¿Somos iguales? Using a structural violence framework to understand gender and health inequities from an intersectional perspective in the Peruvian Amazon

Abstract

Background: In the Peruvian Amazon, historical events of colonization and political marginalization intersect with identities of ethnicity, class and geography in the construction of gender and health inequities. Gender-based inequalities can manifest in poor health outcomes via discriminatory practices, healthcare system imbalances, inequities in health research, and differential exposures and vulnerabilities to diseases. Structural violence is a comprehensive framework to explain the mechanisms by which social forces such as poverty, racism and gender inequity become embodied as individual experiences and health outcomes, and thus may be a useful tool in structuring an intersectional analysis of gender and health inequities in Amazonian Peru. Objective: The aim of this paper is to explore the intersection of gender inequities with other social inequalities in the production of health and disease in Peru’s Amazon using a structural violence approach. Design: Exploratory qualitative research was performed in two Loreto settings – urban Iquitos and the rural Lower Napo River region – between March and November 2015. This included participant observation with prolonged stays in the community, 46 semi-structured individual interviews and three group discussions. Thematic analysis was performed to identify emerging themes related to gender inequalities in health and healthcare and how these intersect with layered social disadvantages in the reproduction of health and illness. We employed a structural violence approach to construct an intersectional analysis of gender and health inequities in Amazonian Peru. Results: Our findings were arranged into five interrelated domains within a gender, structural violence and health model: gender as a symbolic institution, systemic gender-based violence, interpersonal violence, the social determinants of health, and other health outcomes. Each domain represents one aspect of the complex associations between gender, gender inequity and health. Through this model, we were able to explore: gender, health and intersectionality; structural violence; and to highlight particular local gender and health dynamics. Intersecting influences of poverty, ethnicity, geography and gender served as significant barriers to healthcare in both rural and urban settings.

Gender equality in science, medicine, and global health: where are we at and why does it matter?

“…4 Gender discrimination at any of these levels detrimentally affects health and social outcomes. 4,5 For example, interpersonal violence, including violence against women, is influenced by harmful gender norms and broader systems of oppression; 6,7 confronting these gendered structures is relevant to all people. More insidiously, gender inequalities contribute to increased levels of stress and anxiety: among women through their socially prescribed role as caregivers, 8 among men through their socially prescribed role as breadwinners, 9 and among transgender people, in whom nonconformity to gender norms is often socially penalised.…”

Sociodemographic and health situation of teenage students according to sex

“…An exploratory analysis was initially conducted to evaluate the variables' frequency distribution, with the purpose of characterizing the sample according to gender. To identify the association between the dependent and independent variables, Pearson's Chi-square Test (2) was used. Student's t-test was used to analyze the variables related to social and health issues.…”

“…It is worth noting that urban violence, inserted in structural violence, is related to social inequities, affecting especially socioeconomically disadvantaged individuals, as shown by studies conducted in Peru, the United States and the Soviet Union (2)(3) . The implications of this kind of violence for teenagers are revealed by the difference between homicide rates in the general population (20/100 thousand) and among those aged between 15 and 19 years old (43.2/100 thousand) (1) .…”

“…This difference between the sexes is not limited to the sphere of violence and other social issues. It has also been associated with other variables, such as those related to health (2,4,7) . To investigate these differences, it is important to question: what is the association between the sex of teenage students and their sociodemographic, sexual and reproductive variables, as well as social and health issues?…”

Intersections between gender and other relevant social determinants of health inequalities

“…Especially interesting examples of papers that take an intra-categorical perspective are Logié’s paper exploring the experiences of violence among internally displaced youth in Haiti [15]; and Shannon et al’s analysis of gender, violence and health in the Amazon of Peru [16]. The first, because it focuses on a category of oppression that has not yet received much attention: displacement.…”