Handbook on Gender and Health
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Handbook on Gender and Health

Edited by Jasmine Gideon

This Handbook brings together a groundbreaking collection of chapters that uses a gender lens to explore health, healthcare and health policy in both the Global South and North. Empirical evidence is drawn from a variety of different settings and points to the many ways in which the gendered dimensions of health have become reworked across the globe.
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Chapter 23: Capacities to exercise strategic decision-making agency: exploring the gendered production of health within intimate partnerships and households

Rachel Tolhurst, Esther Richards, Eleanor MacPherson, Dorcas M. Kamuya, Flavia Zalwango and Sally Theobald


This chapter explores the conceptualization and empirical evidence for gendered social processes for the production of health and illness within intimate relationships and households, drawing on international literature, additional grey literature from the Global South and four case studies from the authors’ own research. In particular, the chapter considers the capacity (by both women and men in different contexts) to exercise strategic agency in making decisions with regard to health and well-being both in their own lives and in those of their children. The authors explore how these capacities are conceptualized in both the development and health literature and the findings of empirical research in this area, particularly in three areas that have received particular attention in health: maternal, sexual and reproductive and child health. They then present and discuss four case studies from their own research in sub-Saharan Africa which illustrate the dynamics of the gendered production of health in intimate partnerships and households at different stages of the life cycle, including gendered bargaining processes (and their material and ideological bases), in order to explore these complex processes and outcomes in more depth. The case studies also examine the ways in which gender interacts with other axes of inequality to shape health experiences and outcomes, including for example age, livelihood strategies, socio-economic status, geographical location (for example, urban or rural), marital status and household structure. Finally, the authors discuss whether and how capacities for exercising strategic agency have been considered in health policies, programming and interventions within different contexts, and identify key areas for action and further research.

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