women’s health in Nepal: sociocultural perspectives

Before diving into women’s health and socio-cultural perspectives of women’s health, lets understand the difference in gender and sex.

Distinction between gender and Sex

Gender refers to “the array of socially constructed roles and relationships, personality traits, attitudes, behaviors, values, relative power and influence that society ascribes to the two sexes on a differential basis. Gender is relational—gender roles and characteristics do not exist in isolation, but are defined in relation to one another and through the relationships between women and men, girls and boys”, sex refers to biological differences, whereas gender refers to social differences.

Biological differences are de facto universal truth, which can’t be modified. However, the formation of gender has been contributed by many factors. The impact of nurturing of people of gender gets manifested in different ways in different areas.  The roles and responsibilities are cultured in the man and woman since their birth when they are biologically identified as of particular sex. The people around them treat according to their sexes following the existing tradition and the existing norms and practices and the infants will later learn to identify themselves as per their sexual organs and assigned roles and responsibilities and expectations and they tag themselves into two categories, male and female which is often termed as a gender binary.

Society and culture reinforces the gender role and life style of man and woman in the society and they can be a threat or booster to women’s health and well-being.

What is women’s health?

When we say women’s health, people tend to believe that we are talking about pregnancy, child bearing and its complications. They are partly right because these phenomena are peculiar to women, however, there are so many other facets related to women’s health.

Women’s health can be understood in broader aspects. It refers to a state of complete physical, mental, social and spiritual well-being and not merely the absence of disease or infirmity in the women. According to WHO, the top ten issues of women’s health are Cancer: breast cancer and cervical cancers claim many women’s well being. Those can be detected earlier and treated, Reproductive and sexual health: unsafe sex is a major risk factor, maternal health, HIV, sexually transmitted infections, violence against women, mental health, Noncommunicable diseases, problems of adolescents, and geriatrics problems.

What are the determinants of health?

Determinants of health are those factors, which affect the health of anyone. They can be broadly listed as following factors that affect health of an individual directly or indirectly.

Social/cultural: norms, values, traditions, roles, occupation, investment, habits, gender

Economic: we get something in expense of something. And everything has some value. Even health care should be purchased.

Political: political will

Biological: age, sex, ethnicity etc keep one in risk of particular condition.

Environmental: physical environment, where one resides also affect the health of an individual. Availability of safe drinking water, clean air, healthy workplaces and protective houses are predictors of good health.

Gender and Sex as determinants of Health

Sex itself is a biological determinant of health.

And gender is also other important social and cultural factor that determines one’s health outcome.

In the context of Nepal or where the sex preference for son is high, the girl gets different treatment since her conception characterized in the form of sex selective abortion. If the newborn is a girl, then there won’t be celebration, as that would happen if the newborn were a boy and when they grow up, they would be nurtured differently to prepare them for their future roles and responsibilities. The impression of being strong, leader, caretaker, family head is continued for men, while the notion of being sensitive, beautiful and attractive, submissive, dutiful, child bearer is inculcated in girls since their childhood. 

Based on biological differences, women and men have different health needs in addition to some basic health needs. For example women should go through different steps of life during her reproductive age. Starting from development of secondary sexual characters, women go through various changes, like menstruation, pregnancy, childbearing, menopausal stage, she is at increased risk of other diseases like osteoporosis, cervical cancer, and breast cancer. The hormonal fluctuations every months and during various stages of life, causes many changes in their physical and emotional health state of women.

However, their health has been understudied, as they tend to stay in the niche, where professionals don’t get any access.

Those biological differences already put women at particular need; her status in the society, roles, and responsibilities further exacerbates her health need and may help in deteriorating her health condition.

Economically women are usually dependent on family’s income, they aren’t considered and not prepared to be breadwinner of the family, even though they work hard at house, and in the informal sector, they don’t earn hard cash, making them dependent on their spouse. Their health seeking behavior, investment on health depends on the perception, awareness and kindness of husbands. If he is willing to invest on the health of family or her wife, then they will be investing on them.

Studies have shown that that husband’s perception of pregnancy complications, age at marriage, family type, and treatment place decision are significant towards use of health care services by mothers.

Nevertheless, the roles and responsibilities and expectations for man also put them at increased risk of accidents and injury, violence, stress and many more. 

Social/ cultural factors:

What is norm? Norm is the standards of proper and acceptable behavior established by the society. Example: man is breadwinner of a family and has to work outside home. He should earn more than his wife. This leads to the perception that girls doesn’t require education and she will be qualified to formal employment and she will not have cash to trade for her health care.

What is value? : Values are the worth placed on something by the society or the degree of importance of something or action. Example: man looks after parents so a family should have at least one son to look after and guard other members in the future. A woman gives birth to number of children, or in some cases practices sex selective abortion until she will have sufficient number of son, putting herself at risk of maternal death and morbidity.

What is tradition? tradition is belief and behavior transmitted from generation to generation.

What is habit?  Habits are formed during socialization process of a person starting from their childhood.

What is taboo?  It refers to social or religious custom of prohibiting some actions and behaviors. Example: women are prohibited to take part in religious functions, to visit temples and forbidden to touch water and food, other would consume during menstruations. In extreme case, are prohibited to enter house and they should pass that duration in nearby shed.

What is custom? Custom is and accepted way of behaving in particular community, society or group.

How do they affect health of man and woman differently?: these are crucial factors that determine the health of a person. As for an example, the tradition of weaning for male and female infants differs in Nepal. The female infants are weaned one month earlier than male infants, this might have certain reasons but one reason could be sex preference for male children. Weaning earlier might make them adapted earlier to other foods, but there may be risks of infections when they are weaned earlier.  Some of the examples are already mentioned. They really are booster of our healthy habits, health seeking behaviors.

Women are supposed to be submissive and obedient to their husband and the family. Men were free to marry as many women as they wanted though legal penalization is in practice now. This was acceptable in the society whereas it was not acceptable to marry another man even by widow for woman. Such societal restrictions and cultural boundaries have led to deterioration of woman’s status and their health.

However, this varies ethnic groups. In certain ethnic groups women have more liberty and have central position even inside the border of Nepal.

Transition in 21^st Century

Nevertheless, the time is changing, society and cultural value is changing today. Due to technological advancement, demographic transition, globalization, established political system and societal stability, the gender-based role is being changed over the time.

Family is investing resources on education of both male and female regardless of sex. There is quota reservation in education, parliament and the occupational sector for women, to encourage their involvement and adopt gender mainstreaming. No. of women are increased in the formal sector of occupation. Their status in such sector remains questionable though. They have to work hard to prove themselves than their counterparts. Those changes would certainly bring changes in the future. However we should never stop watching through gender based analytic lens to continue the achievement and progress gender equality and prosperous world.