The influence of patriarchy on women's health

Background Patriarchy is a strong determinant of women’s health as it produces unequal living conditions which drive inequalities in health. Patriarchy impacts health and social outcomes through various factors like discriminatory values, norms, beliefs and practices, differential exposures and vulnerabilities to disease, disability and injuries, biases in health systems, and biases in health research. The Nepali society is largely dictated by rigid gender roles governed by religious and cultural beliefs. Therefore, Nepali women are likely to be impacted by patriarchal structures. It is important to address these patriarchal norms to better understand individual health-seeking behavior and health outcomes for Nepali women. Hence, this study aims to explore the influence of patriarchy on ethnically Nepali women’s health. Methods The Integrated Doctoral Research uses two unique qualitative methods: a. The first study uses autoethnography as a research method to provide a transformative family history of my grandmother and me to explore the influence of patriarchy on women’s health. My data include written personal reflections from my recollections of my grandmother’s stories and my own lived experiences. Analysis involved critically drawing meaning to my grandmother’s and my experiences with healthcare and the part patriarchy played in them.
b. The second study uses exploratory feminist qualitative inquiry as a research method to explore the influence of patriarchy on Nepali-speaking Bhutanese (NSB) women’s diabetes management. Fifteen NSB women with Type 2 diabetes were interviewed. Interviews were transcribed and analyzed using thematic analysis based on the conceptual framework. Results The first study of this IDR, i.e. the autoethnography on the author’s personal and family life, found that patriarchal oppression consisting of child marriage, polygamy, unequal gender and power relations, lack of financial and overall autonomy, and poor access to health, nutrition and reproductive care impacted the author’s grandmother’s life. Various moments of transformation between their grandmother and them led to dismantling many but not all patriarchal norms of their grandmother’s such as education, urbanization, economic freedom, leftist ideologies, liberal faith, sexual and reproductive health advocacy, and finally, and most importantly, love. The second study, focused on the influences of patriarchy on NSB women’s diabetes management, found that cultural influences such as family structure, religious beliefs, traditional healthcare and gender roles determined NSB women’s patriarchal upbringing and lifestyle. Unpaid household production were largely influenced by patriarchy and was dependent on women. Moreover, multiple (forced) immigrations led to poor socioeconomic indicators and marginalization of NSB women. Women’s access to healthcare (including diabetes) were largely dependent on other family members due to poor financial, healthcare and overall autonomy. Women’s ability and attempts to maintain a healthy diabetes lifestyle was determined by their physical health condition, knowledge regarding good dietary practices and confidence to manage their disease. Additionally, women experienced adverse physical and emotional symptoms related to diabetes amid their attempted adherence to diabetes self-management. Conclusion The autoethnography and the explorative qualitative inquiry, both found that different structures and forms of patriarchy dictated women’s health. Culture, household production and state impacted predictors of women’s health such as healthcare access and autonomy, access to a healthy lifestyle, and self-esteem and self-efficacy. Cultural practices that started early within women’s lives, such as child marriage, religious restrictions in addition to women’s access to education and their autonomy related to finance and mobility, impacted their access to healthcare, knowledge regarding their diabetes and self-efficacy. Although many of these patriarchal norms were dismantled due to progressive changes in the author’s life, in the case of the NSB women, these influences were magnified due to their multiple resettlements as former refugees. Future interventions tailored to women’s health and healthy should factor in gender roles and patriarchy as an important social determinant of health.