The World Is Not Mine: Factors and Issues of Rural Elderly Women’s Access to Modern Healthcare Services in Bangladesh

Author: Mohammad Hamiduzzaman

Hamiduzzaman, Mohammad, 2018 The World Is Not Mine: Factors and Issues of Rural Elderly Women’s Access to Modern Healthcare Services in Bangladesh, Flinders University, College of Nursing and Health Sciences

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Bangladesh is one of the poorest countries with disparities in accessing modern healthcare services. Rural elderly women are a vulnerable population who face the compounding effects of increasing longevity and comorbidity resulting in a greater requirement for healthcare than other population groups. Despite the recognition of treatment requirements, women’s access to modern healthcare does not feature significantly in government policy or in research literature. This study aims to explore the factors and issues that have an impact on rural elderly women’s access to modern healthcare in Bangladesh.

A systematic review of the literature on rural elderly women’s access to healthcare revealed the effects that personal beliefs and behaviours, the healthcare system, socioeconomic factors, and the cultural context have on access in relation to downstream and upstream social determinants. It has been found that downstream determinants, such as the healthcare behaviours of the women and the healthcare system, are influenced by upstream determinants including living conditions, and socioeconomic and cultural circumstances.

A blended critical social theoretical framework was developed based on Jurgen Habermas’s ‘Theory of Communicative Action’ and Axel Honneth’s ‘Theory of Recognition & Misrecognition’ to explore the healthcare, social, and individual spheres of the women and their access to modern healthcare. The data collection method used was face-to-face audiotaped semi-structured interviews with both healthcare professionals and rural elderly women. A combined thematic and critical discourse analysis provided an understanding of the healthcare system, the socioeconomic and cultural context, the women’s issues, and social relationships that exist and affect access for these women.

Five themes emerged from the views of healthcare professionals relating to the women’s access, including: unequal distribution of healthcare services, marginalisation in the relationships between rural elderly woman and healthcare professionals, an inability to pay for services, negative social responses, and a mistrust of medical treatment. The themes evident from the views of the women themselves included: an exclusionary healthcare system, oppressive social conditions, repressive social relationships, and self-exclusion as a result of the internalisation of sociocultural values.

The problematisation of rural elderly women’s access to modern healthcare presented numerous social determinants in the healthcare, social, and individual spheres. Whilist the healthcare sphere as an institution was inadequate, the professionals who provided care lacked gerontological education and training and were not responsible legally or professionally to the women. In the social sphere, the poor socioeconomic status of the women, unemployment, low incomes, and a lack of financial support from family members and the government contributed to poor access. This sphere was further affected by religion, male domination, and socio-political alienation that created repression for the women. The healthcare and social spheres played a role in shaping the women’s knowledge, beliefs, and behaviours resulting in inadequate access, which was also affected by hegemonic family relationships. Access to modern healthcare was subject to healthcare, social, and family support, as well as the women’s personal choices and decisions. The healthcare, socioeconomic, and political implications require significant policy changes in the future to improve the women’s access to modern healthcare in Bangladesh.

Keywords: Rural elderly women, social determinants, healthcare access, modern healthcare services

Subject: Health Sciences thesis

Thesis type: Doctor of Philosophy
Completed: 2018
School: College of Nursing and Health Sciences
Supervisor: Dr Anita De Bellis