences of Gender-Based Violence | | |
Their could be physical health outcomes such as sexually transmitted diseases (STDs), common mental disorders, posttraumatic stress disorder, obsessive-compulsive disorder, psychosomatic illnesses such as chronic fatigue syndrome, headache, insomnia, dyspareunia, eating disorder, and irritable bowel syndrome. The gender-based violence may also lead to fatal outcomes such as homicide, suicide, or HIV.[15]
The home is considered a safe space for women. However, the alarming fact is most of the violent attacks on women take place in the “haven” of the family. Physical battering may include pushing, clubbing, stabbing, or shooting. The injuries inflicted may be severe and, for some women, will be fatal. Thirty percent of suicides and 60% of homicides of women are associated with domestic violence. If the attack also includes rape, then it may lead to unwanted pregnancy, gynecological problems, or STDs.[10]
| Gender and Sexually Transmitted Diseases | | |
Many women find it difficult to negotiate for safety in a heterosexual relationship. The sexual experience, even today, is viewed from the male perspective. The experience of sex is defined in terms of male desire and control. Women are viewed as mere objects of gratification for male desire.[16] This further makes women difficult to articulate their own needs of safety and pleasure.[17] This makes very young women vulnerable as they are exploited by older men because of their presumed passivity and freedom from infection.[18]
The gender inequalities in income and wealth are further reinforced by the cultural norms of the society. Men being the sole provider of the families and needs of women, they succumb to sexual demands from men.[18] This power imbalance between the two genders in society makes sexual intercourse a very gendered act. It can be pulled to an extent where women are pushed toward selling sex for subsistence.[19] The women face a fear of abandonment in societies where they women are not encouraged to play any other roles other than marriage and motherhood, they face a fear of abandonment. In many societies, divorced, separated women and their children are deprived from social and legal entitlements. In some countries, women are legally bound to have sex with their husbands, and they do not have the right to refuse it.
As well as economic and social insecurity, many women also have to face the threat of physical violence if they are not sufficiently responsive to a partner's desires. Under these circumstances, many will prefer to risk unsafe sex in the face of more immediate threats to their well-being. It is the outcome of complex interpersonal negotiations, in which the social constraints of gender inequality play a key role. It is often the poorest women who have the fewest choices, run the most frequent risks and are most likely to become infected.[20]
If a woman does become infected with HIV or other STD, gender inequalities may further influence the progression of the disease and her survival chances. However, funds are still spent disproportionately on men.[20] Even in the resourceful country like the United States, the allocation of funds is influenced by gender bias.[21] Moreover, women have often been excluded from clinical trials conducted for the diagnosis and treatment of HIV.[18]
| Gender and Health Seeking | | |
In many societies, women are not accorded with the freedom of movement and making the decision of travel on their own. There are restrictions in being treated by male physicians. The treatment by a man may be considered as dishonor for a woman and her family. Under such pressure, she may choose to not being treated rather than being treated by a male physician. The opportunity costs of medical treatment may also be greater for a woman. There would be no one to replace her role at home or in fields during harvest time in the rural community. The visit to a health-care provider could impose greater burdens on the household.[22]
| Conclusion | | |
Considering the given evidence, it seems imperative to build resilience among women through proper training. Most of the National Health Programs focussing on women's health, like Reproductive Maternal Neonatal Child Health + Adolescent, Janani Shishu Swastha Karyakram, emphasize health and nutrition status, without taking into consideration biopsychosocial factors. Due to a lack of a holistic approach to women's health, expected outcomes are not achieved.
The concept of Self-Help Groups of women has originated in Bangladesh and has successfully spread across India. The microfinancing provided by the self-help group has helped in poverty alleviation in many parts of the world. This platform has also been utilized in enhancing their financial and health literacy. However, this platform has not adequately explored to improve resilience among women in India. Today, there are over 2.2 million SHGs in India, representing 33 million members and this platform could be explored effectively to improve their health through building their resilience.
Acknowledgment
We acknowledge the Indian Council of social science research for their funding support for the ongoing project titled” Impact of short-term and sustained support resilience building program on women empowerment: Community-Based Cluster trial, Nagpur District, Maharashtra” at AIIMS Nagpur. The article is an excerpt from the ongoing project.
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