Parental share in public and domestic spheres: a population study on gender equality, death, and sickness

Type of Family Support for Infant and Toddler Care That Relieves Parenting Stress: Does the Number of Children Matter?

The present study aimed to investigate the status and relationships between family support for infant and toddler care and parenting stress, and to explore differences related to the number of children in the families. We conducted a survey among 13,390 Chinese parents who were randomly sampled from six provinces of China. Descriptive analysis, multivariate analysis of variance, and regression analysis indicated that (1) current family support for infant and toddler care in China is insufficient; (2) most Chinese parents reported moderate parenting stress, with the highest scores given for parental distress, followed by difficult child, and parent-child dysfunctional interaction; (3) the larger the number of children in the family, the less the family support for infant and toddler care, the greater the parenting stress; (4) there was a difference between the effects of family support for infant and toddler care on relieving parenting stress among families with different numbers of children. These findings indicate that different types of family support for infant and toddler care should be provided for families with different numbers of children, to ease parenting stress and promote the implementation of the government's current fertility policy.

Traditionalism vs egalitarianism: Is there an association between gender attitudes and mental health?

OBJECTIVE

This study sought to assess the extent to which gender attitudes are associated with mental health among Australian men and women.

METHODS

This study used a sample of 26,188 individuals drawn from five waves of the Household, Income and Labour Dynamics in Australia Survey. Gender attitudes were classified into three groups (traditional, moderate-egalitarian and egalitarian), and were constructed from six items. Mental health was measured using the Mental Health Inventory (MHI-5). We calculated the magnitude of associations between gender attitudes and mental health, stratified by gender, and adjusted for potential confounding.

RESULTS

Compared to men with egalitarian attitudes, poorer mental health was observed among men with moderate-egalitarian (-1.16, 95% confidence interval = [-1.84, -0.49]) and traditional gender attitudes (-2.57, 95% confidence interval = [-3.33, -1.81]). Among women, poorer mental health was observed among those with moderate-egalitarian (-0.78, 95% confidence interval = [-1.34, -0.22]) and traditional attitudes (-1.91, 95% confidence interval = [-2.55, -1.26]) compared to those with egalitarian attitudes.

CONCLUSIONS

For both men and women, egalitarian gender attitudes were associated with better mental health.

Gender equality and sick leave among first-time parents in Sweden

Aims: To examine gender equality in the family and sick leave among first-time parents. Methods: Heterosexuals who became first-time parents between 2002 and 2009 (N = 223,332) were identified in national registers. Gender equality in the family was evaluated by parental insurance and income from gainful employment representing the domestic and work spheres respectively and was defined as each parent contributing 40-60% of the family total. The risk of a new medically certified sick-leave spell (>14 days) was evaluated by hazard ratio (HR) using the Cox proportional hazard regression, adjusted for demographic and socioeconomic factors. Results: Gender equality was associated with an increased risk of sick leave compared with traditional roles where women had the main responsibility in the domestic sphere and men in the work sphere (HR 1.30 in women and 1.19 in men). In addition, situations with one partner exposed to double burden or untraditional settings were associated with an increased risk. Conclusions: Equal sharing or taking the lion's share of paid work and domestic responsibilities were associated with an increased risk of sick leave among first-time parents in Sweden. Family-friendly policies are important for facilitating the life of dual earner families, but do not fully counteract the work-life demands of first-time parents.

Associations between gender equality and health: a systematic review

This systematic review sought to evaluate the impact of gender equality on the health of both women and men in high-income countries. A range of health outcomes arose across the 48 studies included. Gender equality was measured in various ways, including employment characteristics, political representation, access to services, and with standard indicators (such as the Global Gender Gap Index and the Gender Empowerment Measure). The effects of gender equality varied depending on the health outcome examined, and the context in which gender equality was examined (i.e. employment or domestic domain). Overall, evidence suggests that greater gender equality has a mostly positive effect on the health of males and females. We found utility in the convergence model, which postulates that gender equality will be associated with a convergence in the health outcomes of men and women, but unless there is encouragement and support for men to assume more non-traditional roles, further health gains will be stymied.

Preventing intimate partner violence through paid parental leave policies

Paid parental leave policies have the potential to strengthen economic supports, reduce family discord, and provide opportunities to empower women (Basile et al., 2016; Niolon et al., 2017). In this article, we present a theory of change and evidence to suggest how paid parental leave may impact intimate partner violence (IPV). In doing so, we present three mechanisms of change (i.e., reduction in financial stress, increase in egalitarian parenting practices, and promotion of child/parent bonding) through which paid parental leave could reduce rates of IPV. We also describe limitations of the current state of knowledge in this area, as well as opportunities for future research. Ultimately, our goal is to facilitate the identification and implementation of approaches that have the potential to reduce violence at the population level. Paid parental leave embodies the potential of policies to change societal-level factors and serve as an important prevention strategy for IPV.

Examples of sex/gender sensitivity in epidemiological research: results of an evaluation of original articles published in JECH 2006-2014

BACKGROUND

During the last decades, sex and gender biases have been identified in various areas of biomedical and public health research, leading to compromised validity of research findings. As a response, methodological requirements were developed but these are rarely translated into research practice. The aim of this study is to provide good practice examples of sex/gender sensitive health research.

METHODS

We conducted a systematic search of research articles published in JECH between 2006 and 2014. An instrument was constructed to evaluate sex/gender sensitivity in four stages of the research process (background, study design, statistical analysis, discussion).

RESULTS

In total, 37 articles covering diverse topics were included. Thereof, 22 were evaluated as good practice example in at least one stage; two articles achieved highest ratings across all stages. Good examples of the background referred to available knowledge on sex/gender differences and sex/gender informed theoretical frameworks. Related to the study design, good examples calculated sample sizes to be able to detect sex/gender differences, selected sex/gender sensitive outcome/exposure indicators, or chose different cut-off values for male and female participants. Good examples of statistical analyses used interaction terms with sex/gender or different shapes of the estimated relationship for men and women. Examples of good discussions interpreted their findings related to social and biological explanatory models or questioned the statistical methods used to detect sex/gender differences.

CONCLUSIONS

The identified good practice examples may inspire researchers to critically reflect on the relevance of sex/gender issues of their studies and help them to translate methodological recommendations of sex/gender sensitivity into research practice.

Scoping review: national monitoring frameworks for social determinants of health and health equity

BACKGROUND

The strategic importance of monitoring social determinants of health (SDH) and health equity and inequity has been a central focus in global discussions around the 2011 Rio Political Declaration on SDH and the Millennium Development Goals. This study is part of the World Health Organization (WHO) equity-oriented analysis of linkages between health and other sectors (EQuAL) project, which aims to define a framework for monitoring SDH and health equity.

OBJECTIVES

This review provides a global summary and analysis of the domains and indicators that have been used in recent studies covering the SDH. These studies are considered here within the context of indicators proposed by the WHO EQuAL project. The objectives are as follows: to describe the range of international and national studies and the types of indicators most frequently used; report how they are used in causal explanation of the SDH; and identify key priorities and challenges reported in current research for national monitoring of the SDH.

DESIGN

We conducted a scoping review of published SDH studies in the PubMed(®) database to obtain evidence of socio-economic indicators. We evaluated, selected, and extracted data from national scale studies published from 2004 to 2014. The research included papers published in English, Italian, French, Portuguese, and Spanish.

RESULTS

The final sample consisted of 96 articles. SDH monitoring is well reported in the scientific literature independent of the economic level of the country and magnitude of deprivation in population groups. The research methods were mostly quantitative and many papers used multilevel and multivariable statistical analyses and indexes to measure health inequalities and SDH. In addition to the usual economic indicators, a high number of socio-economic indicators were used. The indicators covered a broad range of social dimensions, which were given consideration within and across different social groups. Many indicators included in the WHO EQuAL framework were not common in the studies in this review due to their intersectoral and interdisciplinary nature.

CONCLUSIONS

Our review illustrates that the attention to SDH monitoring has grown in terms of its importance and complexity within the scientific health literature. We identified a need to make indicators more wide-ranging in order to include a broader range of social conditions. The WHO EQuAL framework can provide intersectoral and interdisciplinary means of building a more comprehensive standardised approach to monitoring the SDH and improving equity in health.

The mediating effect of effort-reward imbalance in household and family work on the relationship between education and women's health

Occupational stress as a key determinant for explaining health inequalities has been well established while the impact of stress related to family work has rarely been considered. This study investigates whether stress in household and family work may contribute to health inequalities in women. We used a population-based sample of German mothers (n = 3129) to determine the total, direct and indirect effects of education on somatic complaints by means of OLS regression-based mediation models. Inference about indirect effects was determined by 95% bias corrected bootstrap confidence intervals. Education was assessed by a measure combining school education and vocational training. Stress was measured using the adopted effort-reward-imbalance (ERI) questionnaire for household and family work. The von Zerssen list of somatic complaints was used as measure of subjective health. We found a significant total effect of education on somatic complaints (p ≤ 0.001) as well as significant indirect effects through 'effort' (p = 0.006) and 'reward' in household and family work (p ≤ 0.001). However, the subscales of ERI pointed into different directions: while levels of 'effort' increased with women's educational attainment, levels of distress related to low 'reward' decreased with higher levels of education. Our findings suggest that the effect of women's education on somatic complaints is mediated through stress related to low reward for household and family work. In particular, lack of 'societal esteem' for household and family work contributed to health disadvantages in lower educated mothers. We conclude that research on health inequality would benefit from taking stressful experiences in household and family work greater into account.

Parental Gender Equality and Use of Oral Contraceptives Among Young Women: A Longitudinal, Population-based Study in Sweden

BACKGROUND

Little is known about how parental gender equality early in their children lives can influence daughters' decision to use contraceptive pills.

AIM

The study aimed at exploring whether maternal working time and paternity leave in Sweden during the first two years of their daughters' lives is associated with the use of oral contraceptives when they are adolescents or young adults.

MATERIALS AND METHODS

The study population was selected from a cohort of all Swedish fathers and mothers who had their first child together between 1988 and 1989 (n = 57,520 family units). Multivariate logistic regression was used to estimate the association.

RESULTS

Mothers' longer working time was mildly associated with daughters' oral contraceptive pill use, though no clear trend was observed. Longer paternity leave periods (>30 days) were not associated with use of oral contraceptives among their daughters, but 1-30 day periods showed a mild positive association.

CONCLUSION

For maternal working time, there seems to be an association, but trends by working hours are not clear. There is no clear association between paternity leave during the first two years of their daughters' life and the use of oral contraceptives when they are adolescents and young adults.

Cross-national differences in the gender gap in subjective health in Europe: does country-level gender equality matter?

Multiple studies have found that women report being in worse health despite living longer. Gender gaps vary cross-nationally, but relatively little is known about the causes of comparative differences. Existing literature is inconclusive as to whether gender gaps in health are smaller in more gender equal societies. We analyze gender gaps in self-rated health (SRH) and limiting longstanding illness (LLI) with five waves of European Social Survey data for 191,104 respondents from 28 countries. We use means, odds ratios, logistic regressions, and multilevel random slopes logistic regressions. Gender gaps in subjective health vary visibly across Europe. In many countries (especially in Eastern and Southern Europe), women report distinctly worse health, while in others (such as Estonia, Finland, and Great Britain) there are small or no differences. Logistic regressions ran separately for each country revealed that individual-level socioeconomic and demographic variables explain a majority of these gaps in some countries, but contribute little to their understanding in most countries. In yet other countries, men had worse health when these variables were controlled for. Cross-national variation in the gender gaps exists after accounting for individual-level factors. Against expectations, the remaining gaps are not systematically related to societal-level gender inequality in the multilevel analyses. Our findings stress persistent cross-national variability in gender gaps in health and call for further analysis.

Patterns of gender equality at workplaces and psychological distress

Research in the field of occupational health often uses a risk factor approach which has been criticized by feminist researchers for not considering the combination of many different variables that are at play simultaneously. To overcome this shortcoming this study aims to identify patterns of gender equality at workplaces and to investigate how these patterns are associated with psychological distress. Questionnaire data from the Northern Swedish Cohort (n = 715) have been analysed and supplemented with register data about the participants' workplaces. The register data were used to create gender equality indicators of women/men ratios of number of employees, educational level, salary and parental leave. Cluster analysis was used to identify patterns of gender equality at the workplaces. Differences in psychological distress between the clusters were analysed by chi-square test and logistic regression analyses, adjusting for individual socio-demographics and previous psychological distress. The cluster analysis resulted in six distinctive clusters with different patterns of gender equality at the workplaces that were associated to psychological distress for women but not for men. For women the highest odds of psychological distress was found on traditionally gender unequal workplaces. The lowest overall occurrence of psychological distress as well as same occurrence for women and men was found on the most gender equal workplaces. The results from this study support the convergence hypothesis as gender equality at the workplace does not only relate to better mental health for women, but also more similar occurrence of mental ill-health between women and men. This study highlights the importance of utilizing a multidimensional view of gender equality to understand its association to health outcomes. Health policies need to consider gender equality at the workplace level as a social determinant of health that is of importance for reducing differences in health outcomes for women and men.

Can the impact of gender equality on health be measured? A cross-sectional study comparing measures based on register data with individual survey-based data

Background

The aim of this study was to investigate potential associations between gender equality at work and self-rated health.

Methods

2861 employees in 21 companies were invited to participate in a survey. The mean response rate was 49.2%. The questionnaire contained 65 questions, mainly on gender equality and health. Two logistic regression analyses were conducted to assess associations between (i) self-rated health and a register-based company gender equality index (OGGI), and (ii) self-rated health and self-rated gender equality at work.

Results

Even though no association was found between the OGGI and health, women who rated their company as “completely equal” or “quite equal” had higher odds of reporting “good health” compared to women who perceived their company as “not equal” (OR = 2.8, 95% confidence interval = 1.4 – 5.5 and OR = 2.73, 95% CI = 1.6-4.6). Although not statistically significant, we observed the same trends in men. The results were adjusted for age, highest education level, income, full or part-time employment, and type of company based on the OGGI.

Conclusions

No association was found between gender equality in companies, measured by register-based index (OGGI), and health. However, perceived gender equality at work positively affected women’s self-rated health but not men’s. Further investigations are necessary to determine whether the results are fully credible given the contemporary health patterns and positions in the labour market of women and men or whether the results are driven by selection patterns.

The importance of childhood and adulthood aspects of gendered life for adult mental ill-health symptoms--a 27-year follow-up of the Northern Swedish Cohort

BACKGROUND

The increasing gender equality during the 20th century, mainly in the Nordic countries, represents a major social change. A well-established theory is that this may affect the mental health patterns of women and men. This study aimed at examining associations between childhood and adulthood gendered life on mental ill-health symptoms.

METHODS

A follow-up study of a cohort of all school leavers in a medium-sized industrial town in northern Sweden was performed from age 16 to age 42. Of those still alive of the original cohort, 94% (n = 1007) participated during the whole period. Gendered life was divided into three stages according to whether they were traditional or non-traditional (the latter includes equal): childhood (mother's paid work position), adulthood at age 30 (ideology and childcare), and adulthood at age 42 (partnership and childcare). Mental ill-health was measured by self-reported anxious symptoms ("frequent nervousness") and depressive symptoms ("frequent sadness") at age 42. The statistical method was logistic regression analysis, finally adjusted for earlier mental ill-health symptoms and social confounding factors.

RESULTS

Generally, parents' gendered life was not decisive for a person's own gendered life, and adulthood gender position ruled out the impact of childhood gender experience on self-reported mental ill-health. For women, non-traditional gender ideology at age 30 was associated with decreased risk of anxious symptoms (76% for traditional childhood, 78% for non-traditional childhood). For men, non-traditional childcare at age 42 was associated with decreased risk of depressive symptoms (84% for traditional childhood, 78% for non-traditional childhood). A contradictory indication was that non-traditional women in childcare at age 30 had a threefold increased risk of anxious symptoms at age 42, but only when having experienced a traditional childhood.

CONCLUSION

Adulthood gender equality is generally good for self-reported mental health regardless of whether one opposes or continues one's gendered history. However, the childcare findings indicate a differentiated picture; men seem to benefit in depressive symptoms from embracing this traditionally female duty, while women suffer anxious symptoms from departing from it, if their mother did not.

Domestic work and psychological distress--what is the importance of relative socioeconomic position and gender inequality in the couple relationship?

Aims

The aim of this study was to investigate whether the relation between responsibility for domestic work and psychological distress was influenced by perception of gender inequality in the couple relationship and relative socioeconomic position.

Methods

In the Northern Swedish Cohort, all pupils who studied in the last year of compulsory school in a northern Swedish town in 1981 have been followed regularly until 2007. In this study, participants living with children were selected (n = 371 women, 352 men). The importance of relative socioeconomic position and perception of gender inequality in the couple relationship in combination with domestic work for psychological distress was examined through logistic regression analysis.

Results

Two combinations of variables including socioeconomic position (‘having less than half of the responsibility for domestic work and partner higher socioeconomic position’ and ‘having more than half the responsibility for domestic work and equal socioeconomic position’) were related to psychological distress. There were also higher ORs for psychological distress for the combinations of having ‘less than half of the responsibility for domestic work and gender-unequal couple relationship’ and ‘more than half the responsibility for domestic work and gender-unequal couple relationship’. Having a lower socioeconomic position than the partner was associated with higher ORs for psychological distress among men.

Conclusions

This study showed that domestic work is a highly gendered activity as women tend to have a greater and men a smaller responsibility. Both these directions of inequality in domestic work, in combination with experiencing the couple relationship as gender-unequal, were associated with psychological distress There is a need for more research with a relational approach on inequalities in health in order to capture the power relations within couples in various settings.

Could gender equality in parental leave harm off-springs' mental health? A registry study of the Swedish parental/child cohort of 1988/89

INTRODUCTION

Mental ill-health among children and young adults is a growing public health problem and research into causes involves consideration of family life and gender practice. This study aimed at exploring the association between parents' degree of gender equality in childcare and children's mental ill-health.

METHODS

The population consisted of Swedish parents and their firstborn child in 1988-1989 (N = 118 595 family units) and the statistical method was multiple logistic regression. Gender equality of childcare was indicated by the division of parental leave (1988-1990), and child mental ill-health was indicated by outpatient mental care (2001-2006) and drug prescription (2005-2008), for anxiety and depression.

RESULTS

The overall finding was that boys with gender traditional parents (mother dominance in childcare) have lower risk of depression measured by outpatient mental care than boys with gender-equal parents, while girls with gender traditional and gender untraditional parents (father dominance in childcare) have lower risk of anxiety measured by drug prescription than girls with gender-equal parents.

CONCLUSIONS

This study suggests that unequal parenting regarding early childcare, whether traditional or untraditional, is more beneficial for offspring's mental health than equal parenting. However, further research is required to confirm our findings and to explore the pathways through which increased gender equality may influence child health.

Sickness absence in gender-equal companies: a register study at organizational level

Background

The differences in sickness absence between men and women in Sweden have attracted a great deal of interest nationally in the media and among policymakers over a long period. The fact that women have much higher levels of sickness absence has been explained in various ways. These explanations are contextual and one of the theories points to the lack of gender equality as an explanation. In this study, we evaluate the impact of gender equality on health at organizational level. Gender equality is measured by an index ranking companies at organizational level; health is measured as days on sickness benefit.

Methods

Gender equality was measured using the Organizational Gender Gap Index or OGGI, which is constructed on the basis of six variables accessible in Swedish official registers. Each variable corresponds to a key word illustrating the interim objectives of the "National Plan for Gender Equality", implemented by the Swedish Parliament in 2006. Health is measured by a variable, days on sickness benefit, also accessible in the same registers.

Results

We found significant associations between company gender equality and days on sickness benefit. In gender-equal companies, the risk for days on sickness benefit was 1.7 (95% CI 1.6-1.8) higher than in gender-unequal companies. The differences were greater for men than for women: OR 1.8 (95% CI 1.7-2.0) compared to OR 1.4 (95% CI 1.3-1.5).

Conclusions

Even though employees at gender-equal companies had more days on sickness benefit, the differences between men and women in this measure were smaller in gender-equal companies. Gender equality appears to alter health patterns, converging the differences between men and women.

Relative health effects of education, socioeconomic status and domestic gender inequity in Sweden: a cohort study

Introduction

Limited existing research on gender inequities suggests that for men workplace atmosphere shapes wellbeing while women are less susceptible to socioeconomic or work status but vulnerable to home inequities.

Methods

Using the 2007 Northern Swedish Cohort (n = 773) we identified relative contributions of perceived gender inequities in relationships, financial strain, and education to self-reported health to determine whether controlling for sex, examining interactions between sex and other social variables, or sex-disaggregating data yielded most information about sex differences.

Results and Discussion

Men had lower education but also less financial strain, and experienced less gender inequity. Overall, low education and financial strain detracted from health. However, sex-disaggregated data showed this to be true for women, whereas for men only gender inequity at home affected health. In the relatively egalitarian Swedish environment where women more readily enter all work arenas and men often provide parenting, traditional primacy of the home environment (for women) and the work environment (for men) in shaping health is reversing such that perceived domestic gender inequity has a significant health impact on men, while for women only education and financial strain are contributory. These outcomes were identified only when data were sex-disaggregated.

The relationship between a less gender-stereotypical parenthood and alcohol-related care and death: a registry study of Swedish mothers and fathers

BACKGROUND

In general men tend to drink more alcohol and experience more alcohol-related sickness, injuries and mortality than women. In this paper, the overall hypothesis was that increased gender similarity in the division of parental duties would lead to convergence in alcohol-related harm. The aim was to analyse whether the risk of alcohol harm differs between parents who fit a gender-stereotypical versus those with a less gender-stereotypical division of childcare and paid work.

METHODS

The study sample was a retrospective registry-based cohort study of all Swedish couples who had their first child together in 1978 (N = 49,120). A less gender-stereotypical parenthood was indicated by paternity leave for fathers (1978-1979) and full-time work for mothers (1980). The outcome was inpatient care and/or death caused by alcohol psychosis, alcoholism, liver disease, or alcohol intoxication in the two decades following (1981-2001). Our main statistical method was multivariate logistic regression with odds ratios used to estimate relative risks.

RESULTS

The main results show that fathers who took paternity leave had 18% lower risk of alcohol-related care and/or death than other fathers. Mothers who worked full-time about two years after having a child had 71% higher risk than mothers who were unemployed or worked part-time.

CONCLUSION

A less gender-stereotypical division of duties between parents in early parenthood may contribute to a long-term decreased gender disparity regarding risky alcohol consumption and alcohol-related harm. In order to know more about the causal direction however, future research has to consider subjects' drinking patterns in the years prior to parenthood.

Does increased gender equality lead to a convergence of health outcomes for men and women? A study of Swedish municipalities

This study examines associations between indicators of gender equality and public health. We compare Swedish municipalities on nine indicators in both the private and public sphere, and an additive index, and study the correlations with indicators of morbidity and mortality. The hypothesis that a higher level of gender equality is associated with a convergence of health outcomes (life expectancy, sickness absence) between men and women was supported for equality of part-time employment, managerial positions and economic resources for morbidity, and for temporary parental leave for mortality. Our main finding is that gender equality was generally correlated with poorer health for both men and women. Our conclusions are tentative due to the methodological uncertainties. However, the results suggest an unfortunate trade-off between gender equality as we know it and public health. Sweden may have reached a critical point where further one-sided expansion by women into traditionally male roles, spheres and activities will not lead to positive health effects unless men also significantly alter their behaviour. Negative effects of this unfinished equality might be found both for women, who have become more burdened, and men, who as a group have lost many of their old privileges. We propose that this contention be confronted and discussed by policymakers, researchers and others. Further studies are also needed to corroborate or dispute these findings.