Monica Christianson

Central gender theoretical concepts in health research: the state of the art

Despite increasing awareness of the importance of gender perspectives in health science, there is conceptual confusion regarding the meaning and the use of central gender theoretical concepts. We argue that it is essential to clarify how central concepts are used within gender theory and how to apply them to health research. We identify six gender theoretical concepts as central and interlinked—but problematic and ambiguous in health science: sex, gender, intersectionality, embodiment, gender equity and gender equality. Our recommendations are that: the concepts sex and gender can benefit from a gender relational theoretical approach (ie, a focus on social processes and structures) but with additional attention to the interrelations between sex and gender; intersectionality should go beyond additive analyses to study complex intersections between the major factors which potentially influence health and ensure that gendered power relations and social context are included; we need to be aware of the various meanings given to embodiment, which achieve an integration of gender and health and attend to different levels of analyses to varying degrees; and appreciate that gender equality concerns absence of discrimination between women and men while gender equity focuses on womens and mens health needs, whether similar or different. We conclude that there is a constant need to justify and clarify our use of these concepts in order to advance gender theoretical development. Our analysis is an invitation for dialogue but also a call to make more effective use of the knowledge base which has already developed among gender theorists in health sciences in the manner proposed in this paper.

Eyes Wide Shut--sexuality and risk in HIV-positive youth in Sweden: a qualitative study.

Aims: This study explores the perception of sexual risk-taking behaviour in young HIV+ women and men in Sweden and their understanding of why they caught HIV. Method: In-depth interviews were conducted with 10 HIV+ women and men aged 17—24 years, 7 born in Sweden and 3 immigrants. Interviews were tape-recorded, transcribed verbatim, and analysed according to the stages of grounded theory. Results: The core category varying agency in the gendered sexual arena illustrated a spectrum of power available to these informants during sexual encounters. Two subcategories contextualized sexual practice: sociocultural blinds and from consensual to forced sex. Lack of adult supervision as a child, naïve views, being in love, alcohol and drugs, the macho ideal, and cultures of silence surrounding sexuality both individually and structurally all blinded them to the risks, making them vulnerable. Grouping narratives according to degree of consensus in sexual encounters demonstrated that sexual risks happened in a context of gendered power relations. Conclusion: This pioneering study reveals mechanisms that contribute to vulnerability and varied agency that may help in understanding why and how young people are at risk of contracting HIV. Public health strategies, which consider the role of gender and social background in the context of risky behaviours, could be developed from these findings.

Concepts of risk among young Swedes tested negative for HIV in primary care.

Objective. To explore why young adults test for HIV, how they construct the HIV risk, and what implications testing has for them. Design. Six tape-recorded focus-group interviews were transcribed verbatim and analysed according to a grounded theory approach. Subjects and setting. Women and men between 18 and 24 years of age were recruited from a youth clinic in northern Sweden in 2004–05 after being tested and found to be HIV negative. Results. A core category – reconsidering risk and four categories – HIV: a distant threat; the risk zone; responsibility: a gendered issue; a green card – emerged. HIV was described as being far away. Stereotypical images of risk actors emerged but were perceived to be clichés. “Ordinary” people including themselves were also considered at risk. Many had event-driven reasons for testing for HIV, multiple partners being one. One closer risk zone was “the bar”; a dating milieu that often was expected to include “one-night stands” for both women and men. Responsibility for testing was a gendered issue: it was “natural” for women, while men rather “escaped from responsibility”. A resistance towards testing was revealed among young men. Receiving a negative HIV test result was “a green card”, confirming healthiness and providing relief. Most informants felt “clean” and discussed how to restart with renewed ambitions. Conclusions. As participating in focus-group interviews was apparently an “eye-opener” for many, a counselling conversation reconsidering risk following an HIV test might be a good idea. Liberal HIV testing among young men and women could evoke insights and maturation and start a process of reflections concerning their sexual risk-taking behaviour.

Conflicting discourses of church youths on masculinity and sexuality in the context of HIV in Kinshasa Democratic Republic of Congo.

Abstract Masculinity studies are fairly new and young churchgoers are an under-researched group in the current Congolese church context. In response to this knowledge gap, this paper attempts to explore discourses of young churchgoers from deprived areas of Kinshasa regarding masculinity and sexuality in the era of HIV. A series of 16 semi-structured interviews were conducted with unmarried young churchgoers from the Salvation Army, Protestant and Revival churches. The interviews were tape-recorded, transcribed verbatim and analysed using discourse analysis. Five main discourses emerged: ‘we are aware of the church message on sex’, ‘young men need sex’, ‘young women need money’, ‘to use or not to use condoms’ and ‘we trust in the church message’. Although all informants knew and heard church messages against premarital sex, many of them were sexually active. The perception was that young men were engaged in sexual activities with multiple partners as a result of sexual motivations surrounding masculinity and sexual potency, while young women sought multiple partners through transactional and intergenerational sex for economic reasons. These sexual practices of young people conflicted with church messages on sexual abstinence and faithfulness. However, a small number of participants challenged current gender norms and suggested alternative ways of being a man or a woman. To elucidate these alternatives, we suggest that church youths and church leaders might take concrete actions to deconstruct misconceptions about being men. In this way, they can possibly enhance a frank and fruitful dialogue on sex, sexuality and gender to promote positive masculinities and constructive partnerships to prevent HIV.

Challenges and strategies for sustaining youth-friendly health services - a qualitative study from the perspective of professionals at youth clinics in northern Sweden.

BackgroundYouth-friendly health-care services — those that are accessible, acceptable, equitable, appropriate and effective for different youth subpopulations – are beneficial for youth health, but not easy to implement and sustain. Sweden is among the few countries where youth-friendly health-care services have been integrated within the public health system and sustained for a long time.This study explores the challenges and strategies in providing sustainable youth-friendly health-care services, from the perspective of professionals working in youth clinics in northern Sweden.MethodsEleven semi-structured interviews with various health-care professionals working in youth clinics in northern Sweden were conducted. The interviews were transcribed verbatim, and analysed using thematic analysis in relation to the World Health Organization domains of youth friendliness.ResultsFour themes emerged from the analysis of the data: 1) ‘Meeting youths on their own terms – the key to ensuring a holistic and youth-centred care’ was related to the acceptability and appropriateness of the services; 2) ‘Organizational challenges and strategies in keeping professionals’ expertise on youth updated’ referred to the domain of effectiveness; 3) ‘Youth clinics are accessible for those who know and can reach them’ was related to the domains of accessibility and equity, and 4) ‘The challenge of combining strong directions and flexibility in diverse local realities’ focused on the struggle to sustain the youth clinics organization and their goals within the broader health system.ConclusionsProfessionals working in youth clinics are perceived as motivated, interested and knowledgeable about youth, and the clinics ensure confidentiality and a youth-centred and holistic approach. Challenges remain, especially in terms of ensuring equitable access to different youth subpopulations, improving monitoring routines and ensuring training and competence for all professionals, independently of the location and characteristics of the clinic. Youth clinics are perceived as an indisputable part of the Swedish health system, but organizational challenges are also pointed out in terms of weak clear directives and leadership, heavy workload, local/regional diversity and unequitable distribution of resources.

Beyond a Dichotomous View of the Concepts of 'Sex' and 'Gender' Focus Group Discussions among Gender Researchers at a Medical Faculty

Introduction The concepts of ‘sex’ and ‘gender’ are both of vital importance in medicine and health sciences. However, the meaning of these concepts has seldom been discussed in the medical literature. The aim of this study was to explore what the concepts of ‘sex’ and ‘gender’ meant for gender researchers based in a medical faculty. Methods Sixteen researchers took part in focus group discussions. The analysis was performed in several steps. The participating researchers read the text and discussed ideas for analysis in national and international workshops. The data were analysed using qualitative content analysis. The authors performed independent preliminary analyses, which were further developed and intensively discussed between the authors. Results The analysis of meanings of the concepts of ‘sex’ and ‘gender’ for gender researchers based in a medical faculty resulted in three categories; “Sex as more than biology”, with the subcategories ‘sex’ is not simply biological, ‘sex’ as classification, and ‘sex’ as fluid and changeable; ”Gender as a multiplicity of power-related constructions”, with the subcategories: ‘gender’ as constructions, ‘gender’ power dimensions, and ‘gender’ as doing femininities and masculinities; “Sex and gender as interwoven”, with the subcategories: ‘sex’ and ‘gender’ as inseparable and embodying ‘sex’ and ‘gender’. Conclusions Gender researchers within medicine pointed out the importance of looking beyond a dichotomous view of the concepts of ‘sex’ and ‘gender’. The perception of the concepts was that ‘sex’ and ‘gender’ were intertwined. Further research is needed to explore how ‘sex’ and ‘gender’ interact.

Searching for best practices of youth friendly services - a study protocol using qualitative comparative analysis in Sweden

BackgroundSwedish youth clinics constitute one of the most comprehensive and consolidated examples of a nationwide network of health care services for young people. However, studies evaluating their ‘youth-friendliness’ and the combination of factors that makes them more or less ‘youth-friendly’ have not been conducted. This protocol will scrutinise the current youth-friendliness of youth clinics in northern Sweden and identify the best combination of conditions needed in order to implement the criteria of youth-friendliness within Swedish youth clinics and elsewhere.Methods/designIn this study, we will use qualitative comparative analysis to analyse the conditions that are sufficient and/or necessary to implement Youth Friendly Health Services in 20 selected youth-clinics (cases). In order to conduct Qualitative Comparative Analysis, we will first identify the outcomes and the conditions to be assessed. The overall outcome – youth-friendliness – will be assessed together with specific outcomes for each of the five domains – accessible, acceptable, equitable, appropriate and effective. This will be done using a questionnaire to be applied to a sample of young people coming to the youth clinics. In terms of conditions, we will first identify what might be the key conditions, to ensure the youth friendliness of health care services, through literature review, interviews with professionals working at youth clinics, and with young people. The combination of conditions and outcomes will form the hypothesis to be further tested later on in the qualitative comparative analysis of the 20 cases. Once information on outcomes and conditions is gathered from each of the 20 clinics, it will be analysed using Qualitative Comparative Analysis.DiscussionThe added value of this study in relation to the findings is twofold: on the one hand it will allow a thorough assessment of the youth-friendliness of northern Swedish youth clinics. On the other hand, it will extract lessons from one of the most consolidated examples of differentiated services for young people. Methodologically, this study can contribute to expanding the use of Qualitative Comparative Analysis in health systems research.

Sex and gender traps and springboards: a focus group study among gender researchers in medicine and health sciences.

We explored the difficulties that gender researchers encounter in their research and the strategies they use for solving these problems. Sixteen Swedish researchers, all women, took part in focus group discussions; the data were analyzed using qualitative content analysis. The problems reported fell into four main categories: the ambiguity of the concepts of sex and gender; traps associated with dichotomization; difficulties with communication; and issues around publication. Categories of suggested problem-solving strategies were adaptation, pragmatism, addressing the complexities, and definition of terms. Here the specific views of gender researchers in medicine and health sciences—“medical insiders”—bring new challenges into focus.

Promoting women's human rights: A qualitative analysis of midwives' perceptions about virginity control and hymen 'reconstruction'.

Abstract Objectives To explore midwives’ perceptions regarding virginity control and hymen ‘reconstructions’, and how these practices can be debated from a gender perspective. Methods An international group of 266 midwives answered an open-ended question in a Web survey. The great majority came from the Western world, among them, the majority were from Europe. Data were analysed using qualitative content analysis. Results Three themes emerged: misogynistic practices that cement the gender order, which revealed how the respondents viewed virginity control and hymen ‘reconstructions’; raising public awareness and combatting practices that demean women, which were suggested as strategies by which to combat these practices; and promoting agency in women and providing culturally sensitive care, which were considered to improve health care encounters. Conclusions Virginity control and hymen ‘reconstructions’ are elements of patriarchy, whereby violence and control are employed to subordinate women. To counter these practices, macro and micro-level activities are needed to expand womens human rights in the private and the public spheres. Political activism, international debates, collaboration between sectors such as health care and law-makers may lead to increased gender equality. A women-centred approach whereby women are empowered with agency will make women more capable of combatting virginity control and hymen ‘reconstruction’. Chinese Abstract 摘要 目的：研究助产士关于处女控制和处女膜修复的认知，以及怎样从性别角度来反对这些行为。 方法 一个由266个助产士组成的国际小组在互联网上回答了一个开放式的问题。大多数人来自于西方国家，其中多数来自欧洲。数据分析采用定性内容分析。 结果出现了三个论题：藐视妇女的行为加固了性别歧视，揭示了这些调查对象是怎样看待处女控制和处女膜修复的；这个问题引起了公众的关注，要反对那些贬低女性的行为。这些建议被作为抵制这种行为的对策；促进妇女机构的形成，并且从文化角度提供敏感护理以促进卫生保健的发展。. 结论 处女控制和处女膜修复是父权制的基础，凭借暴力和控制来使女性服从。为了反抗这些行为，在一些私人和公共的领域里需要宏观和微观的行为去发展女性的人权。政治活动，国际辩论，部门之间的协作，比如健康保健与立法部门，可能会促进性别平等。一个以女性为中心的提案将会使得妇女更有能力去反对处女控制与处女膜修复。

Not Used But Almost…-A Gender and Agency Analysis of the Grey Zone Between Consensual and Nonconsensual Sexual Intercourse

Rape is a widespread but underreported problem among women. In this article I explore the complexities surrounding the fine line between consensual and nonconsensual sexual intercourse, by studying a rape through which a young woman was infected with HIV. I provide an analysis of how to understand and interpret this episode by applying a gender perspective based on patriarchy—namely, womens submissive position in heterosexual situations compared with men—and the concept of agency, that is, the individuals own decision-making ability, own choices, and different courses of action available, to outline the frame of action available to the informant. The inclusion of agency and a gender perspective offers new dimensions on how to understand and give meaning to narratives that are seldom told.