Fundamentals of Midwifery: A Textbook for Students (24 page)

Lower birth weights
49Increased infant mortality rates
Increased rates of chronicHave lower paid jobsmental illnessillnessesPoor neighbourhoods
Figure 3.2
The impact of poverty on health.Impact of poorer housingRespiratoryLess likely to achieve potential in education
Limits a person’s opportunities forhealthNeighbour hoodCrimeSafety
Poverty and exclusion
employment
Have lower expectationsPoorer physical healthPoor mental healthMore likely to be in debtLower paid employment
Figure 3.3
The impact of poverty on social exclusion.
Gender and sexuality
Gender and sexuality are terms which are sometimes used interchangeable or incorrectly, andare a key component of everyone’s identity. The definitions which we will use in this chapter are that gender is a socially constructed identity (Marchbank and Letherby 2007) which is based around our biological sex. Sexuality is based around desire and is related to the people we are
physically attracted to and have sexual intercourse with. Both these parts of our identities are related to displays within society. When and how these parts of our identity are formed is open to much debate and controversy, related to the nature and nurture debate. These discussions have developed significantly over the last decade. Previously all the focus was around the binary50 nature of gender and sexuality, with female and male and heterosexuality and ‘other’; now thisincludes transgender, transsexual, bisexual, lesbian and gay (LGBT) communities (Equality Chal- lenge Unit 2010). This is important in relation to power relations within society and what is termed as a social norm, and the consequences of stepping outside this norm. This has an impact on how certain groups within society can be excluded and discriminated against and therefore may not be happy to share information with healthcare workers. There is a particular impact on lesbian mothers, who have often not had the care they wanted or needed (Jackson 2003; Lee 2004; Dahl et al. 2013). Many lesbian couples do not tell their midwives about their sexuality, and this is their right; however, it can lead to inappropriate care being given and can affect the way that the woman’s partner is treated. This is not surprising, though, in the face of prejudice or lack of under- standing displayed by society and NHS staff. The Department of Health (2009) has outlined how members of the LGBT community can be more effectively and fairly cared for. However, it is essential that there is not a heterosexual assumption within the maternity services, and that women are able to speak freely about their sexuality without fear of prejudice or discrimination; otherwise this group of women and their families will remain largely invisible.
Activity 3.5 Think about how you portray gender in your everyday life. What actions do you take whichdisplays your gender to others. For example, deciding to use the male or female toilets.Every society has roles, identities, expectations and characteristics which are assigned to people on the basis of their gender (Kane 2012). These tend to focus on two binary opposites of women and men and femininity and masculinity (Marchbank and Letherby 2007). However, there is some room for adaptation and development over time; for example, what are seen as feminine and masculine characteristics. The gender roles that people are socialised into have an impact on how the family works and what are seen as men and women’s roles. These have changed over time as societies’ and communities’ views have changed and developed. This can lead to clashes between the generations as what was once seen as outside the social norm can now be identified as normal. An example of this would be the change in attitudes in the UK to pregnancy outside marriage; at one time an unmarried woman who had a baby was seen as a scandal and something to be frowned upon. This had a negative impact on her family. In the 21st century, for most families within the UK this is not now the case, and in fact in many com- munities this is the norm. In the past, women out of wedlock were hidden away in mental health institutions for stepping outside the norm; the mother and the baby may have lived there for the rest of their lives. This shame and guilt is still present in some cultures and communities and can lead to the woman’s life being in danger, linked to so-called ‘honour killings’, although as one of the interesting gender differences, historically the man who was the father of the baby would mostly escape any punishment. This is evidence of the inequality between genders and how their behaviour is sanctioned and labelled as acceptable or unacceptable dependent on their gender. Kane (2012, p. 13) describes gender as a ‘