Gender, Women’s Health Care Concerns and Other Social Factors in Health and Health Care: Volume 36

This chapter provides an introduction to the volume along with a brief review of literature on gender, women’s health concerns, and other social factors in health and health care services.

Literature review.

The chapter argues for the importance of greater examination of gender, women’s health concerns, and social factors in health and health care services.

Reviews the issues of gender, women, and social factors and previews this book.

This research explores how gender influences the experience of cancer care and proposes a new explanation for gender differences in posttraumatic growth among individuals who received blood or marrow transplantation as treatment for lymphoma.

We use mixed methods, combining quantitative examination of surveys with 180 survivors with qualitative findings from semi-structured face-to-face interviews with 50 survivors. Participants were 2–25 years after transplantation. Quantitative data were analyzed using statistical modeling; qualitative data were analyzed using thematic coding.

A quantitative examination indicates that compared to men, women report greater posttraumatic growth and more positive impacts of cancer despite having lower physical health. These gender differences are robust even after controlling for physical and emotional well-being, life satisfaction, and social support. Qualitative findings from in-depth interviews show that gender norms and expectations about masculinity and femininity shape how individuals experience illness and perform the role of patient and survivor. Expectations about being a good patient and survivor are more aligned with expectations about femininity and tend to conflict with expectations about masculinity. Gender norms discourage men from reporting personal growth from cancer and encourage women to overemphasize the positive aspects of having had cancer.

This study was conducted two or more years after treatment had ended; therefore, potential for recall bias existed. Nevertheless, the findings suggest that viewing cancer as transformative is part of a gender performance that limits opportunities for individuals to experience and express a diverse range of reactions which, at times, increases the emotional burden on individuals.

By combining survey data with in-depth interviews, the study offers new insights into the causes of gender differences in the reporting of patient outcomes after illness.

Encouraging patient involvement is a cornerstone of many healthcare interventions and decision-making models to ensure that treatment decisions reflect the needs, values, and desires of patients. Involved patients are thought to be empowered patients who feel a sense of efficacy in regards to their own health. However, there is a lack of understanding of how patients relate to empowerment and involvement and, most importantly, how these constructs relate to one another in patients’ decision-making experiences.

Through an inductive analysis, this chapter draws on qualitative interviews of women diagnosed with breast cancer prior to 40 years of age (n = 69).

By examining the intersection of how patients define their own involvement in treatment decisions and their sense of empowerment, we find four orientations to decision-making (Advocates, Bystanders, Co-Pilots, and Downplayers) with involvement and empowerment being coupled for some respondents, but decoupled for others.

Our findings suggest expanding what it means to be an “active” patient as respondents had multiple ways of characterizing involvement, including being informed or following their doctor’s advice. Our findings also suggest a more critical examination of the origins and potential downsides of patient empowerment as some respondents reported feeling overwhelmed or pushed into advocacy roles. The sample was disproportionately higher socioeconomic status with limited racial/ethnic diversity. Empowerment and involvement may be enacted differently for other social groups and other medical conditions.

By examining first-person patient narratives, we conclude that patients’ experience may not fully align with current academic or clinical discussions of patient involvement or empowerment.

To examine associations by gender between cancer history and major health insurance transitions (gains and losses), and relationships between insurance transitions and access to care.

Longitudinal 2008–2013 Medical Expenditure Panel Survey data were pooled yielding 2,223 cancer survivors and 50,692 individuals with no cancer history ages 18–63 years upon survey entry, with gender-specific sub-analyses. Access-to-care implications of insurance loss or gain were compared by cancer history and gender.

Initially uninsured cancer survivors were significantly more likely to gain insurance coverage than individuals with no cancer history (RR: 1.25; 95% CI: 1.08–1.44). Females in particular were significantly more likely to gain insurance (unmarried RR: 1.16; 95% CI: 1.06–1.28; married RR: 1.09; 95% CI: 1.02–1.16). Significantly higher rates of difficulty accessing needed medical care and prescription medications were reported by those remaining uninsured, those who lost insurance, and women in general. Remaining uninsured, losing insurance, and male gender were associated with lack of a usual source of care.

Additional outreach to disadvantaged populations is needed to improve access to affordable insurance and medical care. Future longitudinal studies should assess whether major Affordable Care Act (ACA) provisions enacted after the 2008–2013 study period (or those of ACA’s replacement) are addressing these important issues.

Loss of health insurance coverage can reduce health care access resulting in poor health outcomes. Cancer survivors may be particularly at risk of insurance coverage gaps due to the long-term chronic disease trajectory. This study is novel in exploring associations between cancer history by gender and health insurance transitions, both gains and losses, in a national non-elderly adult sample.

There is extensive research documenting the physical outcomes of childbirth, but significantly less on socio-psychological outcomes. Investigating women’s perception of dignified treatment during birth contributes to a salient, under-examined aspect of women’s childbirth experiences.

We use a two-part conceptualization of dignity, respect and autonomy, to understand how birth experiences and interactions either facilitate or undermine women’s perceived dignity. Data came from the Listening-to-Mothers I survey, the first nationally representative study of postpartum women in the United States (n = 1,406). Through linear regression analysis, we separately modeled women’s perception of respectful treatment and women’s perception of medical autonomy during birth.

Overall women reported high scores for both autonomy and respect. Differences between the models emerged related primarily to the role of interventions and provider support. While women’s perceived dignity is related to elements that she brings in to the delivery room (e.g., birth knowledge, health status), much variation was explained by the medical encounter itself (e.g., type of medical interventions, pain management, nurse support, and number of staff present).

This study is cross-sectional, and required either a telephone or internet access, thus limiting the full generalizability of findings. Two findings have direct practical relevance for promoting women’s dignity in childbirth. First, the number of staff persons present during labor and birth was negatively associated with both respect and autonomy. Second, that women with high levels of knowledge about their legal rights during childbirth were more likely to report high scores on the dignity scale. Limiting staff in the delivery room and including knowledge of legal rights in childbirth education or during prenatal visits may be two mechanisms to promote dignity in birth.

These findings address an important, under-examined aspect of women’s childbirth experiences. This study investigates how different birth experiences and interactions either promote or violate childbearing women’s perception of dignity, and has significant implications for the provision of maternal healthcare. The results reinforce the importance of focusing on the socio-psychological dimensions of childbirth.

Most researchers examining educational disparities in unintended pregnancy take a rational-choice perspective, defining pregnancy intention as a fixed state within decontextualized individuals. However, evidence suggests that women’s reproductive intentions may be more relational than rational, and that relationship context varies by education. This study investigated if relationship context could explain educational disparities in unintended pregnancy.

Using the 2006–2015 National Survey of Family Growth (n = 4,320 pregnancies), I calculated structural equation models and predicted probabilities to examine if relational stability (marital status) and partner specificity (wanting a baby with a particular man) mediated the association between education and pregnancy intendedness for White, Hispanic, and Black women.

Relational stability and partner specificity mediated the association between education and pregnancy intention for all three groups. Education was rendered insignificant after controlling for race, marital status, partner specificity, and age. Marital status was a better predictor for White women than Hispanic women, and was not statistically significant for Black women. Partner specificity had greater influence on pregnancy intendedness than marital status, and its effect varied only slightly by race. Thus, disparities in marriage and access to desired partners influence educational disparities in unintended pregnancy.

These findings suggest that partner specificity could prove particularly useful in predicting unintended pregnancy as rates of non-marital pregnancies continue to rise. They also indicate that a shift in research and policy focus from decontextualized individuals to relationships between women and men is warranted.

Procedures can be categorized as certain surgeries based on their necessity and outcomes while others are classified as uncertain surgeries based on these areas. To account for this variance, policies such as the Affordable Care Act (ACA) call for health care providers to engage in shared decision making (SDM) with patients to ensure they are informed of treatment options and asked their preferences. Yet, gender may influence the decision-making process. Thus, this project examines the decision process and how gender impacts patients’ participation in decisions to undergo certain surgeries compared to uncertain surgeries.

This research project analyzed data from the National Survey of Medical Decisions 2006–2007 which surveyed the medical decisions of US residents 40 and older.

First, the data reveals that women felt more informed having uncertain surgeries compared to men. Second, patients were less likely asked their preference for surgery when undergoing certain surgeries compared to uncertain surgeries. Third, compared to men, women having uncertain surgeries were less likely to make the final decision to have surgery, compared to sharing the final decision with health care providers.

Due to the sample size, this project could not perform three-way interactions between gender, race, and surgery type.

Gender influences the level patients feel informed having uncertain surgeries. Though policy calls for SDM, health care providers are less likely to ask patients their preference for surgery regarding certain surgeries, relative to uncertain surgeries. Gender impacts the final decision-making process regarding whether patients should have uncertain surgeries.

Existing descriptions of trust in health care largely assume a straightforward association between a patient’s relationship with a regular provider and his or her trust in health care. I extend status characteristics theory (SCT) and social identity theory (SIT) to suggest greater variability in this association by investigating the role of social differences between patients and their regular providers. Whereas the SIT extension predicts lower trust in dissimilar than similar dyads, the predictions from the SCT extension depend on status in dissimilar dyads. Further, research examining how social differences in patient–provider dyads shape trust largely emphasizes racial differences, but the theories implicate gender differences too.

I analyze a longitudinal dataset of patient–provider dyads offering a conservative test of the extensions.

Results generally support predictions from the SCT extension. Specifically, patients’ status based on differences in either race or gender: (1) is inversely related to their trust in health care and (2) influences the resiliency of their trust, whereby the degree health care met prior expectations matters less (more) for the trust of low (high) status patients than equal status patients.

When patients and providers differ on both race and gender, findings sometimes depart from predictions. This indicates differences in two social categories is a unique situation where the contributions of each category are distinct from that of the other.

This research extends SCT to explain greater variability in the connection between patient–provider dyads and trust in health care, while also showing how gender compares to race.

This study examines weight loss surgery patients’ experiences with vanity stigma. First, the research explores if and how vanity stigma occurrences differ for female and male surgery patients. Second, the research interrogates the role of this stigma in shaping patients’ feelings about their bodies.

The data stems from qualitative interviews (n = 44) and surveys (n = 55) with pre-operative and post-operative weight loss surgery patients. The author used narrative interview analysis to inductively identify and analyze prevalent themes.

Participants’ stigma experiences are differentiated by gender. Approximately half of female participants reported perceiving vanity stigma. Women who faced negative accusations were likely to distance themselves from such claims by citing personal disinterest in their bodies, whereas women who did not perceive vanity accusations were likely to express approval and pleasure in their post-weight loss bodies. Men, in contrast, were not accused of vanity. Men frequently characterized their post-surgical, post-weight loss bodies as having utilitarian value.

The study concludes that gender norms play a role in shaping bariatric surgery patients’ experiences with vanity stigma and body-related feelings. Limitations include the small number (n = 9) of male participants and the lack of a representative sampling frame for bariatric surgery patients.

Previous studies have not explored how gender shapes bariatric surgery patients’ experiences with appearance-related social scrutiny. This chapter adds to existing research on gendered body norms and reveals gendered dimensions of vanity stigma.

Previous research shows differences between women and men in utilization of facilities of health care (FHC) across the general population in a number of countries. In this chapter, we focus on the capability to use FHC, because it refers to an individual freedom to choose between alternative FHC directed to restore or to improve own health in situations of health needs. Based on several empirical studies and on the insights of the capability approach, we propose that there are cross-national differences between women and men in the capability to use FHC, and that these differences are due to gender differences in the extent of educational skills, and due to differences in the extensiveness of social security policies across countries. The objective of this study was to question these propositions.

We tested the hypotheses using the data from the European Social Survey (in a sample of 38,992 respondents from 22 countries) which we analyzed performing multilevel analyses.

The findings show that in Central, North, West, and East European countries, women have more capabilities to use FHC than men. They suggest that the low-skilled women in Central, North, and West European countries have higher level of the capability to use FHC than women with more educational skills.

The findings do not specify which particular social program or policy is more effective in enhancing women’s capability to use FHC.

This chapter focuses on women’s freedom or the capability to use FHC.

Barbados is at a very advanced stage of population aging. Health care services are designed to ensure universal access for all Barbadians but the contributing factors for older adults’ health care utilization are not well explored. This chapter examines gender differences in the correlates of seeking medical care among older adults in Barbados.

Logistic regression models were applied to data drawn from the 2000 Survey of Health, Well-Being and Aging of Older Adults in Latin America and the Caribbean (SABE), Bridgetown sample (n = 1,068).

Health needs, based on chronic conditions, were positively associated with seeking medical care for men and women. Different forms and directions of intergenerational support were associated with men and women seeking care. Among men, receiving financial support was positively associated with seeking care. Among women, providing financial support was associated with lower odds of seeking care while receiving instrumental support was associated with higher odds of seeking care.

Medical care is only one form of health care use and there is no specification of the nature of care or consultation. The sample is cross-sectional and limited to older adults in urban areas. The relative importance of enabling factors and health needs, especially, may differ across time and space within Barbados.

The study contributes to the literature on health care utilization among older adults within developing countries and highlights the pertinence of family relations influencing gender differences in health care utilization.

To determine the health status of women before, during, and after the war, and to explore women’s perceived health needs and current access to healthcare.

Individual interviews and focus groups were conducted in urban and rural areas. A total of 52 women participated in the study (N = 52; Individual Interviews, n = 12; Focus Group Participants, n = 40).

Women’s health concerns and healthcare needs overlap between the rural and urban communities. The women reported the needs for empowerment in the forms of social support groups for health, specialists for women’s health, education, resources, prevention, financial support to look for medical services, and mental health issues.

Since these focus groups and interviews were conducted, the women have continued to meet. The strength of these meetings is represented in the forms of preparing a meal, eating, and socializing in unity. The social support experienced in these gatherings allows the women to openly express their issues, fears, concerns, joys, and successes. The CBPR approach is an important necessity when working with vulnerable populations. There were some inherent limitations due to economic issues to support the gatherings, transportation, and health-related complications that may have prevented women from attending.

Disparate health outcomes and biologic–environmental interactions are represented in female survivors of war. Their issues began or were exacerbated during war and continue today. In the future, we seek to identify and establish a culturally and gender-specific intervention for health access, prevention, maintenance, and improvements.

The measurement of gender in health research often consists of the substitution of the word “gender” in a question that is really asking about sex (physiological characteristics). When gender roles and expressions are actually measured it is normally with a tool such as the Bem Sex Role Inventory (BSRI), which is time-consuming to complete and requires expertise to analyze. This study introduces a brief gender measure: a categorical, single-item, self-report, gender measure (SR-Gender), and demonstrates the validity and usability of this new tool.

The SR-Gender was validated in two studies. Participants in Study One were 137 undergraduates. Concurrent criterion validity was assessed by an analysis comparing responses to the SR-Gender and the BSRI and an open-ended gender question. The goal was to ascertain whether the gender identities that these students reported in the SR-Gender were consistent with the classifications obtained on other gender measurement tools. In the second study, the SR-Gender was used with a group of adults over 65 years old in a study of aging with illness.

This study established that the SR-Gender classifications of gender identity were consistent with the results obtained by the open-ended gender question and more complex BSRI measure. The SR-Gender was easily understood and used by younger and older adults, and resulted in nuanced gender classifications.

The SR-Gender takes seconds to complete and provides health researchers with categorical gender classifications that can then be used in analysis of health outcomes, separately or in tandem with physiological sex. It treats masculinity and femininity as independent constructs and includes the potential for androgynous and undifferentiated responses. It is not recommended for in-depth gender research due to the simplicity of the tool.

This chapter introduces the SR-Gender, a simple, quick, and easy-to-use gender measure that could transform health research from paying lip service to gender to actual gender classification, allowing researchers to directly explore the impact of gender identity on health, separately or interacting with other social determinants of health.

This research explores the subjective health experiences of women incarcerated in a provincial detention center in Ottawa, Canada.

Narrative interviews conducted with 16 previously incarcerated women were analyzed to explore how health issues shaped their experiences in detention.

Women identified a set of practices and conditions that negatively impacted health, including the denial of medication, medical treatment, and healthcare, limited prenatal healthcare, and damaged health caused by poor living conditions.

Findings suggest that structural health problems emerge in penal environments where healthcare is provided by the same agency responsible for incarceration. The incompatibility between the mandates of incarceration and healthcare suggests that responsibility for institutional healthcare should be transferred to provincial healthcare bodies.

This research responds to the lack of research on carceral health experiences within both penal scholarship and medical sociology, particularly in relation to women and those confined in jails.