Abstract
Healthcare has long been a gendered enterprise, with women taking responsibility for maintaining health and engaging with service providers. Universal healthcare provision notwithstanding, women nonetheless undertake a range of healthcare work, on their own account and on behalf of others, which remains largely invisible. As part of a multi-method comparative European study that looked at access to healthcare in diverse neighbourhoods from the point of view of people’s own health priorities, the concept of ‘healthcare bricolage’ describes the process of mobilizing resources and overcoming constraints to meet particular health needs. Bricolage mediates between different kinds of resources to meet particular challenges and describing these processes makes visible that work which has been unseen, over-looked and naturalised, as part of a gendered caring role. Drawing on 160 semi-structured interviews and a survey with 1,755 residents of highly diverse neighbourhoods in Germany, UK, Sweden and Portugal, this article illustrates the gendered nature of healthcare bricolage. The complex variations of women’s bricolage within and beyond the public healthcare system show how gendered caring roles intersect with migration status and social class in the context of particular healthcare systems.
Highlights
The gendered nature of healthcare work is inherent to the way that health and welfare systems have developed over the years: supporting the health of others, both in private settings and mediating with professional service providers, has been taken for granted as a natural part of women’s roles as mothers, daughters, sisters, aunts, wives, partners and neighbours
While health outcomes are patterned by gender, our interest here is in making visible the gendered processes involved in getting access to healthcare when living in diverse neighbourhoods, including their intersection with other dimensions of identity and structure, migrant status and racism
Both in the crude and in the adjusted model, men were less likely to bricolage than women and, if they do report bricolage, it tends to be contained within the healthcare system, with less adding to the system
Summary
The gendered nature of healthcare work is inherent to the way that health and welfare systems have developed over the years: supporting the health of others, both in private settings and mediating with professional service providers, has been taken for granted as a natural part of women’s roles as mothers, daughters, sisters, aunts, wives, partners and neighbours. Theoretical approaches that have sought to understand the complex contingencies of how gender plays out alongside other aspects of identity and structure have yet to be regularly operationalized in health research (Annandale, 2013), despite efforts to establish working definitions (Hammarström et al, 2014). Access to healthcare is gendered both structurally, in terms of the political economy, and interactionally, in terms of how identity and discrimination play out interpersonally (Ettorre, Annandale, Hildebrand, Porroche-Escudero, & Rothman, 2017). Gender is both structural and individual, but is neither organizationally nor interpersonally determinant, since it intersects with other aspects of identity and of distribution (Fraser, 2000). Intersectional approaches hold the promise of allowing the complexities of gender as they play out in different cultures, to extend beyond binary gendered categories (Richards et al, 2016)
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