Debt, shame, and survival: becoming and living as widows in rural Kerala, India
Tóm tắt
The health and well-being of widows in India is an important but neglected issue of public health and women’s rights. We investigate the lives of Indian women as they become widows, focussing on the causes of their husband’s mortality and the ensuing consequences of these causes on their own lives and identify the opportunities and challenges that widows face in living healthy and fulfilling lives. Data were collected in a Gram Panchayat (lowest level territorial decentralised unit) in the south Indian state of Kerala. Interviews were undertaken with key informants in order to gain an understanding of local constructions of ‘widowhood’ and the welfare and social opportunities for widows. Then we conducted semi-structured interviews with widows in the community on issues related to health and vulnerability, enabling us to hear perspectives from widows. Data were analysed for thematic content and emerging patterns. We synthesized our findings with theoretical understandings of vulnerability and Amartya Sen’s entitlements theory to develop a conceptual framework. Two salient findings of the study are: first, becoming a widow can be viewed as a type of ‘shock’ that operates similarly to other ‘economic shocks’ or ‘health shocks’ in poor countries except that the burden falls disproportionately on women. Second, widowhood is not a static phenomenon, but rather can be viewed as a multi-phased process with different public health implications at each stage. More research on widows in India and other countries will help to both elucidate the challenges faced by widows and encourage potential solutions. The framework developed in this paper could be used to guide future research on widows.
Tài liệu tham khảo
Chen M: Perpetual mourning: Widowhood in Rural India. 2000, Oxford: Oxford University Press
United Nations: Widowhood: Invisible Women, Secluded or Excluded. 2001, New York: United Nations Division for the Advancement of Women
Mohindra KS: Women’s Health and Poverty Alleviation in India. 2009, New Delhi: Academic Foundation
Mohindra KS, Nikiema B: Women’s health in developing countries: can we move beyond instrumentalism?. Int J Health Serv. 2010, 40: 543-567. 10.2190/HS.40.3.i.
Agarwal B: Widows versus daughters of widows as daughters? Property, land and economic security in rural India. Widows in India: Social Neglect and Public Action. Edited by: Chen M. 1998, New Delhi: Sage Publication, 124-169.
Drèze J, Sen A: India: Development and Participation. 2002, New Delhi: Oxford University Press
Drèze J, Srinivasan PV: Widowhood and poverty in rural India: some inferences from household survey data. J. Devel. Econ. 1997, 54: 217-234. 10.1016/S0304-3878(97)00041-2.
Bhatt PNM: Widowhood and mortality in India. Widows in India: Social Neglect and Public Action. Edited by: Chen M. 1998, New Delhi: Sage Publication, 174-188.
Gulati L: Dimensions of female aging and widowhood: Insights from Kerala Experience. Econ Pol Wkly. 1992, October 24–31: 93-99.
Government of India: National Human Development Report, 2001. 2002, New Delhi: Planning Commission
Eapen M, Kodoth P: Family structure, women’s education and work: re-examining the ‘high status’ of women in Kerala. Tracking Gender Equity under the Economic Reforms. Edited by: Mukhopadyay S, Surdarshan R. 2003, New Delhi: Kali for Women
Agarwal B, Panda P: Toward Freedom from Domestic Violence: The Neglected Obvious. J Human Devel. 2007, 8: 359-388. 10.1080/14649880701462171.
Irudaya Rajan S: Population Ageing and Health in India. 2006, Mumbai: CEHAT
Mohindra KS, Haddad S, Narayana D: Women’s health in a rural community in Kerala, India: do caste and socioeconomic position matter?. J Epidemiol Community Health. 2006, 60: 1020-1026. 10.1136/jech.2006.047647.
Mohindra KS, Narayana D, Haddad S: My story is like a goat tied to a hook.” Views from a marginalised tribal group in Kerala (India) on the consequences of falling ill: A Participatory Poverty and Health Assessment. J Epidemiol Community Health. 2010, 64: 488-494. 10.1136/jech.2008.086249.
Government of India: Economic Review 2000. 2000, New Delhi: Ministry of Finance
Government of India: Economic Review 2002/3. 2003, New Delhi: Ministry of Finance
Sen A: Poverty and Famines: An Essay on Entitlement and Deprivation. 1981, Oxford: Oxford University Press
Galea S, Ahern J, Karpati A: A model of underlying socioeconomic vulnerability in human populations: evidence from variability in population health and implications for public health. Soc Sci Med. 2005, 60: 2417-2430. 10.1016/j.socscimed.2004.11.028.
Naudé W, Santos-Paulino A, McGillivray M: Measuring vulnerability: an overview and introduction. Oxford Devel. Stud. 2009, 37: 183-191. 10.1080/13600810903085792.
Alwang J, Siegel P, Jørgensen S: Vulnerability: A View From Different Disciplines. Social Protection Discussion Paper Series. 2001, Washington DC: World Bank
Bates I, Fenton C, Gruber J, Lallo D, Medina L, Squire S, Theobald S, Thomson R, Tolhurst R: Vulnerability to malaria, tuberculosis, and HIV/AIDS infection and disease. Part I: determinants operating at individual and household level. Lancet Infect Dis. 2004, 4: 267-277. 10.1016/S1473-3099(04)01002-3.
Kottow M: The vulnerable and the susceptible. Bioethics. 2002, 17: 460-471.
Wagstaff A: The economic consequences of health shocks: Evidence from Vietnam. J Health Econ. 2006, 26: 82-100.
Abegunde D, Stanciole E: The economic impact of chronic diseases: how do households respond to shocks? Evidence from Russia. Soc Sci Med. 2008, 66: 2296-2307. 10.1016/j.socscimed.2008.01.041.
Kabir A, Rahman A, Salway S, Pryer J: Sickness among the urban poor: a barrier to livelihood security. J Int Devel. 2000, 12: 707-722. 10.1002/1099-1328(200007)12:5<707::AID-JID703>3.0.CO;2-G.
Ellsberg M, Heise L: Bearing witness: ethics in domestic violence research. Lancet. 2002, 359: 1599-1604. 10.1016/S0140-6736(02)08521-5.
Berg J, Kremelberg D, Dwivedi P, Verma S, Schensul J, Gupta K, Chandran D, Singh SK: The effects of husband’s alcohol consumption on married women in three low-income areas of greater Mumbai. AIDS Behav. 2010, 14: S126-S135. 10.1007/s10461-010-9735-7.
Devine A, Kermode M, Chandra P, Herrman H: A participatory intervention to improve the mental health of widows of injecting drug users in north-east India as a strategy for HIV prevention. BMC Int Health Hum Rights. 2007, 7: 3-10.1186/1472-698X-7-3.
Bank W: World Development Report: Gender Inequality and Development. 2012, Washington: World Bank
Kabeer N: ‘Can buy me love?’ Re-evaluating the empowerment potential of loans to poor women in rural Bangladesh IDS Discussion paper No 363. 1998, Brighton: Institute of Development Studies
Agarwal B: A Field of One’s Own: Gender and Land Rights in South Asia. 1994, Cambridge: Cambridge University Press
Chen M, Drèze J: Widows and health in rural North India. Economic and Political Weekly. 1992, October 24–31: WS-81-WS-92.
Sen A: Inequality Re-examined. 1992, Oxford: Oxford University Press
Stroebe M, Schut H, Stroebe W: Health outcomes of bereavement. Lancet. 2007, 370: 1960-1973. 10.1016/S0140-6736(07)61816-9.
Vlassof C: The value of sons in an Indian village: how widows see it. Popul Stud. 1990, 44: 5-20. 10.1080/0032472031000144356.
Dutta PV: The Performance of Social Pensions in India: The Case of Rajasthan. SP Discussion Paper No. 0834. 2008, New Delhi: The World Bank
Chen M: Widows in India: Social Neglect and Public Action. 1998, New Delhi: Sage Publication
Prasad KV: Social security for destitute widows in Tamil Nadu. Econ Pol Wkly. 1995, April 15: 794-796.
Iyer A, Sen G, George A: The dynamics of gender and class in access to health care: evidence from rural Karnataka, India. Int J Health Serv. 2007, 37: 537-554. 10.2190/1146-7828-5L5H-7757.
Smith S: Microcredit and health programs: to integrate or not to integrate? An economist’s perspective. Microenterprise Development for Better Health Outcomes. Edited by: Rodriguez-Garcia R, Macinko M, Waters W. 2001, Connecticut: Greenwood Press
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