Iyer Aditi, Sen Gita, George Asha
Indian Institute of Management Bangalore, Bangalore, India.
Int J Health Serv. 2007;37(3):537-54. doi: 10.2190/1146-7828-5L5H-7757.
In the early 1990s, India embarked upon a course of health sector reform, the impact of which on an already unequal society is now becoming more apparent. This study sought to deepen understanding of equity effects by exploring gender and class dynamics vis-à-vis basic access to health care for self-reported long-term ailments. The authors drew on the results of a cross-sectional household survey in a poor agrarian region of south India to test whether gender bias in treatment-seeking is class-neutral and whether class bias is gender-neutral. They found evidence of "pure gender bias" in non-treatment operating against both non-poor and poor women, and evidence of "rationing bias" in discontinued treatment operating against poor women overall, but with some differences between the poor and poorest households. In poor households, men insulated themselves and passed the entire burden of rationing onto women; but among the poorest, men, like women, were forced to curtail treatment. There were economic class differences in continued, discontinued, and no treatment, but class was a gendered phenomenon operating through women, not men.
20世纪90年代初，印度开始了卫生部门改革进程，其对一个已然不平等的社会所产生的影响如今正变得愈发明显。本研究旨在通过探讨性别与阶层动态关系，以加深对公平效应的理解，具体针对自我报告的长期疾病的基本医疗保健获取情况。作者利用印度南部一个贫困农业地区的横断面家庭调查结果，来检验寻求治疗过程中的性别偏见是否与阶层无关，以及阶层偏见是否与性别无关。他们发现存在针对非贫困和贫困女性的“纯性别偏见”，即不进行治疗；还发现针对贫困女性总体存在“配给偏见”，即中断治疗，但贫困家庭与最贫困家庭之间存在一些差异。在贫困家庭中，男性使自己免受影响，将配给的全部负担转嫁到女性身上；但在最贫困家庭中，男性和女性一样，都被迫减少治疗。在持续治疗、中断治疗和不治疗方面存在经济阶层差异，但阶层是一种通过女性而非男性起作用的性别化现象。
