Bargaining Power within Households: Can it Prevent HIV?

Over the last few months, we’ve been looking at how gender imparity has affected equity and efficiency in some very high-power spaces: politics, the corporate board, academia, and the STEM fields. But what about those more banal, day-to-day issues of gender imparity---those that most people don’t even see? Namely, how couples relate to one another. As commonplace as it might seem, relationship dynamics can have wide and profound consequences for society.

In the WAPPP seminar this week on “Intra-household bargaining power and HIV prevention,” WAPPP Fellow and PhD Candidate at the University of St. Gallen in Switzerland, Berit Gerritzen, looked at how married couples in rural Malawi approach issues of sexual health. Approximately 14.3 percent of the adult population of Malawi were living with HIV/AIDS in 2005, demonstrating the need for better information on its transmission.

And because many HIV infections throughout Sub-Saharan Africa take place during heterosexual intercourse between persons in stable couple relationships, the way that each of those partners approaches the other---and the issue itself---can be most telling for the diffusion of the virus.

Through data from the Malawi Diffusion and Ideational Change Project, Gerritzen looked at questions of (a) whether partners spoke about HIV risk, (b) accepted condom usage within marriage, (c) self-reported infidelity, among other issues including, of course, (d) HIV infection itself. Gerritzen cross-referenced those answers with indicators of household bargaining power, namely a spouse’s personal economic status, the number of wives in the family, local political participation, and other demographic data.

While conceding that there are a number of additional variables at play, Gerritzen concludes that factors associated with gains in female bargaining power---such as a wife’s own earnings and education, fewer co-wives, and political participation---are in fact generally related to increases in spousal discussions of sexual health, greater acceptance of condom use within marriage, and other HIV risk-reduction efforts.

When women demand the processes and outcomes that they know to be best for themselves, the household’s own welfare improves. And behaviors within the house are often what influence societal health outcomes, further strengthening the case that empowering women and increasing agency has benefits far beyond equality.



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Guest Post: Why Diversity Matters in Medicine

Earlier this fall, I had the opportunity to attend the 97th Annual Clinical Congress of the American College of Surgeons. It's the meeting of the bigwigs. Surgeons from across the country travel to Chicago to attend top-notch skill sessions, expert panels, and lectures on leading research. Speakers feature the premiere innovators and investigators in their specialties. As a medical student, I attended residency interview training sessions and resident panels. I also made sure I took the opportunity to take a step back and soak in the entire experience. I wrote down some of my first impressions...

#1 - There are lots of white men here.

I've written quite a bit about the importance of mentorship on my blog, specifically about how mentors have shaped my career trajectory. I'm not sure that I would've chosen General Surgery without the skilled and caring surgeons I worked with in Asheville and Linville, NC. I certainly wouldn't have considered rural surgery without briefly living the craft, getting to know surgeons who have worked in a rural area for many years and then moved back into academia. I cannot stress how important it has been that people like me are already doing what I want to do. With this knowledge, I believe I can accomplish as much as they have, and even push the boundaries.

Aspiring leaders want to know that their dreams are reachable. First, they must have access to the necessary resources (e.g. students of low socioeconomic status must have the educational and financial means to even get to medical school). Second, they want to see someone who has come from their position... and succeeded. Politics aside, it is no longer a question whether an African American can be the President of the United States. We now have a black Commander and Chief. It is no longer a distant dream of possibility; the path has been forged. Resources and mentorship: our youth need both to succeed.

So why is diversity a problem for medicine? I've focused quite a bit on rural disparities. One quarter of the US population lives in a rural area, yet only one out of every ten physicians works there. This population is in dire need of primary care physicians and general surgeons. Studies have shown that women are more likely than men to go into primary care and minority medical students are more likely to care for underserved and indigent populations. Yet only 6.3 percent of the American physician workforce is black. And women make up only a third of all physicians. 

Of course, in 1970, women made up less than one tenth of all physicians, so great strides have been made. But the progress is slow, and often the leadership lacks diversity. I guess this is to be expected, since the more experienced clinicians trained at a time when the medical profession was almost exclusively white men. And their mentors were probably white men, and their mentors were white men.  

To change this pattern we need to work on access to resources, and make sure there is an increasingly diverse group of mentors. In both regards, medicine can (and will) improve. 

Of course, I am another white man. So I guess I'm not helping the statistics. 

Robert Swendiman is an MD candidate at UNC School of Medicine and an MPP candidate at the Harvard Kennedy School, where he is also a Dubin Fellow at the Center for Public Leadership. You can read more on his blog The Language of Medicine.