Who gains, who loses and how: Leveraging gender and class intersections to secure health entitlements

This paper argues that a focus on the middle groups in a multi-dimensional socioeconomic ordering can provide valuable insights into how different axes of advantage and disadvantage intersect with each other. It develops the elements of a framework to analyse the middle groups through an intersectional analysis, and uses it to explore how such groups leverage economic class or gender advantages to secure entitlements to treatment for long-term illness. The study draws upon household survey data on health-seeking for long-term ailments from 60 villages of Koppal district, Karnataka (India). The survey was designed to capture gender, economic class, caste, age and life stage-based inequalities in access to health care during pregnancy and for short and long-term illnesses. There were striking similarities between two important middle groups - non-poor women and poor men - in some key outcomes: their rates of non-treatment when ill, treatment discontinuation and treatment continuation, and the amounts they spent for treatment. These two groups are the obverse of each other in terms of gender and economic class advantage and disadvantage. Non-poor women have an economic advantage and a gender disadvantage, while poor men have the exact opposite. However, despite the similarities in outcomes, the processes by which gender and class advantage were leveraged by each of the groups varied sharply. Similar patterns held for the poorest men except that the class disadvantage they had to overcome was greater, and the results are modified by this. (C) 2011 Elsevier Ltd. All rights reserved.