Health inequalities and the articulation of gender, ethnicity and class in the post partum health care of Negev Bedouin Arab mothers and their children

This thesis is a contribution to the literature and debate on health inequalities and in particular on health care delivery to ethnic minority women and children. Its argument is that when discussing the causes of health inequalities of ethnic minorities, a perspective which focuses solely on the gender, ethnicity, or class of the ethnic minority is inadequate. It is argued that health outcomes, service delivery and experience of patients is shaped by the way gender,ethnicity and class intermesh. The specific context of the research is the organisation, delivery and experience of formal and informal health care to Negev Bedouin Arab mothers and their infants during and after childbirth in hospital and during the first two months post partum. Methodologically a combination of qualtitative and quantitative data have been collected over a period of four years. The quantitative data are from an epidemiological infant feeding study which was carried out from 1981-83 and which the researcher coordinated. A subsample of 412 women and their infants in this study were interviewed after delivery, during their stay in hospital and subsequently at home between 40-50 days after birth. The qualitative data was gathered in 1984 by observation and unstructured interviewing with Bedouin Arab women both in the hospital setting and in two sub tribes, one of which was living in a neighbourhood of a planned urban settlement and the other was living in an encampment. The mothers and grandmothers interviewed during the fieldwork were women known to the researcher from fieldwork undertaken 12 years previously in the Negev. This thesis explores the way in which the quantitative and qualitative data complement each other. In Part One there are three introductory chapters. Chapter 1 explores the literature on gender, ethnicity and class relations both in general and in relation to health inequalities. Chapter 2 sets out the gender, ethnicity and class relations of Negev Bedouin Arab society and Israeli society in general and in the delivery of health care. Chapter 3 sets out the methodology both theoretically and empirically. Part Two is comprised of Chapters 4 and 5 which deal with hospital care to mothers and infants at childbirth and post partum. Part Three focuses on the informal health care setting of the home. Chapter 6 deals with the care given to mothers in the home during the first 40 days. Chapters 7 and 8 explore the health of the infants in terms of their growth and development and how this is related to mother's infant feeding options and their socio economic environment. The way in which gender, ethnicity and class relations intermesh in Israeli and Bedouin Arab society influences both the living conditions and the health outcomes of the infants. Chapter 9 sets out the conclusions which are subdivided in to those which are pertinent to the theoretical debate on gender, ethnicity and class relations and health inequalities, those which are methodological, and those which are pertinent to enhancing health service delivery in this setting