China’s One Child Policy

Warning: talks about abortion, human trafficking and forced sterilisation

China’s one child policy was in place between 1979 and 2015 and, as the name suggests, it was about limiting families to having one child.  There were exceptions, for example ethnic minorities were not subject to the policy and in the 1980s, a change meant that rural families could have a second child if their first was a girl.  If both parents were only children, then they themselves could have two children.  At some point, it was also possible to apply for permission for a second child if the first had a disability. 

In 2013, there was a partial relaxation that meant if one parent was an only child, the couple could have two children.

In 2015, China announced that every family now had the right to 2 children.

“The policy has in one way or another affected the life of every single person in China – which is every fifth person on the planet.”
– Mari Manninen

It is likely one of the most extreme and controversial birth control policy that humanity has seen. 

So why did it come into being?

Controlling population growth was thought to be the key to increasing economic prosperity and standard of living.  In 1957, Mao Zedong said:

“Our country has so many people, which no country in the world can compare with.  It would be better to have fewer births.  (Re)production needs to be planned.  In my view, humankind is completely incapable of managing itself.”

By the mid 1960s, China had developed its own version of the contraceptive pill and had “expanded the national distribution and propaganda network devoted to promoting birth control” (Whyte, Feng & Cai).

Across the globe, during the 1960s and 1970s, there was concern about population increases and by the late 70s, China’s population was approaching one billion.  To tackle this, in the 1970s, a campaign was established to reduce the population and it had the slogan ‘later, longer, fewer’; get married later, wait longer between children and have fewer children.  This campaign came with heavy coercion and enforcement and in the 70s the average number of children per family dropped from almost six to under three.  By 1979 the one child policy was officially introduced.

Before we look at how the policy was enforced, I think we need to consider gender. 

UN statistics say that China has over 60 million missing girls, girls who should have been born or shouldn’t have died as children.  Research carried out in rural China in 2000 showed that if a family had a boy and was pregnant again, 40% had an ultrasound the second time round.  If the first child had been a girl, that leapt to 70%.  However, this leaning towards boys precedes the one child policy; killing baby girls wasn’t uncommon in the 1930s and 40s but had since decreased, until the 1980s.

There is a myth that Chinese parents only wanted boys but it’s not so clear cut and it’s important to take into account cultural expectations for each gender.  Men are the ones who would be expected to support their aging parents and alongside the introduction of the one-child policy, what little health care and elder services there were for farmers, were slashed, making it even more important to have a boy.  Further if you only have so much food, you had to prioritise which children would get it.  Think about children as an investment in your future.

This seems horrific and brutal but reflects the traditions of the culture – men would carry out the heavy work on the farm, they were the ones who’d earn money and help to secure the family, they were the ones who carried on the family line and it is the men who make the offerings for the ancestors. 

Families did still want girls but it seems to be as well as a boy, rather than instead of.

Of course, for any policy such as this to be successful, enforcement is crucial.  As we’ve already noted, methods predating the policy were strongly coercive and methods once the policy was implemented were no gentler.  They varied locally but were often intrusive and brutal.

Birth planning enforcers would keep detailed records about the women of child bearing age in their area.  This included any previous children, details of their menstrual cycle and their use of contraception.  In some places, pregnancy tests had to be taken regularly and exams were carried out to check they weren’t pregnant.  All of this meant that they could identify illegal pregnancies in the early stages.  These birth planning enforcers oversaw villages, neighbourhoods and were even found in work places. 

Each region had their own pregnancy quota, as did some factories, and women had to apply for permission.  Village quotas were stopped in the 2000s but potential parents still had to apply for permission before getting pregnant.  If you wanted to apply to have a second child – ie if your first child was a girl or was disabled – you had to wait until your first child was at least 4.  Today, with the two child policy, there is no need to wait and permission is no longer required.  However, it is required that parents register online or with the local family planning office when a pregnancy begins.

If you managed to avoid the stern eye of the birth planning enforcer and had a child without permission or outside the policy, you could expect to be fined.  If you didn’t pay the fine (and in some cases, even if you did), the child would not be given a hakou, an official household registration record.  Without it, you essentially don’t exist.  You can’t go to school, work, get healthcare, get married or even get on a train.

As the fines are an important source of income for local government, it is obviously in their interest to enforce them.  In 2012, fines for unpermitted children amounted to the equivalent of 3 billion euros.

It is hard to know how many unpermitted children exist, but one estimate puts it as high as 25 million.  That’s 25 million people who have no rights and no access to basic services.  And any children those unpermitted people have, will also have no rights.

Manninen quotes 18 year old Zedong in her book Secrets and Siblings:

“I felt like I had no worth.  Even dogs have papers, but I had nothing.  Everyone looks down on me… It’s not my fault I don’t have hukou… Even foreigners were able to get official papers to live in China permanently while many Chinese couldn’t even get the basic hukou.”

As well as being fined, you would risk losing your job, having your home and property damaged, stolen or destroyed and in some cases you risk being illegally detained.

“Sometimes a family would lose their bicycle, or their radio.  They might have holes chopped in their roof.  Often the family pig would be confiscated.  In the worst cases, the disobedient family’s house would be razed to the ground.”
– Manninen

If you did get pregnant and it was discovered before birth, abortion was ‘encouraged’.  According to statistics, up to 13 million abortions are performed each year in China and the number will be higher if you take into account illegal abortions.  This works out at one abortion for every one hundred people in China.  Abortion is common in China and easy to get, further women are entitled to at least two weeks off work to have one. 

Regular harassment and pressure to get an abortion was not enough, and forced abortions could be carried out at any stage of pregnancy, with one woman reporting that she had been forced into one at 9 months.  The viability of the foetus was not relevant to the procedure.

This left millions of women facing the choice to have an abortion or face a fine and risk losing their job and more.  If a girl was born, they then faced another issue; should they let their child die so that they could have a boy?  Whilst it did occur, child abandonment became less common towards the end of the regime, with only seriously ill and disabled babies being left on the side of the road. 

As a disabled person this hits me hard, but in a world where you can only have one child, having a disabled child who isn’t going to be able to provide for you in your later years, has long term consequences.  As does the cost implication of meeting additional needs.  Further, in China it is often considered shameful to have a disabled child.

As well as abortion pressure, there was also pressure to be sterilised or to have an IUD inserted.  In rural areas, once you had one child, you were required to get an IUD and there would be 6 monthly checks to ensure it was still in place.  After a second child, one of the parents would be sterilized.

In rural areas, sterilisations were brutal.  They were often performed without anaesthesia, with women laid side by side on the ground and the operation performed right there. 

Inevitably, all of these practices have had a long lasting impact on the country as well as the individual people who’s lives have been touched by the policy.

There is a regularly touted statistic from the Chinese government that the policy prevented 400 million births, fuelled the economy and improved wellbeing.  The birth rate figure used here is based on overly simplistic assumptions.  Further, given that “at least 70 per cent of the decline in fertility from 1970 up to the present was achieved prior to the launching of the one-child policy” (Whyte, Feng & Cai) and coercive birth control enforcement was already in place before the policy, it seems unlikely that the policy had much effect. 

When it was introduced in 1979, the one child policy was “based on politics and pseudo-science, rather than necessity, much less on good demography.  China could have achieved further progress in lowering fertility with some version of a two-child policy, a choice that would have sharply reduced the human suffering caused after 1980” (Whyte, Feng & Cai).

As well as aiming to reduce population growth, the policy was implemented to improve the economy and the quality of life for the residents, however:

“[The] economic reforms may have lifted 500 million above the poverty line, but that still leaves nearly a quarter of its 185 million retirees living on less than a dollar a day.”
– Mei Fong

But there is an upside to the policy, those girls who were the only child were the beneficiaries of the family’s resources and some have thus had the opportunity to receive a higher level of education and support than they otherwise might have.  In 2010, a quarter of Chinese women in cities had a university degree, double the number in 1990.

“The death rate of women and children has also fallen, and their health has improved due to fewer births and fewer mouths to feed.”
– Manninen

Of course, nothing is so simple and the increased education and career opportunities for women has led to a higher number of single adults.  So called ‘leftover men’ are found in rural areas and are less well off and less educated whereas ‘leftover women’ live in cities and are well educated.  This creates a disparity – the men who are available for marriage are not likely to want the kind of women who are and vice versa.

Men, for example, are stereotypically looking for young, beautiful women who haven’t been married before and parents often echo, or push, this thinking.  For example, there are wedding markets where parents come to advertise their unmarried sons and daughters, sometimes without their knowledge.  The continuation of the family line is important and parents see it as their duty to find their child a wife or husband.

The term ‘leftover women’ has been coined to pressure women to marry young and to deter them from being career orientated but the reality is that there are more unmarried men than women.  According to the Chinese Academy of Social Sciences, by now China should have 30 million more men of marrying age than women.  That’s the same as half the entire UK population.

It is this gender disparity that has resulted in women from China and surrounding countries being trafficked and sold to be wives.  One study estimated that, in a four year period, about 21,000 women and girls from northern Myanmar were forced into marriage in one Chinese province alone.

As well as the impact on the children who were born under the policy, there is the effect that it has had on the older generation.  By 2050 it’s estimated that more than a quarter of the population will be over 65 and that poses the question, who will support them?  If they had one child, that child will have grown up to become an adult facing the burden of supporting their elders alone.

“…because of the one-child policy, each young Chinese faces supporting four grandparents, two parents–plus however many children they bear. Shanghai recently passed a law requiring children to visit parents in nursing homes. This oppressive, upside-down pyramid–known as “4-2-1” in China–is another reason Chinese are reluctant to add to their burden by having more kids.”
Time

And then there are the families who were unable to have a child, or whose child died.  People look down on childless couples and in some places they face discrimination, finding it hard to get into a retirement home or get a burial plot.  The concern is that without children, there won’t be enough money for continued payment or maintenance fees.  There is also no one to support them with other needs as they age.

As the Time quote suggested, there seems little appetite for having more than one child, even though the policy changed in 2015.  Although there was an increase in births initially, there hasn’t been much lasting change. 

The government is now trying other initiatives to raise the rate; some areas offer longer parental leave, financial support and in some areas it’s now harder to get a divorce or abortion.  Lowering the age for marriage and offering free or subsidised pregnancy care are other ways that China is attempting to increase the birth rate.

Whatever happens next, I suspect the burden will once again fall disproportionately on women, whether through forced marriages, through trafficking or through forced childbearing.

Resources:

Secrets and Siblings, Mari Manninen

Challenging Myths About China’s One-Child Policy, Martin King Whyte, Wang Feng and Yong Cai

Reinventing China’s Abortion Police, Lucy Ash

One Child Policy, Last Week Tonight

China’s Unmarried ‘Leftover’ Women, Vice Asia

One Child Policy, BBC

One from the archives… feminism

There’s a lot of posts on my blog now – I’ve been writing it for over seven years – and so I wanted to highlight a few old posts. I’m going to do this every so often I think.

Today we are dipping into feminism…

York Festival of Ideas

Over the last couple of weeks, I have been very busy!  It’s been the Festival of Ideas which is an amazing array of talks, lectures and workshops, the majority of which are free and accessible.  It’s my idea of heaven and came with a book stall…  What more could you want?!?!

There were many interesting topics and I thought an intriguing way to share my experience would be to share titbits from each lecture.

The Magic of Numbers
Children learn number words before they learn the concept and they learn the concept of numbers before the digital representations.  The step after that is comparing numbers but you can see that even just the initial process is quite complicated and I find it amazing that such young children are able to acquire the knowledge as quickly as they do.

Disposing of mass murderers
What happens when mass murderers die?  Should they be entitled to a funeral like everyone else?  Should their wishes be respected even if they violate the wishes of the victims families?  Are the remains of mass murderers toxic, and if so why, and who is toxic and who is not?

Whilst this talk did look at some specifics, the wider questions it raised were very interesting.

The Science of Sin
Why do we do the things we know we shouldn’t?  An interesting kick off example was that we don’t touch ovens because we get instantly burnt, we how many of us go without suncream and later pay the price?

On a smaller scale, each of the 7 sins aren’t that bad and can even be helpful, but anything taken to the extreme seems to turn out awfully… Take pride, it can be a healthy dose of self confidence, or it can be narcassism.  Envy can motivate you to raise yourself up, but can also lead you to tear someone else down.

Write what you wonder
Tackling the idea that you should write what you know, this workshop asked us to look at the world through a lens of wonder, of curiosity and of childlikeness.  Look at what is under the surface.  Be an explorer.  Be open.  Be uncertain.

Love Factually: The science of who, how and why we love
Laura Mucha turned to science in a quest to understand love it all it’s many forms, be it lust, romantic love or companionate love.  She unpicked the idea of love as an object – “the one” – and turned it into a skill that requires us to work at it.

The Gendered Brain?
The myth that there is a female brain was tossed out in this talk, in fact all brains are different and because they are plastic, they are always changing.  Our environment shapes our brains and our brains shape our environment.

Whilst there is no female brain, there are brains that have been moulded by society’s ideas of gender and what women are and aren’t good at.  If you give a girl a test and tell her that it’s ok if she doesn’t do well because girls are bad at the topic, then she will perform worse than if you hadn’t said anything.

This is important because society has scripts for gender and children seek to understand and perform these (on the whole).  They become aware of gender from birth to 2 years old, they detect gender and align themselves with their gender between 2 and 5 and from 5 to 15 they start to or continue to comply with this gender script.  With this in mind, it is so important that we start to unpick and break down the scripts and stereotypes and roles that permeate our society.

Nine Pints: The mysterious, miraculous world of blood
Blood is fascinating.  It is priceless.  And yet it is also disgusting.  Especially if it’s menstrual blood… If it’s blood being donated then it’s the gift of life.  If it comes from a vagina, then at best it tends to be considered dirty, at worst, toxic and contaminated.

Unseen, blood keeps you alive.  Seen, it signals a problem.

The Wonder of Trees
Trees teach us that everything is connected.  They teach us respect and cooperation.  They give and give and we take and take.  Not just the wood that makes their trunks, but the oxygen they give out, the food they provide, the medicines that they create.  And we take and we take.

We plant rows of trees, uniform, in plantations.  But these are not wild trees.  They will not talk to each other, care for each other and nurture each other like a wild forest.

In a naturally grown wood, the trees communicate, they share resources and they share warnings.  They give each other space to grow, they cross species boundaries and they sacrifice themselves for others.

Trees literally make us healthier.  The air around a tree is cleaner, as the tree absorbs pollutants.  Studies have shown that time around trees improves our attention span, our memory and makes us heal more quickly.

When you can, take the time to say hello to a tree, get to know it, and thank it.

Wilderness as a place

This is one of those posts that I sat down, wrote and barely edited because I really wanted to get it out there so forgive me any errors or untidy phrases.

Today Robert MacFarlane posted an open question on twitter:

“like many, I have long been fascinated by the complex relations of “mental health” and “nature”. Where, for you, is the most interesting current research & writing (from any time) to be found concerning this broad area?”

I too am fascinated by the relationships between mental health and nature as well as the added dimension of physical health which interplays with both mental health and nature.  I was excited to read the numerous replies but quickly found myself disappointed.  Repeatedly Miles Richardson was held up as a example of current research and writing and he is someone I follow on twitter and have read some of his research.  But beyond this there were numerous anecdotes which highlighted the privilege with which many people view and experience nature.  There was an unspoken assumption in many of the tweets that nature meant somewhere “out there”, away from humans, somewhere that could be described as wilderness.  By creating that distance we not only put ourselves outside of nature but we make it impossible for some people to engage with nature.

Immediately my mind goes to those of us who can’t walk and thus require carefully cultivated paths which inevitably regulate our experience.  Hidden and undiscovered or rarely used places are considered to be more natural than tarmacked or wooden decking paths.  This means I cannot truly experience nature in the eyes of those people but I know that this isn’t true.  I experience nature deeply in my own way, perhaps more so because of my disability and limitations. Other reasons people may not be able to get off the beaten track include where they live, finances, transport, lack of information and so on.

Another common narrative about nature and mental health is that of getting away from technology.  Now, if I am leaving my house I have to either be pushed by a carer or go in my electric wheelchair.  And I am aware that the people replying probably mean computers and phones when they deride technology but my wheelchair is technology and I cannot engage with anything outside without it.  Technology is not antithetical to nature.  Like everything in this world it’s about how we use it.  Technology can help us to identify bird calls or trees, put names to the flowers we’re seeing and in that sense can help to more deeply engage us with the nature we are experiencing.  Taking photos with cameras and phones can help us see more closely and help us to slow down.

A third thread is that of how easy and simple it is to go out in nature and how foolish we are if we don’t.  Again, an example from my own life.  If I have found somewhere suitable to go and be in nature, somewhere accessible, with parking so we can take my wheelchair and not worry about the battery dying.  Say all of those things are sorted and say then it rains.  Just a little rain, no big deal; the words of many people who think nature is easy.  We whip out my wheelchair waterproof, wrangle it over me and the chair and in doing so I’ve got wet.  Assuming no more water leaks in, which it always does, I will still get chilled and probably ill as a result.  The same is true in winter, even on dry days – being in a wheelchair, not moving, means you feel so much colder than those around you and for many people with physical health issues, this has greater consequences.

Beyond that single thread of tweets, this idea of wilderness being true nature is prevalent in society and it gives us permission to ignore the nature that permeates our city, the nature which is literally on our doorstep, or ramp in my case.  Doing this deprives us of experiences but also alters how we think about conservation – it is something out there, not something in our everyday lives.

Privileging wilderness is also insidious because it has traditionally meant that female nature writers have not been able to engage with nature writing, or at least have not been granted the same status as their male equivalents, by virtue of not being able to access those places deemed wild.  The male monopoly on nature writing was challenged in the second half of the 1800s by writers such as Mary Roberts and Anne Pratt who “wrote with humour and insight about native weeds” (The Oxford Book of Nature Writing).

“What sees the stranger in passing by? A small and insignificant looking weed, covering the top of an old wall, or springing from interstices where the mortar has fallen out between the stones.  What sees the botanist in this simple weed?  An object of great interest; formed especially for the place which it is designed to fill.”
– Mary Roberts, 1845

This close-looking at the immediate environment juxtaposed with the drive to exotic and unusual that had driven men up till this point.  Instead of great adventures in search of rare and wonderful orchids, women had to find something to meet their interest nearer to home.  When we look at this through the lens of place, we see the male wilderness and the female domestic environments reflected in their writings.  I suggest that it’s possible these female nature writers were more in tune with nature than the male explorers.  To know a place intimately and deeply gives you a stronger sense of connection than you get from passing through.

“If there’s one thing that underlies the work of many women nature writers, however, it’s a sense of interconnectedness, a dissolving of barriers between nature and culture, wild lands and home.”
Vivian Wagner, Creative Nonfiction, Issue 61 – Learning from Nature

Wilderness also, often, suggests vast plains of uninhabited lands filled with large, strong feature – perhaps a mountain range.  By virtue of having 65 million people living on a 242,495 km² island, there is not much of the UK that could be considered wilderness in the sense that Americans or Canadians experience.   But is that the only kind of wilderness? Wagner cites Annie Dillard as being a wilderness writer but notes that her wildernesses are small, consisting of a wood behind a suburban house, a neighbourhood creek and a field by a busy road.  Dillard has rejected the idea of nature being confined to raging rivers far removed from roads and hillscapes which have never seen telephone poles and has found what many feel as the spiritual power of nature in her own back yard.

“The birds and I share a natural history.  It is a matter of rootedness, of living inside a place for son long that the mind and imagination fuse.”
– Terry Tempest Williams

William’s here illustrates the power of intimacy and longevity. You can be part of a place, part of nature, part of the wild simply by being there and paying attention for a while.

“As with the work of many other women writers, Strayed’s wilderness is not separate and distinct from herself.  Rather, the larger world and Strayed herself are interwoven and connected, one shaping the other.”
– Wagner

The interesting paradox of Cheryl Strayed’s Wild, is that the wilderness she escaped to and wrote about is now marketed as a route which you can recreate and experience through her experiences rather than a landscape with which you can create your own connections.

Despite everything I’ve just said about women finding alternatives to traditional wilderness, I am not saying that women do not write of the “true wilderness” but instead that historically, by focusing on local nature, women were able to break into the field of nature writing in a way that perhaps they couldn’t have otherwise.

“Ornithology and botany within the confines of home and neighborhood were considered to be fitting pursuits for woman, but solitary back-country living … and wilderness exploration … were most emphatically not.”
– Lorraine Anderson on Victorian society

I’d like to leave you with an image.

I am laying in bed, incredibly ill.  Every time I move I am violently sick.  But my bedroom window is open and through the net curtains I can hear a blackbird singing.  When I last made it into my kitchen, I saw a female blackbird repeatedly gathering nesting materials and flying up to a vent in a wall.  I do not know, but I like to think, that this is the male who was with her.

A wood pigeon coos the repetitive ‘coo coooo coo cu cu’ and I am reminded of the two, with their soft grey jackets and peach breasts, that perch on my fence, day after day.  Occasionally interacting, often just coexisting quietly like an old couple in companionable silence sitting on a bench in the sun.

I cannot leave my bed, I can barely sit up to look out the window, but I am nature and I am with nature.

Women and water

Water is not a gender neutral resource.  We’ve already seen that it’s often considered to be feminine when looking through a symbolic lens but if we look to how water is seen through a gendered lens, we see that it reflects and reinforces inequality.

In terms of daily interaction with water and management of water, the experiences of men and women are very different.  This is more so in less developed countries where water is interacted with more directly than in more developed countries, where you turn on a tap and don’t need to think about it.

Talking about The Rising Tide, a report from 2017 looking at gender and water, Caren Grown from the World Bank said:

“(The report shows us that) water is an arena where gender relations play out in ways that often mirror inequalities between the sexes. And it examines how norms and practices related to water often exacerbate ingrained gender and other hierarchies.”

In parts of the world where water is not available on tap, the day to day collection of water falls predominantly to women and so does the use of water.  For example, it is used in cooking, cleaning, washing clothes and washing children.  The many ways women use water throughout their lives is expressed in detail in Table 3.3 in The Rising Tide, page 30.  This table goes through the stages of live from prenatal through to the elderly phase of women’s life and considers changing needs.   For example, there is increased neonatal mortality in water stressed areas and the decreased likelihood of the baby being washed means they have increased susceptibility to diseases with lifelong implications.  As well as the direct health impacts of drinking unclean water during pregnancy, women in some parts of the world are putting their bodies under immense strain as the collect water whilst carrying a child.  This leads to other health issues such as back problems.

For men, the main use for domestic water is personal hygiene so inevitably, they have different perspectives.  This is important because when it comes to water management on a larger scale, it is often a male dominated world.  It is men who typically make up the employees at water companies, or at least in the technical side of the business.  Men are making decisions about water on a bigger scale despite not being involved in a more tangible way at home.

According to a 2014 report by the International Water Association on human resource capacity in 15 developing countries in the water supply, sanitation, and hygiene sector, an average of only 17 percent of staff in the water and sanitation sector are female. Especially in technical fields in the public and private water sectors, female professionals are significantly underrepresented.
The Rising Tide

In counties where water has become industrialised, we do see a less gendered interaction in the home, although it is still common to find women responsible for washing, cleaning and cooking.  But because water is available on tap, the interaction takes less time, less effort and is therefore less unequal than in other parts of the world.  But again, if we turn to a society level view instead of domestic we find that the picture is less equal.  Writing about the UK in 2004, Veronica Strang noted that:

“The groups directly in control of water resources are very male-dominated, most particularly in terms of who actually owns, makes decisions about or acts upon water… women have the least part in looking after or controlling water resources directly, and in terms of real ownership of water they are almost invisible. However, there remains one place where their water management is crucial: in the domestic sphere they are – as they have always been – the major users and managers of water.”

This is crucial to note as “control of water is inevitably control of life and livelihood” (Colin Ward).  The groups who control this vital resource have political, economic and social power.  We, in the UK, are on the whole, passive recipients of water.  We turn on a tap and it’s there.  We do not value it the same as we did when we had to collect it and carry it.

“If you carry water, it’s part of you… you kind of embody it really, then you are really in touch with it”
– Karen Wimhurst, quoted by Strang

Because of the gendered experience of water, the impact on women of poor water supply is different than that for men.  An example is that women cannot relieve themselves in the open air in the same way as men and so poor sanitation has a greater impact on them.  They also tend to shoulder the responsibility for the health and cleanliness of their children, and water quality and availability play an important role in that.

Around the world, about 1 in 10 people cannot be sure that their water is safe to drink.  This means that you either risk drinking water which could harm you or you must boil it to sterilise it.  In parts of the world where fuel is scarce, or must be collected, this isn’t always as easy as it sounds.  If you’ve already spent a considerable about of time collecting the water for the day and then you must go out and find firewood, you rapidly lose time you need to spend on cooking and looking after children etc.  More people are killed by drinking bad water than by war.

There is also the economic impact as girls are taken out of school to help collect water and because there is unsuitable facilities for maintaining personal hygiene, especially important to girls when they begin menstruating.  This limits their job opportunities and deprives them of education.

Let’s turn for a moment to a few facts and figures from the United Nations:

  • About three quarters of households in sub-Saharan Africa fetch water from a source away from their home and 50% to 85% of the time, women are responsible for this task.
  • In South Africa, in poor rural households, women who fetch water and fuel wood spend 25% less time in paid employment.
  • Reducing the time it takes to fetch water from 30 to 15 minutes increased girls’ school attendance by 12% according to a study in Tanzania.
  • About 44 million pregnant women have sanitation-related hookworm infections that pose a considerable health burden in developing societies.

Whilst it is a vast and complex arena, it is crucial that we understand how water and gender interact so that actions can be taken which both enhance access to water but which also help in the journey towards gender equality.

Further than simply perpetuating gender inequality, Strang claims that changes in water management actually “helped to establish male dominance in political, economic and religions terms”.  With this in mind, it is clear that an understanding of the history of water can inform the future and help us to improve water access and quality as well as empowering the lives of women around the world.

To look at water through a gendered lens provides an interesting perspective on a resource that so many of us take for granted.  Similarly, one can view historical changes and attitudes through the lens of water and water management.  If this is a topic of interest, I’d recommend picking up a copy of The Meaning of Water by Veronica Strang and download The Rising Tide.

You might also want to watch a couple of YouTube videos on the subject:

Does gender matter when it comes to mental health diagnoses?

The housekeeping…

Firstly a bit of housekeeping. I’m referring to gender here, not sex; gender includes the societal influences and roles we play rather than just pure biology.  i think this is vital in this discussion because whilst some mental illness is biological, down to genes etc, the environment around a person and their socialisation plays a huge part in causing mental ill health.

I’m focusing mostly on male and female here but am aware that not everyone fits into those gender boxes however, as these are what society predominately uses, it is a helpful way to think about it. Even if you are not male or female, the chances are you are perceived as one or the other which means you’re likely to be affected by the biases and stereotypes
related to that gender. I recognise that not fitting into the male/female boxes is likely to bring it’s own difficulties especially when it comes to engrained social biases and stereotypes. I think how gender affects mental health diagnoses when you’re not cisgendered (your gender matches the sex you were at birth) is probably a blog post on its own and is probably better written by someone with more experience. Similarly, your sexual orientation and how that plays with mental health diagnosis is also not something I’m going to cover right now but sounds interesting to look into (and I feel, as a bi woman, a bit more qualified to speak about that).

Within this discussion we need to remember the historical context in which gender and mental health sits. it would be a travesty to ignore or forget about the way women have been oppressed through the use of mental health diagnoses. a prominent example is the Victorian ‘mad woman in the attic’, a much critiqued view of mental illness.  There are many writers who unpick the use of diagnoses to oppress women who weren’t submissive and obedient. Its an interesting area to read about and there’s lots of blog posts, articles, books etc about it. Here however, I’m looking more at the point of diagnosis in the contemporary world, mostly focussed on the developed world or the global north.

Er, get to the point…

So, men and women can experience a vast array of mental health issues for which they may receive a diagnosis and treatment related to that diagnosis. Having had the issue of equality and mental health diagnosis come up a couple of times in conversation with friends, I wanted to look into it a bit more.

Is there a difference?

Overall, the rates of diagnosed mental illness in men and women is much the same (and is under diagnosed across the board), but disparity does arise when it comes to the rates of diagnosis.

Diagnoses of common mental disorders including depression and anxiety are made up of mostly women eg depression is twice as likely to be diagnosed for a woman than a man.  However when it comes to alcohol addiction in developed countries, 1 in 5 men and 1 in 12 women will receive this diagnosis at some point. Take another example; men are more than three times more likely to be diagnosed with antisocial personality disorder than women.

Interestingly, according to the WHO, there is little gender difference for diagnosis rates of severe and rarer mental disorders such as schizophrenia.  I wonder if this is because they are rarer so have a less engrained stereotype?

So do men and women just have different mental health susceptibilities?

To answer this question, I think we need to start by mentioning that mental illness can be caused by a vast number of things including genetics, life experience, poverty etc.

The WHO states that gender specific risk factors include the nature of the stereotypical gender role, stressors and negative life events. We then have to consider that women are disproportionately affected by gender based violence, low status, economic disadvantage, responsibilities for the care of others etc.

Looking specifically at PTSD for example, because they are more likely to experience sexual violence, women are obviously more likely to have PTSD as a result of that violence. 1 in 3 women who have been raped develop PTSD instead of 1 in 20 when looking at non victims. And at least one in five women suffer rape or attempted rape in their lifetime.

When it comes to the impact of other types of abuse, we know that women who experienced childhood sexual abuse or partner violence as an adult, rates of depression are 3 to 4 times higher than the rest of the population. I’m obviously not saying that men do not suffer abuse, of course they do, but the figures are much higher for women. Lifetime prevalence rate of violence against women ranges from 16% to 50%.

In terms of life events impacting on women and their mental health, an estimated 80% of 50 million people affected by violent conflicts, civil wars, disasters, and displacement are women and children.

Similarly, low status, low income and the burden of taking care of others can place a lot of stress on a woman and in turn result in associated mental illness; women make up around 70% of the world’s poor and are paid significantly less than men. This lack of resources results in higher stress and being less able to seek help, or seek the same quality of help, as men who are earning more, which in turn makes things worse. People with higher income or good health insurance are more likely to seek support and therefore . This lack of resources means that women can get trapped in difficult situations such as domestic abuse as they have limited means to get out and this will obviously have some impact on mental health.

OK, so men and women have different types of mental illness, fine.

No. Sorry, it’s not that simple.  Men and women may in general experience different types of mental illness.  But we don’t know that.  This is because of gender bias occurs in the treatment of mental illness. Even when presenting with the same score on a standardised test, women are more likely to be diagnosed with depression than men. Remember above, we noted that women are more likely to have this type of diagnosis than men…

There is also a difference in presenting for help. Women are more likely to approach their primary carer, such as a GP whereas men are more likely to turn to a specialist and are the main users of inpatient care, again, potentially affecting diagnosis. If you turn up to a substance misuse centre you’re likely to end to with a related diagnosis. Turn up to your gp who hasn’t got much experience about these things and doesn’t ask you the right question, maybe you’ll get a different diagnosis.

Returning to alcohol, men are more likely to admit to having a problem with it than women, again providing a possible reason for the large gap in diagnosis rates between genders. It could also be related to men feeling unable, because of gender stereotypes, to get help for depression, anxiety etc and are self medicating with alcohol which in turn gets picked up as a diagnosis of alcoholism.

Gender stereotypes themselves can get in the way of a diagnosis as they reinforce emotional problems in women and alcohol problems in men. This can be a barrier to a correct diagnosis.

So, why does it matter?

Well, cynically, i think that more money would go into treating, preventing and researching the more common mental illness if they were more commonly diagnosed in men. yes, i’m a feminist so i’m going to say that but look at the differing attitudes between erectile dysfunction and pain women experience during sex. one has lots of money thrown at it, the other is barely acceptable to say.

A second reason why it matters is that it could help understand what causes, triggers or perpetuates mental health issues. if particular conditions are more common in women, can we unpick it further, is it biological or societal? can we do anything to prevent this, such as ensuring women have the opportunity to be economical independent or free from abuse? As with most of these things, prevention is vastly superior to cure.

Thirdly, if diagnoses are bias based on gender than there could well be lots of unsupported men and women who are struggling with their mental health because their support and treatment is wrong due to an incorrect diagnosis. Access to services might be formally or informally restricted because of gender – if alcoholism is seen as male illness it could put a woman off seeking treatment and support. There are numerous accounts of men who’ve tried to seek support for eating disorders and the walls they’ve come across and the stigma they’ve faced. Again, correct diagnosis may mean more men are diagnosed with an eating disorder which in turn would hopefully mean that more men feel able to seek support for it and in doing so, perhaps health practitioners would no longer think about gender at the point of diagnosis.

One commonly quoted stat is that men are more likely to die by suicide than women. What it misses out is that women are more likely to attempt suicide than men.  At the moment this means, in the UK, there is a lot of awareness raising going into supporting men who are suicidal. Which is great. However it seems to be at the expense of support for women. Perhaps diagnosis which wasn’t influenced by gender would help us to see the person in distress and help their actual needs rather than their perceived needs.


I’m fully aware I’ve not referenced things… However if you want to do some more reading and find out more for yourself, here’s a few links I found useful:

WHO
Guardian
Judith Trust

And for reading about whether men and women have different brains, check out Cordelia Fine’s Delusions of Gender.  Well worth a read.