562598
research-article2014
SJP0010.1177/1403494814562598Gender inequality and women’s healthF. Eek and A. Axmon
Scandinavian Journal of Public Health, 2015; 43: 176–182
Original Article
Gender inequality at home is associated with poorer health for women
Frida Eek1 & Anna Axmon2 1Department
of Health Sciences, Lund University, Lund, Sweden, and 2Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
Abstract Background: As more women have joined the work force, the difference in employment rate between men and women has decreased, in Sweden as well as many other countries. Despite this, traditional gender patterns regarding, for example, responsibility for household duties still remain. Women are on sick leave more often than men, and previous studies have indicated that an unequal split of household responsibilities and perceived gender inequality could be associated with negative health outcomes. Aims: The aim of the present study was to explore whether an unequal distribution of responsibilities in the home was related to various health related outcomes among women. Methods: A sample consisting of 837 women living in a relationship, and working at least 50% of full time, responded to a questionnaire including information about division of responsibilities at home as well as various psychological and physiological health related outcomes. Results: The results showed that women living in relationships with perceived more unequal distribution of responsibility for house hold duties showed significantly higher levels of perceived stress, fatigue, physical/psychosomatic symptoms, and work family conflict compared with women living in more equal relationships. They also had significantly increased odds for insufficient time for various forms of recovery, which may further contribute to an increased risk of poor health. Conclusions: Although an increasing employment rate among women is valuable for both society and individuals, it is important to work towards greater gender equality at home to maintain this development without it having a negative effect on women’s health and well-being. Key Words: Equality, gender, work–family conflict, inequality
Introduction Over the last decades, an increasing number of women, in many parts of the world, have joined the work force. Today, the majority of Swedish parents, mothers and fathers, are working. The employment rate among Swedish women (16–64 years) has increased from 68% in 1976 to 72% in 2004. The difference in employment rate between men and women has, during the same period, decreased from a 20% to 3% lower employment rate among women [1]. In 2010, Sweden was one of the countries in EU with the highest employment rate among women aged 20–64 years [2]. Swedish parents were employed to an even higher extent; in 2008, 83% of all children aged 0–17 years had an employed mother and 93% had an employed father [3].
Women are on sick leave more often than men [4]. Higher sick leave among women is not only found in Sweden, but also in many other European countries [5]. In Sweden, among employees in the private sector, psychological/psychiatric diagnoses are the most common reason for a long (3 years. Subjective stress and well-being Subjective global stress was measured with the Perceived Stress Scale (PSS) [20]. PSS contains 14 questions regarding the experience of different aspects of global stress during the last month. Each question is rated from ‘never’ (0) to ‘very often’ (4). The mean score of the 14 items was used in the analyses, hence a possible score range from 0 to 4. Physical/psychosomatic symptoms were measured by the Lund Subjective Health Complaints (LSHC), which is rather similar to the UHI/SHC scale [17]. The LSHC is an inventory assessing the intensity of 13 common health complaints experienced during the last 30 days. These include headache, dizziness, forgetfulness, back pain, neck–shoulder pain and stomach pain. For each health complaint, the parent was to indicate the frequency during the preceding month, from ‘never’ (1) to ‘always (almost every day)’ (5). In the present study, a global measure representing the mean score of all items was used (possible score range 0–5). General physical and mental self-rated health was measured by SRH-7, a single item asking about the subjective perception of current physical and mental well-being, measured from ‘very bad, could not feel any worse’ (1) to ‘very good, could not feel any better’ (7) [21]). Work-related fatigue was assessed by the Swedish Occupational Fatigue Inventory, SOFI-20 [22,23]. SOFI-20 measures work-related fatigue from a multi-dimensional perspective including five different dimensions of fatigue: lack of energy, lack of motivation, physical exertion, physical discomfort and sleepiness. Each item was assessed for the end of a typical workday and rated from ‘not at all’ (0) to ‘to a very high extent’ (6). In the present study, a global measure of the mean score of the 20 items was used. Satisfaction with general life- and work situation was measured by two single questions, asking ‘How satisfied are you, in total, with your work situation?’ and ‘How satisfied are you, in general, with your private life situation (family/leisure time)?’ with seven response alternatives from ‘Very dissatisfied’ (1) to ‘very satisfied’ (7).
measuring work engagement, including the three subscales Vigour, Dedication and Absorption. The mean score of each subscale was analysed in the present study, resulting in three subscale scores with a total score that ranged between 0 and 6. QPS Nordic-36 is the short version (36 items) of the QPS Nordic [24]. This instrument has been developed in Sweden, Denmark, Finland and Norway. It contains a wide variety of dimensions such as work-related demands and control, role expectations, social interaction, leadership, group work and organizational climate. We used the mean scores of the 4 workrelated demands and six control items, as well as the one stress item ‘Have you felt stressed lately?’ (response range from 1, not at all, to 5, very much) variable as measures of different aspects of workrelated stress as dependent variables in our analyses. Work–family conflict We used an eight-item inventory covering both time- and strain-based conflict between work and family. Two different dimensions of work–family interference were measured: work-to-family conflict (WFC), that is spill-over effects from work on family life, and family-to-work conflict (FWC), that is spill-over from effects from family obligation and demands on working life, with four items for each dimension [26]. Response alternatives ranged from ‘do not at all agree’ (1) to ‘agree completely’ (5). The mean score of the four items for each dimension was used in the present study, resulting in two subscores with a possible score range from 1 to 5. Recovery and leisure activities The questionnaire also included a study-specific questionnaire regarding the experience of time for different recovery and leisure activities. The questions asked about whether the respondents experienced having sufficient time for physical exercise, social intercourse with partner, children, relatives, friends, hobbies and relaxation. The response alternatives were ‘yes’ (0), ‘partly but I desire more’ (1), ‘no, far from enough’ (2) and ‘not interested in this’ (3). These variables were dichotomized into enough time for the activity (response alternative 0) versus insufficient time for it (response alternative 1 and 2). Statistical analysis
Work stress and engagement Work stress was measured with the General Nordic Questionnaire for Psychological and Social Factors at Work (QPS Nordic)-36 [24] and work engagement was assessed using the Utrecht Work Engagement Scale (UWES) [25]. UWES is a 17-item instrument
The statistical analyses aimed to explore possible differences between women experiencing unequal or equal distribution of household duties in their relationship (independent variable), regarding subjective measures of stress and well-being, work engagement, work–family conflict and insufficient
Gender inequality and women’s health 179 Table I. Descriptives of participants. All
Equal
Unequal
N=837
N=553
N=284
Age (mean/SD) Education % (n) (n=822) ≤9 years 10–11 years 12–13 years University;
research-article2014
SJP0010.1177/1403494814562598Gender inequality and women’s healthF. Eek and A. Axmon
Scandinavian Journal of Public Health, 2015; 43: 176–182
Original Article
Gender inequality at home is associated with poorer health for women
Frida Eek1 & Anna Axmon2 1Department
of Health Sciences, Lund University, Lund, Sweden, and 2Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
Abstract Background: As more women have joined the work force, the difference in employment rate between men and women has decreased, in Sweden as well as many other countries. Despite this, traditional gender patterns regarding, for example, responsibility for household duties still remain. Women are on sick leave more often than men, and previous studies have indicated that an unequal split of household responsibilities and perceived gender inequality could be associated with negative health outcomes. Aims: The aim of the present study was to explore whether an unequal distribution of responsibilities in the home was related to various health related outcomes among women. Methods: A sample consisting of 837 women living in a relationship, and working at least 50% of full time, responded to a questionnaire including information about division of responsibilities at home as well as various psychological and physiological health related outcomes. Results: The results showed that women living in relationships with perceived more unequal distribution of responsibility for house hold duties showed significantly higher levels of perceived stress, fatigue, physical/psychosomatic symptoms, and work family conflict compared with women living in more equal relationships. They also had significantly increased odds for insufficient time for various forms of recovery, which may further contribute to an increased risk of poor health. Conclusions: Although an increasing employment rate among women is valuable for both society and individuals, it is important to work towards greater gender equality at home to maintain this development without it having a negative effect on women’s health and well-being. Key Words: Equality, gender, work–family conflict, inequality
Introduction Over the last decades, an increasing number of women, in many parts of the world, have joined the work force. Today, the majority of Swedish parents, mothers and fathers, are working. The employment rate among Swedish women (16–64 years) has increased from 68% in 1976 to 72% in 2004. The difference in employment rate between men and women has, during the same period, decreased from a 20% to 3% lower employment rate among women [1]. In 2010, Sweden was one of the countries in EU with the highest employment rate among women aged 20–64 years [2]. Swedish parents were employed to an even higher extent; in 2008, 83% of all children aged 0–17 years had an employed mother and 93% had an employed father [3].
Women are on sick leave more often than men [4]. Higher sick leave among women is not only found in Sweden, but also in many other European countries [5]. In Sweden, among employees in the private sector, psychological/psychiatric diagnoses are the most common reason for a long (3 years. Subjective stress and well-being Subjective global stress was measured with the Perceived Stress Scale (PSS) [20]. PSS contains 14 questions regarding the experience of different aspects of global stress during the last month. Each question is rated from ‘never’ (0) to ‘very often’ (4). The mean score of the 14 items was used in the analyses, hence a possible score range from 0 to 4. Physical/psychosomatic symptoms were measured by the Lund Subjective Health Complaints (LSHC), which is rather similar to the UHI/SHC scale [17]. The LSHC is an inventory assessing the intensity of 13 common health complaints experienced during the last 30 days. These include headache, dizziness, forgetfulness, back pain, neck–shoulder pain and stomach pain. For each health complaint, the parent was to indicate the frequency during the preceding month, from ‘never’ (1) to ‘always (almost every day)’ (5). In the present study, a global measure representing the mean score of all items was used (possible score range 0–5). General physical and mental self-rated health was measured by SRH-7, a single item asking about the subjective perception of current physical and mental well-being, measured from ‘very bad, could not feel any worse’ (1) to ‘very good, could not feel any better’ (7) [21]). Work-related fatigue was assessed by the Swedish Occupational Fatigue Inventory, SOFI-20 [22,23]. SOFI-20 measures work-related fatigue from a multi-dimensional perspective including five different dimensions of fatigue: lack of energy, lack of motivation, physical exertion, physical discomfort and sleepiness. Each item was assessed for the end of a typical workday and rated from ‘not at all’ (0) to ‘to a very high extent’ (6). In the present study, a global measure of the mean score of the 20 items was used. Satisfaction with general life- and work situation was measured by two single questions, asking ‘How satisfied are you, in total, with your work situation?’ and ‘How satisfied are you, in general, with your private life situation (family/leisure time)?’ with seven response alternatives from ‘Very dissatisfied’ (1) to ‘very satisfied’ (7).
measuring work engagement, including the three subscales Vigour, Dedication and Absorption. The mean score of each subscale was analysed in the present study, resulting in three subscale scores with a total score that ranged between 0 and 6. QPS Nordic-36 is the short version (36 items) of the QPS Nordic [24]. This instrument has been developed in Sweden, Denmark, Finland and Norway. It contains a wide variety of dimensions such as work-related demands and control, role expectations, social interaction, leadership, group work and organizational climate. We used the mean scores of the 4 workrelated demands and six control items, as well as the one stress item ‘Have you felt stressed lately?’ (response range from 1, not at all, to 5, very much) variable as measures of different aspects of workrelated stress as dependent variables in our analyses. Work–family conflict We used an eight-item inventory covering both time- and strain-based conflict between work and family. Two different dimensions of work–family interference were measured: work-to-family conflict (WFC), that is spill-over effects from work on family life, and family-to-work conflict (FWC), that is spill-over from effects from family obligation and demands on working life, with four items for each dimension [26]. Response alternatives ranged from ‘do not at all agree’ (1) to ‘agree completely’ (5). The mean score of the four items for each dimension was used in the present study, resulting in two subscores with a possible score range from 1 to 5. Recovery and leisure activities The questionnaire also included a study-specific questionnaire regarding the experience of time for different recovery and leisure activities. The questions asked about whether the respondents experienced having sufficient time for physical exercise, social intercourse with partner, children, relatives, friends, hobbies and relaxation. The response alternatives were ‘yes’ (0), ‘partly but I desire more’ (1), ‘no, far from enough’ (2) and ‘not interested in this’ (3). These variables were dichotomized into enough time for the activity (response alternative 0) versus insufficient time for it (response alternative 1 and 2). Statistical analysis
Work stress and engagement Work stress was measured with the General Nordic Questionnaire for Psychological and Social Factors at Work (QPS Nordic)-36 [24] and work engagement was assessed using the Utrecht Work Engagement Scale (UWES) [25]. UWES is a 17-item instrument
The statistical analyses aimed to explore possible differences between women experiencing unequal or equal distribution of household duties in their relationship (independent variable), regarding subjective measures of stress and well-being, work engagement, work–family conflict and insufficient
Gender inequality and women’s health 179 Table I. Descriptives of participants. All
Equal
Unequal
N=837
N=553
N=284
Age (mean/SD) Education % (n) (n=822) ≤9 years 10–11 years 12–13 years University;
