When Family Comes First: Diabetes, Social Roles, and Coping among Women in Urban North India Open Access
Weaver, Lesley Jo (2014)
Abstract
Why is it so hard for us to do what is best for our health, and why do we often feel compelled to do things that are harmful for our bodies? The research described in this dissertation sought to respond to this persistent human problem by exploring health choices among a group of people with magnified self-care needs: women with type 2 diabetes in New Delhi, India. The general theme of the research was how type 2 diabetic women balance their mental health, social health, and physical health in this rapidly developing part of the world.
Between 2009 and 2011, the research engaged over 400 diabetic and non-diabetic women recruited from public, private, and charitable clinics in New Delhi. Using mixed methods, it investigated women's perceptions of appropriate gendered social roles, their ability or disability to participate in these roles, their mental health status using both locally derived and standard screeners, health management choices, and actual physical health outcomes (measured using anthropometrics and blood biomarkers).
The research found that women experience significant psychosocial and practical conflicts living with diabetes, an illness requiring a great deal of self-care, in a cultural context where gender roles strongly emphasize women's service to others. This tension can be conceptualized as a choice between self-care for the sake of one's physical health and other-care for the sake of one's social health (and, of course, for others' benefit). In this calculus, the care of others usually wins out. The vast majority of women in my study do not attain good diabetes control, but do report good mental health, unlike many people with diabetes in other parts of the world. I suggest that this anomalous result is partially due to the possibility that by choosing the care of others over self-care, women preserve a crucial ability to participate in social roles that shape their identities and confer social status. This, however, comes at the expense of their physical health, and as such I emphasize the centrality of women's service-oriented gendered roles in shaping their health choices. I consider the theoretical implications of this scenario for anthropology, and also address the practical implications of these findings for diabetic women's health. The dissertation concludes with recommendations for practitioners engaged in global health policy and programming about culturally viable ways to improve women's adherence to self-care regimens for diabetes and other chronic illnesses.
This work was supported by the Fulbright-Hays Foundation, the American Institute of Indian Studies, the Lemelson/Society for Psychological Anthropology, and the National Science Foundation.
Table of Contents
Preface............................................................................................................................................................................................... 1
Chapter 1: Introduction........................................................................................................................................................ 7
Chapter 2: "One Only Goes to the Doctor When One's Health is Bad"................................................... 53
Chapter 3: "Tension Happens"....................................................................................................................................... 79
Chapter 4: Domesticity and Disability................................................................................................................... 122
Chapter 5: Vulnerability.................................................................................................................................................. 159
Chapter 6: Resilience......................................................................................................................................................... 203
Chapter 7: Conclusions.................................................................................................................................................... 235
Appendix.................................................................................................................................................................................... 264
Bibliography........................................................................................................................................................................... 278
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