Multiple roles and health among British and Finnish women: the influence of socioeconomic circumstances

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Abstract

Two contrasting hypotheses have been presented to predict women's health variations. The multiple burden hypothesis predicts that combining a paid job, being married, and having children is likely to be detrimental to women's health. The multiple attachment hypothesis predicts that multiple roles provide attachment to the community, which is likely to be beneficial to women's health. These hypotheses are examined in Britain and Finland, which have different patterns of women's employment participation. Lone mothers form a critical case, since they have fewer attachments and greater burdens, and therefore are expected to have poorer health. The socioeconomic position of lone mothers differs in Britain and Finland, but in both societies they are likely to have fewer attachments. We assess the extent to which health variations between women with different family and parental role combinations are because of the differences in their socioeconomic status and material circumstances. Comparable surveys from Britain and Finland from 1994 were used. Perceived general health and limiting long-standing illness were analysed for working age women (20–49 years) by family type and employment status, as well as other socioeconomic variables. In both countries, women living in two parent families and having children had better health than women living in other family types or on their own. Lone mothers form a disadvantaged group and showed overall worse health in both countries. Adjusting for employment status, education and household income weakened the association between family type and poor health. The findings are broadly in accordance with the multiple attachment hypothesis. Despite the more generous welfare state and high full-time employment among Finnish women, single lone mothers report poorer health than other women in Finland as well as in Britain. However, in Britain the disadvantaged social position of lone mothers accounts for a greater proportion of their poor health than in Finland.

Introduction

This paper focuses on health variations among working age women in two different welfare states, that is Britain and Finland in the mid-1990s. The production of health variations among women is a complex process, emerging from women's social, structural and material position as well as their family status and parental roles (Arber, 1991). The two countries under study differ in the nature of welfare policies to support child care among working mothers and to support lone mothers, as well as in the level of paid employment of women (Forssén, 1998). They therefore provide appropriate cases for comparing the extent to which the patterning of women's health by employment and family status varies in Britain and Finland, and to what extent this variation is because of their differential socioeconomic and material circumstances (Arber & Lahelma, 1993).

Among men, health variations have traditionally been studied using a social class framework, whereas among women a role framework has been common. For example, studies have examined whether family and parental roles, as well as the ‘additional’ role of paid employment are associated with women's health (Nathanson, 1980; Gove, 1984). However, to deepen the understanding of the production of health variations among women we need to go beyond both the social class framework and the role framework, and examine women's employment participation, socioeconomic status and material circumstances simultaneously with their family and parental roles. An increasing stream of research has shown the importance of combining women's structural and material position in society, and their family roles in the analysis of health variations (Bartley, Popay, & Plewis, 1992; Popay, Bartley, & Owen, 1993; Macran, Clarke, Slogget, & Bethune, 1994; Macran, Clarke, & Joshi, 1996; Martikainen, 1995; Arber & Cooper, 2000).

Previous studies suggest that marriage is supportive of good health (Verbrugge, 1979; Macintyre, 1992; Martikainen, 1995). On the one hand, this is likely to be due to social supports and material advantages of marriage. On the other hand, poorer health of unmarried women may relate to the selection in the ‘marriage market’ since women with poor health may be less likely to marry. Being a lone mother seems to be a particularly disadvantageous position for women, including their health, as found by a number of recent studies (Burström, Diderichsen, Shouls, & Whitehead, 1999; Kivelä & Lahelma, 2000; Whitehead, Burström, & Diderichsen, 2000). Lone motherhood implies responsibilities and strains of child rearing which cannot be shared and which therefore may have adverse effects on women's health. However, employment status as well as the material and socioeconomic position of lone mothers vary between different societies, and this is likely to contribute to the variations in the health status of women with different family and parental statuses.

Non-employed women, including housewives and unemployed, may have difficulties finding a job if their health is poor. Khlat, Sermet, and Le Pape (2000) have shown that in France health advantages are found for married women who have a paid job. They discuss the ‘healthy married’ and ‘healthy mother’ effect, in addition to the ‘healthy worker’ effect which has been known for a long time. However, the combinations of different families and work roles may be shaped by women's socioeconomic status as the authors show for French women.

A study examining mental and somatic symptoms found that Finnish women living with a spouse and children were least likely to report these symptoms, which remained unchanged when age and number of children were adjusted (Kivelä & Lahelma, 2000). Recent studies reported in this special issue from the Netherlands (Fokkema, 2001), Britain (Matthews & Power, 2001) and Canada (McDonough, Walters, & Strohschein, 2001; Walters & McDonough, 2001) also support the conclusion that combining multiple roles of being an employee, a spouse and a mother are associated with good rather than poor health. There is by now an increasing evidence suggesting the health advantages related to multiple roles among women, but less is known about the extent to which this is caused by a differential socioeconomic and material circumstances associated with role occupancy.

Section snippets

Women's employment and family status in Britain and Finland

Whether the combination of being an employee, a spouse and a mother is good or bad for women's health and well-being has become an increasingly important policy issue in many countries, because of the increase in labour force participation of women with dependent children (Rubery, Smith, & Fagan, 1997). Different employment arrangements, such as part-time and full-time employment, may contribute to women's health in varying ways according to a women's family status, and socioeconomic

Hypotheses and aims

Britain and Finland show contrasting features in relation to women's participation in paid employment, and it is therefore appropriate to examine the patterning of women's health with regard to their different employment status and family role arrangements. From previous work on women's employment patterns and social roles as determinants of health, two competing hypotheses can be drawn which predict health variations according to different combinations of employment, socioeconomic position,

Data

We examine the relevance of the multiple burden and the multiple attachment hypothesis for variations in women's health by using comparable data sets from Britain and Finland, both from 1994. The British data is derived from the General Household Survey (GHS), collected by the governmental Office for National Statistics (ONS) (Bennett, Jarvis, Rowlands, Singleton, & Haselden, 1996). This survey is nationally representative and comprised personal interviews with all adults aged 16 or over in

Prevalence of illhealth

Age adjusted prevalence of ‘less than good’ perceived health and LLI by the social background variables showed broadly similar distributions in Britain and Finland. As expected, women in younger age-groups and with higher household income and education had better health than other women (Table 1).

Employment status was associated with health (Table 1). Employed women reported the best health in both countries, with similar level of health among the full-time and part-time employed. The groups

Family type, employment status and health

To examine the patterning of women's perceived health and LLI by family type, and the bearing of women's employment status, educational level and household income on this patterning, multivariate logistic regression analysis was used for the two countries and the two health indicators.

Discussion

We have examined the associations between family type and illhealth among British and Finnish women aged 20–49, while also examining women's employment status, educational level and household income. This comparative study was based on cross-sectional surveys.

A key concern was to examine the extent of differences between countries in family structure and employment participation, as well as related social policies, that also differentiate women's health. In Britain, being a lone mother and

Acknowledgements

This study was supported by a grant from the Academy of Finland, Research Council for Health (#37800).

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