The Sociology of South Asian Women's Health

• Chapter 1

IntroductionSara Rizvi Jafree 
Chapter 2South Asian Women's Health Behaviour: Theoretical Explanations Sara Rizvi Jafree Deepti SastryIt is imperative to consider theoretical explanations that provide a premise for the health behaviour of South Asian women. This chapter relies on using western theories and the available South Asian theories to explain health behaviour of women. One of the reasons for South Asian theory lagging behind Western theory is because indigenous researchers have been reluctant to develop philosophical models and suffer persecution from male dominated community notables, religious leaders, and politicians. Multiple theories are used to explain the different health behaviours and choices of South Asian women, as the range of behaviour patterns across regions and ethnicities is diverse and complex. Broad areas of influence covered in this chapter, include: (i) culture and community, (ii) religion and the state, (iii) the individual woman herself, (iv) the capitalist economy, and (iv) transnational factors. This chapter is an important read for diverse populations such as students, practitioners, researchers, and policy-makers.

Chapter 3 Oral Narrations of Social Rejection Suffered by South Asian Women with Irreversible Health Conditions  Sara Rizvi JafreeFareen RahmanThere is no better way to understand the sociocultural factors influencing the health behaviour, health recovery, and overall well-being of South Asian women with regard to their lived experiences of health than by hearing their voiced experiences. This chapter presents oral narrations of four women across South Asia with current health conditions of chronic nature or who have experienced major health setbacks in life. The women belong to diverse socioeconomic strata, which helps to put into context how social beliefs and attitudes transcend wealth and class. Two of the women participants face permanent health conditions from birth -- paralysis and blindness; and the other two have developed health conditions after marriage -- cancer and infertility. The findings reveal that the most complex and frustrating challenge for South Asian women has not been their health condition or lack of resources and health infrastructure, but the social and family support, public attitudes, and community acceptance that they have had to contend with through different stages of their health. Though the health experiences of all four women are different, they reveal the main challenges women face due to social customs, religious interpretations, and traditional values that are prevalent in South Asia. 
Chapter 4 Dependency in Health Decision-making of South Asian Women Sara Rizvi JafreeRubeena ZakarShaheda Anwar It is common to measure women's decision-making through variables like: choice in marriage, education, and employment; however, the variable of health decision-making has been less researched and emphasized. The complexity of health decision-making is that it is still considered a private domain. The strength of this chapter is that it uses recent secondary data from the Demographic Health Surveys of Bangladesh, India, and Pakistan to highlight predictors for health decision-making for women of reproductive age. This chapter discusses the salient cultural factors that influence or control health decision-making in women of South Asia: (i) gender gaps and family factor, (ii) health education and health behaviour, (iii) nature of employment, (iv) violence and safety, and (v) quality of healthcare services and traditional healers. Necessary recommendations for health policy improvement for women of South Asia are recommended based on empirical evidence.

Chapter 5 Poverty, Health Coverage, and Credit Opportunities for South Asian WomenFionnuala GormleySara RizviThis chapter aims at identifying the determinants of the feminization of poverty from a South Asian perspective that influences women's ability to access health care. Salient demographic and cultural areas like: (i) family composition, (ii) control over resources, (iii) access to education and health, (iv) social protection inequality, and (v) labour market inequalities.  
Attempts at breaking the cycle of poverty are discussed in detail by describing the strengths and limitations of programs in Pakistan, Bangladesh, and India. The attempt in South Asia has been to compensate the lack of State provision for social and health security through microcredit opportunities. This chapter identifies critical problems that prevent the microfinance sector from facilitating emergence from poverty in women like informal sector employment, financial risks, and lack of or insufficient health insurance coverage. Secondary data has also been presented in this chapter along with a case study from Pakistan on the lived health experiences of women microfinance borrowers. 
Chapter 6Refugee, Displaced, and Climate-Affected Women of South Asia and Their Health ChallengesSara Rizvi JafreeBajiyanta MukhopadhyaySouth Asia is one of the countries of the world suffering from substantial political mismanagement, ethnic conflict, natural disasters, and environmental degradation. Nearly 50 million refugees have crossed borders in South Asia since the colonial rule ended and are suffering from inadequate protection and services for health. Estimates from 2018 suggest that more than 10.3 million women of the region are currently suffering as a consequence of displacement caused by conflict or climate change. More women are suffering compared to men. 
The feminization of displacement has brought to attention that women compared to men during and after migration face considerable challenges in health experiences due to greater emotional and physical burdens and also due to greater vulnerabilities from violence and sexual abuse. Areas of disadvantages faced by displaced and migrant women are discussed in this chapter, in context to health challenges, including: (i) women-only households and lack of assets and information network, (ii) limited work opportunities and shortages of basic necessities, (iii) evacuation delays and life in temporary shelters, (iv) risk of violence, forced marriages, and unplanned pregnancies, and (v) mental health and pressure of additional care roles. Secondary data from UNHCR has also been used, and a useful summary has been developed by the authors to classify the health impacts on women caused by environmental alterations due to displacement and climate change. The chapter recommends critical health reforms and extended health policy in the region for displaced women.  
Chapter 7Social Barriers to Mental Well-being in Women of South AsiaMasha Asad Khan Sara Rizvi Jafree
Tahira JibeenThe mental health of South Asian women is a grossly neglected area. Health budgets in the region are negligible, and rarely do any public- or private-sector health centres have separate wards or practitioners for service delivery. This is despite the fact that women of South Asia are known to commonly face problems related to domestic violence, gender inequity, and sexual abuse, which places them at greater risk for mental health challenges. According to the literature, the common and rising mental health challenges amongst South Asian women include: (i) post-traumatic stress disorder, (ii) dissociation disorders, (iii) conversion disorder and depression, (iv) self-harm and suicide, and (v) eating disorders. This chapter investigates the social risk factors for mental distress in South Asian women, covering areas such as status of the girl child, rights of passage, expectations of marriage, and non-conformity. The authors also examine the wider social and economic costs to society of neglecting women's mental health. Secondary data is used to present a comparative assessment of mental health challenges and incidence among women sufferers across South Asian states. The authors also present a case study containing a thematic analysis of the perceptions of women primary care providers regarding mental health of South Asian women. The chapter ends with recommendations for improved mental health policy for women of the region.
Chapter 8  The Political Sociology of South Asian Women's HealthFarooq HasnatSara Rizvi JafreeAinul MominaZamurrad AwanThe sociology of political systems of South Asia and its influence on women's health behaviour and health outcomes has been a neglected area in research. Where the sociology of health is important for helping us consider that social factors determine health, such as gender, class, wealth, ethnicity, and literacy; it is the sociology of politics that helps us identify that public health policy is instrumental in closing the social gaps of health inequality. In this chapter the authors consider that in the capitalist democracies of the modern world, health is political because the planning and distribution of public health services is dependent on political intervention and also because some social groups have more access compared to others. The role of the state becomes more important especially in conservative and traditional milieus like South Asia where regressive cultural forces prevent women from maintaining optimal health or seeking health recovery. The chapter discusses key areas such as: (i) political representation, (ii) government budget for health, (iii) government licensing, regulation, and honesty, (iv) skewed population ratios, and (v) poverty and health financing. The authors also present a systematic recommendation for women's health policy reform at state level for South Asian countries.

Chapter 9 The Culture of Health Regulation and Its Implications on Maternal and Reproductive Health in South AsiaAinul MominaSara Rizvi Jafree