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¿Somos iguales? Exploring gender and health inequalities in the Peruvian Amazon

Authors

Dr Geordan Shannon (UCL IGH), Dr Audrey Prost (UCL IGH), Dr Jolene Skordis-Worrall (UCL IGH), Carlos Caceres (Universidad Peruana Cayetano Heredia), Angelica Motta (Universidad Peruana Cayetano Heredia)

Background

In the Peruvian Amazon, historical events of colonization and political marginalization intersect with identities of ethnicity, class and geography in the construction of gender and health inequities. Gender-based inequalities can manifest in poor health outcomes via discriminatory practices, healthcare system imbalances, inequities in health research, and differential exposures and vulnerabilities to diseases. Furthermore, the intersections between gender, ethnicity, and poverty can be explored within the context of local healthcare systems. While a growing body of literature explores gender and health dynamics in rural Peru, information around gender dynamics specific to Amazonian communities is limited. The aim of the paper is to explore gender inequalities in health and how they intersect with other social inequalities two Amazonian settings of Peru: Iquitos and the Lower Napo River.

Method

Exploratory qualitative research was performed in two Loreto settings - urban Iquitos and the rural Lower Napo River region - between March and November 2015. This included participant observation with prolonged stays in the community, 46 semi-structured individual interviews and three group discussions. Thematic analysis was performed to identify emerging themes related to gender inequalities in health and healthcare, and how these intersect with layered social disadvantages in the reproduction of health and illness.

Results

Many identified gender inequities in health were concentrated around sexual and reproductive health and domestic violence. Domestic violence was identified as a major social and health concern in this region, influenced by cultural norms such as machismo. Through locating the research within the local healthcare system, we were able to investigate the "intersectionality" of gender, poverty and ethnicity and how this impacts individual health. We found that inequities faced by women in the public healthcare system often reflected more widespread social inequities.

Conclusion

Overlapping influences of poverty, ethnicity, geography and gender served as significant barriers to healthcare in both rural and urban settings.